Máscaras de tecido em locais públicos: intervenção essencial na prevenção da COVID-19 no Brasil

Naiá Ortelan Andrêa Jacqueline Fortes Ferreira Luciana Leite Julia Moreira Pescarini Ana Cristina Souto Mauricio Lima Barreto Estela M. L. Aquino Sobre os autores

Resumo

Acumulam-se evidências de que o uso de máscaras é uma medida indispensável de proteção à COVID-19, devido ao alto poder de transmissão do novo coronavírus por via respiratória, inclusive por indivíduos assintomáticos. Por sua vez, o uso das máscaras de tecido em locais públicos tem se consolidado como medida adicional de proteção às medidas de distanciamento social e higienização das mãos. Objetivou-se sistematizar as evidências científicas que justificam o amplo uso de máscaras de tecido como prevenção à COVID-19 e descrever a evolução dos posicionamentos contrários ou favoráveis ao seu uso em ambientes extradomiciliares, diante do avanço da pandemia do novo coronavírus pelo mundo. A triagem de artigos e documentos oficiais do Brasil e de outros países indica que o uso de máscaras em locais públicos tornou-se uma intervenção essencial graças ao potencial de reduzir a velocidade de propagação do novo coronavírus. Recomenda-se que o poder público adote estratégias para aumentar a oferta deste produto e fomente estudos para avaliação do impacto da medida no controle da pandemia no Brasil. É imperativo assegurar disponibilidade de máscaras a grupos socioeconomicamente desfavorecidos e garantir que determinados grupos raciais não sejam estigmatizados diante do uso de máscaras em ambientes extradomiciliares.

Palavras-chave:
Máscaras de tecido; Máscaras caseiras; COVID-19; SARS-CoV-2; Novo coronavírus

Abstract

There is increasing evidence that the use of masks is an indispensable protective measure against COVID-19, given the high transmissibility of the new coronavirus through the respiratory system, including by asymptomatic individuals. The use of cloth masks in public places has been established as a protective measure to be adopted alongside social distancing and hand hygiene. This narrative review aims to systematize the scientific evidence that informs the widespread use of cloth masks as a preventive measure against COVID-19 and to describe the evolution of positions contrary to or in favor of its use outside the home, in view of the advance of the new coronavirus pandemic globally. The scientific articles, technical notes, governmental decrees and other documents analyzed indicate that widespread use of masks has the potential to reduce the spread of the new coronavirus. We recommend that the Brazilian government adopt strategies to increase the supply of reusable cloth masks to the public, especially to vulnerable populations and to support studies on the impact of this measure to control the pandemic in the country. Finally, it is imperative to ensure that use of masks does not exacerbate stigmatization of racial groups that already face prejudice.

Key words:
Cloth masks; Homemade masks; COVID-19; SARS-CoV-2; Novel coronavirus

Introdução

Desde a emergência do vírus da síndrome respiratória aguda grave 2 (SARS-CoV-2), debates sobre medidas de controle da pandemia têm ganhado destaque na mídia e na literatura científica. Sabe-se que a transmissão do novo coronavírus entre humanos ocorre principalmente na interação pessoa-pessoa pelo contato com gotículas produzidas por via oral e nasal (na respiração, fala, tosse ou espirro de indivíduos infectados, sejam doentes ou assintomáticos) e que o vírus permanece em boas condições no ar por até três horas e em superfícies rígidas por até 72 horas11 Centers for Disease Control and Prevention (CDC). Coronavirus Disease 2019 (COVID-19) - Prevention & Treatment [Internet]. Washington: CDC; 2020 [acessado 2020 Maio 4]. Disponível em: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html

2 Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, Marimuthu K. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA 2020; 323(16):1610-1612.
-33 van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lloyd-Smith JO, Wit E, Munster VJ. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020; 382(16):1564-1567..

Devido a sua prolongada viabilidade em alguns materiais no ambiente, o SARS-CoV-2 pode também ser transmitido mediante o contato com superfícies contaminadas22 Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MSY, Marimuthu K. Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA 2020; 323(16):1610-1612.,44 Kampf G, Todt D, Pfaender S, Steinmann E. Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents. J Hosp Infect 2020; 104(3):246-251.. Desse modo, as primeiras recomendações para evitar a disseminação da doença foram o amplo distanciamento social e a higienização correta e frequente das mãos55 Ghinai I, McPherson TD, Hunter JC, Kirking HL, Christiansen D, Joshi K, Rubin R, Morales-Estrada S, Black SR, Pacilli M, Fricchione MJ, Chugh RK, Walblay KA, Ahmed NS, Stoecker WC, Hasan NF, Burdsall DP, Reese HE, Wallace M, Wang C, Moeller D, Korpics J, Novosad SA, Benowitz I, Jacobs MW, Dasari VS, Patel MT, Kauerauf J, Charles EM, Ezike NO, Chu V, Midgley CM, Rolfes MA, Gerber SI, Lu X, Lindstrom S, Verani JR, Layden JE, Illinois COVID-19 Investigation Team. First known person-to-person transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the USA. Lancet 2020; 395(10230):1137-1144.

6 World Health Organization (WHO). Shortage of personal protective equipment endangering health workers worldwide. Geneva: WHO; 2020.

7 Agência Nacional de Vigilância Sanitária (ANVISA). Orientações Gerais - Máscaras faciais de uso não profissional. Brasília: ANVISA; 2020.
-88 Brasil. Ministério da Saúde (MS). Nota Técnica: Uso de máscaras caseiras. Brasília: MS; 2020.; e, para pacientes sintomáticos ou que testaram positivo para o SARS-CoV-2, o isolamento domiciliar e a quarentena dos seus respectivos contatos99 World Health Organization (WHO). Responding to community spread of COVID-19: interim guidance [Internet]. Genebra: WHO; 2020 [acessado 2020 Maio 6]. Disponível em: https://apps.who.int/iris/handle/10665/331421.

Com o avançar da pandemia, o uso ampliado das máscaras em ambientes extradomiciliares (estabelecimentos comerciais, parques, locais de trabalho, transportes públicos, entre outros) passou a ser discutido como medida adicional de proteção, a partir da experiência acumulada por outros países em epidemias prévias1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.. O debate sobre essa proposição se fortaleceu devido ao papel de indivíduos assintomáticos, oligossintomáticos ou pré-sintomáticos na disseminação da doença1111 Tong Z-D, Tang A, Li K-F, Li P, Wang H-L, Yi J-P, Zhang Y-L, Yan J-B. Potential Presymptomatic Transmission of SARS-CoV-2, Zhejiang Province, China, 2020. Emerg Infect Dis 2020; 26(5):1052-1054.

12 Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, Wang M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14):1406-1407.
-1313 Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, Bardossy AC, Oakley LP, Tanwar S, Chisty Z, Bell JM, Methner M, Harney J, Jacobs JR, Carlson CM, McLaughlin HP, Stone N, Clark S, Brostrom-Smith C, Page LC, Kay M, Lewis J, Russell D, Hiatt B, Gant J, Duchin JS, Clark TA, Honein MA, Reddy SC, Jernigan JA, Public Health - Seattle & King County, CDC COVID-19 Investigation Team. Asymptomatic and presymptomatic SARS-CoV-2 infections in residents of a long-term care skilled nursing facility-King County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69(13):377-381., diante das evidências de que a COVID-19 apresenta um longo período de incubação1414 Wang Y, Wang Y, Chen Y, Qin Q. Unique epidemiological and clinical features of the emerging 2019 novel coronavirus pneumonia (COVID-19) implicate special control measures. J Med Virol 2020; 92(6):568-576.

15 Huang R, Xia J, Chen Y, Shan C, Wu C. A family cluster of SARS-CoV-2 infection involving 11 patients in Nanjing, China. Lancet Infect Dis 2020; 20(5):534-535.
-1616 Kraemer MUG, Yang C-H, Gutierrez B, Wu C-H, Klein B, Pigott DM, Open COVID-19 Data Working Group, du Plessis L, Faria NR, Li R, Hanage WP, Brownstein JS, Layan M, Vespignani A, Tian H, Dye C, Pybus OG, Scarpino SV. The effect of human mobility and control measures on the COVID-19 epidemic in China. Science 2020; 368(6490):493-497. e do entendimento de que há uma alta carga viral no estágio inicial da doença1212 Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, Wang M. Presumed Asymptomatic Carrier Transmission of COVID-19. JAMA 2020; 323(14):1406-1407.,1717 Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song Y, Xia J, Guo Q, Song T, He J, Yen H-L, Peiris M, Wu J. SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. N Engl J Med 2020; 382(12):1177-1179.

18 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.
-1919 Ling Z, Xu X, Gan Q, Zhang L, Luo L, Tang X, Liu J. Asymptomatic SARS-CoV-2 infected patients with persistent negative CT findings. Eur J Radiol 2020; 126:108956..

A adoção de uma política universal de uso de máscaras descartáveis durante a pandemia, resultaria em uma demanda difícil de ser atendida ocasionando a escassez do equipamento de proteção para profissionais de saúde e demais usuários recorrentes2020 Wang M-W, Zhou M-Y, Ji G-H, Ye L, Cheng Y-R, Feng Z-H, Chen J. Mask crisis during the COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24(6):3397-3399.,2121 Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020; 8(5):434-436.. No início de abril, a Organização Mundial da Saúde (OMS) recomendava que as máscaras descartáveis fossem utilizadas exclusivamente por profissionais de saúde, indivíduos imunossuprimidos e casos suspeitos ou confirmados do novo coronavírus. A OMS alertava ainda sobre a ausência de evidências que embasassem a indicação do amplo uso de máscaras feitas a partir de materiais alternativos99 World Health Organization (WHO). Responding to community spread of COVID-19: interim guidance [Internet]. Genebra: WHO; 2020 [acessado 2020 Maio 6]. Disponível em: https://apps.who.int/iris/handle/10665/331421. Somente no dia 5 de junho de 2020, a OMS divulgou orientações para uso e fabricação de máscaras de pano como proteção contra a COVID-19, e passou a recomendar o amplo uso em locais onde há ampla transmissão da doença e em situações em que o distanciamento social não é possível, como no transporte público2222 World Health Organization (WHO). Advice on the use of masks in the community, during home care and in healthcare settings in the context of the novel coronavirus (COVID-19) outbreak [Internet]. 2020 [acessado 2020 Maio 6]. Disponível em: https://www.who.int/publications/i/item/advice-on-the-use-of-masks-in-the-community-during-home-care-and-in-healthcare-settings-in-the-context-of-the-novel-coronavirus-(2019-ncov)-outbreak.
https://www.who.int/publications/i/item/...
.

Esse artigo tem o objetivo de realizar uma revisão narrativa da literatura sobre a eficácia e adesão ao uso de máscaras de tecido em locais públicos para a prevenção da COVID-19 e descrever a evolução dos posicionamentos contrários ou favoráveis ao seu uso em ambientes extradomiciliares, diante do avanço da pandemia do novo coronavírus pelo mundo.

Métodos

Esta revisão narrativa partiu do levantamento de artigos sobre o uso de máscaras no contexto do novo coronavírus, publicados na base Medline (PubMed), que só inclui publicações aprovadas por peer review2323 Chen Q, Allot A, Lu Z. Keep up with the latest coronavirus research. Nature 2020; 579(7798):193., contempla a base SciELO e também manuscritos em fase de pré-publicação (preprints) disponíveis nas bases do MedRxiv, constituindo, assim, o maior e principal repositório da literatura biomédica disponível.

Para a seleção de artigos relevantes, buscamos as palavras-chave “mask and covidormask and coronavirus”, ormask and covid-19”, ormask and covid19” nos títulos e resumos de artigos publicados até o dia 12 de junho de 2020. Foram incluídos artigos originais, editoriais, cartas ao editor, comentários e revisões de literatura, em português, inglês e espanhol disponíveis na íntegra. Foram excluídos artigos que apresentassem dados exclusivos referentes ao uso de máscaras cirúrgicas (TNT e variantes), máscaras respiratórias (N95, FFP2) e descartáveis; que tratassem de máscaras faciais destinadas à cobertura de outras porções da face, não incluindo o trato respiratório (e.g. máscaras para os olhos e face shields) e referentes ao uso de máscaras apenas entre profissionais de saúde.

Além dos artigos científicos selecionados, foram consultados documentos oficiais estaduais e federais implementados no Brasil, tais como decretos, portarias e leis estaduais disponíveis no site LegisWeb2424 LegisWeb. LegisWeb [Internet]. [acessado 2020 Set 29]. Disponível em: https://www.legisweb.com.br/
https://www.legisweb.com.br...
; notas técnicas do Ministério da Saúde do Brasil (MS) e da Agência Nacional de Vigilância Sanitária (ANVISA); e regulamentações sobre o uso de máscaras de tecido em ambientes extradomiciliares adotadas em outros países no contexto da pandemia da COVID-19. Para tal, as informações foram extraídas do site Mask4All2525 Masks4All. What Countries Require or Recommend Masks In Public? [Internet]. [acessado 2020 Set 29]. Disponível em: https://masks4all.co/what-countries-require-masks-in-public
https://masks4all.co/what-countries-requ...
, uma organização não-governamental que reúne informações relativas à regulamentação do uso de máscaras em todos os países. Todas as fontes de informações descritas foram consultadas até o dia 12 de junho.

Uma síntese quantitativa dos principais achados dos artigos selecionados foi realizada, com extração das seguintes informações: autoria, revista, título, data de publicação, tipo de publicação e posicionamento relacionado à recomendação do uso de máscaras de tecido como medida de prevenção e controle da COVID-19 (Quadro 1). Os posicionamentos dos autores sobre o uso de máscaras de tecido no contexto da COVID-19 foram classificados como: i) A favor; ii) Sem posicionamento; e iii) Contra. A evolução temporal desses posicionamentos foi analisada de forma gráfica.

Quadro 1
Artigos selecionados quanto ao seu posicionamento com relação ao amplo uso de máscaras de tecido.

Adicionalmente, extraíram-se informações referentes à adesão e eficácia do uso de máscaras de tecido descritas nos artigos selecionados. Uma síntese qualitativa dos principais achados sobre o uso de máscaras de tecido em ambientes extradomiciliares, os argumentos que embasaram os posicionamentos a favor e contra o seu uso, bem como possíveis diferenças observadas entre os países quanto à adoção dessa recomendação, também foi realizada. Dessa forma, as informações obtidas foram sintetizadas e discutidas com base nas evidências publicadas até o momento.

Resultados

A seguir são apresentados os resultados desta revisão narrativa, que não propôs fornecer uma descrição detalhada e exaustiva da literatura, mas sim explorar criticamente um tema ainda pouco conhecido.

A busca resultou em 450 artigos, dos quais 931010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,2020 Wang M-W, Zhou M-Y, Ji G-H, Ye L, Cheng Y-R, Feng Z-H, Chen J. Mask crisis during the COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24(6):3397-3399.,2121 Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020; 8(5):434-436.,2626 Leung CC, Lam TH, Cheng KK. Let us not forget the mask in our attempts to stall the spread of COVID-19. Int J Tuberc Lung Dis 2020; 24(4):364-366.

27 Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 2020; 16(10):1745-1752.

28 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.

29 Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020; 395(10228):945.

30 Zhai Z. Facial mask: A necessity to beat COVID-19. Build Environ 2020; 175:106827.

31 Liu X, Zhang S. COVID-19: Face masks and human-to-human transmission. Influenza Other Respi Viruses 2020; 14(4):472-473 .

32 Ma Q-X, Shan H, Zhang H-L, Li G-M, Yang R-M, Chen J-M. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.

33 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.

34 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...

35 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.

36 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.

37 Wang M-W, Cheng Y-R, Ye L, Zhou M-Y, Chen J, Feng Z-H. The COVID-19 outbreak: The issue of face masks. Infect Control Hosp Epidemiol 2020; 41(8):974-975.

38 Han G, Zhou Y-H. Possibly critical role of wearing masks in general population in controlling COVID-19. J Med Virol 2020; 10.1002/jmv.25886.
https://doi.org/10.1002/jmv.25886...

39 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.

40 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .

41 Pleil JD, Beauchamp JD, Risby TH, Dweik RA. The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19. J Breath Res 2020; 14(3):030201.

42 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .

43 Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA 2020; 323(20):2103.

44 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.

45 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .

46 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.

47 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.

48 Garcia LP. Use of facemasks to limit COVID-19 transmission. Epidemiol Serv Saude 2020; 29(2):e2020023.

49 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.

50 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.

51 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.

52 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.

53 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.

56 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...

57 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.

58 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.

59 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.

60 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.

61 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...

62 Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, Witecka K-F, Rymaszewska J. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain Behav Immun 2020; 87:161-162.

63 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.

64 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.

65 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.

66 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880.

67 Soto DM, Cardona Maya WD, Agudelo EL, Bueno-Sánchez JC. The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America. Infect Control Hosp Epidemiol 2020; 1-2.

68 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.

69 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.

70 Kashyap A, Singh K, Sabat D, Maini L. Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic. J Clin Orthop Trauma 2020; 11(Supl. 3):S298-S300.

71 Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther 2020; 33(4):e13567.

72 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.

73 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.

74 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.

75 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.

76 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .

77 Chiang C-H, Chiang C-H, Chiang C-H. Letter to editor - Can universal masking help with our recovery from the COVID-19 pandemic? Int J Surg 2020; 79:125-126.

78 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.

79 Middleton JD, Lopes H. Face masks in the covid-19 crisis: caveats, limits, and priorities. BMJ 2020; 369:m2030.

80 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501

81 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084.

82 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.

83 Han C, Shi J, Chen Y, Zhang Z. Increased flare of acne caused by long-time mask wearing during COVID-19 pandemic among general population. Dermatol Ther 2020; 33(4):e13704.

84 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.

85 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.

86 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987

87 Liu PL. COVID-19 Information Seeking on Digital Media and Preventive Behaviors: The Mediation Role of Worry. Cyberpsychol Behav Soc Netw 2020; 23(10):677-682.

88 Jung F, Krieger V, Hufert FT, Küpper J-H. How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective. Clin Hemorheol Microcirc 2020; 74(4):363-372.

89 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...

90 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.

91 Greenhalgh T. Laying straw men to rest: author's reply to 'Urgency and uncertainty: covid-19, face masks, and evidence informed policy'. BMJ 2020; 369:m2240

92 Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, Mohajer S, HajiAliBeigloo R, Nia MN, Jamei F, Mazlom SR. Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound Emerg Dis 2020; 10.1111/tbed.13662.
https://doi.org/10.1111/tbed.13662...

93 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.

94 Ho K-F, Lin L-Y, Weng S-P, Chuang K-J. Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments. Sci Total Environ 2020; 735:139510.

95 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260.

96 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210.

97 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.

99 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.

100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017.

101 Wu H-L, Huang J, Zhang CJP, He Z, Ming W-K. Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: Reflections on public health measures. EClinicalMedicine 2020; 21:100329.

102 Stone TE, Kunaviktikul W, Omura M, Petrini M. Editorial: Facemasks and the Covid 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks? Nurs Health Sci 2020; 22(2):339-342.

103 Chowdhury A, Jahan N, Wang S. One month of the novel coronavirus 2019 outbreak: Is it still a threat? Virusdisease 2020; 31(2):1-5.

104 Amendola L, Saurini MT, Di Girolamo F, Arduini F. A rapid screening method for testing the efficiency of masks in breaking down aerosols. Microchem J 2020; 157:104928.

105 Kim MN. What Type of Face Mask Is Appropriate for Everyone-Mask-Wearing Policy amidst COVID-19 Pandemic? J Korean Med Sci 2020; 35(20):e186.

106 Lam SKK, Hung MSY, Chien WT. Uncertainty surrounding the use of face masks in the community amid the COVID-19 pandemic. Int J Nurs Stud 2020; 108:103651.

107 King FM. Covid-19: face masks could foster distrust and blame. BMJ 2020; 369:m2009.

108 Cheng S-T. Covid-19: are face masks a good long term strategy? BMJ 2020; 369:m2005.

109 Lazzarino AI, Steptoe A, Hamer M, Michie S. Covid-19: Important potential side effects of wearing face masks that we should bear in mind. BMJ 2020; 369:m2003.

110 Schroter RC. Social distancing for covid-19: is 2 metres far enough? BMJ 2020; 369:m2010.

111 Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020; 15(5):e0233668.

112 Szepietowski JC, Matusiak L, Szepietowska M, Krajewski PK, Bialynicki-Birula R. Face Mask-induced Itch: A Self-questionnaire Study of 2,315 Responders During the COVID-19 Pandemic. Acta Derm Venereol 2020; 100:adv00152.

113 Aggarwal N, Dwarakanathan V, Gautam N, Ray A. Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis. Indian J Public Health 2020; 64(Supl.):S192-S200.

114 Zhao M, Liao L, Xiao W, Yu X, Wang H, Wang Q, Lin YL, Kilinc-Balci FS, Price A, Chu L, Chu MC, Chu S, Cui Y. Household Materials Selection for Homemade Cloth Face Coverings and Their Filtration Efficiency Enhancement with Triboelectric Charging. Nano Lett 2020; 20(7):5544-5552.
-115115 Filho C, Vieira LJES, Silva RM. Buscas na internet sobre medidas de enfrentamento à COVID-19 no Brasil: descrição de pesquisas realizadas nos primeiros 100 dias de 2020. Epidemiol Serv Saúde 2020; 29(3):e2020191. cumpriram os critérios de inclusão e foram selecionados para inclusão nesta revisão (Figura 1).

Figura 1
Fluxograma ilustrando o processo de seleção dos artigos incluídos nesta revisão narrativa.

Os manuscritos selecionados foram classificados de acordo com o mês e tipo de publicação científica (Figura 2). Os meses de abril (n=33)3333 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.

34 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...

35 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.

36 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.
-3737 Wang M-W, Cheng Y-R, Ye L, Zhou M-Y, Chen J, Feng Z-H. The COVID-19 outbreak: The issue of face masks. Infect Control Hosp Epidemiol 2020; 41(8):974-975.,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.

40 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .

41 Pleil JD, Beauchamp JD, Risby TH, Dweik RA. The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19. J Breath Res 2020; 14(3):030201.

42 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .

43 Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA 2020; 323(20):2103.

44 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.

45 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .

46 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.
-4747 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.,4949 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.

50 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.

51 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.

52 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.

53 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.

56 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...

57 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.

58 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.

59 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.
-6060 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.,9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.
-9999 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.,102102 Stone TE, Kunaviktikul W, Omura M, Petrini M. Editorial: Facemasks and the Covid 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks? Nurs Health Sci 2020; 22(2):339-342.,103103 Chowdhury A, Jahan N, Wang S. One month of the novel coronavirus 2019 outbreak: Is it still a threat? Virusdisease 2020; 31(2):1-5.,115115 Filho C, Vieira LJES, Silva RM. Buscas na internet sobre medidas de enfrentamento à COVID-19 no Brasil: descrição de pesquisas realizadas nos primeiros 100 dias de 2020. Epidemiol Serv Saúde 2020; 29(3):e2020191. e maio (n=35)1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,6161 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...

62 Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, Witecka K-F, Rymaszewska J. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain Behav Immun 2020; 87:161-162.

63 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.

64 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.

65 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.

66 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880.

67 Soto DM, Cardona Maya WD, Agudelo EL, Bueno-Sánchez JC. The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America. Infect Control Hosp Epidemiol 2020; 1-2.

68 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.

69 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.

70 Kashyap A, Singh K, Sabat D, Maini L. Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic. J Clin Orthop Trauma 2020; 11(Supl. 3):S298-S300.

71 Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther 2020; 33(4):e13567.

72 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.

73 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.

74 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.

75 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.

76 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .

77 Chiang C-H, Chiang C-H, Chiang C-H. Letter to editor - Can universal masking help with our recovery from the COVID-19 pandemic? Int J Surg 2020; 79:125-126.

78 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.

79 Middleton JD, Lopes H. Face masks in the covid-19 crisis: caveats, limits, and priorities. BMJ 2020; 369:m2030.

80 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501

81 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084.
-8282 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.,8484 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.,100100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017.,104104 Amendola L, Saurini MT, Di Girolamo F, Arduini F. A rapid screening method for testing the efficiency of masks in breaking down aerosols. Microchem J 2020; 157:104928.

105 Kim MN. What Type of Face Mask Is Appropriate for Everyone-Mask-Wearing Policy amidst COVID-19 Pandemic? J Korean Med Sci 2020; 35(20):e186.

106 Lam SKK, Hung MSY, Chien WT. Uncertainty surrounding the use of face masks in the community amid the COVID-19 pandemic. Int J Nurs Stud 2020; 108:103651.

107 King FM. Covid-19: face masks could foster distrust and blame. BMJ 2020; 369:m2009.

108 Cheng S-T. Covid-19: are face masks a good long term strategy? BMJ 2020; 369:m2005.

109 Lazzarino AI, Steptoe A, Hamer M, Michie S. Covid-19: Important potential side effects of wearing face masks that we should bear in mind. BMJ 2020; 369:m2003.

110 Schroter RC. Social distancing for covid-19: is 2 metres far enough? BMJ 2020; 369:m2010.

111 Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020; 15(5):e0233668.
-112112 Szepietowski JC, Matusiak L, Szepietowska M, Krajewski PK, Bialynicki-Birula R. Face Mask-induced Itch: A Self-questionnaire Study of 2,315 Responders During the COVID-19 Pandemic. Acta Derm Venereol 2020; 100:adv00152.,116116 Han C, Shi J, Chen Y, Zhang Z. Increased flare of acne caused by long-time mask wearing during COVID -19 pandemic among general population. Dermatol Ther 2020; 33(4):e13704. concentraram o maior número de publicações, sendo os artigos de opinião, editoriais ou comentários os mais predominantes até abril (n=25), enquanto os estudos transversais tornaram-se mais frequentes após essa data (Figura 2). Dos artigos selecionados, 49,5% são artigos de opinião, comentários, cartas e editoriais; 34,4%, estudos transversais; e 16,1%, revisões sistemáticas e metanálises1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,2828 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.,4545 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .,6060 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.,6565 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.,7676 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .,8686 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987,8989 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...
,9090 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.,9595 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260.,101101 Wu H-L, Huang J, Zhang CJP, He Z, Ming W-K. Facemask shortage and the novel coronavirus disease (COVID-19) outbreak: Reflections on public health measures. EClinicalMedicine 2020; 21:100329.,103103 Chowdhury A, Jahan N, Wang S. One month of the novel coronavirus 2019 outbreak: Is it still a threat? Virusdisease 2020; 31(2):1-5.,105105 Kim MN. What Type of Face Mask Is Appropriate for Everyone-Mask-Wearing Policy amidst COVID-19 Pandemic? J Korean Med Sci 2020; 35(20):e186.,113113 Aggarwal N, Dwarakanathan V, Gautam N, Ray A. Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis. Indian J Public Health 2020; 64(Supl.):S192-S200. (Figura 2).

Figura 2
Tipos de publicações científicas sobre uso de máscaras de tecido no combate à pandemia por mês de publicação.

Os artigos também foram classificados quanto ao seu posicionamento com relação ao amplo uso de máscaras de tecido (Figura 3). Dos artigos incluídos (n=93), 77,4% (n=72) se posicionaram a favor do amplo uso de máscaras de tecido no contexto da COVID-191010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,2626 Leung CC, Lam TH, Cheng KK. Let us not forget the mask in our attempts to stall the spread of COVID-19. Int J Tuberc Lung Dis 2020; 24(4):364-366.

27 Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 2020; 16(10):1745-1752.

28 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.

29 Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020; 395(10228):945.

30 Zhai Z. Facial mask: A necessity to beat COVID-19. Build Environ 2020; 175:106827.

31 Liu X, Zhang S. COVID-19: Face masks and human-to-human transmission. Influenza Other Respi Viruses 2020; 14(4):472-473 .

32 Ma Q-X, Shan H, Zhang H-L, Li G-M, Yang R-M, Chen J-M. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.

33 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.

34 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...

35 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.

36 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.

37 Wang M-W, Cheng Y-R, Ye L, Zhou M-Y, Chen J, Feng Z-H. The COVID-19 outbreak: The issue of face masks. Infect Control Hosp Epidemiol 2020; 41(8):974-975.

38 Han G, Zhou Y-H. Possibly critical role of wearing masks in general population in controlling COVID-19. J Med Virol 2020; 10.1002/jmv.25886.
https://doi.org/10.1002/jmv.25886...

39 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.

40 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .

41 Pleil JD, Beauchamp JD, Risby TH, Dweik RA. The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19. J Breath Res 2020; 14(3):030201.

42 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .

43 Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA 2020; 323(20):2103.

44 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.

45 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .

46 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.

47 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.

48 Garcia LP. Use of facemasks to limit COVID-19 transmission. Epidemiol Serv Saude 2020; 29(2):e2020023.

49 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.

50 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.

51 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.

52 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.

53 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.

56 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...

57 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.

58 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.

59 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.

60 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.

61 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...

62 Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, Witecka K-F, Rymaszewska J. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain Behav Immun 2020; 87:161-162.

63 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.

64 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.

65 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.

66 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880.

67 Soto DM, Cardona Maya WD, Agudelo EL, Bueno-Sánchez JC. The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America. Infect Control Hosp Epidemiol 2020; 1-2.

68 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.

69 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.

70 Kashyap A, Singh K, Sabat D, Maini L. Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic. J Clin Orthop Trauma 2020; 11(Supl. 3):S298-S300.

71 Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther 2020; 33(4):e13567.

72 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.

73 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.

74 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.

75 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.

76 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .

77 Chiang C-H, Chiang C-H, Chiang C-H. Letter to editor - Can universal masking help with our recovery from the COVID-19 pandemic? Int J Surg 2020; 79:125-126.

78 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.

79 Middleton JD, Lopes H. Face masks in the covid-19 crisis: caveats, limits, and priorities. BMJ 2020; 369:m2030.

80 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501

81 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084.

82 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.

83 Han C, Shi J, Chen Y, Zhang Z. Increased flare of acne caused by long-time mask wearing during COVID-19 pandemic among general population. Dermatol Ther 2020; 33(4):e13704.

84 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.

85 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.

86 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987

87 Liu PL. COVID-19 Information Seeking on Digital Media and Preventive Behaviors: The Mediation Role of Worry. Cyberpsychol Behav Soc Netw 2020; 23(10):677-682.

88 Jung F, Krieger V, Hufert FT, Küpper J-H. How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective. Clin Hemorheol Microcirc 2020; 74(4):363-372.

89 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...

90 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.

91 Greenhalgh T. Laying straw men to rest: author's reply to 'Urgency and uncertainty: covid-19, face masks, and evidence informed policy'. BMJ 2020; 369:m2240

92 Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, Mohajer S, HajiAliBeigloo R, Nia MN, Jamei F, Mazlom SR. Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound Emerg Dis 2020; 10.1111/tbed.13662.
https://doi.org/10.1111/tbed.13662...

93 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.

94 Ho K-F, Lin L-Y, Weng S-P, Chuang K-J. Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments. Sci Total Environ 2020; 735:139510.

95 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260.
-9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210. e 4,3% (n=4)9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.

99 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.
-100100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017. se posicionaram contra o seu uso. É importante destacar que todos os artigos que se posicionaram contra o uso de máscaras eram artigos de opinião, comentários, cartas ou editoriais. Entre aqueles que se posicionaram a favor, destacam-se os estudos transversais (n=28)1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,2727 Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 2020; 16(10):1745-1752.,3333 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.,4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,4646 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.,4949 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.,5050 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.,5353 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.
-5555 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.,5757 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.,5959 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.,6161 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...
,6363 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.,6464 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.,6868 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.,7373 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.,7575 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.,7878 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.,8080 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501,8282 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.,8484 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.,8585 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.,8787 Liu PL. COVID-19 Information Seeking on Digital Media and Preventive Behaviors: The Mediation Role of Worry. Cyberpsychol Behav Soc Netw 2020; 23(10):677-682.,8888 Jung F, Krieger V, Hufert FT, Küpper J-H. How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective. Clin Hemorheol Microcirc 2020; 74(4):363-372.,9292 Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, Mohajer S, HajiAliBeigloo R, Nia MN, Jamei F, Mazlom SR. Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound Emerg Dis 2020; 10.1111/tbed.13662.
https://doi.org/10.1111/tbed.13662...
,9393 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.,9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210. e as revisões de literatura (n=10)1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,2828 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.,4545 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .,6060 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.,6565 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.,7676 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .,8686 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987,8989 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...
,9090 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.,9595 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260., considerando um universo de 32 e 15 estudos, respectivamente (Quadro 1). As primeiras publicações sobre o tema estavam divididas entre as possíveis implicações do uso universal de máscaras na redução dos estoques de máscaras descartáveis e a recomendação do uso de máscaras de tecido como medida adicional na contenção da pandemia. A partir de abril, as publicações que recomendavam a adoção do uso universal de máscaras, em especial as de tecido, aumentaram de 9,72% (n=7)1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,2626 Leung CC, Lam TH, Cheng KK. Let us not forget the mask in our attempts to stall the spread of COVID-19. Int J Tuberc Lung Dis 2020; 24(4):364-366.

27 Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 2020; 16(10):1745-1752.

28 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.

29 Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020; 395(10228):945.

30 Zhai Z. Facial mask: A necessity to beat COVID-19. Build Environ 2020; 175:106827.
-3131 Liu X, Zhang S. COVID-19: Face masks and human-to-human transmission. Influenza Other Respi Viruses 2020; 14(4):472-473 . para 90,28% (n=65)1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,3333 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.

34 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...

35 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.

36 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.

37 Wang M-W, Cheng Y-R, Ye L, Zhou M-Y, Chen J, Feng Z-H. The COVID-19 outbreak: The issue of face masks. Infect Control Hosp Epidemiol 2020; 41(8):974-975.

38 Han G, Zhou Y-H. Possibly critical role of wearing masks in general population in controlling COVID-19. J Med Virol 2020; 10.1002/jmv.25886.
https://doi.org/10.1002/jmv.25886...

39 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.

40 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .

41 Pleil JD, Beauchamp JD, Risby TH, Dweik RA. The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19. J Breath Res 2020; 14(3):030201.

42 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .

43 Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA 2020; 323(20):2103.

44 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.

45 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .

46 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.

47 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.

48 Garcia LP. Use of facemasks to limit COVID-19 transmission. Epidemiol Serv Saude 2020; 29(2):e2020023.

49 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.

50 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.

51 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.

52 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.

53 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.

56 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...

57 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.

58 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.

59 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.

60 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.

61 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...

62 Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, Witecka K-F, Rymaszewska J. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain Behav Immun 2020; 87:161-162.

63 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.

64 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.

65 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.

66 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880.

67 Soto DM, Cardona Maya WD, Agudelo EL, Bueno-Sánchez JC. The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America. Infect Control Hosp Epidemiol 2020; 1-2.

68 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.

69 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.

70 Kashyap A, Singh K, Sabat D, Maini L. Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic. J Clin Orthop Trauma 2020; 11(Supl. 3):S298-S300.

71 Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther 2020; 33(4):e13567.

72 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.

73 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.

74 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.

75 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.

76 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .

77 Chiang C-H, Chiang C-H, Chiang C-H. Letter to editor - Can universal masking help with our recovery from the COVID-19 pandemic? Int J Surg 2020; 79:125-126.

78 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.

79 Middleton JD, Lopes H. Face masks in the covid-19 crisis: caveats, limits, and priorities. BMJ 2020; 369:m2030.

80 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501

81 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084.

82 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.

83 Han C, Shi J, Chen Y, Zhang Z. Increased flare of acne caused by long-time mask wearing during COVID-19 pandemic among general population. Dermatol Ther 2020; 33(4):e13704.

84 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.

85 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.

86 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987

87 Liu PL. COVID-19 Information Seeking on Digital Media and Preventive Behaviors: The Mediation Role of Worry. Cyberpsychol Behav Soc Netw 2020; 23(10):677-682.

88 Jung F, Krieger V, Hufert FT, Küpper J-H. How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective. Clin Hemorheol Microcirc 2020; 74(4):363-372.

89 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...

90 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.

91 Greenhalgh T. Laying straw men to rest: author's reply to 'Urgency and uncertainty: covid-19, face masks, and evidence informed policy'. BMJ 2020; 369:m2240

92 Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, Mohajer S, HajiAliBeigloo R, Nia MN, Jamei F, Mazlom SR. Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound Emerg Dis 2020; 10.1111/tbed.13662.
https://doi.org/10.1111/tbed.13662...

93 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.

94 Ho K-F, Lin L-Y, Weng S-P, Chuang K-J. Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments. Sci Total Environ 2020; 735:139510.

95 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260.
-9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210.. Essa diferença também pode ser observada entre os países (Figura 4), que passaram a recomendar intensamente o uso de máscaras em ambiente extradomiciliar a partir do mês de abril (as datas da regulamentação podem ser consultadas na Tabela 1).

Figura 3
Posicionamentos das publicações científicas sobre o amplo uso de máscaras de tecido no combate à pandemia por mês de publicação.

Figura 4
Países que regulamentaram o uso de máscaras em ambiente extradomiciliar desde o início da pandemia.

Tabela 1
Sequência cronológica dos países que decretaram oficialmente a utilização de máscaras faciais em locais públicos*.

Evolução das recomendações sobre o uso de máscaras para o controle da COVID-19 ao longo do curso da epidemia

Com o avanço da pandemia de COVID-19, discussões sobre o uso de máscaras em ambientes extradomiciliares como intervenção em saúde pública emergiram, com posições favoráveis1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,2020 Wang M-W, Zhou M-Y, Ji G-H, Ye L, Cheng Y-R, Feng Z-H, Chen J. Mask crisis during the COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24(6):3397-3399.,2626 Leung CC, Lam TH, Cheng KK. Let us not forget the mask in our attempts to stall the spread of COVID-19. Int J Tuberc Lung Dis 2020; 24(4):364-366.

27 Zhong B-L, Luo W, Li H-M, Zhang Q-Q, Liu X-G, Li W-T, Li Y. Knowledge, attitudes, and practices towards COVID-19 among Chinese residents during the rapid rise period of the COVID-19 outbreak: a quick online cross-sectional survey. Int J Biol Sci 2020; 16(10):1745-1752.

28 Adhikari SP, Meng S, Wu Y-J, Mao Y-P, Ye R-X, Wang Q-Z, Sun C, Sylvia S, Rozelle S, Raat H, Zhou H. Epidemiology, causes, clinical manifestation and diagnosis, prevention and control of coronavirus disease (COVID-19) during the early outbreak period: a scoping review. Infect Dis Poverty 2020; 9(1):29.

29 Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020; 395(10228):945.

30 Zhai Z. Facial mask: A necessity to beat COVID-19. Build Environ 2020; 175:106827.
-3131 Liu X, Zhang S. COVID-19: Face masks and human-to-human transmission. Influenza Other Respi Viruses 2020; 14(4):472-473 .,3434 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...
,3535 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.,3737 Wang M-W, Cheng Y-R, Ye L, Zhou M-Y, Chen J, Feng Z-H. The COVID-19 outbreak: The issue of face masks. Infect Control Hosp Epidemiol 2020; 41(8):974-975.,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.

40 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .

41 Pleil JD, Beauchamp JD, Risby TH, Dweik RA. The scientific rationale for the use of simple masks or improvised facial coverings to trap exhaled aerosols and possibly reduce the breathborne spread of COVID-19. J Breath Res 2020; 14(3):030201.

42 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .

43 Desai AN, Aronoff DM. Masks and Coronavirus Disease 2019 (COVID-19). JAMA 2020; 323(20):2103.

44 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.

45 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 .

46 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.

47 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.

48 Garcia LP. Use of facemasks to limit COVID-19 transmission. Epidemiol Serv Saude 2020; 29(2):e2020023.

49 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.

50 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.

51 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.

52 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.

53 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.

54 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.

56 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...

57 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.

58 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.

59 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.

60 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.

61 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...

62 Szczesniak D, Ciulkowicz M, Maciaszek J, Misiak B, Luc D, Wieczorek T, Witecka K-F, Rymaszewska J. Psychopathological responses and face mask restrictions during the COVID-19 outbreak: Results from a nationwide survey. Brain Behav Immun 2020; 87:161-162.

63 Kang Y-J. Lessons Learned From Cases of COVID-19 Infection in South Korea. Disaster Med Public Health Prep 2020; 1-8.

64 Clements JM. Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire. JMIR Public Health Surveill 2020; 6(2):e19161.

65 Esposito S, Principi N. To mask or not to mask children to overcome COVID-19. Eur J Pediatr 2020; 179(8):1267-1270.

66 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880.

67 Soto DM, Cardona Maya WD, Agudelo EL, Bueno-Sánchez JC. The feasibility of generalized face mask usage during the COVID-19 pandemic: a perspective from Latin America. Infect Control Hosp Epidemiol 2020; 1-2.

68 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.

69 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.

70 Kashyap A, Singh K, Sabat D, Maini L. Fast and economic cardboard cutout use to increase compliance of face mask wear during COVID-19 pandemic. J Clin Orthop Trauma 2020; 11(Supl. 3):S298-S300.

71 Matusiak L, Szepietowska M, Krajewski P, Bialynicki-Birula R, Szepietowski JC. Inconveniences due to the use of face masks during the COVID-19 pandemic: A survey study of 876 young people. Dermatol Ther 2020; 33(4):e13567.

72 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.

73 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.

74 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.

75 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605.

76 Clase CM, Fu EL, Joseph M, Beale RCL, Dolovich MB, Jardine M, Mann JFE, Pecoits-Filho R, Winkelmayer WC, Carrero JJ. Cloth Masks May Prevent Transmission of COVID-19: An Evidence-Based, Risk-Based Approach. Ann Intern Med 2020; 173(6):489-491 .

77 Chiang C-H, Chiang C-H, Chiang C-H. Letter to editor - Can universal masking help with our recovery from the COVID-19 pandemic? Int J Surg 2020; 79:125-126.

78 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.

79 Middleton JD, Lopes H. Face masks in the covid-19 crisis: caveats, limits, and priorities. BMJ 2020; 369:m2030.

80 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501

81 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084.
-8282 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869.,8484 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.

85 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.

86 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987

87 Liu PL. COVID-19 Information Seeking on Digital Media and Preventive Behaviors: The Mediation Role of Worry. Cyberpsychol Behav Soc Netw 2020; 23(10):677-682.

88 Jung F, Krieger V, Hufert FT, Küpper J-H. How we should respond to the Coronavirus SARS-CoV-2 outbreak: A German perspective. Clin Hemorheol Microcirc 2020; 74(4):363-372.

89 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...

90 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5.

91 Greenhalgh T. Laying straw men to rest: author's reply to 'Urgency and uncertainty: covid-19, face masks, and evidence informed policy'. BMJ 2020; 369:m2240

92 Wong LP, Alias H, Danaee M, Ziaee M, Abedi F, Ziaee A, Mohajer S, HajiAliBeigloo R, Nia MN, Jamei F, Mazlom SR. Uncovering psychobehavioral implications of SARS-CoV-2 infection in Iran. Transbound Emerg Dis 2020; 10.1111/tbed.13662.
https://doi.org/10.1111/tbed.13662...

93 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.

94 Ho K-F, Lin L-Y, Weng S-P, Chuang K-J. Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments. Sci Total Environ 2020; 735:139510.

95 Esposito S, Principi N, Leung CC, Migliori GB. Universal use of face masks for success against COVID-19: evidence and implications for prevention policies. Eur Respir J 2020; 55(6):2001260.
-9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210.,102102 Stone TE, Kunaviktikul W, Omura M, Petrini M. Editorial: Facemasks and the Covid 19 pandemic: What advice should health professionals be giving the general public about the wearing of facemasks? Nurs Health Sci 2020; 22(2):339-342.,103103 Chowdhury A, Jahan N, Wang S. One month of the novel coronavirus 2019 outbreak: Is it still a threat? Virusdisease 2020; 31(2):1-5.,116116 Han C, Shi J, Chen Y, Zhang Z. Increased flare of acne caused by long-time mask wearing during COVID -19 pandemic among general population. Dermatol Ther 2020; 33(4):e13704.

117 Luan R-S, Wang X, Sun X, Chen X-S, Zhou T, Liu Q-H, Lü X, Wu X-P, Gu D-Q, Tang M-S, Cui H-J, Shan X-F, Ouyang J, Zhang B, Zhang W, Emergency Research Group Sichuan University Covid. Epidemiology, Treatment, and Epidemic Prevention and Control of the Coronavirus Disease 2019: a Review. Sichuan Da Xue Xue Bao Yi Xue Ban 2020; 51(2):131-138.

118 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.

119 Sugrue M, O'Keeffe D, Sugrue R, MacLean L, Varzgalis M. A cloth mask for under-resourced healthcare settings in the COVID19 pandemic. Ir J Med Sci 2020; 189(4):1155-1157.
-120120 Lewis D. Is the coronavirus airborne? Experts can't agree. Nature 2020; 580(7802):175. e contrárias9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.

99 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.
-100100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017.. Posições contrárias ao amplo uso de máscaras9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.

99 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.
-100100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017. em ambientes públicos, foram observadas, sobretudo, até a primeira semana de março, baseadas nas suposições de que i) essa recomendação poderia afrouxar as medidas de distanciamento social adotadas pela população99 World Health Organization (WHO). Responding to community spread of COVID-19: interim guidance [Internet]. Genebra: WHO; 2020 [acessado 2020 Maio 6]. Disponível em: https://apps.who.int/iris/handle/10665/331421,121121 World Health Organization (WHO). Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance, 27 February 2020. Genebra: WHO; 2020.; ii) a manipulação e o uso inadequados das máscaras poderia elevar o risco de transmissão do novo coronavírus122122 Bamber JH, Christmas T. Covid-19: Each discarded face mask is a potential biohazard. BMJ 2020; 369:m2012.; iii) o crescimento da demanda poderia agravar a escassez de máscaras cirúrgicas para profissionais de saúde1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,2121 Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020; 8(5):434-436.,6969 Sra HK, Sandhu A, Singh M. Use of Face Masks in COVID-19. Indian J Pediatr 2020; 87:553.,121121 World Health Organization (WHO). Rational use of personal protective equipment for coronavirus disease (COVID-19): interim guidance, 27 February 2020. Genebra: WHO; 2020.,123123 Todd B. Where Are the Masks? Am J Nurs 2020; 120(6):18-19.,124124 Lepelletier D, Grandbastien B, Romano-Bertrand S, Aho S, Chidiac C, Géhanno J-F, Chauvin F, French Society for Hospital Hygiene and the High Council for Public Health. What face mask for what use in the context of COVID-19 pandemic? The French guidelines. J Hosp Infect 2020; 105(3):414-418.; e iv) essa recomendação poderia oportunizar a prática de preços abusivos. Reforçamos que as posições contrárias são embasadas exclusivamente em artigos de opinião, comentários e editoriais, os quais não apresentam evidências científicas que mostrassem a não eficácia do uso de máscaras para contenção da disseminação da doença9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.

98 Szarpak L, Smereka J, Filipiak KJ, Ladny JR, Jaguszewski M. Cloth masks versus medical masks for COVID-19 protection. Cardiol J 2020; 27(2):218-219.

99 Lazcano-Ponce E, Alpuche-Aranda C. Public health literacy in the face of the Covid-19 pandemic emergency. Salud Publica Mex 2020; 62(3):331-340.
-100100 Martin GP, Hanna E, Dingwall R. Urgency and uncertainty: covid-19, face masks, and evidence informed policy. BMJ 2020; 369:m2017..

Evidências acerca da efetividade do uso de máscaras como controle de doenças infecciosas respiratórias

Estudos anteriores à atual pandemia já haviam comprovado a efetividade do uso massivo de máscaras, inclusive de máscaras de tecido, em locais extradomiciliares como estratégia de controle à disseminação de doenças infecciosas respiratórias1010 Liang M, Gao L, Cheng C, Zhou Q, Uy JP, Heiner K, Sun C. Efficacy of face mask in preventing respiratory virus transmission: A systematic review and meta-analysis. Travel Med Infect Dis 2020; 36:101751.,1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,4444 MacIntyre CR, Hasanain SJ. Community Universal Face Mask Use during the COVID 19 pandemic-from households to travelers and public spaces. J Travel Med 2020; 27(3):taaa056.,5656 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...
,125125 Brienen NCJ, Timen A, Wallinga J, van Steenbergen JE, Teunis PFM. The effect of mask use on the spread of influenza during a pandemic. Risk Anal 2010; 30(8):1210-1218.,126126 Davies A, Thompson K-A, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep 2013; 7(4):413-418., incluindo a SARS127127 Leung GM, Ho L-M, Chan SKK, Ho S-Y, Bacon-Shone J, Choy RYL, Hedley AJ, Lam T-H, Fielding R. Longitudinal assessment of community psychobehavioral responses during and after the 2003 outbreak of severe acute respiratory syndrome in Hong Kong. Clin Infect Dis 2005; 40(12):1713-1720.. De acordo com um estudo britânico128128 Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen H, von Delft A, Price A, Fridman L, Tang L, Tan V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. Face masks against COVID-19: an evidence review. Preprints 2020; 10.20944/preprints202004.0203.v1.
https://doi.org/10.20944/preprints202004...
, a eficácia do uso de máscaras no combate a doenças respiratórias depende de três pontos principais: i) da capacidade de bloquear o vírus (eficácia da máscara); ii) da proporção de pessoas que a utilizam em público (aderência ao uso); e iii) da taxa de transmissão da doença.

Estudos ainda sugerem que, apesar de apresentarem uma eficácia menor do que as máscaras cirúrgicas, as máscaras de tecido, se usadas corretamente, funcionam como barreira mecânica à transmissão do vírus, impedindo ou reduzindo o contato dos indivíduos com gotículas contaminadas1818 Ma QX, Shan H, Zhang HL, Li GM. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9):1567-1571.,5757 Wilson AM, Abney SE, King M-F, Weir MH, López-García M, Sexton JD, Dancer SJ, Proctor J, Noakes CJ, Reynolds KA. COVID-19 and non-traditional mask use: How do various materials compare in reducing the infection risk for mask wearers? J Hosp Infect 2020; 105(4):640-642.,104104 Amendola L, Saurini MT, Di Girolamo F, Arduini F. A rapid screening method for testing the efficiency of masks in breaking down aerosols. Microchem J 2020; 157:104928.,105105 Kim MN. What Type of Face Mask Is Appropriate for Everyone-Mask-Wearing Policy amidst COVID-19 Pandemic? J Korean Med Sci 2020; 35(20):e186.,125125 Brienen NCJ, Timen A, Wallinga J, van Steenbergen JE, Teunis PFM. The effect of mask use on the spread of influenza during a pandemic. Risk Anal 2010; 30(8):1210-1218.,126126 Davies A, Thompson K-A, Giri K, Kafatos G, Walker J, Bennett A. Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep 2013; 7(4):413-418.,129129 Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog 2013; 9(3):e1003205.,130130 Lustig SR, Biswakarma JJH, Rana D, Tilford SH, Hu W, Su M, Rosenblatt MS. Effectiveness of Common Fabrics to Block Aqueous Aerosols of Virus-like Nanoparticles. ACS Nano 2020; 14(6):7651-7658.. Esta redução ocorre porque, se uma gota contaminada atingir a trama do tecido de uma máscara ao invés da boca ou do nariz, ela tende a ficar retida, diminuindo o número de gotículas contaminadas que chegam às vias respiratórias. Ao evitar a contaminação de seus usuários, as máscaras de tecido ajudam a retardar a velocidade de evolução da epidemia3838 Han G, Zhou Y-H. Possibly critical role of wearing masks in general population in controlling COVID-19. J Med Virol 2020; 10.1002/jmv.25886.
https://doi.org/10.1002/jmv.25886...
e contribuem para o estabelecimento de uma curva epidêmica mais longa e plana9797 Mahase E. Covid-19: What is the evidence for cloth masks? BMJ 2020; 369:m1422.. Contudo, se as máscaras forem posicionadas ao rosto de forma inadequada, com eventuais aberturas laterais, podem ter sua efetividade protetora diminuída em até 60%5454 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347..

Pesquisadores da Universidade de Duke (EUA), analisaram 14 tipos de máscaras para avaliar sua eficácia na proteção contra gotículas respiratórias emitidas pela fala. Os resultados mostraram que, de fato, as máscaras profissionais N95 são as mais eficazes (redução da transmissão de gotículas para menos de 0,1%), seguidas pelas máscaras cirúrgicas de três camadas ou de polipropileno e algodão (redução da transmissão de gotículas em 90% ou mais, em comparação com a ausência de cobertura facial). As máscaras de tecido de algodão, feitas à mão, vieram na sequência, fornecendo boa cobertura, eliminando 70% a 90% das gotículas expelidas pela fala, e se equiparando ao desempenho das máscaras N95 com válvulas131131 Fischer EP, Fischer MC, Grass D, Henrion I, Warren WS, Westman E. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Sci Adv 2020; 6(36):eabd3083..

Ainda sobre o poder de filtração das máscaras de tecido, um estudo realizado em Teipei não encontrou diferenças significativas na concentração de partículas entre 20-1.000 nm no ar em ambientes fechados (carro e quarto) após a permanência de pessoas gripadas utilizando máscaras de tecido de três camadas versus estas mesmas pessoas utilizando máscaras cirúrgicas9494 Ho K-F, Lin L-Y, Weng S-P, Chuang K-J. Medical mask versus cotton mask for preventing respiratory droplet transmission in micro environments. Sci Total Environ 2020; 735:139510., sugerindo poder de filtração semelhante entre os modelos. Nos Estados Unidos, diante da escassez de máscaras profissionais durante a pandemia da COVID-19, o CDC chegou a recomendar que fosse feito o uso de máscaras de tecido por profissionais de saúde que não atuam diretamente com pacientes infectados4545 Abd-Elsayed A, Karri J. Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic. Anesth Analg; 131(1):4-6 ..

Evidências sobre o uso de máscaras em locais públicos na prevenção da COVID-19

Com relação à proporção de pessoas que fazem o uso de máscaras, há grande heterogeneidade nas normas adotadas por diferentes países e regiões e, também, na taxa de aderência destas populações, mesmo mediante indicação ao uso de máscaras. A aderência das pessoas à medida de prevenção depende, entre outros fatores, da consistência da informação veiculada pelo poder público, da confiabilidade da população nas autoridades públicas e sanitárias e no conhecimento da população acerca da doença132132 Goodman JL, Borio L. Finding Effective Treatments for COVID-19: Scientific Integrity and Public Confidence in a Time of Crisis. JAMA 2020; 323(19):1899-1900.. Entretanto, no final de março, cerca de três meses após o início da pandemia, Laestadius et al.8080 Laestadius L, Wang Y, Ben Taleb Z, Kalan ME, Cho Y, Manganello J. Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis. JMIR Public Health Surveill 2020; 6(2):e19501 avaliaram as diretrizes e informações acerca do uso de máscaras em sites oficiais de agências e ministérios de saúde de 25 países e reportaram a falta de sistematização e alinhamento das informações prestadas à população.

O primeiro país a decretar a obrigatoriedade do uso de máscaras em locais públicos foi a Mongólia, em 14 de março, sucedido pelo Vietnã, Venezuela e República Tcheca133133 Masks4All. Quais países exigem máscaras em público ou recomendam máscaras? [Internet]. [acessado 2020 Jul 11]. Disponível em: https://masks4all.co/pt/what-countries-require-masks-in-public/
https://masks4all.co/pt/what-countries-r...
(Tabela 1). Até o dia 13 de julho de 2020, seis meses após o início da pandemia, 129 países haviam passado a recomendar o amplo uso de máscaras em locais públicos, de forma geral ou mais restritiva. Em outros 17 países, a obrigatoriedade foi adotada em parte do território (municípios/estados)133133 Masks4All. Quais países exigem máscaras em público ou recomendam máscaras? [Internet]. [acessado 2020 Jul 11]. Disponível em: https://masks4all.co/pt/what-countries-require-masks-in-public/
https://masks4all.co/pt/what-countries-r...
. Ou seja, dos 193 países considerados Estados soberanos, até o dia 13 de Julho, 146 já se posicionavam favoravelmente ao uso de máscaras como medida preventiva à disseminação da COVID-19, destacando a relevância desta do ponto de vista de saúde pública (Figura 4). Para Li et al.8989 Li DTS, Samaranayake LP, Leung YY, Neelakantan P. Facial protection in the era of COVID-19: A narrative review. Oral Dis 2020; 10.1111/odi.13460.
https://doi.org/10.1111/odi.13460...
, a eficácia da obrigatoriedade do amplo uso de máscaras é uma das grandes lições desta pandemia. Atualmente, as máscaras são consideradas capazes de reduzir a gravidade da COVID-19, e possibilitar que as novas infecções sejam assintomáticas134134 Gandhi M, Rutherford GW. Facial Masking for Covid-19 - Potential for 'Variolation' as We Await a Vaccine. N Engl J Med 2020; 383(18):e101..

Alguns países recomendaram o uso de máscaras no início da pandemia mesmo na ausência de evidências científicas consolidadas sobre a capacidade da medida de reduzir o seu ritmo de expansão da pandemia8181 Majeed A, Seo Y, Heo K, Lee D. Can the UK emulate the South Korean approach to covid-19? BMJ 2020; 369:m2084., possivelmente pautados pelo princípio da precaução - definido como uma estratégia para abordar questões de dano potencial, quando falta um amplo conhecimento científico sobre o assunto. Segundo Greenhalgh et al.3636 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435., é necessário aplicar este princípio diante de questões de relevância para a proteção da saúde da população, principalmente quando análises de custo-benefício indicam poucos efeitos adversos potenciais e a possibilidade de alcançar benefícios significativos135135 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA 2020; 10.1001/jama.2020.13107.
https://doi.org/10.1001/jama.2020.13107...
.

Os efeitos benéficos da adoção precoce das máscaras de tecido por alguns países ficaram evidentes em estudos que comparam o avançar da COVID-19 em diferentes regiões e em estudos que realizaram rastreamento de casos de infecção por SARS-CoV2. Um estudo transnacional comparou, por exemplo, a evolução da pandemia na Áustria e República Tcheca, sugerindo a eficácia do uso de máscaras no combate à COVID-19128128 Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen H, von Delft A, Price A, Fridman L, Tang L, Tan V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. Face masks against COVID-19: an evidence review. Preprints 2020; 10.20944/preprints202004.0203.v1.
https://doi.org/10.20944/preprints202004...
. Ambos os países estabeleceram requisitos de distanciamento social na mesma data, mas somente a República Tcheca incorporou, ao mesmo tempo, o uso obrigatório de máscaras. A partir daí, observou-se trajetória ascendente no número de infectados pelo coronavírus na Áustria, enquanto a curva epidêmica da República Tcheca manteve-se longa e plana. Apenas quando a Áustria também determinou por decreto governamental o uso de máscaras, os dois países voltaram a ter trajetórias similares128128 Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen H, von Delft A, Price A, Fridman L, Tang L, Tan V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. Face masks against COVID-19: an evidence review. Preprints 2020; 10.20944/preprints202004.0203.v1.
https://doi.org/10.20944/preprints202004...
.

De forma similar, Cheng et al.4040 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 . compararam a evolução da incidência de COVID-19 em Hong Kong com a evolução da doença em outros oito países, e atribuíram a baixa taxa de contaminação em Hong Kong à adoção universal e voluntária do uso de máscaras pela maioria da população (96,6% durante o estudo) no início da pandemia. Este mesmo estudo rastreou algumas rotas de transmissão entre os primeiros 961 casos reportados em Hong Kong, identificando que onze núcleos de infecção de 113 pacientes ocorreram em espaços de lazer sem uso de máscaras, incluindo restaurantes, karaokês e academias de ginástica, e que apenas três núcleos ocorreram em locais de trabalho onde o uso de máscaras era praticado5353 Cheng VCC, Wong S-C, Chuang VWM, So SY-C, Chen JH-K, Sridhar S, To KK-W, Chan JF-W, Hung IF-N, Ho P-L, Yuen K-Y. The role of community-wide wearing of face mask for control of coronavirus disease 2019 (COVID-19) epidemic due to SARS-CoV-2. J Infect 2020; 81(1):107-114.. Outros estudos epidemiológicos que rastrearam rotas de infecção e transmissão também concluíram que a taxa de transmissão foi menor em situações nas quais as máscaras foram utilizadas3131 Liu X, Zhang S. COVID-19: Face masks and human-to-human transmission. Influenza Other Respi Viruses 2020; 14(4):472-473 .,7575 Gao Q, Hu Y, Dai Z, Xiao F, Wang J, Wu J. The epidemiological characteristics of 2019 novel coronavirus diseases (COVID-19) in Jingmen, Hubei, China. Medicine 2020; 99(23):e20605..

A partir de dados sobre a evolução da pandemia na Itália e em Nova Iorque, ambos severamente atingidos pela COVID-19, Zhang et al.9393 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863. apontam que a obrigatoriedade de cobertura das vias respiratórias evitou mais de 76 mil e 66 mil novos casos de infecção pelo novo coronavírus, respectivamente9393 Zhang R, Li Y, Zhang AL, Wang Y, Molina MJ. Identifying airborne transmission as the dominant route for the spread of COVID-19. Proc Natl Acad Sci USA 2020; 117(26):14857-14863.. As medidas que tornaram compulsório o uso de máscaras de tecido em ambientes públicos nos estados de Nova Iorque e Washington foram adotadas após modelos de predição indicarem que a adoção massiva de máscaras, mesmo as menos eficazes, poderia reduzir a transmissão do novo coronavírus colaborando para o achatamento da curva epidêmica e dos picos de letalidade4646 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.,5959 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.. Outros estudos afirmam que a recomendação de manter a distância de dois metros quando em local público só é eficaz se a medida for associada ao uso de máscaras5252 Setti L, Passarini F, De Gennaro G, Barbieri P, Perrone MG, Borelli M, Palmisani J, Di Gilio A, Piscitelli P, Miani A. Airborne Transmission Route of COVID-19: Why 2 Meters/6 Feet of Inter-Personal Distance Could Not Be Enough. Int J Environ Res Public Health 2020; 17(8):2932.,7373 Feng Y, Marchal T, Sperry T, Yi H. Influence of wind and relative humidity on the social distancing effectiveness to prevent COVID-19 airborne transmission: A numerical study. J Aerosol Sci 2020; 105585.. Alguns estudos sugerem que a pandemia de COVID-19 poderia ser contida se a maioria ou de preferência todas as pessoas usassem máscaras de tecido em locais públicos2121 Feng S, Shen C, Xia N, Song W, Fan M, Cowling BJ. Rational use of face masks in the COVID-19 pandemic. Lancet Respir Med 2020; 8(5):434-436.,118118 Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L. Face masks for the public during the covid-19 crisis. BMJ 2020; 369:m1435.,128128 Howard J, Huang A, Li Z, Tufekci Z, Zdimal V, van der Westhuizen H, von Delft A, Price A, Fridman L, Tang L, Tan V, Watson GL, Bax CE, Shaikh R, Questier F, Hernandez D, Chu LF, Ramirez CM, Rimoin AW. Face masks against COVID-19: an evidence review. Preprints 2020; 10.20944/preprints202004.0203.v1.
https://doi.org/10.20944/preprints202004...
,136136 van der Sande M, Teunis P, Sabel R. Professional and home-made face masks reduce exposure to respiratory infections among the general population. PLoS One 2008; 3(7):e2618..

Brooks et al.135135 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA 2020; 10.1001/jama.2020.13107.
https://doi.org/10.1001/jama.2020.13107...
compararam o uso de máscaras à imunidade de rebanho obtida com vacinas, visto que quanto mais as pessoas aderem a essa medida preventiva em público (onde o distanciamento social recomendado não é possível), maior é a proteção da comunidade135135 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA 2020; 10.1001/jama.2020.13107.
https://doi.org/10.1001/jama.2020.13107...
. Os mesmos autores afirmaram que a proteção em nível comunitário proporcionada pelo uso de máscaras de tecido pode reduzir o número de novas infecções e intervenções municipais mais perturbadoras da sociedade, como o fechamento do comércio e o lockdown - a política pública que exige que os cidadãos permaneçam em casa.

Ainda que diversos estudos indiquem a eficácia das máscaras no controle da pandemia e que um número crescente de países exija o uso das máscaras de tecido em ambientes extradomiciliares, a taxa de adesão pelas populações varia expressivamente. Certamente, a recomendação das autoridades sanitárias pelo uso de máscaras influencia o comportamento da população, conforme indica um estudo (ainda em preprint) realizado nos EUA que relata um aumento de 12% no uso de máscaras entre os americanos em apenas cinco dias após o anúncio do CDC137137 Goldberg MH, Gustafson A, Maibach EW, Ballew MT, Bergquist P, Kotcher JE, Marlon JR, Rosenthal SA, Leiserowitz A. Mask-wearing increases after a government recommendation: A natural experiment in the U.S. during the COVID-19 pandemic. Front Commun 2020; 5(44):1-6.. Todavia, entre os estudos incluídos nessa narrativa, as maiores taxas de aderência ao uso de máscaras são de países asiáticos com histórico de uso desse recurso no controle de outras doenças infecciosas respiratórias e poluição do ar4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,4949 Chen X, Ran L, Liu Q, Hu Q, Du X, Tan X. Hand Hygiene, Mask-Wearing Behaviors and Its Associated Factors during the COVID-19 Epidemic: A Cross-Sectional Study among Primary School Students in Wuhan, China. Int J Environ Res Public Health 2020; 17(8):2893.,5050 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.,9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210.,111111 Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020; 15(5):e0233668..

As populações da Coreia do Sul e de Singapura, por exemplo, já vinham utilizando máscaras em público, especialmente depois do surto de SARS em 2003, o que facilitou a transposição da medida no cenário de pandemia pelo vírus SARS-CoV-2. Na Coreia do Sul, ainda no início da pandemia, mais de 60% da população já utilizava máscaras5050 Lee M, You M. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19). Int J Environ Res Public Health 2020; 17(9):2977.. Em Hong Kong, o uso de máscaras em ambientes extradomiciliares saltou de 74,5% para 98,8% entre os entrevistados, entre janeiro e março de 20204242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .. Diversos estudos em Hong Kong encontram taxas de aderência semelhante, entre 97% e 99%8282 Chan EYY, Huang Z, Lo ESK, Hung KKC, Wong ELY, Wong SYS. Sociodemographic Predictors of Health Risk Perception, Attitude and Behavior Practices Associated with Health-Emergency Disaster Risk Management for Biological Hazards: The Case of COVID-19 Pandemic in Hong Kong, SAR China. Int J Environ Res Public Health 2020; 17(11):3869., e o amplo uso de máscaras de tecido tem sido considerado uma das estratégias mais eficazes no combate à pandemia na região4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .. Na China, a adesão às máscaras é de mais de 80%6868 Huang Y, Wu Q, Wang P, Xu Y, Wang L, Zhao Y, Yao D, Xu Y, Lv Q, Xu S. Measures Undertaken in China to Avoid COVID-19 Infection: Internet-Based, Cross-Sectional Survey Study. J Med Internet Res 2020; 22(5):e18718.,8484 Liu X, Luo W-T, Li Y, Li C-N, Hong Z-S, Chen H-L, Xiao F, Xia J-Y. Psychological status and behavior changes of the public during the COVID-19 epidemic in China. Infect Dis Poverty 2020; 9(1):58.,138138 Chen Y, Jin YL, Zhu LJ, Fang ZM, Wu N, Du MX, Jiang MM, Wang J, Yao YS. The network investigation on knowledge, attitude and practice about COVID-19 of the residents in Anhui Province. Zhonghua Yu Fang Yi Xue Za Zhi 2020; 54(4):367-373.. Em comparação, na Índia e na Malásia, estudos sobre comportamento do público com relação à pandemia indicou aderência mais baixa às máscaras, que são utilizadas por pouco mais de 70% e 51% dos entrevistados, respectivamente9696 Dkhar SA, Quansar R, Saleem SM, Khan SMS. Knowledge, attitude, and practices related to COVID-19 pandemic among social media users in J&K, India. Indian J Public Health 2020; 64(Supl.):S205-S210.,111111 Azlan AA, Hamzah MR, Sern TJ, Ayub SH, Mohamad E. Public knowledge, attitudes and practices towards COVID-19: A cross-sectional study in Malaysia. PLoS One 2020; 15(5):e0233668..

A efetividade do uso das máscaras de tecido para o controle da COVID-19 é bem suportada pela literatura quando em conjunto com outras medidas de combate à pandemia como a higienização correta das mãos e o distanciamento social8686 Chu DK, Akl EA, Duda S, Solo K, Yaacoub S, Schünemann HJ, COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395(10242):1973-1987. O uso das máscaras de tecido sem a adoção destas outras medidas não pode, entretanto, ser interpretado pelos usuários como solução para a crise sanitária, visto que sua eficácia, quando descumpridas outras recomendações, é ainda um tema controverso6060 MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud 2020; 108:103629.,113113 Aggarwal N, Dwarakanathan V, Gautam N, Ray A. Facemasks for prevention of viral respiratory infections in community settings: A systematic review and meta-analysis. Indian J Public Health 2020; 64(Supl.):S192-S200..

Evidências sobre o uso de máscaras na prevenção da COVID-19 no Brasil

A avaliação dos padrões de buscas online no Brasil evidenciou um pico no interesse sobre o coronavírus no país no dia 21 de março, e um interesse expressivo da população brasileira acerca do uso de máscaras logo após a publicação da recomendação do MS115115 Filho C, Vieira LJES, Silva RM. Buscas na internet sobre medidas de enfrentamento à COVID-19 no Brasil: descrição de pesquisas realizadas nos primeiros 100 dias de 2020. Epidemiol Serv Saúde 2020; 29(3):e2020191..

Os dois primeiros estados brasileiros a decretarem oficialmente a obrigatoriedade do uso de máscaras em ambientes extradomiciliares como medida adicional de combate à pandemia foram Pará e Santa Catarina, em 16 de abril, seguidos por Minas Gerais, Amapá e Goiás88 Brasil. Ministério da Saúde (MS). Nota Técnica: Uso de máscaras caseiras. Brasília: MS; 2020. (Tabela 2). Já assoladas pela pandemia, as capitais Manaus e Rio de Janeiro fizeram o mesmo em 14/04 e 18/04, respectivamente. A Figura 5 ilustra os estados brasileiros de acordo com o mês em que foi decretado oficialmente o uso obrigatório de máscaras em ambiente extradomiciliar.

Figura 5
Estados brasileiros que sancionaram leis estabelecendo o uso mandatório de máscaras em ambientes extradomiciliares por mês de decreto oficialmente publicado.

Tabela 2
Data em que os estados brasileiros sancionaram a obrigatoriedade do uso de máscaras em locais públicos.

Em nível federal, o Projeto de Lei (PL 1.562/2020), que determinava o uso obrigatório de máscaras em locais públicos ou locais privados acessíveis ao público em todo o território nacional enquanto durasse o estado de calamidade pública decorrente da pandemia, foi aprovado pelo Plenário da Câmara dos Deputados em 9 de junho, e seguiu para sanção presidencial139139 Senado Federal. Bolsonaro veta uso obrigatório de máscara no comércio, em escolas e em igrejas [Internet]. Senado Notícias; 2020 [acessado 2020 Jul 11]. Disponível em: https://www12.senado.leg.br/noticias/materias/2020/07/03/bolsonaro-veta-uso-obrigatorio-de-mascara-no-comercio-em-escolas-e-em-igrejas
https://www12.senado.leg.br/noticias/mat...
. Porém, o presidente só sancionou a Lei nº 14.019 no dia 2 de julho de 2020140140 Brasil. Lei nº 14.019, de 2 de julho de 2020. Altera a Lei nº 13.979, de 6 de fevereiro de 2020, para dispor sobre a obrigatoriedade do uso de máscaras de proteção individual para circulação em espaços públicos e privados acessíveis ao público, em vias públicas e em transportes públicos, sobre a adoção de medidas de assepsia de locais de acesso público, inclusive transportes públicos, e sobre a disponibilização de produtos saneantes aos usuários durante a vigência das medidas para enfrentamento da emergência de saúde pública de importância internacional decorrente da pandemia da Covid-19. Diário Oficial da União 2020; 8 set., quando todos os estados brasileiros, exceto o Rio de Janeiro, já exigiam o uso de máscaras em ambientes extradomiciliares. Além disso, o presidente vetou importantes partes do PL, como o uso das máscaras em órgãos e entidades públicas e em estabelecimentos comerciais, industriais, templos religiosos, instituições de ensino e demais locais fechados em que haja aglomeração de pessoas. A Presidência também excluiu da proposta dispositivo que agravava a punição para infratores reincidentes ou que deixassem de usar máscara em ambientes fechados139139 Senado Federal. Bolsonaro veta uso obrigatório de máscara no comércio, em escolas e em igrejas [Internet]. Senado Notícias; 2020 [acessado 2020 Jul 11]. Disponível em: https://www12.senado.leg.br/noticias/materias/2020/07/03/bolsonaro-veta-uso-obrigatorio-de-mascara-no-comercio-em-escolas-e-em-igrejas
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. De acordo com o texto sancionado, os estabelecimentos também não serão obrigados a fornecer máscaras gratuitamente aos funcionários, e o poder público não será obrigado a fornecer o material a populações em situação de vulnerabilidade socioeconômica, conforme previsto pelo PL. É importante salientar que o fornecimento de máscaras a populações vulneráveis ou mesmo a toda a população de cidades ou regiões já é uma medida adotada pelos governos de outras nações6666 Parry J. Covid-19: Hong Kong government supplies reusable face masks to all residents. BMJ 2020; 369:m1880. e em alguns estados brasileiros, a exemplo da Bahia. Por esse e outros motivos, o governo brasileiro se tornou uma referência de como não proceder durante uma crise sanitária.

O uso das máscaras de tecido como uma medida adicional de proteção frente à pandemia de COVID-19 é especialmente relevante para populações em vulnerabilidade social diante da impossibilidade de adoção de medidas de distanciamento social em diversos contextos brasileiros, a exemplo das periferias e favelas e dos transportes públicos3434 Zhou Z-G, Yue D-S, Mu C-L, Zhang L. Mask is the possible key for self-isolation in COVID-19 pandemic. J Med Virol 2020; 10.1002/jmv.25846.
https://doi.org/10.1002/jmv.25846...
,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.,4040 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .,4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,4646 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.,5959 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.. De maneira geral, em situações de escassez de recurso, a entrega de máscaras deve ser estratégica e priorizar grupos de risco, além dos casos suspeitos ou confirmados de infecção, para a otimização do efeito de proteção a nível populacional3333 Worby CJ, Chang H-H. Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun 2020; 11(1):4049.. Por outro lado, ressaltamos também a necessidade de considerar os potenciais efeitos da adoção desta medida protetiva para alguns segmentos da população, como quando aplicados recortes sociais para grupos etários e étnico-raciais. Especificamente, alertamos para a possibilidade de que o amplo uso de máscaras pela população negra exponha este grupo social a um maior assédio pela polícia e a situações de preconceito e injúria racial141141 CNN. Why some people of color say they won't wear homemade masks [Internet]. 2020 [acessado 2020 Maio 4]. Disponível em: https://www.cnn.com/2020/04/07/us/face-masks-ethnicity-coronavirus-cdc-trnd/index.html
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; e que o amplo uso de máscaras prejudique a comunicação não verbal com grupos que já têm a sua capacidade de comunicação reduzida, a exemplo dos surdos e/ou mudos142142 Martin V. Uso de máscaras prejudica comunicação dos surdos [Internet]. pleno.news 2020 [acessado 2020 Maio 4]. Disponível em: https://pleno.news/comportamento/pandemia-uso-de-mascaras-afeta-comunicacao-de-pessoas-surdas.html
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Discussão

Esta síntese narrativa mostra a rápida evolução do conhecimento e a mudança de percepção a respeito desta medida de controle adicional à transmissão do SARS-CoV-2, revelando não apenas a contribuição científica prolífera e profusa em meio à pandemia, mas também como a COVID-19 tem desafiado os limites do conhecimento. O grande número de artigos publicados diariamente e a baixa qualidade de artigos envolvendo a temática, bem como a ausência de estudos observacionais sobre o uso correto das máscaras, revelam os principais desafios de se produzir revisões de forma mais oportuna em um momento onde a produção tem crescido exponencialmente.

Diante da evolução da pandemia e das evidências acumuladas nos últimos meses, a recomendação do amplo uso de máscaras de tecido em público se destaca como uma importante estratégia para: i) reduzir a propagação do novo coronavírus2626 Leung CC, Lam TH, Cheng KK. Let us not forget the mask in our attempts to stall the spread of COVID-19. Int J Tuberc Lung Dis 2020; 24(4):364-366.,2929 Leung CC, Lam TH, Cheng KK. Mass masking in the COVID-19 epidemic: people need guidance. Lancet 2020; 395(10228):945.,3535 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.,3939 Gandhi M, Havlir D. The Time for Universal Masking of the Public for Coronavirus Disease 2019 Is Now. Open Forum Infect Dis 2020; 7(4):ofaa131.,4040 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .,4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,4646 Eikenberry SE, Mancuso M, Iboi E, Phan T, Eikenberry K, Kuang Y, Kostelich E, Gumel AB. To mask or not to mask: Modeling the potential for face mask use by the general public to curtail the COVID-19 pandemic. Infect Dis Model 2020; 5:293-308.,4848 Garcia LP. Use of facemasks to limit COVID-19 transmission. Epidemiol Serv Saude 2020; 29(2):e2020023.,5151 Cho-Han Chiang, Cho-Hung Chiang, Cho-Hsien Chiang, Yee-Chun Chen. The Practice of Wearing Surgical Masks during the COVID-19 Pandemic. Emerg Infect Dis 2020; 26(8):1962.,5454 Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S. Aerosol Filtration Efficiency of Common Fabrics Used in Respiratory Cloth Masks. ACS Nano 2020; 14(5):6339-6347.

55 Victor CWT, Shing YT, Wai KP, Helen KWL, Shara WYL. A reality check on the use of face masks during the COVID-19 outbreak in Hong Kong. EClinicalMedicine 2020; 22:100356.
-5656 Wu E, Qi D. Masks and thermometers: Paramount measures to stop the rapid spread of SARS-CoV-2 in the United States. Genes Dis 2020; 10.1016/j.gendis.2020.04.011.
https://doi.org/10.1016/j.gendis.2020.04...
,5858 Sunjaya AP, Jenkins C. Rationale for universal face masks in public against COVID-19. Respirology 2020; 5(7):678-679.,5959 Ngonghala CN, Iboi E, Eikenberry S, Scotch M, MacIntyre CR, Bonds MH, Gumel AB. Mathematical assessment of the impact of non-pharmaceutical interventions on curtailing the 2019 novel Coronavirus. Math Biosci 2020; 325:108364.,135135 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA 2020; 10.1001/jama.2020.13107.
https://doi.org/10.1001/jama.2020.13107...
; ii) reduzir a possibilidade do descarte inapropriado das máscaras descartáveis, que podem se tornar focos secundários de infecção da doença2020 Wang M-W, Zhou M-Y, Ji G-H, Ye L, Cheng Y-R, Feng Z-H, Chen J. Mask crisis during the COVID-19 outbreak. Eur Rev Med Pharmacol Sci 2020; 24(6):3397-3399.,7272 Ogoina D. COVID-19: The Need for Rational Use of Face Masks in Nigeria. Am J Trop Med Hyg 2020; 103(1):33-34.,122122 Bamber JH, Christmas T. Covid-19: Each discarded face mask is a potential biohazard. BMJ 2020; 369:m2012.; e iii) ajudar na contenção da transmissão de outras doenças infectocontagiosas, como a influenza4242 Cowling BJ, Ali ST, Ng TWY, Tsang TK, Li JCM, Fong MW, Liao Q, Kwan MY, Lee SL, Chiu SS, Wu JT, Wu P, Leung GM. Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. Lancet Public Health 2020; ;5(5):e279-e288 .,7474 Noh JY, Seong H, Yoon JG, Song JY, Cheong HJ, Kim WJ. Social Distancing against COVID-19: Implication for the Control of Influenza. J Korean Med Sci 2020; 35(19):e182.,8585 Lee H, Lee H, Song K-H, Kim ES, Park JS, Jung J, Ahn S, Jeong EK, Park H, Kim HB. Impact of Public Health Interventions on Seasonal Influenza Activity During the SARS-CoV-2 Outbreak in Korea. Clin Infect Dis 2020; ciaa672.,143143 Chow A, Hein AA, Kyaw WM. Unintended Consequence: Influenza plunges with public health response to COVID-19 in Singapore. J Infect 2020; 81(2):e68-e69., reduzindo a carga de doenças da população, a sobrecarga do sistema de saúde e permitindo melhor atendimento a quem dele necessita.

Dessa forma, a ampla adoção de máscaras de tecido pode ser vista também como um exemplo de dever cívico. Trata-se de um pequeno esforço e uma solução de baixa tecnologia altamente eficaz e capaz de mudar a trajetória epidemiológica dos países, favorecendo os esforços nacionais e globais contra a COVID-19135135 Brooks JT, Butler JC, Redfield RR. Universal Masking to Prevent SARS-CoV-2 Transmission-The Time Is Now. JAMA 2020; 10.1001/jama.2020.13107.
https://doi.org/10.1001/jama.2020.13107...
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Essa revisão da literatura nos permitiu avaliar a nível nacional e internacional a relevância do uso de máscaras de tecido como medida adicional de proteção à transmissão do SARS-CoV-2. Apesar do seu escopo, essa revisão apresenta algumas limitações: i) a revisão narrativa pode ser criticada por não apresentar uma estrutura rígida como a revisão sistemática e a integrativa, entretanto, apresenta-se como uma alternativa adequada para identificar lacunas, explorar de forma crítica o tema ainda pouco conhecido144144 Jesson J, Matheson L, Lacey FM. Doing Your Literature Review: Traditional and Systematic Techniques. Thousand Oaks: Sage Publications; 2011., além de ser realizada num tempo mais curto, a fim de contemplar a urgência de respostas visando o controle da pandemia; e ii) a inclusão de artigos em fase de pré-publicação (base MedRxiv) que ainda não passaram pela revisão por pares e podem ter sua qualidade questionada, porém isso se justifica pelo propósito de produzir evidências que deem suporte para recomendações para o controle da pandemia.

As evidências acumuladas nos poucos meses da epidemia fortalecem a ideia de que o amplo uso de máscaras de tecido em ambientes extradomiciliares é uma intervenção de saúde pública promissora que, associada às medidas preventivas de distanciamento social e de higienização das mãos, contribui para a redução da velocidade de disseminação da COVID-19, reduzindo o número de casos e óbitos. Estas evidências foram rapidamente absorvidas para políticas públicas, na medida em que um número crescente de países vem adotando a obrigatoriedade do seu uso em locais públicos. Um estudo realizado na Alemanha mostrou que o uso de máscaras pela população foi percebido como um contrato social e a política de uso obrigatório das mesmas é mais justa que a política de uso voluntário145145 Betsch C, Korn L, Sprengholz P, Felgendreff L, Eitze S, Schmid P, Böhm R. Social and behavioral consequences of mask policies during the COVID-19 pandemic. Proc Natl Acad Sci USA 2020; 117(36):21851-21853.. Muitos entenderam que as evidências existentes fornecem elementos suficientes para ação baseada no princípio da precaução. Neste caso específico, trata-se de uma intervenção que tem o potencial de ter alta efetividade com baixo risco de efeitos adversos146146 Greenhalgh T. Face coverings for the public: Laying straw men to rest. J Eval Clin Pract 2020; 26(4):1070-1077..

No Brasil, onde vivenciamos a escassez de máscaras descartáveis, a reduzida capacidade de testagem e triagem de casos suspeitos e a existência de grandes adensamentos urbanos, muitos deles com moradias sem acesso a água e com elevada aglomeração intradomiciliar, o uso de máscaras de tecido pode ser ainda mais relevante no combate à propagação da doença. Seu uso se torna essencial sobretudo diante da flexibilização das medidas de distanciamento social e da implantação de estratégias para o retorno gradual às atividades4040 Cheng KK, Lam TH, Leung CC. Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity. Lancet 2020; S0140-6736(20)30918-1 .,4747 Thomson GA. COVID-19: Leaving lockdown-Of Schrodinger, cats, testing and masks. Int J Clin Pract 2020; 74(8):e13519.,147147 Instituto Brasileiro de Geografia e Estatística (IBGE). Síntese de indicadores sociais: uma análise das condições de vida da população brasileira: 2019 [Internet]. 2019 [acessado 2020 Maio 2]. Disponível em: https://biblioteca.ibge.gov.br/index.php/biblioteca-catalogo? view=detalhes&id=2101678
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, que já começam a ser discutidas e realizadas por gestores públicos, apesar do contínuo agravamento da pandemia no país. As previsões atuais dos cenários pós-pandemia sugerem que o uso de máscaras de tecido em ambientes extradomiciliares será uma medida importante na desaceleração de uma possível segunda onda de contágio6161 Hoertel N, Blachier M, Blanco C, Olfson M, Massetti M, Rico MS, Limosin F, Leleu H. Lockdown exit strategies and risk of a second epidemic peak: a stochastic agent-based model of SARS-CoV-2 epidemic in France. medRxiv 2020; 10.1101/2020.04.30.20086264.
https://doi.org/10.1101/2020.04.30.20086...
,7878 Goscé L, Phillips PA, Spinola P, Gupta DRK, Abubakar PI. Modelling SARS-COV2 Spread in London: Approaches to Lift the Lockdown. J Infect 2020; 81(2):260-265.. Ademais, cabem também ações educativas que promovam o uso correto de máscaras de tecido como uma nova norma social3535 Javid B, Weekes MP, Matheson NJ. Covid-19: should the public wear face masks? BMJ 2020; 369:m1442.,9090 Goh Y, Tan BYQ, Bhartendu C, Ong JJY, Sharma VK. The face mask: How a real protection becomes a psychological symbol during Covid-19? Brain Behav Immun 2020; 88:1-5..

Assim, são necessárias ações conjuntas entre as esferas do poder público no intuito de: i) apoiar ou desenvolver estratégias que possibilitem o aumento da produção e distribuição do produto à população, inclusive para doação aos grupos mais vulneráveis e com menos recursos, assim como sua comercialização em estabelecimentos comerciais que tenham permissão para seguirem abertos no período de pandemia; ii) incentivar e fomentar a produção caseira e a confecção de máscaras de tecido por costureiras autônomas, assegurando-lhes condições dignas de trabalho, remuneração e proteção à saúde; e iii) assegurar que grupos raciais ou socioeconomicamente desfavorecidos não sejam estigmatizados com a adoção de medidas compulsórias de uso de máscaras em ambientes extradomiciliares.

Conclusão

A ampla adesão ao uso de máscaras de tecido em ambientes extradomiciliares é uma intervenção eficaz que, em conjunto ao distanciamento social e higienização correta das mãos, tem sido adotada, em maior ou menor escala, por todos os continentes com o avançar da pandemia por contribuir com a redução da velocidade de transmissão do SARS-CoV-2.

Por fim, representam uma alternativa mais econômica, logisticamente viável e acessível para a população, além de ser ambientalmente sustentável e colaborar para a manutenção dos estoques das máscaras profissionais.

Agradecimentos

Todos os autores são colaboradores da Rede CoVida e agradecem ao Grupo de Síntese de Evidências pelas discussões. Agradecemos Jessyca Teixeira pela ajuda na elaboração dos mapas. Luciana Leite agradece a bolsa de pós-doutorado financiada pela Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Código de Financiamento 001.

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Datas de Publicação

  • Publicação nesta coleção
    12 Fev 2021
  • Data do Fascículo
    Fev 2021

Histórico

  • Recebido
    21 Jul 2020
  • Aceito
    02 Nov 2020
  • Publicado
    04 Nov 2020
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