key: cord-341462-gxpia9rs authors: Lim, Soo; Yoon, Ho Il; Song, Kyoung-Ho; Kim, Eu Suk; Kim, Hong Bin; FIDSA title: Face Masks and Containment of Coronavirus Disease 2019 (COVID-19): Experience from South Korea date: 2020-06-12 journal: J Hosp Infect DOI: 10.1016/j.jhin.2020.06.017 sha: doc_id: 341462 cord_uid: gxpia9rs nan A novel coronavirus (SARS-CoV-2) emerged in the city of Wuhan, China in December 2019 and has now spread worldwide. Since the end of February 2020, the COVID-19 spread to South Korea and there was a rapid increase in COVID-19 cases from the end of February to mid-March. Fortunately, due to the efforts from both government and private sectors, the spread of the disease has been declining rapidly and only a few cases were reported in May. There are several reasons why COVID-19 has been relatively well controlled in South Korea. Wearing a face mask in public seems to have been one of the major contributing factors. During the COVID-19 pandemic, the use of face masks has been discouraged in several countries, particularly in Europe. However, our government has strongly advised wearing a mask (11, 12) from the beginning. Hence, we felt it would be highly informative to share the experience of South Korea from a public health perspective. In South Korea, an aggressive "trace, test, and treat" program was put in place. The general public was advised to avoid large gatherings and crowded places, and to keep quarantine protocols, such as wearing a mask, washing hands, and social distancing. Among these, wearing a mask is counted as one of the most effective preventive measures among general protocols. According to a recently published article, 63.2% of Koreans reported wearing a facial mask when they were outside (1). In another international survey, the reported rate of wearing face masks among Koreans was even higher (94%) and the highest among 28 countries (2). The increased awareness of particulate matter (PM) also needs to be mentioned. South Korea has had the highest PM level among OECD countries (4) . Over the last few years, people in Korea became more and more aware of the problem after government started to issue alerts. Yellow dust (also called yellow sand or Asian dust), a natural source of particulate matter(PM), originates from the deserts of Mongolia and northern China, particularly in springtime, and has long been a public health issue after a formal warning in February, 2014 (5) . The professional medical societies in South Korea have warned about health hazards from impaired infant health to increased adult mortality rate, and people are advised to wear a facial mask when PM level is very high (6) (7) (8) (9) (10) . This increasing public concern regarding PM has made wearing a face mask a matter of everyday life during epidemics of respiratory diseases in South Korea. The acceptance of wearing face masks might be influenced by cultural differences. In European countries, wearing a face mask traditionally has been taken to indicate illness or bad intention. By contrast, it seems to be generally regarded as a sign of thoughtfulness and modesty in South Korea. Interestingly, young Korean pop (Kpop) singers made mask-4 wearing a fashion trend. So, wearing a mask is considered as a fashion item by young persons in many Asian countries. Although N95 respirators showed several advantages over medical masks in experimental conditions, several meta-analyses have concluded that there are insufficient data to support the superiority of N95 respirators over medical masks in protecting against transmissible respiratory pathogens including SARS-CoV-2 in clinical settings (14) (15) (16) . A recently published article clearly showed the effectiveness of surgical face masks in reducing respiratory viral shedding (17) To conclude, considering the relatively low incidences of severe cases or mortality and good control of COVID-19 in several countries where self-quarantine principles are well established, wearing protective masks is an important strategy to stop the spread of respiratory viruses such as SARS-CoV-2. Among several ways that were helpful for South Korea to combat this pandemic effectively, adhering to quarantine protocols such as wearing an appropriate mask in the proper way seems to have been vital. Maintaining social distance at all times and washing hands thoroughly also must have played a critical role for controlling COVID-19. The authors have nothing to declare. Psychological and Behavioral Responses in South Korea During the Early Stages of Coronavirus Disease 2019 (COVID-19) The Coronavirus: a vast scared majority around the world Middle East respiratory syndrome: what we learned from the 2015 outbreak in the Republic of Korea Exposure to PM2.5 in countries and regions Fine, ultrafine, and yellow dust: emerging health problems in The difference in effect of ambient particles on mortality between days with and without yellow dust events: Using a larger dataset in Effects of Long-Term Exposure to Air Pollution: A Population-Based Study With 900 845 Person-Years of Follow-up Association between Post-Diagnosis Particulate Matter Exposure among 5-Year Cancer Survivors and Cardiovascular Disease Risk in Three Metropolitan Areas from South Korea Chinese Yellow Dust and Korean infant health Particulate-Matter Related Respiratory Diseases. Tuberc Respir Dis (Seoul) Wearing face masks in the community during the COVID-19 pandemic: altruism and solidarity Mask is the possible key for self-isolation in COVID-19 pandemic Excuse me! BMJ Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses Respiratory virus shedding in exhaled breath and efficacy of face masks