This document discusses universal masking in hospitals during the COVID-19 pandemic. While masks provide little protection outside healthcare settings, they may offer benefits within hospitals. First, masks are important personal protective equipment for healthcare workers interacting with symptomatic patients. Additionally, masks may help reduce transmission from asymptomatic or mildly symptomatic healthcare workers to other staff and patients. However, masks alone provide only slight protection if the eyes are exposed or the mask is touched. Universal masking policies in hospitals aim to reduce transmission, but may give a false sense of security and increase face touching. The greatest impact may be reducing anxiety.

1. Universal Masking in Hospitals in the
Covid-19 Era
List of authors.
• Michael Klompas, M.D., M.P.H.,
• Charles A. Morris, M.D., M.P.H.,
• Julia Sinclair, M.B.A.,
• Madelyn Pearson, D.N.P., R.N.,
• and Erica S. Shenoy, M.D., Ph.D.
FONTE: LEIA NO SEU CELULAR
As the SARS-CoV-2 pandemic continues to explode, hospital systems are scrambling to
intensify their measures for protecting patients and health care workers from the virus.
An increasing number of frontline providers are wondering whether this effort should
include universal use of masks by all health care workers. Universal masking is already
standard practice in Hong Kong, Singapore, and other parts of Asia and has recently
been adopted by a handful of U.S. hospitals.
We know that wearing a mask outside health care facilities offers little, if any,
protection from infection. Public health authorities define a significant exposure to
Covid-19 as face-to-face contact within 6 feet with a patient with symptomatic Covid-
19 that is sustained for at least a few minutes (and some say more than 10 minutes or
even 30 minutes). The chance of catching Covid-19 from a passing interaction in a

2. public space is therefore minimal. In many cases, the desire for widespread masking is a
reflexive reaction to anxiety over the pandemic.
The calculus may be different, however, in health care settings. First and foremost, a
mask is a core component of the personal protective equipment (PPE) clinicians need
when caring for symptomatic patients with respiratory viral infections, in conjunction
with gown, gloves, and eye protection. Masking in this context is already part of routine
operations for most hospitals. What is less clear is whether a mask offers any further
protection in health care settings in which the wearer has no direct interactions with
symptomatic patients. There are two scenarios in which there may be possible benefits.
The first is during the care of a patient with unrecognized Covid-19. A mask alone in
this setting will reduce risk only slightly, however, since it does not provide protection
from droplets that may enter the eyes or from fomites on the patient or in the
environment that providers may pick up on their hands and carry to their mucous
membranes (particularly given the concern that mask wearers may have an increased
tendency to touch their faces).
More compelling is the possibility that wearing a mask may reduce the likelihood of
transmission from asymptomatic and minimally symptomatic health care workers with
Covid-19 to other providers and patients. This concern increases as Covid-19 becomes
more widespread in the community. We face a constant risk that a health care worker
with early infection may bring the virus into our facilities and transmit it to others.
Transmission from people with asymptomatic infection has been well documented,
although it is unclear to what extent such transmission contributes to the overall spread
of infection.1-3
More insidious may be the health care worker who comes to work with mild and
ambiguous symptoms, such as fatigue or muscle aches, or a scratchy throat and mild
nasal congestion, that they attribute to working long hours or stress or seasonal
allergies, rather than recognizing that they may have early or mild Covid-19. In our
hospitals, we have already seen a number of instances in which staff members either
came to work well but developed symptoms of Covid-19 partway through their shifts or
worked with mild and ambiguous symptoms that were subsequently diagnosed as
Covid-19. These cases have led to large numbers of our patients and staff members

3. Volume 26, Number 5—May 2020
Policy Review
Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—
International Travel-Related Measures
FONTE DO ARTIGO: LEI NO SEU CELULAR OU PASSE ADIANTE TIRE
UMA FOTO.
Methods and Results
We searched for literature reporting or estimating the effectiveness of NPIs related to
international travel and movement, including entry and exit screening travelers, travel
restrictions, and border closures on pandemic or interpandemic influenza. We conducted
literature searches on PubMed, Medline, Embase, and Cochrane Library for peer-
reviewed articles published from January 1, 1946, through April 28, 2019. The search
terms used were identified from relevant systematic reviews and research reports (8,9).
We collected additional studies from secondary references from included studies or
other relevant searches. Articles were eligible for inclusion if they reported or estimated
the effectiveness of international travel–related NPIs for pandemic influenza using
quantitative indicators such as delaying the introduction of infection, delaying the
epidemic peak, or reducing the size of the peak. We excluded articles if they did not
investigate the quantitative effectiveness of international travel–related NPIs or were
editorials, reviews, or commentaries without primary data. Furthermore, we restricted
articles to those published in English. Two independent reviewers (S.R. and H.G.)
screened titles and abstracts and assessed full-text articles for eligibility. A third
reviewer (B.J.C.) adjudicated any disagreements between the 2 reviewers.
We extracted the information on the effectiveness of NPIs from included studies by
using a structured data-extraction form. Information of interest included the study
setting, specific measures implemented, timing of intervention implementation, study

4. results regarding effectiveness indicators, and potential barriers to implementation. The
assessment of quality of evidence considered study design and assigned generally
higher quality to randomized trials, lower quality to observational studies, and lowest
quality to simulation studies. We provide full search terms, search strategies, selection
of articles, and summaries of the selected articles (Appendix).
RESUMO DA HISTORIA
“Sabemos que usar uma máscara fora dos centros de saúde
oferece pouca ou nenhuma proteção contra infecções …
“A chance de pegar o Covid-19 de uma interação passageira em
um espaço público é… mínima….
“… Durante o atendimento de um paciente com Covid-19 não
reconhecido…. Porém, uma máscara sozinha nesse cenário
reduzirá levemente o risco, já que não fornece proteção contra
gotículas que podem entrar nos olhos ou de fomites sobre o
paciente ou no ambiente que os prestadores de serviços podem
pegar nas mãos e transportar para as membranas mucosas
(particularmente devido à preocupação de que os usuários de
máscaras possam ter uma tendência maior a tocar seus rostos) …
“… Máscaras universais por si só não são uma panaceia….
“A extensão do benefício marginal do mascaramento universal além
dessas medidas fundamentais é discutível….
“A maior contribuição dos protocolos de mascaramento
expandidos pode ser reduzir a transmissão da ansiedade”.
Na verdade, usando máscaras, você pode atrasar outras pessoas
no desenvolvimento de anticorpos de memória para proteção
duradoura contra a infecção viral, para que nossa sociedade possa
voltar ao normal.
A desinfecção de carrinhos de supermercado também é
inútil. O CDC emitiu um boletim tardio, o vírus COVID-19 não é
transmitido pelo contato com superfícies contaminadas. Os vírus

5. nem estão vivos. Você não pode matá-los como bactérias. Eles se
replicam apenas uma vez dentro de uma célula viva do seu corpo.
O que é necessário para a transmissão do vírus de outra
pessoa infectada é a proximidade muito perto para facilitar a
transmissão aérea do pulmão infectado para o não infectado. E
mesmo assim, em pessoas saudáveis, a infecção deve ativar
anticorpos e células T de memória para produzir imunidade
duradoura. Até que isso aconteça, o público é alvo de um vírus
que geralmente não produz nenhum sintoma.
A tuberculose infecta 2 bilhões de pessoas no
planeta e mata 1,3 milhão por ano. E o COVID-19
é muito menos transmissível que o sarampo, varíola
e poliomielite. Por faixa etária, o COVID-19 é
considerado apenas letal em pessoas com mais de
80 anos.
A tuberculose é uma doença grave e está entre as 10 causas de morte no mundo: são 10
milhões de casos por ano e mais de 1 milhão de óbitos.
No Brasil, em 2019, foram registrados 73.864 mil casos novos da doença. A taxa de
mortalidade caiu cerca de 8% na última década. Foram 4.881 mortes em 2008, contra
4.490 em 2018.