Exploration of Transmission Dynamics and Clinical Manifestations


Knowledge regarding the transmission of the Coronavirus disease 2019 (COVID-19) is accruing almost every day since its major across different geographical regions. COVID-19 is identified as a respiratory disease. The spectrum of transmission with this virus can extend from mild and non-respiratory symptoms to severe forms of respiratory illness with dysfunction of organs and death. Nevertheless, in many cases, it has been recognized that the infection is caused among people without any physical symptoms.

Concerning the current evidence, WHO has reported that the COVID-19 virus is generally transmitted among people through respiratory droplets and different other contact routes. The droplet transmission usually occurs if a person has close contact (less than 1 meter) with the infected person which exposure to possibly infective respiratory droplet transpires. Hence, using medical or high-quality masks is a mandatory precaution for people to avoid potentially infective respiratory droplets from the COVID-19 infected person. In such a condition, the risk for a person with mental illness is significantly high as their one of the most vulnerable groups. It can easily get infected due to its inability to understand the transmission process of the virus.


Therefore, this report mainly deals with developing concepts regarding wear masks in mental health wards of NHS hospitals to prevent people from the COVID-19 pandemic. Additionally, the report evaluates critical challenges to be faced by the healthcare professionals and workers on wearing masks in mental health wards in NHS. A critical examination of cost-benefit analysis regarding the wearing of masks in NHS is also a key aspect addressed in this report. And finally, the discussion in this report identifies the change theory and implementation strategy to support the wearing of masks among the professionals in Mental Health Wards of NHS hospitals.

Review of Literature and Current Policy

The interim guidance report of WHO (2020) provides a detailed insight regarding the significance of using masks to limit the spread of COVID-19. According to WHO (2020), using face masks is one of the critical parts of the comprehensive prevention and control measure package. It can substantially limit and control the spread of viral respiratory illnesses, mainly COVID-19, from one person to another. The interim guidance report further notified that the use of masks could also be used for the safety of a person to protect oneself from an infected person. Simultaneously, wearing masks by an infected person can further protect other individuals during the interaction. Therefore, it is evident that the use of shows is one of the fundamental parts to prevent the spread of COVID-19 to other healthy persons.

According to Veluri (2020), it has been argued that wearing a face mask by the health professionals and workers in mental healthcare wards is crucial as the persons with mental illness are less conscious regarding the seriousness of the disease along with their prevention processes. Also, the use of masks by health professionals and workers can also is critical because it can prevent a healthy person from source control from whom the virus can be transmitted through infective droplets released from the mouth and nose.

Galea et al. (2020) argued that the impacts of using face masks in mental healthcare settings are considerably limited, specifically in inpatient psychiatric patient facilities. The empirical evidence of the authors critically stated that the professionals and workers within the mental healthcare facilities barely make any types of physical contact with the patients. However, they are seen to use adequate preventive measures by wearing PPE kits to contact the person with mental illness in the facilities. Nevertheless, the evidence-based research findings of Pal et al. (2020) also demonstrated that creating a transparent physical barrier between clinicians or health professionals and workers with mentally ill patients in the wards. This can enable the whole mental health facility to avert the potential spread of infection of the COVID-19 virus. However, the authors further argued that the use of face shield might negatively impact the wellbeing of the psychiatric population as they won't observe the facial expressions of the medical practitioners or professionals in the mental healthcare setting.

According to Pamungkasih (2019), it has been identified that patients with a mental disability may also believe that the health professionals and workers using face masks due to their door, which can further create a negative perception and it can deteriorate their physical and mental condition. The professionals and workers’ usage of face shield may additionally result among mental illness patients feeling discomfort, or they may have a feeling of being judged which can severely increase their mental illness. At the same time, Pal et al. (2020) also recognized that the barrier in viewing facial expression of the clinicians, professionals, or workers could further lead mentally challenged patients to increase fear and/or paranoia among individuals within the mental healthcare setting. The authors further argued that these emotions could also be heightened among psychiatric inpatients due to their illness chronicity.

Why masks have not been so widely adopted in NHS Mental Health Trusts

Individuals who struggle with mental health issues can face enhanced distress associated to mask use even after Covid-19 pandemic. According to Jones (2021), it is likely that individuals who did not face social anxiety before pandemic find themselves feeling more anxious than usual as people arise from the pandemic into much indeterminate future, particularly within social conditions where social abilities are rusty and the new regulations for social participation are yet to be established. Researchers reviewed current literatures and addressed three aspects that can support social nervousness associated with mask use, which are hypersensitivity to social norms, prejudice in the exposure of social and emotional facial cues and tendency for self-concealment as a form of safety behaviour. Ontario (2021) found that mask wearing by individuals with social nervousness is possibly to be influenced by their insight of social standards and prospects, which can be constant with public health rules and can differ according to region and background. Another important effect is that masks can act as a kind of self-concealment approach that empowers individuals with social anxiety to hide their self-perceived faults. Hence, the desire for self-concealment can inspire the utilisation of masks over and more than the desire to safeguard them from infection. Owing to self-concealment activity, it can be hard for certain individuals to discard mask, even when mask wearing is no longer necessary by people (Wang & et. al., 2020).

According to Stieg (2021), wearing a mask has become second nature for many individuals throughout pandemic. However, as governments lift mask directives and more individuals get completely vaccinated for Covid-19, it can be observed that going mask less in public and transitioning back to normal will make people feel out of place or awkward. According to () mask protocols throughout pandemic essentially enhances struggles with social nervousness. It is featured by an intense, persistent fear of being observed and judged by others. Individuals with social nervousness have a tendency to be actually anxious regarding behaving in manners that follow social standards. Coming out from the pandemic, it can be observed that the anxiety level regarding interrelating with individuals is little higher than normal. People will become self-conscious regarding revealing themselves to other at close distance and without masks. Social standards and prospects are changing quickly as things are opening up; therefore it is only natural to feel indeterminate regarding new regulations. Individuals with social nervousness will possibly face renewed fear and anxiety regarding acting awkwardly or inappropriately in relation to whether to wear mask. Apart from face masks objective for containing and stop spreading Covid-19, they perform as safety blanket that releases certain social stresses that arrive with anxiety of exposing flaws in appearance or indications of nervousness.

Discussion of Change Theories, Stipulating Chosen Change Theory and Rationale for Choice

Concerning the underlying problem of this study, implementing a pertinent change theory can bring valuable insight. About the problem identified in this research, the implementation of Kotter’s Change Management Theory can provide significant support to determine the importance of wearing face masks in mental healthcare wards in NHS settings. The following discussion offers a clear understanding of the change management theory of Kotter along with its justification of use while implementing change in patient care activities of mentally disabled patients in NHS.

Kotter’s Change Management Theory

Kotter’s change management theory includes eight stages that drive for transformational change within an organizational setting (Neumeier, 2012). About the current issue of wearing masks in mental healthcare wards in NHS, the implementation and justification of the eight stages of Kotter’s change management theory have been discussed below:

Stage 1: Creating Urgency: According to Kotter, creating urgency for change is a critical step as without a sense of urgency, people are more likely to resist change in any process or activity (Kotter, 1996). About the current NHS mental healthcare settings, creating an urgency of using masks by the professionals, clinicians and workers can help the ward to minimize the potential threat of spreading COVID-19 in the hospitals. In this context, helping mental healthcare professionals and workers to understand the significance of wearing face masks and providing them knowledge about the infective nature of the virus can help NHS to make workers use medical face masks in healthcare facilities successfully.

Stage 2: Forming Powerful Coalition: According to Kotter’s change management model, n this stage, the guiding team members must have sufficient knowledge, skills, credibility, and influence to mobilize the change (Clark, 2010). According to the change management plan for NHS mental healthcare setting, the change management team members must have adequate knowledge and understanding about the infective nature and harmful impacts of COVID-19 on individuals. Also, convincing practitioners, professionals, and workers in mental healthcare wards in NHS can be an essential process of the coalition to bring change. In this context, the NHS staff members and other workers will be directed and controlled under strong leadership guidance, which has a long-term vision and commitment to make change for the betterment of the nursing and healthcare staffs in the mental wards of NHS. Forming of coalition process will further include building a competent team to execute activities relating to change in NHS settings successfully.

Stage3: Creating Vision for Change: In the third stage, creating a vision relating to change must include a collective sense regarding the desired results (Campbell, 2008). According to the change management plan for NHS mental health wards, the vision for change includes a collective sense of understanding the significance of wearing face masks in mental health hospitals. Additionally, the change management plan also incorporates determining value and develops a summary that captures the future result of avoiding the spread of the fatal virus in the hospitals.

Stage 4: Communicating Vision: Once the vision is constructed, it is imperative for the change management leader to frequently communicate and convince members regarding the necessity of adopting change (Kotter, 1996). According to the proposed plan for mental health wards in NHS, the communication of vision maintains a clear and brief explanation about the idea when interacting with the stakeholders, mainly professionals and other working members in the hospitals. Additionally, the communication process of vision for change further aims to engage continuous dialogue with the professionals and other nursing staff to build trust and commitment.

Stage 5: Removing Obstacles: The fifth stage of the model generally indicates the importance of eliminating possible obstacles that can be generated during implementing change (Kotter, 1996). About the proposed change management plan for NHS, the leader will play a significant role in terms of identifying and documenting possible obstacles across different operational processes in hospitals. In this context, barriers relating to human and other process-related issues will be handled appropriately. In the case of the human will, the change management process will focus on convincing individual (s) through demonstrating the use of face masks and their effectiveness in preventing the spread of the infective virus of COVID-19 to the professionals and workers.

Stage 6: Creating Short-term Wins: The primary purpose of creating short-wins in Kotter’s change management model is to motivate team members through witnessing success following the implementation of change (Neumeier, 2012). According to the change management plan for NHS, the short-term win will be celebrated visibly with a strong connection of the vision. The process can help the change management process set new goals regarding masks for professionals when providing healthcare services to mental health patients.

Stage 7: Building on the Change: The stage generally describes the continuous motivation gained from achieving the short-term goals. According to the model, the critical focus on identifying improvement areas following short-term change can lead the whole change management process to accomplish the desired outcome. Simultaneously, the change management process in NHS includes identifying a range of critical areas following the removal of barriers in wearing masks at NHS mental health wards. The process helps the whole change management process look for long-term improvement when defending professionals, workers, and mental health patients from COVID_19.

Stage 8: Anchoring Changes in Corporate Culture: The stage primarily explains the progression of the change. Additionally, creating a long-term plan through embracing the change will be a key focus area of the proposed change plan for NHS. In this context, the professionals and workers will be convinced using an effective communication process about their contribution in protecting themselves and patients from the spread of COVID-19 in the hospitals.

Findings to Include Cost-Benefit Analysis

According to a critical investigation of results retrieved from recent past literature, it has been identified that the use of face masks is seen to be a barrier and issue among the professionals working in the mental health ward of NHS hospitals or private mental healthcare centers. Simultaneously, the review also witnessed that the use of face masks by the patients may also destabilize the mental health condition of the patients in mental health hospitals as they might feel discomfort. However, the literature also justified the significance of using medically-approved facemasks for professionals, clinicians, and workers in the healthcare settings due to the severe infective nature of COVID-19. Therefore, based on a mixture of findings, it can be justified that the use of face masks should be a compulsory practice for professionals and other staff members in the mental health patient care units in NHS. This is because minimum or less knowledge about the infection of the virus may increase risks for patients with mental illness. In this regard, the strategy of implementing a change management plan using Kotter’s change management model can provide significant support to protect patients along with healthcare professionals and workers from the infection of COVID-19 in NHS settings. Based on the application process of the change management strategy, it has been found that critical compliance to the procedures, especially creating vision and maintaining appropriate communication in broadening knowledge about the infection of COVID-19, can protect professionals and patients in the NHS health care settings.

Therefore, based on the findings gathered from both reviews of literature and change management strategy, the following cost-benefit analysis has been constructed.

Cost-Benefit Analysis

Benefits of face masks

  • Having face masks in areas where maintaining adequate distance is not possible, for example, public places, most possibly minimizes the spread of Covid-19 based droplets and minimizes the threat of transferring the virus.
  • It is certain that diseased people can transmit Covis-19 to others, few days before demonstrating medical symptoms or throughout the virus spreading development period. Nevertheless, there exists no consistent information regarding the level of virus elements that can be applied by an asymptomatic individual while maintaining a minimum safe distance.
  • Face masks are efficient in minimizing the repetition number to below unity, hence inhibiting the spread of Covid-19 in the short run. In face masking for source control and inhibition of additional space, the limiting value of virus components requires a longer time to spread, with high minimization in virus exposure.
  • Increased face mask coverage results in reduced cumulative death and additional time to enlarge the healthcare system's capability to give care for those who ultimately face the virus. According to Nannyonga (2020), when face mask coverage ranges between 80% to 100%, 91% depreciation in virus exposure and spread curve is compressed after 220 days. However, the masks require conforming to WHO guidelines of medical-grade masks or three-layer fabric masks. With low effectiveness masks, Covid-19 can spread within the community.
  • Face masks minimize the vulnerability of spreading the virus, specifically since this spreading can happen from individuals with no symptoms. However, its effectiveness is subject to proper utilization of masks. Any mask can only become effective when it is fitted, worn, and discarded correctly. However, people do not check the cover appropriately; continue touching the external contaminated surface for adjusting it, without appropriate washing of hands and appropriate sanitizing (Jannu, 2017).

Costs of face masks

  • Face masks provide a false feeling of security and make people less compliant with other infection control activities.
  • Face masks minimize the capability to communicate, to understand, and to impersonate the expressions of those with whom people cooperate. By using face masks, positive emotions become less identifiable, and negative emotions are intensified. Emotional mimicry is minimized, and therefore bonding between people is reduced. The low level of the nonverbal combination while using masks makes individuals feel insecure, discouraged, and psychologically anxious (Spitzer, 2020). This is specifically true for mentally weak people or people with a hearing problem.
  • The most common adverse effect of wearing a face mask for a long time is a bilateral headache. It can happen one to four times throughout one month period of utilization of a face mask.
  • Face masks can additionally generate perioral dermatitis with rashes and rawness, i.e., septicity in the skin around the face due to salvia, sweat, and humid vapor between the mask and the skin. This can give a breeding basis for bacteria. Itchy rashes can be generated by irritant dermatitis, generated by covers and rubber thread irritating the nose and ears.
  • Breathing inside the mask dampens them. In case there is excessive moisture, the shows become airtight. Hence, the air is breathed in and breathed out unfiltered throughout the boundaries, losing the protecting influence for the wearer and the environment. Furthermore, a segment of CO2 previously breathed out is inhaled at every breathing cycle. This occurrence enhances breathing frequency and deepness, and they can worsen the stress of Covid—19 if infected individuals wearing masks spread more polluted air. This can exacerbate the medical situation of infected persons if the enhanced inhalation pushes the virus-related stress down into their lungs (Matuschek, Moll & Haussmann, 2020). When infected individuals inhale air in their masks, the virus load enhances.
  • Wearing face masks can make glasses become foggy and hence cause anything from discomfort to accidents.
  • Face masks make breathe-out air go into the eyes. This creates an uncomfortable feeling and an impulse to itch the eyes. If the hands are contaminated, such an act can result in virus infection.
  • Face masks markedly inhibit face identification, which can make the activities of theft and burglary easier. If wearing face masks becomes a regular act in society, the level covering the face influences the social interactions, and the capability to identify other individuals become unclear.
  • If the face masks are not changed and washed regularly and adequately, pathogens can accumulate in the front. When misused, the risk of spreading a pathogen and also being infected by it enhances.

Recommendations from Findings of Study

It is a well-known fact that masks are the leading measures to restrain transmission, and thus it tends to save the lives of many people. It is highly recommended to wear face masks to minimize the airborne spread of the SAR-CoV-2 virus. However, according to medical science, everything that has a positive side has a negative side. It has been noted that wearing a face mask for a prolonged period led to bilateral headaches. It has further been pointed out that a face mask might lead to perioral dermatitis that might lead to rashes and redness because of sweat and saliva. It may lead to a breeding ground for bacteria. It is recommended from the findings that face masks should be implemented in NHS and implemented without any delays, even if the mask is homemade or are of low quality. Such measures would lead to controlling of COVID-19 pandemic. The public needs to be aware of the detrimental impacts of face masks over face recognition and determination, communication, along with social-emotional interaction.

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Use of face mask in health clinic is significant as they nurses and healthcare professionals are supposed to interact with the patient. A nurse or health professional who has been unwell or has mild symptoms such as muscle ache, sore throat, fatigue, and slight cough needs to wear a mask all the time because the risk of spreading the virus to the patient might be pretty high. Suppose the healthcare professional is awaiting the COVID-19 test result or the ones who have been tested positive need to wear a mask. A health care caring for someone who is suspected or confirmed COVID 19 needs to wear a mask compulsorily. There needs to be a system for administering exposures based on risk assessment to promote and support health workers stating occupational and nonoccupational exposures to or symptoms related to COVID-19. It is recommended from the findings of the study that there needs to be some system to administer suspected infections along with some measures for health workers who test positive for SARS-CoV-2 and the ones who are symptomatic. The ones that test negative for SARS-CoV-2 need to be in place. There must be clear criteria developed for returning to work for discontinuing isolation in COVID 19. Health care facilities and systems need to administer a blame-free culture about COVID-19 infections in health workers. It is pretty significant to make use of the personal protective equipment use, hand hygiene best practices, execution of universal masking policies in the context of healthcare facilities, along with proper training for infection prevention and control for all the health workers in NHS. It is significant to make use or introduce environmental and engineering controls such as adequate ventilation. It is also important to implement different administrative rules. The administrative controls are IPC policies and methods and good behaviors, and compliance with crucial IPC measures in general areas. It is also suggested to follow recommended public health measures in the home as well as community settings. The health care workers of NHS need to self-monitor for symptoms suggestive of COVID-19 and need to stop working or report their immediate superior and self-isolate themselves in case new or worsening symptoms prevails.


Since the spread of acute respiratory syndrome coronavirus 2, the virus that led to coronavirus disease 2019, utilization of face masks has been quite imperative. Face masks are utilized by medical workers as droplet precautions when caring for patients possessing respiratory infections. Evidence is suggesting the fact that COVID-19 might be transferred before symptoms start. Hence, there might be minimization in community transmission in case of everyone, along with people who have been infected but are asymptomatic and contagious, is regularly wearing face masks. Respiratory masks are considered to be protective devices that tend to cover some part of the face. It protects the person wearing them and the immediate environment from breathable pollutants. In case there is a limited supply of the protective masks, it needs to be reserved for health care workers offering their care in hospitals and care facilities. People need to wear the show correctly. It needs to fit airtight to the skin, or else the impact is lost. The outside portion of the masks need not be touched. In case the supply is not a problem, then under such circumstances, surgical masks must be utilized by health care workers only once. High-quality masks FFP2/3 tends to be reasonably reliable protection from COVID.

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