Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review
Background: Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission.Methods: Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2021-01-01
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| Series: | Frontiers in Medicine |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2020.594269/full |
| _version_ | 1819055707136196608 |
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| author | Daniela Coclite Antonello Napoletano Silvia Gianola Andrea del Monaco Daniela D'Angelo Alice Fauci Laura Iacorossi Roberto Latina Giuseppe La Torre Claudio M. Mastroianni Cristina Renzi Greta Castellini Primiano Iannone |
| author_facet | Daniela Coclite Antonello Napoletano Silvia Gianola Andrea del Monaco Daniela D'Angelo Alice Fauci Laura Iacorossi Roberto Latina Giuseppe La Torre Claudio M. Mastroianni Cristina Renzi Greta Castellini Primiano Iannone |
| author_sort | Daniela Coclite |
| collection | DOAJ |
| description | Background: Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission.Methods: Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing a mask. We searched MEDLINE, EMBASE, SCISEARCH, The Cochrane Library, and pre-prints from inception to 22 April 2020 without restriction by language. We rated the certainty of evidence according to Cochrane and GRADE approach.Findings: Our search identified 35 studies, including three randomized controlled trials (RCTs) (4,017 patients), 10 comparative studies (18,984 patients), 13 predictive models, nine laboratory experimental studies. For reducing infection rates, the estimates of cluster-RCTs were in favor of wearing face masks vs. no mask, but not at statistically significant levels (adjusted OR 0.90, 95% CI 0.78–1.05). Similar findings were reported in observational studies. Mathematical models indicated an important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy. In the best-case scenario, when the mask efficacy is at 95%, the R0 can fall to 0.99 from an initial value of 16.90. Levels of mask filtration efficiency were heterogeneous, depending on the materials used (surgical mask: 45–97%). One laboratory study suggested a viral load reduction of 0.25 (95% CI 0.09–0.67) in favor of mask vs. no mask.Interpretation: The findings of this systematic review and meta-analysis support the use of face masks in a community setting. Robust randomized trials on face mask effectiveness are needed to inform evidence-based policies.PROSPERO registration: CRD42020184963. |
| first_indexed | 2024-12-21T13:11:47Z |
| format | Article |
| id | doaj.art-1a15565438e54b41b5b4f978cf49283e |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-21T13:11:47Z |
| publishDate | 2021-01-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Medicine |
| spelling | doaj.art-1a15565438e54b41b5b4f978cf49283e2022-12-21T19:02:51ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-01-01710.3389/fmed.2020.594269594269Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic ReviewDaniela Coclite0Antonello Napoletano1Silvia Gianola2Andrea del Monaco3Daniela D'Angelo4Alice Fauci5Laura Iacorossi6Roberto Latina7Giuseppe La Torre8Claudio M. Mastroianni9Cristina Renzi10Greta Castellini11Primiano Iannone12Centro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyUnit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, ItalyDirectorate General for Economics, Statistics and Research, Bank of Italy, Rome, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, ItalyDepartment of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, ItalyInstitute of Epidemiology & Health Care, University College London-UCL, London, United KingdomUnit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, ItalyCentro Eccellenza Clinica, Qualità e Sicurezza delle Cure, Istituto Superiore di Sanità, Rome, ItalyBackground: Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission.Methods: Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing a mask. We searched MEDLINE, EMBASE, SCISEARCH, The Cochrane Library, and pre-prints from inception to 22 April 2020 without restriction by language. We rated the certainty of evidence according to Cochrane and GRADE approach.Findings: Our search identified 35 studies, including three randomized controlled trials (RCTs) (4,017 patients), 10 comparative studies (18,984 patients), 13 predictive models, nine laboratory experimental studies. For reducing infection rates, the estimates of cluster-RCTs were in favor of wearing face masks vs. no mask, but not at statistically significant levels (adjusted OR 0.90, 95% CI 0.78–1.05). Similar findings were reported in observational studies. Mathematical models indicated an important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy. In the best-case scenario, when the mask efficacy is at 95%, the R0 can fall to 0.99 from an initial value of 16.90. Levels of mask filtration efficiency were heterogeneous, depending on the materials used (surgical mask: 45–97%). One laboratory study suggested a viral load reduction of 0.25 (95% CI 0.09–0.67) in favor of mask vs. no mask.Interpretation: The findings of this systematic review and meta-analysis support the use of face masks in a community setting. Robust randomized trials on face mask effectiveness are needed to inform evidence-based policies.PROSPERO registration: CRD42020184963.https://www.frontiersin.org/articles/10.3389/fmed.2020.594269/fullpandemicsface maskprevention and control [MeSH]SARS—CoV−2COVID−19disease outbreaks |
| spellingShingle | Daniela Coclite Antonello Napoletano Silvia Gianola Andrea del Monaco Daniela D'Angelo Alice Fauci Laura Iacorossi Roberto Latina Giuseppe La Torre Claudio M. Mastroianni Cristina Renzi Greta Castellini Primiano Iannone Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review Frontiers in Medicine pandemics face mask prevention and control [MeSH] SARS—CoV−2 COVID−19 disease outbreaks |
| title | Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review |
| title_full | Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review |
| title_fullStr | Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review |
| title_full_unstemmed | Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review |
| title_short | Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review |
| title_sort | face mask use in the community for reducing the spread of covid 19 a systematic review |
| topic | pandemics face mask prevention and control [MeSH] SARS—CoV−2 COVID−19 disease outbreaks |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2020.594269/full |
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