masks

Objective: To evaluate the personal protective effects of wearing versus not wearing surgical face masks in public spaces on self-reported respiratory symptoms over a 14 day period.

Design: Pragmatic randomised superiority trial.

Setting: Norway.

Participants: 4647 adults aged ≥18 years: 2371 were assigned to the intervention arm and 2276 to the control arm.

Interventions: Participants in the intervention arm were assigned to wear a surgical face mask in public spaces (eg, shopping centres, streets, public transport) over a 14 day period (mask wearing at home or work was not mentioned). Participants in the control arm were assigned to not wear a surgical face mask in public places.

Main outcome measures: The primary outcome was self-reported respiratory symptoms consistent with a respiratory infection. Secondary outcomes included self-reported and registered covid-19 infection.

Results: Between 10 February 2023 and 27 April 2023, 4647 participants were randomised of whom 4575 (2788 women (60.9%); mean age 51.0 (standard deviation 15.0) years) were included in the intention-to-treat analysis: 2313 (50.6%) in the intervention arm and 2262 (49.4%) in the control arm. 163 events (8.9%) of self-reported symptoms consistent with respiratory infection were reported in the intervention arm and 239 (12.2%) in the control arm. The marginal odds ratio was 0.71 (95% confidence interval (CI) 0.58 to 0.87; P=0.001) favouring the face mask intervention. The absolute risk difference was -3.2% (95% CI -5.2% to -1.3%; P<0.001). No statistically significant effect was found on self- reported (marginal odds ratio 1.07, 95% CI 0.58 to 1.98; P=0.82) or registered covid-19 infection (effect estimate and 95% CI not estimable owing to lack of events in the intervention arm).

Conclusion: Wearing a surgical face mask in public spaces over 14 days reduces the risk of self-reported symptoms consistent with a respiratory infection, compared with not wearing a surgical face mask.

Trial registration: ClinicalTrials.gov NCT05690516.

Author/s:

Runar Barstad Solberg, Atle Fretheim, Ingeborg Hess Elgersma, Mette Fagernes, Bjørn Gunnar Iversen, Lars G Hemkens, Christopher James Rose, Petter Elstrøm

Patient Questions Surrounding Mask Use for Prevention of COVID-19 and Physician Answers from an Evidence-Based Perspective: a Narrative Review

Bethie Seay — Fri, 03 Sep 2021 05:00:00 +0000

Date Added:

September 3, 2021

Type:

Patient Education Materials

DOI (1):

10.1007/s11606-020-06324-w

MeSH

Evidence-based answers to patients’ questions about masks to prevent the spread of COVID-19.

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Recent mandates to wear masks in public places across the USA combined with conflicting messaging from the media and government agencies have generated a lot of patient questions surrounding the appropriate use and efficacy of cloth masks. Here, we have organized the evidence in the context of real patient questions and have provided example answers from a physician’s perspective. The purpose of this review is to offer healthcare providers with examples of how to respond to patient questions about masks in a way that encourages responsible decision-making. We conclude, based on the evidence showing a benefit for cloth masks and the recent reports supporting a role for aerosols in the transmission of SARS-CoV-2, that cloth masks will be effective when used correctly. We further assert that stronger public messaging surrounding cloth masks in the community setting is needed, and should specify that 2–3 layer, fitted face masks be worn at all times in public as another layer of protection in addition to social distancing, not just when social distancing cannot be maintained.

Author/s:

Martinez, J. A., Miller, R. H., Martinez, R. A.

Masks and Face Coverings for the Lay Public : A Narrative Update

Devin Evans — Thu, 14 Jan 2021 06:00:00 +0000

Date Added:

January 14, 2021

Journal/Publication:

Annals of Internal Medicine

Publication Date:

December 29, 2020

URL:

Masks and Face Coverings for the Lay Public : A Narrative Update

Type:

Meta-analyses, Reviews, and Guidelines, Patient Education Materials

Format:

Article

DOI (1):

10.7326/M20-6625

Keywords

PMID (1):

33370173

MeSH

Policy

Respiratory Physiological Phenomena

A narrative summary of our current understandings regarding mask wearing and prevention of the spread of COVID-19. James W. Mold, MD, MPH

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Whether and when to mandate the wearing of facemasks in the community to prevent the spread of coronavirus disease 2019 remains controversial. Published literature across disciplines about the role of masks in mitigating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission is summarized. Growing evidence that SARS-CoV-2 is airborne indicates that infection control interventions must go beyond contact and droplet measures (such as handwashing and cleaning surfaces) and attend to masking and ventilation. Observational evidence suggests that masks work mainly by source control (preventing infected persons from transmitting the virus to others), but laboratory studies of mask filtration properties suggest that they could also provide some protection to wearers (protective effect). Even small reductions in individual transmission could lead to substantial reductions in population spread. To date, only 1 randomized controlled trial has examined a community mask recommendation. This trial did not identify a significant protective effect and was not designed to evaluate source control. Filtration properties and comfort vary widely across mask types. Masks may cause discomfort and communication difficulties. However, there is no evidence that masks result in significant physiologic decompensation or that risk compensation and fomite transmission are associated with mask wearing. The psychological effects of masks are culturally shaped; they may include threats to autonomy, social relatedness, and competence. Evidence suggests that the potential benefits of wearing masks likely outweigh the potential harms when SARS-CoV-2 is spreading in a community. However, mask mandates involve a tradeoff with personal freedom, so such policies should be pursued only if the threat is substantial and mitigation of spread cannot be achieved through other means.

Author/s:

Czypionka, Thomas, Greenhalgh, Trisha, Bassler, Dirk, Bryant, Manuel B.

Considerations for Wearing Masks: Help Slow the Spread of COVID-19

Brian Desmarais — Thu, 19 Nov 2020 16:10:50 +0000

Date Added:

November 19, 2020

Publisher:

CDC

Publication Date:

November 12, 2020

URL:

Considerations for wearing Masks: Help Slow the Spread of COVID-19

Type:

Patient Education Materials

Format:

Web Page

MeSH

COVID-19

severe acute respiratory syndrome coronavirus 2

pandemics

masks

Centers for Disease Control and Prevention

National Institutes of Health (U.S.)

Advice from the CDC regarding wearing masks during the COVID-19 pandemic. James W. Mold, MD, MPH

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Coronavirus Disease 2019 (COVID-19): People with Certain Medical Conditions

Devin Evans — Wed, 04 Nov 2020 06:00:00 +0000

Date Added:

November 4, 2020

Publisher:

CDC

Publication Date:

November 2, 2020

URL:

Coronavirus Disease 2019 (COVID-19): People with Certain Medical Conditions

Type:

Patient Education Materials

Format:

Article

Keywords

COVID-19

coronavirus

underlying medical conditions

MeSH

severe acute respiratory syndrome coronavirus 2

masks

A summary for patients of conditions that could put them at increased risk for severe COVID-19 infection and measures they can do to reduce their risk. James W. Mold, MD, MPH

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Revisions were made on November 2, 2020 to reflect recent data supporting increased risk of severe illness during pregnancy from the virus that causes COVID-19. Revisions also include addition of sickle cell disease and chronic kidney disease to the conditions that might increase the risk of severe illness among children.

We are learning more about COVID-19 every day. The below list of underlying medical conditions is not exhaustive and only includes conditions with sufficient evidence to draw conclusions; it is a living document that may be updated at any time, subject to potentially rapid change as the science evolves. This list is meant to inform clinicians to help them provide the best care possible for patients, and to inform individuals as to what their level of risk may be so they can make individual decisions about illness prevention. Notably, the list may not include every condition that might increase one’s risk for developing severe illness from COVID-19, such as those for which evidence may be limited or nonexistent (e.g., rare conditions). Individuals with any underlying condition (including those conditions that are NOT on the current list) should consult with their healthcare providers about personal risk factors and circumstances to determine whether extra precautions are warranted.

Author/s:

Centers for Disease Control and Prevention (CDC)

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

Brian Desmarais — Tue, 03 Nov 2020 16:03:56 +0000

Date Added:

November 3, 2020

Journal/Publication:

Lancet

Publication Date:

June 27, 2020

URL:

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

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(20)31142-9.

MeSH

Contact Tracing

Ventilators, Mechanical

masks

No RCTs, but this is likely to be the best evidence we will ever have that face masks and social distancing effectively reduce the spread of COVID-19. James W. Mold, MD, MPH

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Abstract

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings.

Methods: We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047.

Findings: Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] -10·2%, 95% CI -11·5 to -7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; pinteraction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD -14·3%, -15·9 to -10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12-16-layer cotton masks; pinteraction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD -10·6%, 95% CI -12·5 to -7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings.

Interpretation: The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance.

Funding: World Health Organization.

© 2020 World Health Organization. Published by Elsevier Ltd. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.

Author/s:

COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors

How to Select, Wear, and Clean Your Mask

Carly Hughes — Wed, 30 Sep 2020 13:37:50 +0000

Date Added:

September 30, 2020

Publisher:

Centers for Disease Control and Prevention

Publication Date:

August 27, 2020

URL:

How to Select, Wear, and Clean Your Mask

Type:

Public Health Announcements

Format:

Web Page

MeSH

masks

COVID-19

Concise advice regarding the proper use of masks to reduce spread of COVID-19 including materials that could be made into wall charts. James W. Mold, MD, MPH

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Author/s:

Centers for Disease Control and Prevention

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

Brian Desmarais — Fri, 12 Jun 2020 19:24:31 +0000

Date Added:

June 12, 2020

Journal/Publication:

Lancet

Publication Date:

June 1, 2020

URL:

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

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/S0140-6736(20)31142-9

Keywords

face masks

social distancing

eye shields

MeSH

Severe Acute Respiratory Syndrome

COVID-19

severe acute respiratory syndrome coronavirus 2

Coronavirus Infections

Betacoronavirus

masks

Quantification of the impact of social distancing, face masks, and eye shields on spread of the novel coronavirus. James W. Mold, MD, MPH

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Abstract

Funding: World Health Organization.

Author/s:

Chu, D.K., Akl, E.A., Duda, S., Solo, K., Yaacoub, S., Schünemann, H.J., COVID-19 Systematic Urgent Review Group Effort (SURGE) study authors

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial

John Bayhi — Mon, 23 Mar 2020 22:10:43 +0000

Date Added:

March 23, 2020

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

September 3, 2019

Issue:

Volume:

222

Pages:

824-833

URL:

N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial

Format:

Article

DOI (1):

10.1001/jama.2019.11645

Keywords

respiratory disease

respiratory infections

PMID (1):

31479137

This large RCT appears to confirm prior studies showing that regular surgical masks work just as well (or poorly) as N95 masks from preventing influenza in front line health care workers. James W. Mold, MD, MPH

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IMPORTANCE:

Clinical studies have been inconclusive about the effectiveness of N95 respirators and medical masks in preventing health care personnel (HCP) from acquiring workplace viral respiratory infections.

OBJECTIVE:

To compare the effect of N95 respirators vs medical masks for prevention of influenza and other viral respiratory infections among HCP.

DESIGN, SETTING, AND PARTICIPANTS:

A cluster randomized pragmatic effectiveness study conducted at 137 outpatient study sites at 7 US medical centers between September 2011 and May 2015, with final follow-up in June 2016. Each year for 4 years, during the 12-week period of peak viral respiratory illness, pairs of outpatient sites (clusters) within each center were matched and randomly assigned to the N95 respirator or medical mask groups.

INTERVENTIONS:

Overall, 1993 participants in 189 clusters were randomly assigned to wear N95 respirators (2512 HCP-seasons of observation) and 2058 in 191 clusters were randomly assigned to wear medical masks (2668 HCP-seasons) when near patients with respiratory illness.

MAIN OUTCOMES AND MEASURES:

The primary outcome was the incidence of laboratory-confirmed influenza. Secondary outcomes included incidence of acute respiratory illness, laboratory-detected respiratory infections, laboratory-confirmed respiratory illness, and influenzalike illness. Adherence to interventions was assessed.

RESULTS:

Among 2862 randomized participants (mean [SD] age, 43 [11.5] years; 2369 [82.8%]) women), 2371 completed the study and accounted for 5180 HCP-seasons. There were 207 laboratory-confirmed influenza infection events (8.2% of HCP-seasons) in the N95 respirator group and 193 (7.2% of HCP-seasons) in the medical mask group (difference, 1.0%, [95% CI, -0.5% to 2.5%]; P = .18) (adjusted odds ratio [OR], 1.18 [95% CI, 0.95-1.45]). There were 1556 acute respiratory illness events in the respirator group vs 1711 in the mask group (difference, -21.9 per 1000 HCP-seasons [95% CI, -48.2 to 4.4]; P = .10); 679 laboratory-detected respiratory infections in the respirator group vs 745 in the mask group (difference, -8.9 per 1000 HCP-seasons, [95% CI, -33.3 to 15.4]; P = .47); 371 laboratory-confirmed respiratory illness events in the respirator group vs 417 in the mask group (difference, -8.6 per 1000 HCP-seasons [95% CI, -28.2 to 10.9]; P = .39); and 128 influenzalike illness events in the respirator group vs 166 in the mask group (difference, -11.3 per 1000 HCP-seasons [95% CI, -23.8 to 1.3]; P = .08). In the respirator group, 89.4% of participants reported "always" or "sometimes" wearing their assigned devices vs 90.2% in the mask group.

CONCLUSIONS AND RELEVANCE:

Among outpatient health care personnel, N95 respirators vs medical masks as worn by participants in this trial resulted in no significant difference in the incidence of laboratory-confirmed influenza.

TRIAL REGISTRATION:

ClinicalTrials.gov Identifier: NCT01249625.

Author/s:

Radonovich, LJ Jr, Simberkoff, MS, Bessesen, MT, Brown, AC, Cummings, DAT, Gaydos, CA, Los, JG, Krosche, AE, Gibert, CL, Gorse, GJ, Nyquist, AC, Reich, N.G., Rodriguez-Barradas, MC, Price, CS, Perl, TM, ResPECT investigators

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Jeffrey Wilson — Wed, 22 Aug 2018 15:57:24 +0000

Date Added:

November 1, 2018

Journal/Publication:

CHEST

Publisher:

American College of Chest Physicians

Publication Date:

March 1, 2018

Issue:

Volume:

153

Pages:

665-674

URL:

Nasal vs Oronasal CPAP for OSA Treatment: A Meta-Analysis.

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.chest.2017.10.044

Keywords

CPAP

OSA

oronasal mask

PMID (1):

29273515

MeSH

masks

continuous positive airway pressure

sleep apnea syndromes

In adults with obstructive sleep apnea, oronasal CPAP requires higher pressures, is less effective for reducing AHI, and is associated with reduced adherence compared with nasal CPAP.

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BACKGROUND:

Nasal CPAP is the "gold standard" treatment for OSA. However, oronasal masks are frequently used in clinical practice. The aim of this study was to perform a meta-analysis of all randomized and nonrandomized trials that compared nasal vs oronasal masks on CPAP level, residual apnea-hypopnea index (AHI), and CPAP adherence to treat OSA.

METHODS:

The Cochrane Central Register of Controlled Trials, Medline, and Web of Science were searched for relevant studies in any language with the following terms: "sleep apnea" and "CPAP" or "sleep apnea" and "oronasal mask" or "OSA" and "oronasal CPAP" or "oronasal mask" and "adherence." Studies on CPAP treatment for OSA were included, based on the following criteria: (1) original article; (2) randomized or nonrandomized trials; and (3) comparison between nasal and oronasal CPAP including pressure level, and/or residual AHI, and/or CPAP adherence.

RESULTS:

We identified five randomized and eight nonrandomized trials (4,563 patients) that reported CPAP level and/or residual AHI and/or CPAP adherence. Overall, the random-effects meta-analysis revealed that as compared with nasal, oronasal masks were associated with a significantly higher CPAP level (Hedges' g, -0.59; 95% CI, -0.82 to -0.37; P < .001) (on average, +1.5 cm H2O), higher residual AHI (Hedges' g, -0.34; 95% CI, -0.52 to -0.17; P < .001) (+2.8 events/h), and a poorer adherence (Hedges' g, 0.50; 95% CI, 0.21-0.79; P = .001) (-48 min/night).

CONCLUSIONS:

Oronasal masks are associated with a higher CPAP level, higher residual AHI, and poorer adherence than nasal masks.

Author/s:

Andrade, Rafaela G. S., Viana, Fernanda M., Nascimento, Juliana A., Drager, Luciano F., Moffa, Adriano, Brunoni, André R., Genta, Pedro R., Lorenzi-Filho, Geraldo