Utility of Cloth Masks in Preventing Respiratory Infections: A Systematic Review

  1. Agnibho Mondal
  2. Arnavjyoti Das
  3. Rama Prosad Goswami

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Abstract

Background

Using face masks is one of the possible prevention methods against respiratory pathogens. A number of studies and reviews have been performed regarding the use of medical grade masks like surgical masks, N95 respirators etc. However, the use of cloth masks has received little attention.

Objectives

The purpose of this review is to analyze the available data regarding the use of cloth masks for the prevention of respiratory infections. We intended to use data from both clinical and non-clinical studies to arrive at our conclusion.

Methods

We used PubMed, Cochrane Library and Google Scholar as our source databases. Both clinical and non-clinical studies, which had data regarding the efficacy of cloth masks, were selected. Articles not containing analyzable data including opinion articles, review articles etc. were excluded. After screening the search results, ten studies could be included in our review.

Data relevant to our objective was extracted from each study including clinical efficacy, compliance, filtration efficacy etc. Data from some studies were simplified for the purpose of comparison. Extracted data was summarized and categorized for detailed analysis. Qualitative synthesis of the data was performed. But the heterogeneity between the studies did not allow for a meta-analysis.

Discussion

The review was limited by a lack of sufficient clinical studies. Lack of standardization between studies was another limitation.

Although cloth masks generally perform poorer than the medical grade masks, they may be better than no masks at all. Filtration efficacy varied greatly depending on the material used, with some materials showing a filtration efficacy above 90%. However, leakage could reduce efficacy of masks by about 50%. Standardization of cloth masks and appropriate use is essential for cloth masks to be effective. However, result of a randomized controlled trial suggest that they may be ineffective in the healthcare setting.

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  1. ScreenIT

    SciScore for 10.1101/2020.05.07.20093864: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationAssessment of Risk of Bias: The included randomized controlled trials were assessed for risk of bias using the Risk of Bias Tool version 2 by the Cochrane Collaboration.
    Blindingnot detected.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Study Question: The question we seek to answer is stated as follows Data Sources and Searches: We reported our study in compliance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.3 We searched the following databases including PubMed, the Cochrane Library and Google Scholar.
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Cochrane Library
    suggested: (Cochrane Library, RRID:SCR_013000)
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Assessment of Risk of Bias: The included randomized controlled trials were assessed for risk of bias using the Risk of Bias Tool version 2 by the Cochrane Collaboration.
    Cochrane Collaboration
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Our study had several limitations. The number of clinical studies was very small. Also, the results of the included studies were too heterogeneous to allow for a meta-analysis. The paper by Shakya et al.11 only had graphical representation of the data. This data had to be extracted by use of a graph digitizer which maybe prone to some degree of inaccuracy. The lack of standardization of the cloth masks meant that every study used different types of masks, which may lead to non-comparable results and make interpretation difficult.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. ScreenIT

    SciScore for 10.1101/2020.05.07.20093864: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.RandomizationThe result from each author was compared and any disparity was resolved through discus- The included randomized controlled trials were assessed for risk of bias using the Risk of Bias Tool version among all three authors. sion 2 by the Cochrane Collaboration.Blindingnot detected.Power Analysisnot detected.Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    We searched the following databases including PubMed, the Cochrane Library and Google Scholar.
    PubMed
    suggested: (PubMed, SCR_004846)
    In the time of a pandemic there is a noted scarcity We used the following search terms of resources, which includes medical grade masks like • PubMed and Cochrane Library– (mask OR surgical masks and other respirators like N95.
    Cochrane Library–
    suggested: None
    Hence, whether cloth masks may be used in the place of medical grade masks, needs to be an• Google Scholar– allintitle: mask AND (cloth OR swered. fabric OR homemade OR home-made OR improvised) Cloth masks are different from medical grade masks.
    Google Scholar–
    suggested: None
    The result from each author was compared and any disparity was resolved through discus- The included randomized controlled trials were assessed for risk of bias using the Risk of Bias Tool version among all three authors. sion 2 by the Cochrane Collaboration.
    Cochrane Collaboration
    suggested: None
    The series, letters and editorials PubMed search yielded 143 results in total, whereas Cochrane Library and Google Scholar produced 140 • Review articles and 24 results respectively.
    Cochrane Library
    suggested: (Cochrane Library, SCR_013000)
          <div style="margin-bottom:8px">
        <div><b>Google Scholar</b></div>
        <div>suggested: (Google Scholar, <a href="https://scicrunch.org/resources/Any/search?q=SCR_008878">SCR_008878</a>)</div>
      </div>
    </td></tr><tr><td style="min-width:100px;vertical-align:top;border-bottom:1px solid lightgray">This finding contrasted with a previous Cochrane Review2 in 2011.</td><td style="min-width:100px;border-bottom:1px solid lightgray">
      <div style="margin-bottom:8px">
        <div><b>Cochrane Review2</b></div>
        <div>suggested: None</div>
      </div>
    </td></tr></table>

    Results from OddPub: We did not find a statement about open data. We also did not find a statement about open code. Researchers are encouraged to share open data when possible (see Nature blog).

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore is not a substitute for expert review. SciScore checks for the presence and correctness of RRIDs (research resource identifiers) in the manuscript, and detects sentences that appear to be missing RRIDs. SciScore also checks to make sure that rigor criteria are addressed by authors. It does this by detecting sentences that discuss criteria such as blinding or power analysis. SciScore does not guarantee that the rigor criteria that it detects are appropriate for the particular study. Instead it assists authors, editors, and reviewers by drawing attention to sections of the manuscript that contain or should contain various rigor criteria and key resources. For details on the results shown here, including references cited, please follow this link.

  3. Version published to 10.1101/2020.05.07.20093864 on medRxiv