Community use of face masks and similar barriers to prevent respiratory illness such as COVID-19: a rapid scoping review
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Abstract
Evidence for face-mask wearing in the community to protect against respiratory disease is unclear.
Aim
To assess effectiveness of wearing face masks in the community to prevent respiratory disease, and recommend improvements to this evidence base.
Methods
We systematically searched Scopus, Embase and MEDLINE for studies evaluating respiratory disease incidence after face-mask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, face barrier type, and who wore the mask. Preferred outcome was influenza-like illness. Grading of Recommendations, Assessment, Development and Evaluations (GRADE) quality assessment was undertaken and evidence base deficits described.
Results
33 studies (12 randomised control trials (RCTs)) were included. Mask wearing reduced primary infection by 6% (odds ratio (OR): 0.94; 95% CI: 0.75–1.19 for RCTs) to 61% (OR: 0.85; 95% CI: 0.32–2.27; OR: 0.39; 95% CI: 0.18–0.84 and OR: 0.61; 95% CI: 0.45–0.85 for cohort, case–control and cross-sectional studies respectively). RCTs suggested lowest secondary attack rates when both well and ill household members wore masks (OR: 0.81; 95% CI: 0.48–1.37). While RCTs might underestimate effects due to poor compliance and controls wearing masks, observational studies likely overestimate effects, as mask wearing might be associated with other risk-averse behaviours. GRADE was low or very low quality.
Conclusion
Wearing face masks may reduce primary respiratory infection risk, probably by 6–15%. It is important to balance evidence from RCTs and observational studies when their conclusions widely differ and both are at risk of significant bias. COVID-19-specific studies are required.
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SciScore for 10.1101/2020.04.01.20049528: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources The bibliographic databases Scopus, Embase and Medline were searched with the phrases in Box 1 on 31 Jan 2020. Embasesuggested: (EMBASE, RRID:SCR_001650)Medlinesuggested: (MEDLINE, RRID:SCR_002185)Numbers of infections and numbers of people at risk in each study arm were input to Review Manager 5.3 (The Cochrane Collaboration, 2014) for meta-analysis by JB, verified by NJ or LH. Cochrane Collaborationsuggested: NoneResults from OddPub: We did not detect open data. We also did …
SciScore for 10.1101/2020.04.01.20049528: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources The bibliographic databases Scopus, Embase and Medline were searched with the phrases in Box 1 on 31 Jan 2020. Embasesuggested: (EMBASE, RRID:SCR_001650)Medlinesuggested: (MEDLINE, RRID:SCR_002185)Numbers of infections and numbers of people at risk in each study arm were input to Review Manager 5.3 (The Cochrane Collaboration, 2014) for meta-analysis by JB, verified by NJ or LH. Cochrane Collaborationsuggested: NoneResults 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:We found original study authors gave many informative comments on their own study limitations (Supplemental Table 1). We argue that there is merit in combining study types to generate a full view of existing evidence. A difficulty with previous reviews and also in our own review, is the mix of facial barrier used. All of the RCTs included in our review provided specific facemasks (usually surgical grade, rarely P2 or equivalent grade respirator) with instructions how to wear the facemask, as well as told users the frequency facemasks should be changed and how to hygienically dispose of used facemasks. Information was not reported about the types of facemasks that (contrary to protocol) some controls in RCTs used. Only a few of the observational studies collected specific information about what type of face covering was used. We assume that where not explicitly stated, most facemasks worn were surgical grade in the included observational studies. This view concords with survey of facemasks visible in recent street scene photography of Hong Kong, Korean, Chinese and Japanese cities where facemask wearing is common: most of the evident facemasks resemble surgical styles and is somewhat supported by surveys and discussions of habitual facemask users, usually in Far East countries (Wada et al., 2012; Shirai, 2019; Hung, 2018; Burgess and Horii, 2012). Future investigations should collect information about what facemasks people had, how the facemasks were worn, whether they were re...
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.
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SciScore for 10.1101/2020.04.01.20049528: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Most previous similar systematic reviews investigating the effect of facemask use either focused solely on facemask use in health care settings or restricted study design to randomized controlled trials ( RCTs) , many of which were of low quality ( MacIntyre and Chughtai , 2015) . Blinding not detected. Power Analysis not detected. Sex as a biological variable Prevention of primary infection among face veil wearers Figure 3 shows data from two studies ( cross-sectional and cohort ) examining case incidence among women who wore face veils often/always while on Hajj pilgrimage. Table 2: Resources
Software and Algorithms Sentences R… SciScore for 10.1101/2020.04.01.20049528: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement not detected. Randomization Most previous similar systematic reviews investigating the effect of facemask use either focused solely on facemask use in health care settings or restricted study design to randomized controlled trials ( RCTs) , many of which were of low quality ( MacIntyre and Chughtai , 2015) . Blinding not detected. Power Analysis not detected. Sex as a biological variable Prevention of primary infection among face veil wearers Figure 3 shows data from two studies ( cross-sectional and cohort ) examining case incidence among women who wore face veils often/always while on Hajj pilgrimage. Table 2: Resources
Software and Algorithms Sentences Resources " NURS " ) OR LIMIT-TO ( SUBJAREA , " IM EMBASE & Medline via the OVID portal ( ( facemask ? or " face-masks ? " or mask ? EMBASEsuggested: (EMBASE, SCR_001650)RESULTS Altogether , 979 titles and abstracts were retrieved from Scopus , and 1443 from Embase and Medline combined. Medlinesuggested: (MEDLINE, SCR_002185)Numbers of infections and numbers of people at risk in each study arm were input to Review Manager 5.3 (The Cochrane Collaboration, 2014) for meta-analysis by JB, verified by NJ or LH. Cochrane Collaborationsuggested: NoneDue to the rapidity of this review we did not consider other article archives or databases such as Google Scholar, CINAHL and MedRXiv. Google Scholarsuggested: (Google Scholar, SCR_008878)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).
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.
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