Article Figures & Data
Figures
- Figure 1.
Study flowchart for selection of articles.
CDC = Centers for Disease Control and Prevention; CINAHL = Cumulative Index to Nursing and Allied Health Literature.
a Ten studies were non-English and did not answer identified outcome measures.
Tables
Publication Study Type Overall Study Assessmenta Appropriate Study Design Prospective Calculation of Study Size Blinding of Patients and Personnel Patient Selection/Inclusion Criteria Subject Comparability Appropriate Endpoints Assessment of Outcomes/Exposure Follow-Up/Handling of Missing Data Reporting Confounding Appropriate Statistical Analysis Davies et al9 Nonrandomized trial High Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Liu et al10 Nonrandomized trial High Yes No No No Yes Yes Yes Yes Yes Yes Yes Rengasamy et al11 Laboratory efficacy study High Yes No No … … Yes Yes … Yes Yes Yes van der Sande et al12 Nonrandomized trial High Yes No No No Yes Yes Yes Yes Yes Yes Yes Furuhashi13 Laboratory efficacy study Moderate Yes No No … … Yes Yes … Yes Yes Yes Ma et al14 Laboratory efficacy study Moderate Yes No No … … Yes Yes … Yes Yes Yes Quesnel15 Single-case experiment Low Yes No No No Yes Yes Yes Yes Yes Yes No Sellers et al16 Nonrandomized trial Low Yes No No Yes No Yes Yes No No No Yes ↵a Determined by review of 11 appraisal domains in context of study strengths and weaknesses.
Characteristics Outcomes Efficacya Effectivenessb Publication Study Type Population Pathogen/Particle Filtration Fit Airflow Infection MacIntyre et al17 Randomized trial Health care clinicians in high-risk wards in Vietnam (N = 1,607) Viral respiratory infection,c aerosolized particles Cloth < medical … … Cloth < medical († infection in cloth) Davies et al9 Nonrandomized trial Volunteers, general population (N = 21) Aerosolized virus,d aerosolized bacteriad Cloth < medical Cloth < medical Cloth < medical … Liu et al10 Nonrandomized trial Surgeons (N = 50) Bacteriad Cloth < medical … Cloth < medical … Sellers et al16 Nonrandomized trial Human subjects exposed to hand-and-foot virus (N =8) Picornaviruse … … … Cloth = medical († infection in both) van der Sande et al12 Nonrandomized trial Volunteers, general population (N = 39) Particles (0.02-1 μm) … Cloth < medical … … Furuhashi13 Laboratory efficacy study … Bacteriad Cloth < medical … Cloth < medical … Ma et al14 Laboratory efficacy study … Aerosolized virusf Cloth = medical … … … Rengasamy et al11 Laboratory efficacy study … Aerosolized particles (20-1,000 nm) Cloth < N95 … … … Quesnel15 Single-case experiment Single human test subject, general population Bacteriad Cloth = medical … … … hMPV = human metapneumovirus; PCR = polymerase chain reaction.
Note: < indicates less effective or efficacious; = indicates no difference in effectiveness or efficacy; † indicates increased incidence.
↵a Efficacy refers to the performance of mask materials in a laboratory setting.
↵b Effectiveness refers to the performance of masks when used by human subjects in clinical environments.
↵c Influenza-like illness and/or pharyngeal swab multiplex PCR-confirmed infection (rhinovirus, hMPV, influenza, etc).
↵d Viable pathogen detected via postfiltration colony formation.
↵e Viral colony formation from nasal swab.
↵f Virus detected via postfiltration PCR.
Supplemental Tables
Supplemental Tables
Files in this Data Supplement:
- Supplemental data: Tables - PDF file
The Article in Brief
The Potential for Cloth Masks to Protect Health Care Clinicians From SARS-CoV-2: A Rapid Review
Cleveland Piggott , and colleagues
Background The coronavirus disease 2019 (COVID-19) pandemic has led at times to a scarcity of personal protective equipment, including medical masks, for health care clinicians, especially in primary care settings. The objective of this review was to summarize current evidence regarding the use of cloth masks to prevent respiratory viral infections, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), among health care clinicians.
What This Study Found A rapid, evidence-based review summarizes the effectiveness of cloth masks in protecting health care clinicians from respiratory viral infections, such as COVID-19. Nine studies were included in the review, and all but one were conducted prior to the COVID-19 pandemic. The only randomized trial of cloth face masks published at the time of this review compared the infection rates of influenza-like illness among groups of health care professionals who wore cloth masks, medical masks, or inconsistent mask use in the hospital setting. That study reported wide-ranging confidence intervals when comparing groups, but overall, they conclude that cloth mask use was associated with significantly higher viral infections than exclusive use of medical masks. A majority of studies were conducted in laboratory settings and evaluated either cloth face mask fit and airflow when compared to other kinds of mask or the filtration abilities of cloth material and masks. All filtration studies tested aerosolized particles including noncoronavirus, bacteria, and simulated biologic particles, and results were highly variable but suggested some level of participle filtration. Notably, available filtration studies did not specifically test COVID-19 transmission or respiratory droplet transmission. The lab studies all conclude that cloth masks provided an inferior fit and were less effective at filtering viral particles compared to standard medical or N95 masks.
Implications
- Conclusions of this qualitative review align with current Center for Disease Control and Prevention guidelines that recommend use of an N95 respirator for care of patients with COVID-19. The authors also recommend that for health care professionals without access to medical masks, a cloth mask should be paired with the plastic face shield, with frequent cloth mask changes to reduce the risk of moisture retention.
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