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Comparative Efficacy of N95, Surgical, Medical, and Non-Medical Facemasks in Protection of Respiratory Virus Infection: A Living Systematic Review and Network Meta-Analysis
University of Padua - Department of Neurosciences; University of Padua - Neuroscience Center; King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab
University of Ioannina - Department of Hygiene and Epidemiology; Linkoping University - Department of Medicine and Health Sciences (IMH); Linkoping University - Pain and Rehabilitation Center
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale
Background: Current facemask guidelines for respiratory viruses vary, impeding policymakers and the general population in determining which facemasks are effective as personal protective equipment (PPE). We aimed to evaluate the comparative efficacy of N95, surgical/medical, and non-medical facemasks in preventing respiratory virus infection.
Methods: This living systematic review and network meta-analysis (NMA) incorporated 31 published and unpublished randomised controlled trials (RCTs) and observational studies investigating specific mask efficacy against influenza virus, SARS-CoV-1, MERS-CoV, and SARS-CoV-2. We searched PubMed, Google Scholar, and medRxiv databases for studies published up to 22 October 2020 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection.
Findings: N95 or equivalent masks were the most effective in conferring protection against coronavirus infections (RR, 0.37; 95% CI, 0.24–0.55; p < 0.001) consistently across subgroup analyses of causative viruses (SARS-CoV-1/MERS-CoV versus SARS-CoV-2) and clinical settings (community setting versus healthcare setting). There was a consistent trend towards reduced coronavirus and influenza infection rates with surgical or medical facemasks, albeit without reaching statistical significance; surgical or medical masks may show effect but lack in statistical power at this stage to detect a difference.
Interpretation: Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the efficacies may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., FFP2 and KN95) in both community and healthcare settings.
Funding: There was no funding source for this study.
Declaration of Interests: We declare no competing interests.
Kim, Min Seo and Seong, Dawon and Li, Han and Chung, Seo Kyoung and Park, Youngjoo and Lee, Minho and Lee, Seung Won and Yon, Dong Keon and Kim, Jae Han and Lee, Keum Hwa and Solmi, Marco and Dragioti, Elena and Koyanagi, Ai and Jacob, Louis and Kronbichler, Andreas and Tizaoui, Kalthoum and Cargnin, Sarah and Terrazzino, Salvatore and Hong, Sung Hwi and Abou Ghayda, Ramy and Radua, Joaquim and Oh, Hans and kostev, karel and Ogino, Shuji and Lee, I-Min and Giovannucci, Edward and Barnett, Yvonne and Butler, Laurie and McDermott, Daragh and Ilie, Petre-Cristian and Shin, Jae Il and Smith, Lee, Comparative Efficacy of N95, Surgical, Medical, and Non-Medical Facemasks in Protection of Respiratory Virus Infection: A Living Systematic Review and Network Meta-Analysis. Available at SSRN: https://ssrn.com/abstract=3768550 or http://dx.doi.org/10.2139/ssrn.3768550
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale ( email )
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale ( email )
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