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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

43 Pages Posted: 1 Feb 2021

See all articles by Min Seo Kim

Min Seo Kim

Korea University - College of Medicine

Dawon Seong

Yonsei University, College of Medicine

Han Li

University of Florida College of Medicine

Seo Kyoung Chung

Ewha Womans University, College of Medicine

Youngjoo Park

Yonsei University, College of Medicine

Minho Lee

Yonsei University, College of Medicine

Seung Won Lee

Sejong University - Department of Data Science

Dong Keon Yon

Kyung Hee University - Center for Digital Health

Jae Han Kim

Yonsei University - College of Medicine

Keum Hwa Lee

Yonsei University - Department of Pediatrics

Marco Solmi

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

Elena Dragioti

University of Ioannina - Department of Hygiene and Epidemiology; Linkoping University - Department of Medicine and Health Sciences (IMH); Linkoping University - Pain and Rehabilitation Center

Ai Koyanagi

University of Barcelona - Parc Sanitari Sant Joan de Déu, Research and Development Unit

Louis Jacob

University of Versailles Saint-Quentin-en-Yvelines

Andreas Kronbichler

Medical University of Innsbruck - Department of Internal Medicine IV

Kalthoum Tizaoui

Department of Basic Sciences, Medicine Faculty of Tunis, Tunis El Manar University

Sarah Cargnin

Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale

Salvatore Terrazzino

Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale

Sung Hwi Hong

Yonsei University - College of Medicine

Ramy Abou Ghayda

Urology Institute, University Hospitals System, Case Western Reserve University School of Medicine

Joaquim Radua

King's College London - Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab

Hans Oh

University of Southern California - School of Social Work

karel kostev

IQVIA - Department of Epidemiology

Shuji Ogino

Department of Epidemiology, Harvard TH Chan School of Public Health

I-Min Lee

Department of Epidemiology, Harvard TH Chan School of Public Health

Edward Giovannucci

Harvard University - Department of Nutrition

Yvonne Barnett

Anglia Ruskin University

Laurie Butler

Faculty of Science and Engineering, Anglia Ruskin University

Daragh McDermott

School of Psychology and Sport Science, Anglia Ruskin University

Petre-Cristian Ilie

Queen Elizabeth Hospital Foundation Trust

Jae Il Shin

Yonsei University - Department of Pediatrics

Lee Smith

Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University

More...

Abstract

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.

Keywords: COVID-19, Influenza virus, coronavirus, facemask, N95, surgical mask, medical mask, network meta-analysis

Suggested Citation

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

Min Seo Kim

Korea University - College of Medicine ( email )

1 Anam-dong 5 ka
Seoul, 136-701
Korea, Republic of (South Korea)

Dawon Seong

Yonsei University, College of Medicine ( email )

Han Li

University of Florida College of Medicine ( email )

Seo Kyoung Chung

Ewha Womans University, College of Medicine ( email )

Youngjoo Park

Yonsei University, College of Medicine ( email )

Minho Lee

Yonsei University, College of Medicine ( email )

Seung Won Lee

Sejong University - Department of Data Science ( email )

Korea, Republic of (South Korea)

Dong Keon Yon

Kyung Hee University - Center for Digital Health ( email )

Korea, Republic of (South Korea)

Jae Han Kim

Yonsei University - College of Medicine

Korea, Republic of (South Korea)

Keum Hwa Lee

Yonsei University - Department of Pediatrics

Seoul
Korea, Republic of (South Korea)

Marco Solmi

University of Padua - Department of Neurosciences

Padua
Italy

University of Padua - Neuroscience Center

Padua
Italy

King's College London, Institute of Psychiatry, Psychology and Neuroscience, Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab

London
United Kingdom

Elena Dragioti

University of Ioannina - Department of Hygiene and Epidemiology ( email )

Ioannina
Greece

Linkoping University - Department of Medicine and Health Sciences (IMH) ( email )

Linköping
Sweden

Linkoping University - Pain and Rehabilitation Center ( email )

Linköping
Sweden

Ai Koyanagi

University of Barcelona - Parc Sanitari Sant Joan de Déu, Research and Development Unit

Barcelona
Spain

Louis Jacob

University of Versailles Saint-Quentin-en-Yvelines

Andreas Kronbichler

Medical University of Innsbruck - Department of Internal Medicine IV

Austria

Kalthoum Tizaoui

Department of Basic Sciences, Medicine Faculty of Tunis, Tunis El Manar University ( email )

Sarah Cargnin

Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale ( email )

Salvatore Terrazzino

Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale ( email )

Sung Hwi Hong

Yonsei University - College of Medicine

Korea, Republic of (South Korea)

Ramy Abou Ghayda

Urology Institute, University Hospitals System, Case Western Reserve University School of Medicine ( email )

Joaquim Radua

King's College London - Early Psychosis: Interventions and Clinical-Detection (EPIC) Lab

London
United Kingdom

Hans Oh

University of Southern California - School of Social Work

United States

Karel Kostev

IQVIA - Department of Epidemiology ( email )

Frankfurt
Georgia

Shuji Ogino

Department of Epidemiology, Harvard TH Chan School of Public Health ( email )

I-Min Lee

Department of Epidemiology, Harvard TH Chan School of Public Health ( email )

Edward Giovannucci

Harvard University - Department of Nutrition ( email )

Yvonne Barnett

Anglia Ruskin University

East Road
Cambridge CB1 1PT
United Kingdom

Laurie Butler

Faculty of Science and Engineering, Anglia Ruskin University ( email )

Daragh McDermott

School of Psychology and Sport Science, Anglia Ruskin University ( email )

Petre-Cristian Ilie

Queen Elizabeth Hospital Foundation Trust ( email )

Jae Il Shin (Contact Author)

Yonsei University - Department of Pediatrics ( email )

50 Yonsei-ro, Seodaemun-gu
C.P.O. Box 8044
Seoul, 120-752
Korea, Republic of (South Korea)
+82-2-2228-2050 (Phone)
+82-2-393-9118 (Fax)

Lee Smith

Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University ( email )

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