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Brainard, Julii, Jones, Natalia R. 
ORCID: https://orcid.org/0000-0003-4025-2985, Lake, Iain R. ORCID: https://orcid.org/0000-0003-4407-5357, Hooper, Lee ORCID: https://orcid.org/0000-0002-7904-3331 and Hunter, Paul R. ORCID: https://orcid.org/0000-0002-5608-6144
(2020)
Community use of facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid scoping review.
Eurosurveillance, 25 (49).
ISSN 1560-7917
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Abstract
Background: 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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