Community use of facemasks and similar barriers to prevent respiratory illness such as COVID-19: A rapid scoping review

Brainard, Julii, Jones, Natalia R., Lake, Iain R., Hooper, Lee and Hunter, Paul R. (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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Background: Evidence for facemask wearing in the community to protect against respiratory disease is unclear. Aim: To assess efficacy of wearing facemasks 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 incidence of respiratory disease after facemask wearing (or not). Narrative synthesis and random-effects meta-analysis of attack rates for primary and secondary prevention were performed, subgrouped by design, setting, type of face barrier, and who wore the facemask. Preferred outcome was influenza-like illness. GRADE quality assessment was undertaken and evidence base deficits described. Results: 33 studies (12 RCTs) were included. Mask-wearing reduced primary infection by between 6% (in RCTs, OR 0.94, 95%CI 0.75-1.19) and 61% (cohort studies OR 0.85, 95%CI 0.32 to 2.27; case control studies OR 0.39, 95%CI 0.18-0.84; cross-sectional studies OR 0.61, 95%CI 0.45-0.85). RCTs suggested lowest secondary attack rates when both well and ill house-hold members wore masks (OR 0.81, 95%CI 0.48 - 1.37). While poor compliance and controls wearing masks probably underestimated effects in RCTs, effects are likely overestimated in observational studies where mask wearing is associated with other risk-averse behaviours. GRADE was low or very low quality. Conclusion: Wearing facemasks may reduce risk of primary respiratory infection, probably by 6-15%. This review raises significant issues about balancing evidence from RCTs and observational studies when these give very different conclusions and both observational studies and RCTs are at risk of significant bias. Studies specifically addressing COVID-19 infection are required.

Item Type: Article
Uncontrolled Keywords: coronavirus,facemask,influenza-like-illness,hajj,respiratory infection
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Faculty of Science > School of Environmental Sciences
Faculty of Science > Tyndall Centre for Climatic Change
Depositing User: LivePure Connector
Date Deposited: 27 Aug 2020 00:00
Last Modified: 15 Jan 2021 00:58
DOI: 10.2807/1560-7917.ES.2020.25.49.2000725

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