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

PDF (Accepted_Manuscript) - Accepted Version
Download (318kB) | Preview
PDF (Published manuscript) - Published Version
Available under License Creative Commons Attribution.

Download (597kB) | Preview


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.

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
University of East Anglia > Faculty of Science > Research Centres > Tyndall Centre for Climate Change Research
Related URLs:
Depositing User: LivePure Connector
Date Deposited: 27 Aug 2020 00:00
Last Modified: 13 Mar 2022 07:30
DOI: 10.2807/1560-7917.ES.2020.25.49.2000725

Actions (login required)

View Item View Item