Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings

Chou, Roger; Dana, Tracy; Jungbauer, Rebecca; Weeks, Chandler; McDonagh, Marian

doi:10.7326/m20-3213

Cited by 133 publications

(140 citation statements)

References 49 publications

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“…In the absence of clinical trials on SARS-CoV-2, trials on other viruses with similar infection patterns (i.e., documented droplet and suspected airborne transmission) are the best available alternatives. Recent systematic and narrative reviews comparing the effectiveness of respirators versus masks against common viral respiratory infections (including coronaviruses and influenza viruses such as H1N1) come to similar conclusions: both devices offer comparable protection in health care settings (23)(24)(25)(26)(27)(28)(29)(30)(31).…”

Section: Trials Comparing Masks and Respirators In Health Care Settingsmentioning

confidence: 90%

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

Zhang

Duchaine

2020

Clin Microbiol Rev

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SUMMARY Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2’s mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission—taken in its traditional definition (long-distance and respirable aerosols)—are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of “airborne,” going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.

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Section: Trials Comparing Masks and Respirators In Health Care Settingsmentioning

confidence: 90%

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

Zhang

Duchaine

2020

Clin Microbiol Rev

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“…The Scientific Medical Policy Committee (SMPC), in collaboration with staff from ACP's Department of Clinical Policy, developed these practice points on the basis of a rapid systematic evidence review conducted by the Pacific Northwest Evidence-based Practice Center and funded by the Agency for Healthcare Research and Quality (1,2). The SMPC comprises 11 internal medicine physicians representing various clinical areas of expertise and 1 public (nonclinician) member, and includes members with expertise in epidemiology, healthy policy, and evidence synthesis.…”

Section: Appendix: Practice Points Development Processmentioning

confidence: 99%

“…The American College of Physicians (ACP) based these practice points on a rapid, living systematic evidence review funded by the Agency for Healthcare Research and Quality (1,2). See the Appendix (available at Annals.org) for methods used to develop the practice points.…”

Section: Introductionmentioning

confidence: 99%

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1)

Qaseem

Etxeandia-Ikobaltzeta

Yost

et al. 2020

Annals of Internal Medicine

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What is the effectiveness of N95 respirators versus surgical masks versus cloth masks for the prevention of coronavirus disease 2019 (COVID-19) in addition to standard precautions (gloves + handwashing) in community settings? KEY QUESTION 2 What is the effectiveness of N95 respirators versus surgical masks versus cloth masks for the prevention of COVID-19 in addition to standard precautions (gowns + gloves + handwashing) in health care settings?

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“…10 The extent of risk modification with PPE remains unclear. [7][8][9]11 A recent prospective study in the UK and USA suggested a fivefold increased risk for HCW caring for patients with COVID-19 compared to HCW not caring for patients with COVID-19, even with the use of PPE, 12 while another study of HCW in a large healthcare system showed a decrease in positive tests for SARS-CoV-2 associated with a universal masking recommendation. 13 This heterogeneous landscape makes it difficult for the HCW community to determine actual risk of acquiring COVID-19 in healthcare vs. community settings and the effectiveness of various risk-mitigating strategies.…”

Section: Introductionmentioning

confidence: 99%

Impact of the COVID-19 Pandemic on Healthcare Workers’ Risk of Infection and Outcomes in a Large, Integrated Health System

Misra‐Hebert

Jehi

et al. 2020

J GEN INTERN MED

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BACKGROUND: Understanding the impact of the COVID-19 pandemic on healthcare workers (HCW) is crucial. OBJECTIVE: Utilizing a health system COVID-19 research registry, we assessed HCW risk for COVID-19 infection, hospitalization, and intensive care unit (ICU) admission. DESIGN: Retrospective cohort study with overlap propensity score weighting. PARTICIPANTS: Individuals tested for SARS-CoV-2 infection in a large academic healthcare system (N = 72,909) from March 8-June 9, 2020, stratified by HCW and patient-facing status. MAIN MEASURES: SARS-CoV-2 test result, hospitalization, and ICU admission for COVID-19 infection. KEY RESULTS: Of 72,909 individuals tested, 9.0% (551) of 6145 HCW tested positive for SARS-CoV-2 compared to 6.5% (4353) of 66,764 non-HCW. The HCW were younger than the non-HCW (median age 39.7 vs. 57.5, p < 0.001) with more females (proportion of males 21.5 vs. 44.9%, p < 0.001), higher reporting of COVID-19 exposure (72 vs. 17%, p < 0.001), and fewer comorbidities. However, the overlap propensity score weighted proportions were 8.9 vs. 7.7 for HCW vs. non-HCW having a positive test with weighted odds ratio (OR) 1.17, 95% confidence interval (CI) 0.99-1.38. Among those testing positive, weighted proportions for hospitalization were 7.4 vs. 15.9 for HCW vs. non-HCW with OR of 0.42 (CI 0.26-0.66) and for ICU admission: 2.2 vs. 4.5 for HCW vs. non-HCW with OR of 0.48 (CI 0.20-1.04). Those HCW identified as patient facing compared to not had increased odds of a positive SARS-CoV-2 test (OR 1.60, CI 1.08-2.39, proportions 8.6 vs. 5.5), but no statistically significant increase in hospitalization (OR 0.88, CI 0.20-3.66, proportions 10.2 vs. 11.4) and ICU admission (OR 0.34, CI 0.01-3.97, proportions 1.8 vs. 5.2). CONCLUSIONS: In a large healthcare system, HCW had similar odds for testing SARS-CoV-2 positive, but lower odds of hospitalization compared to non-HCW. Patientfacing HCW had higher odds of a positive test. These results are key to understanding HCW risk mitigation during the COVID-19 pandemic.

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Masks for Prevention of Respiratory Virus Infections, Including SARS-CoV-2, in Health Care and Community Settings

Cited by 133 publications

References 49 publications

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1)

Impact of the COVID-19 Pandemic on Healthcare Workers’ Risk of Infection and Outcomes in a Large, Integrated Health System

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