Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers

Loeb, Mark; Bartholomew, Amy; Tarhuni, Wadea; Hassany, Mohamed; Youngster, Ilan; Somayaji, Ranjani; Larios, Oscar; Kim, Joseph; Missaghi, Bayan; Vayalumkal, Joseph; Mertz, Dominik; Chagla, Zain; Cividino, Maureen; Ali, Karim; Mansour, Sarah C.; Castellucci, Lana A; Frenette, Charles; Parkes, Leighanne; Downing, Mark; Muller, Matthew P.; Glavin, Verne; Newton, Jennifer; Hookoom, Ravi; Leis, Jerome A; Smith, Stephanie; Borhan, Sayem; Singh, Pardeep; Pullenayegum, Eleanor; Conly, John

doi:10.7326/m22-1966

Cited by 55 publications

(74 citation statements)

References 15 publications

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“…Compared to the surgical mask upon the short-term effects, N95 masks could impose elevated health risks under extended use. Interestingly, recent data from a large multi-country RCT study show no significant differences between the two mask types in terms of SARS-CoV2 infection rates 137 .…”

Section: N95 Mask Compared To Surgical Maskmentioning

confidence: 97%

WITHDRAWN: Physio-metabolic and clinical consequences of wearing face masks -Systematic review with meta-analysis and comprehensive evaluation

Kisielinski¹,

Hirsch

Wagner

et al. 2022

Preprint

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Background: As face masks are a mandatory public health intervention during the COVID-19 pandemic, adverse effects require substantiated investigation. Methods: A systematic review of 2168 studies yielded 54 publications for synthesis and 37 studies for meta-analysis (on n=8641, m=2482, f=6159, age=34.8±12.5). The median trial duration was only 18 min (IQR=50) for our comprehensive evaluation of mask induced physio-metabolic and clinical outcomes. Results: We found significant effects in both medical masks with a greater impact regarding the N95. These effects included decreased SpO2 (overall SMD=-0.24, 95%CI=-0.38 to -0.11, p=0.0004) and minute ventilation (SMD=-0.72, 95%CI=-0.99 to -0.46, p<0.00001), simultaneously increased blood-CO2 (SMD=+0.64, 95%CI=0.31–0.96, p=0.0001), heart rate (N95: SMD=+0.22, 95%CI=0.03–0.41, p=0.02), systolic blood pressure (surgical: SMD=+0.21, 95%CI=0.03–0.39, p=0.02), skin temperature (overall SMD=+0.80 95%CI 0.23–1.38, p=0.006) and humidity (SMD +2.24, 95%CI=1.32–3.17, p<0.00001). Effects on exertion (overall SMD=+0.9, surgical=+0.63, N95=+1.19), discomfort (SMD=+1.16), dyspnoea (SMD=+1.46), heat (SMD=+0.70) and humidity (SMD=+0.9) were significant in 373 cases with a robust relationship to mask wearing (p<0.006 to p<0.00001). Pooled symptom prevalence was significant in users (n=8128) for: headache (62%, p<0.00001), acne (38%, p<0.00001), skin irritation (36%, p<0.00001), dyspnoea (33%, p<0.00001), heat (26%, p<0.00001), itching (26%, p<0.00001), voice disorder (23%, p<0.03) and dizziness (5%, p=0.01). Discussion: Masks interfered with O2-uptake and CO2-release and compromised respiratory compensation. Though evaluated wearing durations do not represent daily/prolonged use, outcomes independently validate mask-induced exhaustion-syndrome (MIES). MIES can have long-term clinical consequences, especially for vulnerable groups. Conclusion: Face mask side-effects must be assessed (risk-benefit) against the available evidence of their effectiveness against viral transmissions.

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Section: N95 Mask Compared To Surgical Maskmentioning

confidence: 97%

WITHDRAWN: Physio-metabolic and clinical consequences of wearing face masks -Systematic review with meta-analysis and comprehensive evaluation

Kisielinski¹,

Hirsch

Wagner

et al. 2022

Preprint

View full text Add to dashboard Cite

show abstract

“…This is consistent with the observation that using a low-quality (e.g. surgical) mask 72,73 or masking intermittently 74 . As a practical matter, individuals seeking to shield have a limited range of interventions available at this point to reduce risk of infection (vaccine boosters, one-way masking and social isolation), and many individuals are forced into high-contact settings as a result of work, school, medical need, or family commitments.…”

Section: Discussionsupporting

confidence: 91%

“…Our findings linking reduction of contact rate to reduction in risk of infection also provide an explanation for the seeming paradox of the use of face masks-while masks have been compellingly demonstrated to reduce the efficiency of onward viral transmission using a physical sciences framework 14,78,79 , observational studies have confirmed this impact in some cases [66][67][68][69][70][71] , but not others 80,81 . Notably, surgical masks have a minimal impact on reducing risk of infection 72,73 , as does using a highquality mask inconsistently (or sometimes) 74 , exactly as would be expected based on the results presented here.…”

Section: Discussionsupporting

confidence: 78%

Shielding under endemic SARS-CoV-2 conditions is easier said than done: a model-based analysis

Stoddard¹,

Yuan²,

Sarkar

et al. 2023

Preprint

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As the COVID-19 pandemic continues unabated, many governments and public-health bodies worldwide have ceased to implement concerted measures for limiting viral spread, placing the onus instead on the individual. In this paper, we examine the feasibility of this proposition using an agent-based model to simulate the impact of individual shielding behaviors on reinfection frequency. We derive estimates of heterogeneity in immune protection from a population pharmacokinetic (pop PK) model of antibody kinetics following infection and variation in contact rate based on published estimates. Our results suggest that individuals seeking to opt out of adverse outcomes upon SARS-CoV-2 infection will find it challenging to do so, as large reductions in contact rate are required to reduce the risk of infection. Our findings suggest the importance of a multilayered strategy for those seeking to reduce the risk of infection. This work also suggests the importance of public health interventions such as universal masking in essential venues and air quality standards to ensure individual freedom of choice regarding COVID-19.

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“…The lack of superiority of respirators over surgical masks in the prevention of viral respiratory infections in health care workers was demonstrated in four randomized trials identified in this paper [ [8] , [9] , [10] , [11] ], although they involved personnel specifically trained in the use of respirators (with fit test performed). This observation was confirmed by a recent study, which also failed to observe superiority of respirators over masks for the acquisition of COVID-19 [ 29 ]. The conclusion drawn from some experts that respirators should be preferred from an infection prevention point of view for external and self-protection, especially in risk settings such as medical or nursing areas [ 5 ], is therefore not comprehensible, at least on the basis of data with persons wearing respirators.…”

Section: Discussionsupporting

confidence: 71%

Overview of tight fit and infection prevention benefits of respirators (filtering face pieces)

Knobloch¹,

Franke²,

Knobloch³

et al. 2023

Journal of Hospital Infection

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Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers

Cited by 55 publications

References 15 publications

WITHDRAWN: Physio-metabolic and clinical consequences of wearing face masks -Systematic review with meta-analysis and comprehensive evaluation

WITHDRAWN: Physio-metabolic and clinical consequences of wearing face masks -Systematic review with meta-analysis and comprehensive evaluation

Shielding under endemic SARS-CoV-2 conditions is easier said than done: a model-based analysis

Overview of tight fit and infection prevention benefits of respirators (filtering face pieces)

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