Abstract
BackgroundThere is insufficient evidence regarding the role of respirators in the prevention of SARS-CoV-2 infection. We analysed the impact of filtering facepiece class 2 (FFP2) versus surgical masks on the risk of SARS-CoV-2 acquisition among Swiss healthcare workers (HCW).MethodsOur prospective multicentre cohort enrolled HCW from June to August 2020. Participants were asked about COVID-19 risk exposures/behaviours, including preferentially worn mask type when caring for COVID-19 patients outside of aerosol-generating procedures. The impact of FFP2 on (1) self-reported SARS-CoV-2-positive nasopharyngeal PCR/rapid antigen tests captured during weekly surveys, and (2) SARS-CoV-2 seroconversion between baseline and January/February 2021 was assessed.ResultsWe enrolled 3259 participants from nine healthcare institutions, whereof 716 (22%) preferentially used FFP2. Among these, 81/716 (11%) reported a SARS-CoV-2-positive swab, compared to 352/2543 (14%) surgical mask users; seroconversion was documented in 85/656 (13%) FFP2 and 426/2255 (19%) surgical mask users. Adjusted for baseline characteristics, COVID-19 exposure, and risk behaviour, FFP2 use was non-significantly associated with decreased risk for SARS-CoV-2-positive swab (adjusted hazard ratio [aHR] 0.8, 95% CI 0.6–1.0) and seroconversion (adjusted odds ratio [aOR] 0.7, 95% CI 0.5–1.0); household exposure was the strongest risk factor (aHR 10.1, 95% CI 7.5–13.5; aOR 5.0, 95% CI 3.9–6.5). In subgroup analysis, FFP2 use was clearly protective among those with frequent (> 20 patients) COVID-19 exposure (aHR 0.7 for positive swab, 95% CI 0.5–0.8; aOR 0.6 for seroconversion, 95% CI 0.4–1.0).ConclusionsRespirators compared to surgical masks may convey additional protection from SARS-CoV-2 for HCW with frequent exposure to COVID-19 patients.
Highlights
There is insufficient evidence regarding the role of respirators in the prevention of SARS-CoV-2 infec‐ tion
For healthcare workers (HCW) involved in aerosol-generating procedures (AGP), international guidelines unanimously recommend the use of so-called respirators, which include filtering facepiece class 2 (FFP2), N95, or KN95, with the ability to filter microparticles
For SARS-CoV-2, we identified three studies not covered in the above-mentioned meta-analysis
Summary
There is insufficient evidence regarding the role of respirators in the prevention of SARS-CoV-2 infec‐ tion. We analysed the impact of filtering facepiece class 2 (FFP2) versus surgical masks on the risk of SARS-CoV-2 acquisition among Swiss healthcare workers (HCW). Healthcare workers (HCW) have a high risk of exposure to and infection with SARS-CoV-2 [9]. For HCW involved in AGP, international guidelines unanimously recommend the use of so-called respirators, which include filtering facepiece class 2 (FFP2), N95, or KN95, with the ability to filter microparticles. As a consequence of the conflicting opinions about aerosol transmission, guidelines differ regarding recommendations for the use of respirators outside of AGP. The Infectious Diseases Society of America’s recommendation is to use either a surgical mask or a respirator [14]
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