Abstract
BackgroundRespiratory protective devices are critical in protecting against infection in healthcare workers at high risk of novel 2019 coronavirus disease (COVID‐19); however, recommendations are conflicting and epidemiological data on their relative effectiveness against COVID‐19 are limited.PurposeTo compare medical masks to N95 respirators in preventing laboratory‐confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers.Data SourcesMEDLINE, Embase, and CENTRAL from January 1, 2014, to March 9, 2020. Update of published search conducted from January 1, 1990, to December 9, 2014.Study SelectionRandomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers.Data ExtractionReviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence.Data SynthesisFour RCTs were meta‐analyzed adjusting for clustering. Compared with N95 respirators; the use of medical masks did not increase laboratory‐confirmed viral (including coronaviruses) respiratory infection (OR 1.06; 95% CI 0.90‐1.25; I 2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98‐2.28; I 2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49).LimitationsIndirectness and imprecision of available evidence.ConclusionsLow certainty evidence suggests that medical masks and N95 respirators offer similar protection against viral respiratory infection including coronavirus in healthcare workers during non–aerosol‐generating care. Preservation of N95 respirators for high‐risk, aerosol‐generating procedures in this pandemic should be considered when in short supply.
Highlights
Novel 2019 coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, after the identification of >118 000 cases in 114 countries.[1]
We adapted search strategies published by Smith et al by removing terms related to surrogate exposure studies and applying database-specific randomized controlled trial (RCT) filters (Appendix S2A-C).[12,15]
We searched MEDLINE (OVID interface, Epub Ahead of Print, InProcess & Other Non-Indexed Citations, 1946 to Present), Embase (OVID interface, 1974 to Present) and the Cochrane Central Register of Controlled Trials (CENTRAL) from January 1, 2014, to March 9, 2020, for English-language studies to update their search completed on December 9, 2014.12 Two reviewers independently and in duplicate screened titles, abstracts and full-texts of records identified by our searches
Summary
Novel 2019 coronavirus disease (COVID-19) was declared a pandemic by the World Health Organization (WHO) on March 11, 2020, after the identification of >118 000 cases in 114 countries.[1]. N95 respirators are designed to minimize facial seal leakage because of tight fit and prevent inhalation of small airborne particles. They are required to pass filtration tests. Current recommendations to protect healthcare workers against COVID-19 for non–aerosol-generating care are conflicting.[6-9]. The U.S Centers for Disease Control and Prevention (CDC) and European Centre for Disease and Prevention (ECDC) recommend the N95 respirator for non–aerosol-generating routine care of patients with COVID-19,6,7 while the World Health Organization and the Public Health Agency of Canada recommend medical masks.[8,9]. Shortages of personal protective equipment for healthcare workers, including medical masks and N95 respirators, have been widely reported in this pandemic.[11]. We conducted an updated systematic review and meta-analysis to help answer this question
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