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Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials.
Influenza Other Respir Viruses. 2020 07; 14(4):365-373.IO

Abstract

BACKGROUND

Respiratory 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.

PURPOSE

To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers.

DATA SOURCES

MEDLINE, 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 SELECTION

Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers.

DATA EXTRACTION

Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence.

DATA SYNTHESIS

Four 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; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49).

LIMITATIONS

Indirectness and imprecision of available evidence.

CONCLUSIONS

Low 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.

Authors+Show Affiliations

Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.Department of Medicine, Division of Respirology, McMaster University, Hamilton, ON, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada.Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada. Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada.

Pub Type(s)

Comparative Study
Journal Article
Meta-Analysis
Systematic Review

Language

eng

PubMed ID

32246890

Citation

Bartoszko, Jessica J., et al. "Medical Masks Vs N95 Respirators for Preventing COVID-19 in Healthcare Workers: a Systematic Review and Meta-analysis of Randomized Trials." Influenza and Other Respiratory Viruses, vol. 14, no. 4, 2020, pp. 365-373.
Bartoszko JJ, Farooqi MAM, Alhazzani W, et al. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses. 2020;14(4):365-373.
Bartoszko, J. J., Farooqi, M. A. M., Alhazzani, W., & Loeb, M. (2020). Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. Influenza and Other Respiratory Viruses, 14(4), 365-373. https://doi.org/10.1111/irv.12745
Bartoszko JJ, et al. Medical Masks Vs N95 Respirators for Preventing COVID-19 in Healthcare Workers: a Systematic Review and Meta-analysis of Randomized Trials. Influenza Other Respir Viruses. 2020;14(4):365-373. PubMed PMID: 32246890.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: A systematic review and meta-analysis of randomized trials. AU - Bartoszko,Jessica J, AU - Farooqi,Mohammed Abdul Malik, AU - Alhazzani,Waleed, AU - Loeb,Mark, Y1 - 2020/04/21/ PY - 2020/03/28/received PY - 2020/03/31/revised PY - 2020/04/01/accepted PY - 2020/4/5/pubmed PY - 2020/7/7/medline PY - 2020/4/5/entrez KW - COVID-19 KW - N95 respirators KW - SARS-CoV-2 KW - coronavirus KW - masks KW - meta-analysis KW - systematic review SP - 365 EP - 373 JF - Influenza and other respiratory viruses JO - Influenza Other Respir Viruses VL - 14 IS - 4 N2 - BACKGROUND: Respiratory 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. PURPOSE: To compare medical masks to N95 respirators in preventing laboratory-confirmed viral infection and respiratory illness including coronavirus specifically in healthcare workers. DATA SOURCES: MEDLINE, 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 SELECTION: Randomized controlled trials (RCTs) comparing the protective effect of medical masks to N95 respirators in healthcare workers. DATA EXTRACTION: Reviewer pair independently screened, extracted data, and assessed risk of bias and the certainty of the evidence. DATA SYNTHESIS: Four 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; I2 = 0%; low certainty in the evidence) or clinical respiratory illness (OR 1.49; 95% CI: 0.98-2.28; I2 = 78%; very low certainty in the evidence). Only one trial evaluated coronaviruses separately and found no difference between the two groups (P = .49). LIMITATIONS: Indirectness and imprecision of available evidence. CONCLUSIONS: Low 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. SN - 1750-2659 UR - https://www.unboundmedicine.com/medline/citation/32246890/Medical_masks_vs_N95_respirators_for_preventing_COVID_19_in_healthcare_workers:_A_systematic_review_and_meta_analysis_of_randomized_trials_ L2 - https://doi.org/10.1111/irv.12745 DB - PRIME DP - Unbound Medicine ER -