COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Primary Prevention Coclite D, Napoletano A, Gianola S, et al. Face Mask Use in the Community for Reducing the Spread of COVID-19: A Systematic Review. Front Med (Lausanne). 2021 Jan 12;7:594269. doi: 10.3389/fmed.2020.594269. eCollection 2020.

Background: Evidence is needed on the effectiveness of wearing face masks in the community to prevent SARS-CoV-2 transmission. Methods: Systematic review and meta-analysis to investigate the efficacy and effectiveness of face mask use in a community setting and to predict the effectiveness of wearing a mask. We searched MEDLINE, EMBASE, SCISEARCH, The Cochrane Library, and pre-prints from inception to 22 April 2020 without restriction by language. We rated the certainty of evidence according to Cochrane and GRADE approach. Findings: Our search identified 35 studies, including three randomized controlled trials (RCTs) (4,017 patients), 10 comparative studies (18,984 patients), 13 predictive models, nine laboratory experimental studies. For reducing infection rates, the estimates of cluster-RCTs were in favor of wearing face masks vs. no mask, but not at statistically significant levels (adjusted OR 0.90, 95% CI 0.78-1.05). Similar findings were reported in observational studies. Mathematical models indicated an important decrease in mortality when the population mask coverage is near-universal, regardless of mask efficacy. In the best-case scenario, when the mask efficacy is at 95%, the R0 can fall to 0.99 from an initial value of 16.90. Levels of mask filtration efficiency were heterogeneous, depending on the materials used (surgical mask: 45-97%). One laboratory study suggested a viral load reduction of 0.25 (95% CI 0.09-0.67) in favor of mask vs. no mask. Interpretation: The findings of this systematic review and meta-analysis support the use of face masks in a community setting. Robust randomized trials on face mask effectiveness are needed to inform evidence-based policies. PROSPERO registration: CRD42020184963.

Discipline / Specialty Area Score
Pediatrics (General)
Public Health
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Infectious Disease
Occupational and Environmental Health
Comments from MORE raters

Infectious Disease rater

The conclusions of this study are unsurprising. For obvious reasons, a barrier to small particles should be protective against acquiring infection even if the barrier is incomplete. The challenge in these studies is to find a proper and ethical approach to confirming our belief. While we can design an experimental model to look at the theoretical efficacy of masks, the real-world information is much more helpful... and challenging. The best study designs are fraught with their own set of issues. Less good study designs show a greater effect (which is admittedly imperfect). However, since the cost of masks is de minimus and the risk of infection is great, it is helpful to have this guidance from a large meta-analysis to bolster public health recommendations.