Authors
Department of Pulmonary Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
Abstract
INTRODUCTION: Novel coronavirus is believed to be tiny enough (0.08–0.14 μm) to penetrate
through face mask, thus protection offered by cloth mask may be too low. However, the use of cloth
face mask in community has been recommended by the United States Centre for Disease Control
and Prevention and regulatory bodies of other countries. There is paucity of literature on efficacy of
cloth face mask in preventing SARS‑CoV‑2 infection transmission; thus, this review aims to update
the available most recent evidences on efficacy of cloth face masks in prevention of viral infection
transmission.
METHODS: We searched MEDLINE, EMBASE, and Clinical Trials Register for identifying studies
related to this review using free‑text terms and MeSH terms. Both experimental and observational
studies on efficacy of cloth masks which were published in English language have been included
in this review except expert opinions, commentaries, editorials, and review articles. Twelve studies
were eligible to be included in review for data extraction and qualitative synthesis was carried out
from extracted data but quantitative analysis (meta‑analysis) could not be performed because of
serious heterogeneity between the studies.
RESULTS: Cloth face masks show minimum efficacy in source control than the medical grade mask.
The efficacy of cloth face masks filtration varies and depends on the type of material used, number
of layers, and degree of moisture in mask and fitting of mask on face.
CONCLUSION: Cloth face masks have limited efficacy in combating viral infection transmission.
However, it may be used in closed, crowded indoor, and outdoor public spaces involving physical
proximity to prevent spread of SARS‑CoV‑2 infection.
Keywords
of face masks in the COVID‑19 pandemic. Lancet Respir Med
2020;8:434‑6.
2. Centers for Disease Control and Prevention. Coronavirus Disease‑19: Recommendation Regarding the Use of Cloth Face
Coverings, Especially in Areas of Significant Community‑Based
Transmission; 2020. Available from: https://www.cdc.gov/
coronavirus/2019‑ncov/prevent‑getting‑sick/cloth‑face‑cover.
html#studies. [Last accessed on 2020 Apr 25].
3. Jeno M. CDC Updates Guidelines on PPE for Health care
Personnel; COVID‑19 Declared a Pandemic; 11 March,
2020. Available from: https://www.aappublications.org/
news/2020/03/11/coronavirus031120. [Last accessed on 2020
Apr 25].
4. Which Countries have Made Wearing Face Masks Compulsory?
Alijazeera; 24 April, 2020. Available from: https://www.aljazeera.
com/news/2020/04/countries-wearing‑face‑masks‑compulso
ry‑200423094510867.html. [Last accessed on 2020 Apr 24].
5. Office of the Principal Advisor to Government of India. Manual
on Home‑Made Protective Cover for the Face and Mouth for
Curbing Spread of SARS CoV‑2 Virus. 23 April, 2020. Available
from: http://file:///C:/Users/Aiims/Downloads/Advisory
&ManualonuseofHomemadeProtectiveCoverforFace&Mouth.
cleaned.pdf. [Last accessed on 2020 Apr 25].
6. Liu J, Liao X, Qian S, Yuan J, Wang F, Liu Y, et al. Community
transmission of severe acute respiratory syndrome coronavirus
2, Shenzhen, China, 2020. Emerg Infect Dis 2020;26(6):1320‑3.
https://dx.doi.org/10.3201/eid2606.200239.
7. Sharma SK, Mudgal SK, Panda PK, Gupta P, Agarwal P.
COVID–19: Guidance outlines on infection prevention and control
for health care workers. Indian J Comm Health 2020;32(01)8‑14.
8. World Health Organization. Report of the WHO‑China Joint
Mission on Coronavirus Disease 2019 (COVID‑19); 16‑24
February, 2020. Available from: https://www.who.int/docs/
default‑ source/coronaviruse/whochina‑joint‑mission‑oncovid‑19‑final‑report.pdf. [Last accessed on 2020 Apr 25].
9. van Doremalen N, Bushmaker T, Morris DH, Holbrook MG,
Gamble A, Williamson BN, et al. Aerosol and surface stability
of SARS‑CoV‑2 as compared with SARS‑CoV‑1. N Engl J Med
2020;382:1564‑7.
10. Ma QX, Shan H, Zhang HL, Li GM, Yang RM, Chen JM. Potential
utilities of mask‑wearing and instant hand hygiene for fighting
SARS‑CoV‑2. J Med Virol 2020; 1‑5. https://doi.org/10.1002/
jmv.25805.
11. MacIntyre C, Seale H, Dung T, Hien N, Nga P, Chughtai A et al.
Cluster randomised trial of cloth masks compared with medical
masks in healthcare workers. BMJ Open 2015;5:e006577.
12. Bae S, Kim M, Kim J, Cha H, Lim J, Jung J, et al. Effectiveness of
surgical and cotton masks in blocking SARS–CoV‑2: A controlled
comparison in 4 patients. Ann Int Med 2020;M20‑1342. doi:
10.7326/M20‑1342.
13. Davies A, Thompson K, Giri K, Kafatos G, Walker J, Bennett A.
Testing the efficacy of homemade masks: Would they protect
in an influenza pandemic?. Disaster Med Public Health Prep
2013;7:413‑18.
14. Konda A, Prakash A, Moss GA, Schmoldt M, Grant GD, Guha S.
Aerosol filtration efficiency of common fabrics used in respiratory
cloth masks. ACS Nano 2020;14:6339‑47.
15. Neupane B, Mainali S, SharmaA, Giri B. Optical microscopic study
of surface morphology and filtering efficiency of face masks. Peer
J 2019;7:e7142.
16. Chughtai A, Seale H, Dung T, Hayen A, Rahman B,
Raina MacIntyre C. Compliance with the use of medical and
cloth masks among healthcare workers in Vietnam. Ann Occupat
Hygiene 2016;60:619‑30.
17. Shakya K, Noyes A, Kallin R, Peltier R. Evaluating the efficacy
of cloth facemasks in reducing particulate matter exposure. Expo
Sci Environ Epidemiol 2016;27:352‑57.
18. Jung H, Kim J, Lee S, Lee J, Kim J, Tsai P, et al. Comparison
of filtration efficiency and pressure drop in anti‑yellow sand
masks, quarantine masks, medical masks, general masks, and
handkerchiefs. Aerosol Air Qual Res 2014;14:991‑1002.
19. Rengasamy S, Eimer B, Shaffer E. Simple respiratory
protection‑evaluation of the filtration performance of cloth masks
and common fabric materials against 20–1000 nm size particles.
Ann Occup Hyg 2010;54:789‑98.
20. Dato VM, Hostler D, Hahn ME. Simple respiratory mask. Emerg
Infect Dis 2006;12:1033‑4.
21. van der Sande M, Teunis P, Sabel R. Professional and home‑made
face masks reduce exposure to respiratory infections among the
general population. PLoS One 2008;3:e2618.
22. Institute of Medicine (IOM) National Academy of Sciences.
Reusability of Facemasks During an Influenza Pandemic: Facing
the Flu Committee on the Development of Reusable Facemasks for
Use During an Influenza Pandemic. CIDRAP; 2020. Available from:
https://www.cidrap.umn.edu/news‑perspective/2006/04/
iom‑assesses‑reuse‑masks‑flu‑pandemic. [Last accessed on 2020
May 30].
23. HowardJ, HuangA, LiZ, TufekciZ, ZdimalV, van der WesthuizenH,
et al. Face Masks Against COVID‑19: An Evidence Review;
2020. Available from: https://www.preprints.org/manuscript
/202004.0203/v1. [Last accessed on 2020 May 03].
24. Milton DK, Fabian MP, Cowling BJ, Grantham ML, McDevitt JJ.
Influenza virus aerosols in human exhaled breath: Particle
size, culturability, and effect of surgical masks. PLoS Pathog
2013;9:e1003205.
25. Brainard J, Jones N, Lake I, Hooper L, Hunter PR. Face mask and
similar barriers to prevent respiratory illness such as Covid‑19:
A rapid systematic review. BMJ: MedRxic [Internet]. [Last accesed
on 2020 Apr 25]. doi: https://doi.org/10.1101/2020.04.01.20049528.
26. Leung N, Chu D, Shiu E, Chan K, McDevitt J, Hau B, et al.
Respiratory virus shedding in exhaled breath and efficacy of face
masks. Nat Med 2020;26:676‑80.
27. Lee S, Grinshpun S, Reponen T. Respiratory performance offered
by N95 respirators and surgical masks: Human subject evaluation
with NaCl aerosol representing bacterial and viral particle size
range. Ann Occup Hyg 2008;52:177‑85.
28. World Health Organization. Advice on the use of Masks in the
Context of COVID‑19; 2020. Available from: https://apps.who.
int/iris/handle/10665/331693. [Last accessed on 2020 May 10].
29. Wei W, Li Z, Chiew C, Yong S, Toh M, Lee V. Presymptomatic
transmission of SARS‑CoV‑2 — Singapore, January 23–March 16,
2020. MMWR Morb Mortal Wkly Rep 2020;69:411‑15.
30. Jefferson T, Del Mar CB, Dooley L, Ferroni E, Al‑Ansary LA,
Bawazeer GA, et al. Physical interventions to interrupt or reduce
the spread of respiratory viruses. Cochrane Database Syst Rev
2011 Jul; 2011(7):CD006207. doi: 10.1002/14651858.CD006207.
pub4.
31. Cooper D, Hinds W, Price J, Weker R, Yee H. Common materials
for emergency respiratory protection: Leakage tests with a
manikin. Am Ind Hyg Assoc J 1983;44:720‑26.
32. Greenhalgh T, Schmid M, Czypionka T, Bassler D, Gruer L.
Face masks for the public during the covid‑19 crisis. BMJ
2020;369:m1435.
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