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Annals of Internal Medicine Dec 2022It is uncertain if medical masks offer similar protection against COVID-19 compared with N95 respirators. (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
It is uncertain if medical masks offer similar protection against COVID-19 compared with N95 respirators.
OBJECTIVE
To determine whether medical masks are noninferior to N95 respirators to prevent COVID-19 in health care workers providing routine care.
DESIGN
Multicenter, randomized, noninferiority trial. (ClinicalTrials.gov: NCT04296643).
SETTING
29 health care facilities in Canada, Israel, Pakistan, and Egypt from 4 May 2020 to 29 March 2022.
PARTICIPANTS
1009 health care workers who provided direct care to patients with suspected or confirmed COVID-19.
INTERVENTION
Use of medical masks versus fit-tested N95 respirators for 10 weeks, plus universal masking, which was the policy implemented at each site.
MEASUREMENTS
The primary outcome was confirmed COVID-19 on reverse transcriptase polymerase chain reaction (RT-PCR) test.
RESULTS
In the intention-to-treat analysis, RT-PCR-confirmed COVID-19 occurred in 52 of 497 (10.46%) participants in the medical mask group versus 47 of 507 (9.27%) in the N95 respirator group (hazard ratio [HR], 1.14 [95% CI, 0.77 to 1.69]). An unplanned subgroup analysis by country found that in the medical mask group versus the N95 respirator group RT-PCR-confirmed COVID-19 occurred in 8 of 131 (6.11%) versus 3 of 135 (2.22%) in Canada (HR, 2.83 [CI, 0.75 to 10.72]), 6 of 17 (35.29%) versus 4 of 17 (23.53%) in Israel (HR, 1.54 [CI, 0.43 to 5.49]), 3 of 92 (3.26%) versus 2 of 94 (2.13%) in Pakistan (HR, 1.50 [CI, 0.25 to 8.98]), and 35 of 257 (13.62%) versus 38 of 261 (14.56%) in Egypt (HR, 0.95 [CI, 0.60 to 1.50]). There were 47 (10.8%) adverse events related to the intervention reported in the medical mask group and 59 (13.6%) in the N95 respirator group.
LIMITATION
Potential acquisition of SARS-CoV-2 through household and community exposure, heterogeneity between countries, uncertainty in the estimates of effect, differences in self-reported adherence, differences in baseline antibodies, and between-country differences in circulating variants and vaccination.
CONCLUSION
Among health care workers who provided routine care to patients with COVID-19, the overall estimates rule out a doubling in hazard of RT-PCR-confirmed COVID-19 for medical masks when compared with HRs of RT-PCR-confirmed COVID-19 for N95 respirators. The subgroup results varied by country, and the overall estimates may not be applicable to individual countries because of treatment effect heterogeneity.
PRIMARY FUNDING SOURCE
Canadian Institutes of Health Research, World Health Organization, and Juravinski Research Institute.
Topics: Humans; COVID-19; N95 Respirators; SARS-CoV-2; Masks; Respiratory Protective Devices; Canada; Health Personnel
PubMed: 36442064
DOI: 10.7326/M22-1966 -
American Journal of Infection Control Jul 2021Based on the status of the COVID-19 global pandemic, there is an urgent need to systematically evaluate the effectiveness of wearing masks to protect public health from... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Based on the status of the COVID-19 global pandemic, there is an urgent need to systematically evaluate the effectiveness of wearing masks to protect public health from COVID-19 infection.
METHODS
The Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement was consulted to report this systematic review. We conducted a systematic review and meta-analysis to evaluate the effectiveness of using face masks to prevent the spread of SARS-CoV-2. Relevant articles were retrieved from PubMed, Web of Science, ScienceDirect, Cochrane Library, and Chinese National Knowledge Infrastructure, VIP (Chinese) database. There were no language restrictions. This study was registered with PROSPERO under the number CRD42020211862.
RESULTS
A total of 6 studies were included, involving 4 countries, after a total of 5,178 eligible articles were searched in databases and references. In general, wearing a mask was associated with a significantly reduced risk of COVID-19 infection (OR = 0.38, 95% CI: 0.21-0.69, I = 54.1%). For the healthcare workers group, masks were shown to have a reduced risk of infection by nearly 70%. Sensitivity analysis showed that the results were robust.
CONCLUSIONS
The results of this systematic review and meta-analysis support the conclusion that wearing a mask could reduce the risk of COVID-19 infection. Robust randomized trials are needed in the future to better provide evidence for these interventions.
Topics: COVID-19; Humans; Masks; SARS-CoV-2
PubMed: 33347937
DOI: 10.1016/j.ajic.2020.12.007 -
Seminars in Fetal & Neonatal Medicine Oct 2023Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in... (Review)
Review
Opportunities to learn and maintain competence in neonatal intubation have decreased. As many clinicians providing care to the newborn infant are not skilled in intubation, alternative strategies are critical. Most preterm infants breathe spontaneously, and require stabilisation rather than resuscitation at birth. Use of tactile stimulation, deferred cord clamping, and avoidance of hypoxia can help optimise breathing for these infants. Nasal devices appear a promising alternative to the face mask for early provision of respiratory support. In term and near-term infants, supraglottic airways may be the most effective initial approach to resuscitation. Use of supraglottic airways during resuscitation can be taught to a range of providers, and may reduce need for intubation. While face mask ventilation is an important skill, it is challenging to perform effectively. Identification of the best approach to training the use of these devices during neonatal resuscitation remains an important priority.
Topics: Infant; Infant, Newborn; Humans; Intubation, Intratracheal; Infant, Premature; Resuscitation; Masks; Respiration
PubMed: 38000926
DOI: 10.1016/j.siny.2023.101488 -
Pneumologie (Stuttgart, Germany) Jul 2020
Topics: Aerosols; Infection Control; Masks; Personal Protective Equipment
PubMed: 32583379
DOI: 10.1055/a-1199-4557 -
European Archives of... Feb 2022The aim of this study was to reveal the effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints.
PURPOSE
The aim of this study was to reveal the effect of N95 and surgical masks on mucociliary clearance function and sinonasal complaints.
METHODS
Sixty participants were enrolled in this study, including 30 people in N95 mask group and 30 people in surgical mask group. Two interviews, three days apart, were performed with all participants. The participants were asked not to use any mask before the first interview while they were asked to use the determined mask just before the second interview for 8 h. In both interviews, the mucociliary clearance times (MCTs) were measured and participants were asked to score ten distinct sinonasal complaints using visual analog scale (VAS). Data obtained from first interview were named pre-mask data, data obtained from second interview were called after-mask data. In both groups, pre-mask MCTs and VAS scores were compared with after-mask MCTs and VAS scores.
RESULTS
After-mask MCTs (mean = 13.03 ± 6.05 min) were significantly longer than pre-mask MCTs (mean = 10.19 ± 4.21 min) in N95 mask group (p = 0.002). No significant difference was found between after-mask and pre-mask MCTs (mean = 12.05 ± 5.21 min, mean = 11.00 ± 5.44 min, respectively) in surgical mask group (p = 0.234). When after-mask VAS scores were compared with pre-mask VAS scores, it was found that N95 mask use increased nasal blockage and postnasal discharge, surgical mask usage increased nasal blockage.
CONCLUSION
While the use of N95 mask leads to nasal blockage and postnasal discharge, surgical mask use results in nasal blockage. N95 masks cause impairment in mucociliary clearance function. But all these effects are mild. Surgical masks have not been found to have any effect on mucociliary clearance function.
Topics: COVID-19; Humans; Masks; Mucociliary Clearance; N95 Respirators; SARS-CoV-2
PubMed: 33912995
DOI: 10.1007/s00405-021-06838-x -
The American Journal of Medicine Nov 2022
Topics: Humans; Masks; Equipment Design; Policy
PubMed: 35820454
DOI: 10.1016/j.amjmed.2022.06.014 -
Infectious Disease Clinics of North... Mar 2022COVID-19 is a nonspecific viral illness caused by a novel coronavirus, SARS-CoV-2, and led to an ongoing global pandemic. Transmission is primarily human-to-human via... (Review)
Review
COVID-19 is a nonspecific viral illness caused by a novel coronavirus, SARS-CoV-2, and led to an ongoing global pandemic. Transmission is primarily human-to-human via contact with respiratory particles containing infectious virus. The risk of transmission to health care personnel is low with proper use of personal protective equipment, including gowns, gloves, N95 or surgical mask, and eye protection. Additional measures affecting the risk of transmission include physical distancing, hand hygiene, routine cleaning and disinfection, appropriate air handling and ventilation, and public health interventions such as universal masking and stay-at-home orders.
Topics: COVID-19; Humans; Infection Control; Masks; Pandemics; Personal Protective Equipment
PubMed: 35168708
DOI: 10.1016/j.idc.2021.12.002 -
Journal of General Internal Medicine Nov 2020
Topics: Humans; Masks
PubMed: 32909228
DOI: 10.1007/s11606-020-06095-4 -
The American Journal of the Medical... Jun 2022
Topics: Humans; Masks
PubMed: 35378096
DOI: 10.1016/j.amjms.2022.03.006 -
The American Journal of the Medical... May 2022During the COVID-19 pandemic, studies of the physiological effects of masking during exercise have been rare.
BACKGROUND
During the COVID-19 pandemic, studies of the physiological effects of masking during exercise have been rare.
METHODS
Twelve healthcare workers performed a cardiopulmonary exercise test while wearing a surgical mask, an N95 mask, or no mask. Variables were collected at rest, warm-up, anaerobic threshold, and maximal exercise.
RESULTS
From rest to maximal exercise, both the surgical and N95 masks decreased inspiratory flow, minute ventilation, and prolonged inspiratory time compared to the no mask condition. Oxygen uptake (VO) and oxygen pulse (VO/HR) decreased at rest, warm-up, and maximal exercise in both the surgical and N95 mask conditions (vs. no mask). At the anaerobic threshold, the surgical mask also led to a reduction of oxygen uptake and oxygen pulse compared to no mask. The maximal oxygen uptake (VO% predicted) also decreased in both the surgical and N95 mask conditions. In addition, the severity of dyspnea increased, and exercise time decreased for both surgical and N95 masks. Compared to no mask, wearing an N95 mask led to lower breathing frequency and lower ventilation efficacy (assessed by VE/VCO and VE/VO) from rest to maximal exercise (all p < 0.05 for trend). Wearing an N95 also led to retention of carbon dioxide (p < 0.05 for trend).
CONCLUSIONS
Wearing a surgical mask leads to a somewhat negative impact on cardiopulmonary function, and this effect is more serious with an N95 mask. Attention should be paid to exercise while wearing surgical or N95 masks.
Topics: COVID-19; Humans; Masks; N95 Respirators; Oxygen; Pandemics
PubMed: 35235811
DOI: 10.1016/j.amjms.2022.02.006