Effectiveness of masks against viral diseases in healthcare professionals – Kraus – 2021 – Journal of the American College of Emergency Physicians Open

In their study titled “Effectiveness of the N95 Respirator and Surgical Mask Against Viral Respiratory Disease in Health Care: A Systematic Review and Meta-analysis,” Collins et al. present a systematic review and meta-analysis of 9164 participants in 8 studies to assess the effectiveness of surgical masks and N95 respiratory masks in healthcare workers to prevent infection with multiple respiratory viral infections (adenovirus, coronavirus, metapneumovirus, parainfluenza virus, respiratory syncytial virus, influenza and rhinovirus-enterovirus).1 The results of this study suggest that wearing an N95 respirator reduces the risk of infection with non-influenza respiratory viral infections. Specifically, for Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV) -1 and SARS-CoV-2, the use of N95 reduced viral infection by 17% compared to wearing a surgical mask.1 There was no statistically significant difference for infection with laboratory-confirmed influenza infections when wearing an N95 respirator compared to a surgical mask.1

As with any systematic review and meta-analysis, the results are limited by the quality of the available evidence assessed. However, these findings may help inform the science of personal protective equipment (PPE), particularly in the protection of frontline healthcare professionals, including emergency physicians and other staff members. emergency services during current and future pandemics, whether known or emerging viral respiratory illnesses. infections. Specifically, the results of this study may inform supply chain considerations for avoiding PPE shortages and crisis capabilities that were a reality at the start of the COVID-19 pandemic, including decontamination and disposal. unprecedented reuse of N95 respirators.2, 3

During the COVID-19 pandemic, recommendations for mask use have evolved along with our understanding of the transmission of SARS-CoV-2.4-6 Currently available evidence recognizes 3 main modes of transmission of SARS-CoV-2: (1) virus inhalation, (2) virus deposition on mucous membranes and (3) contact with mucous membranes with contaminated hands. the virus.7 Constant wearing of face masks, whether surgical or N95, appears to decrease the spread of SARS-CoV-2 in both communities8 and health facilities,9 especially in high risk places such as emergency.ten The availability and use of different types of masks, in community and healthcare settings, to mitigate the spread of viral respiratory infections, engenders considerations from various angles – political, economic, clinical and supply chain – for to name a few. Addressing each of these perspectives is beyond the scope of this editorial.

The scientific evidence is clear and compelling: Consistent and appropriate use of appropriate masks is a critical component, along with other measures such as vaccinations, tedious hand hygiene, and physical distancing, to reduce the spread of disease. viral respiratory infections, including SARS-CoV-2.11 While not a substitute for other mitigation measures, masks on their own can significantly reduce the spread of symptomatic infections, both in the community and in healthcare settings. A recent large-scale randomized trial showed that the use of masks in rural areas of Bangladesh reduced symptomatic COVID infections by 9%.12 In the United States, counties requiring a school mask have lower pediatric case rates of COVID-19 than counties without a school mask requirement.13 A comparison of ≈1,000 schools in Arizona found a 3.5 times higher likelihood of school-associated COVID-19 outbreaks in schools without a mask requirement compared to schools with a mask requirement.14

The finding that the use of the N95 respirator protects healthcare professionals and all healthcare workers who face non-influenza viral respiratory illnesses, especially compared to surgical masks, is not necessarily new.15 Similar to previous studies, N95 respirators did not appear to provide better protection than surgical masks against influenza.16 Rather than the results themselves, the novelty of the work of Collins et al. lies in its application, especially in the midst of a global pandemic caused by a novel viral respiratory infection. Surgical masks and N95 should both be part of a PPE plan and are important for reducing the spread of viral respiratory illnesses in community and healthcare settings.17

Many medical organizations and professional societies have approved the availability of appropriate PPE, including N95 respirators, for frontline healthcare professionals.18-20 The results of Collins et al. can help inform supply chain considerations for hospitals, healthcare systems, nursing facilities, doctor’s offices, clinics and other healthcare settings so that N95 respirators can continue to function. be a priority to protect healthcare workers against non-influenza respiratory viral infections.5 Consideration should be given to the ideal type of mask, in part depending on the patient population and the clinical setting of care. For example, in a hospital ward caring for patients with confirmed influenza and without evidence of other non-influenza viral infections, surgical masks might be adequate to reduce the risk of influenza infections among healthcare workers. . Conversely, based on the results of this study and others, in an emergency department (ED) where patients have undifferentiated symptoms and are at risk for several viral respiratory infections, including SARS-CoV-2, N95 respirators should be considered the first line. masks to protect emergency physicians, nurses and other healthcare professionals.

Finally, several caveats regarding the use of N95 respirators are worth discussing. First, N95 respirators require the proper fit to be effective. For various reasons, some people may not be able to obtain an adequate seal to be effectively protected by an N95 respirator. Arrangements must be made for these people to provide protection against non-influenza viral respiratory infections. N95 respirators are potentially less comfortable and more irritating to the face and skin, especially if worn for long periods of time. Finally, from a systems point of view, N95 masks are more expensive and potentially more limited in quantity than surgical masks. These are important considerations in building and maintaining a supply chain that meets the dynamic clinical needs of a pandemic response.

There is uncertainty regarding emerging infectious diseases, including respiratory viral infections. As the delta variant has become the dominant strain of SARS-CoV-2 in the United States, reaffirming a multifaceted mitigation strategy that includes masks, principles of physical distancing, tedious hand hygiene, and universal vaccination is fundamental to reducing the spread of infections. Masks are necessary, but not overwhelmingly sufficient to curb the spread of SARS-CoV-2 infections and COVID-19 disease.17

Collins et al. help provide additional evidence for future investigation of which masks, worn in what situations, best protect healthcare professionals. This question is particularly relevant in front-line settings, such as emergency rooms, where HIV positive rates are higher than in other health care settings.9 There remains an opportunity and need for well-controlled prospective studies of clinical and community situations that merit specific types of PPE, including masks and other equipment, to protect healthcare workers and patients from the risk of injury. continued spread of infections. In the meantime, masking strategies for health workers should be targeted above the minimum levels of protection required, based on the best available evidence regarding the characteristics of the infection, including molecular qualities and modes. and methods of transmission.

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