The Potential for Cloth Masks to Protect Healthcare Providers from SARS-CoV-2: A Rapid Review

Abstract

Purpose: The COVID-19 pandemic has led to a scarcity of personal protective equipment including medical masks for healthcare providers (HCP), especially those in primary care settings. The objective of this review is to summarize current evidence on cloth masks to prevent respiratory viral infections, such as SARS-CoV-2, in HCPs.

Methods: We searched five databases, the CDC (cdc.gov), and reference lists of identified articles on April 3, 2020. All identified publications were independently screened by two reviewers. Two authors independently extracted data and graded the studies. The randomized control trial (RCT) was graded using the CONSORT checklist, and the observational and non-human subject studies were graded using 12 domains common across frequently used critical appraisal tools. All discrepancies were resolved by discussion and consensus.

Results: Our search resulted in 136 original publications. Nine studies met inclusion criteria. We performed a qualitative synthesis of the data from these studies. Four non-randomized trials, three laboratory studies, one single-case experiment, and one RCT were identified. Laboratory studies found cloth materials provide measurable levels of particle filtration but are less efficacious at blocking biologic material than medical masks. The RCT found cloth masks were associated with significantly higher viral infections than medical masks.

Conclusions: Current literature suggests cloth materials are somewhat efficacious in filtering particulate matter and aerosols but provide a worse fit and inferior protection compared to medical masks in clinical environments. The quality and quantity of literature addressing this question is lacking. Cloth masks lack evidence for adequate protection of HCPs against respiratory viral infections.