Abstract The aim of this systematic review and network meta‐analysis is to evaluate the comparative effectiveness of N95, surgical/medical and non‐medical facemasks as personal protective equipment against respiratory virus infection. The study incorporated 35 published and unpublished randomized controlled trials and observational studies investigating specific mask effectiveness against influenza virus, SARS‐CoV, MERS‐CoV and SARS‐CoV‐2. We searched PubMed, Google Scholar and medRxiv databases for studies published up to 5 February 2021 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection. The quality of evidence was estimated using the GRADE approach. High compliance to mask‐wearing conferred a significantly better protection (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.23–0.82) than low compliance. N95 or equivalent masks were the most effective in providing protection against coronavirus infections (OR, 0.30; CI, 0.20–0.44) consistently across subgroup analyses of causative viruses and clinical settings. Evidence supporting the use of medical or surgical masks against influenza or coronavirus infections (SARS, MERS and COVID‐19) was weak. Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the effectiveness may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., P2) for best personal protection in healthcare settings until more evidence on surgical and medical masks is accrued. This study highlights a substantial lack of evidence on the comparative effectiveness of mask types in community settings.
Rationale: Coronavirus disease 2019 (COVID-19) has spread worldwide and poses a threat to humanity.However, no specific therapy has been established for this disease yet.We conducted a systematic review to highlight therapeutic agents that might be effective in treating COVID-19.Methods: We searched Medline, Medrxiv.org, and reference lists of relevant publications to identify articles of in vitro, in vivo, and clinical studies on treatments for severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and COVID-19 published in English until the last update on October 11, 2020.Results: We included 36 studies on SARS, 30 studies on MERS, and 10 meta-analyses on SARS and MERS in this study.Through 12,200 title and 830 full-text screenings for COVID-19, eight in vitro studies, 46 randomized controlled trials (RCTs) on 6,886 patients, and 29 meta-analyses were obtained and investigated.There was no therapeutic agent that consistently resulted in positive outcomes across SARS, MERS, and COVID-19.Remdesivir showed a therapeutic effect for COVID-19 in two RCTs involving the largest number of total participants (n = 1,461).Other therapies that showed an effect in at least two RCTs for COVID-19 were sofosbuvir/daclatasvir (n = 114), colchicine (n = 140), , and convalescent plasma therapy (n = 126).Conclusions: This review provides information to help establish treatment and research directions for COVID-19 based on currently available evidence.Further RCTs are required.
Background: Current facemask guidelines for respiratory viruses vary, impeding policymakers and the general population in determining which facemasks are effective as personal protective equipment (PPE). We aimed to evaluate the comparative efficacy of N95, surgical/medical, and non-medical facemasks in preventing respiratory virus infection.Methods: This living systematic review and network meta-analysis (NMA) incorporated 31 published and unpublished randomised controlled trials (RCTs) and observational studies investigating specific mask efficacy against influenza virus, SARS-CoV-1, MERS-CoV, and SARS-CoV-2. We searched PubMed, Google Scholar, and medRxiv databases for studies published up to 22 October 2020 (PROSPERO registration: CRD42020214729). The primary outcome of interest was the rate of respiratory viral infection.Findings: N95 or equivalent masks were the most effective in conferring protection against coronavirus infections (RR, 0.37; 95% CI, 0.24–0.55; p < 0.001) consistently across subgroup analyses of causative viruses (SARS-CoV-1/MERS-CoV versus SARS-CoV-2) and clinical settings (community setting versus healthcare setting). There was a consistent trend towards reduced coronavirus and influenza infection rates with surgical or medical facemasks, albeit without reaching statistical significance; surgical or medical masks may show effect but lack in statistical power at this stage to detect a difference.Interpretation: Our study confirmed that the use of facemasks provides protection against respiratory viral infections in general; however, the efficacies may vary according to the type of facemask used. Our findings encourage the use of N95 respirators or their equivalents (e.g., FFP2 and KN95) in both community and healthcare settings.Funding: There was no funding source for this study.Declaration of Interests: We declare no competing interests.
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