Wearing masks to reduce the spread of respiratory viruses: a systematic evidence mapping

Abstract

Since the outbreak of coronavirus disease in 2019, the controversy over the effectiveness, safety, and enforceability of masks used by the public has been prominent. This study aims to identify, describe, and organize the currently available high-quality design evidence concerning mask use during the spread of respiratory viruses and find evidence gaps. Databases including PubMed, Cochrane Library, Web of Science, EMBASE, WHO International Clinical Trials Registry Platform (ICTRP), clinical trial registry, gray literature database, and reference lists of articles were searched for relevant randomized controlled trials (RCTs) and systematic reviews (SRs) in April 2020. The quality of the studies was assessed using the risk of bias tool recommended by the Cochrane Handbook Version 5.1.0 and the Assessment of Multiple Systematic Reviews (AMSTAR 2) tool. A bubble plot was designed to display information in four dimensions. Finally, twenty-one RCTs and nine SRs met our inclusion criteria. Most studies were of "Low quality" and focused on healthcare workers. Six RCTs reported adverse effects, with one implying that the cloth masks reuse may increase the infection risk. When comparing masks with usual practice, over 70% RCTs and also SRs showed that masks were "beneficial" or "probably beneficial"; however, when comparing N95 respirators with medical masks, 75% of SRs showed "no effect", whereas 50% of RCTs showed "beneficial effect". Overall, the current evidence provided by high-quality designs may be insufficient to deal with a second impact of the pandemic. Masks may be effective in interrupting or reducing the spread of respiratory viruses; however, the effect of an N95 respirator or cloth masks versus medical masks is unclear. Additional high-quality studies determining the impact of prolonged mask use on vulnerable populations (such as children and pregnant women), the possible adverse effects (such as skin allergies and shortness of breath) and optimal settings and exposure circumstances for populations to use masks are needed.

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“…Moreover, our study conducted a systematic and exhaustive search of four databases and utilized a relatively dependable study design, SR. Then, we used the AMSTAR-2 tool to assess the methodological quality of inclusion in SRs, and the GRADE system to assess the quality of evidence for inclusion in SR outcomes, visually presenting the results of the existing evidence in the form of a bubble plot based on multiple significant dimensions. In addition, we determine the rating of conclusions based on the description of research results and conclusions, which may avoid the uncertainty caused by policy recommendations determined solely based on research results or conclusions in a certain sense [ 50 ], which are not only instructive for future research and important for preventing the waste of academic resources, but also essential for policymakers. Nonetheless, it is important to note that this research does have a few limitations.…”

Use of traditional Chinese medicine for the treatment and prevention of COVID-19 and rehabilitation of COVID-19 patients: An evidence mapping study

“…This study was based on the methodology of Global Evidence Mapping ( Katz et al, 2003 ; Bragge et al, 2011 ) and Campbell evidence and gap map ( White et al, 2020 ) with some modifications ( Yang et al, 2018 ; Li et al, 2020 ; Li et al, 2021a ; Li et al, 2021b ). All authors, including experts on evidence-based medicine, EM, and TCM, thoroughly discussed and approved the framework of this study.…”

Extracorporeal Membrane Oxygenation Treatment for Adults: An Evidence Mapping Based on Systematic Reviews

“…Moreover, our study conducted a systematic and exhaustive search of four databases and a relatively dependable study design, SR. Then, we used the AMSTAR-2 tool to assess the methodological quality of inclusion in SRs, and the GRADE system to assess the quality of evidence for inclusion in SR outcomes, visually presenting the results of the existing evidence in the form of a bubble plot based on multiple signi cant dimensions. In addition, we determine the rating of conclusions based on the description of research results and conclusions, which may avoid the uncertainty caused by policy recommendations determined solely based on research results or conclusions in a certain sense [51], which are not only instructive for future research and important for preventing the waste of academic resources, but also essential for policymakers. Nonetheless, it is important to note that this research does have a few limitations.…”