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Review
. 2020 Oct 20;173(8):642-649.
doi: 10.7326/M20-3234. Epub 2020 Jun 18.

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1)

Amir Qaseem  1 , Itziar Etxeandia-Ikobaltzeta  1 , Jennifer Yost  2 , Matthew C Miller  3 , George M Abraham  4 , Adam J Obley  5 , Mary Ann Forciea  3 , Janet A Jokela  6 , Linda L Humphrey  5 ; Scientific Medical Policy Committee of the American College of Physicians; Robert M Centor, Rebecca Andrews, Thomas A Bledsoe, Ray Haeme, Devan L Kansagara, Maura Marcucci
Collaborators, Affiliations
Review

Use of N95, Surgical, and Cloth Masks to Prevent COVID-19 in Health Care and Community Settings: Living Practice Points From the American College of Physicians (Version 1)

Amir Qaseem et al. Ann Intern Med. .

Abstract

Controversy exists around the appropriate types of masks and the situations in which they should be used in community and health care settings for the prevention of SARS-CoV-2 infection. In this article, the American College of Physicians (ACP) provides recommendations based on the best available evidence through 14 April 2020 on the effectiveness of N95 respirators, surgical masks, and cloth masks in reducing transmission of infection. The ACP plans periodic updates of these recommendations on the basis of ongoing surveillance of the literature for 1 year from the initial search date.

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Conflict of interest statement

Disclosures: All financial and intellectual disclosures of interest were declared and potential conflicts were discussed and managed. Dr. Akl participated in discussion of the Practice Points but was recused from authorship and voting due to a moderate-level conflict of interest (author of recent relevant systematic review). A record of disclosures of interest and management of conflicts of interest is kept for each Scientific Medical Policy Committee meeting and conference call and can be viewed at https://www.acponline.org/about-acp/who-we-are/leadership/boards-committees-councils/scientific-medical-policy-committee/disclosure-of-interests-and-conflict-of-interest-management-summary-for-scientific-medical-policy. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-3234.

Figures

Figure.
Figure.. Evidence description.
Evidence search and assessment conducted by the Pacific Northwest Evidence-based Practice Center and funded by the Agency for Healthcare Research and Quality (2). Current search for evidence, completed on 14 April 2020 and updated through 2 June 2020, aimed to identify RCTs and OBSs on the use of N95 respirators, surgical masks, and cloth masks to prevent SARS-CoV-2 infection and coronaviruses (SARS-CoV-1, MERS-CoV) infections and RCTs of N95 respirators, surgical masks, and cloth masks to prevent influenza-like (influenza or other respiratory viruses) infections, as well as all studies on the reuse/extended use of N95 respirators. MERS-CoV = Middle East respiratory syndrome coronavirus; OBS = observational study; PCP = primary care physician; PPE = personal protective equipment; RCT = randomized controlled trial; SARS-CoV-2 = severe acute respiratory syndrome 2. * Different types of respiratory PPE intervention were generally used in addition to additional PPE required for droplet precautions (e.g., gowns, gloves) and hand hygiene in health care settings.
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Comment in

References

    1. Chou R , Dana T , Jungbauer R , et al. Masks for Prevention of COVID-19 in Community and Healthcare Settings: A Living Rapid Review. Rapid Evidence Product. (Prepared by the Pacific Northwest Evidence-based Practice Center under Contract No. 290-2015-00009-I). AHRQ publication no. 20-EHC016. Agency for Healthcare Research and Quality; June 2020. doi:10.23970/AHRQEPCCOVIDMASKS - DOI
    1. Chou R, Dana T, Jungbauer R, et al. Masks for prevention of respiratory virus infections including SARS-CoV-2 in health care and community settings. A living and rapid review. Ann Intern Med. [Forthcoming]. - PMC - PubMed
    1. World Health Organization. Advice on the use of masks in the context of COVID-19. Interim guidance 6 April 2020. Accessed at https://apps.who.int/iris/rest/bitstreams/1274280/retrieve on 29 April 2020.
    1. Centers for Disease Control and Prevention. Recommendation regarding the use of cloth face coverings, especially in areas of significant community-based transmission. Accessed at www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.... on 7 May 2020.
    1. Centers for Disease Control and Prevention. Evaluating and testing persons for coronavirus disease 2019 (COVID-19). Accessed at www.cdc.gov/coronavirus/2019-ncov/hcp/clinical-criteria.html on 8 May 2020.

MeSH terms