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Review
. 2025 Oct 20;22(10):1590.
doi: 10.3390/ijerph22101590.

Evidence of Face Masks and Masking Policies for the Prevention of SARS-CoV-2 Transmission and COVID-19 in Real-World Settings: A Systematic Literature Review

Noe C Crespo  1   2 , Savannah Shifflett  1   2 , Kayla Kosta  1   2 , Joelle M Fornasier  1 , Patricia Dionicio  1   2 , Eric T Hyde  1   2 , Job G Godino  3 , Christian B Ramers  3 , John P Elder  1   2 , Corinne McDaniels-Davidson  1
Affiliations
Review

Evidence of Face Masks and Masking Policies for the Prevention of SARS-CoV-2 Transmission and COVID-19 in Real-World Settings: A Systematic Literature Review

Noe C Crespo et al. Int J Environ Res Public Health. .

Abstract

Objectives: Prevention of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the disease COVID-19 is a public health priority. The efficacy of non-pharmaceutical interventions such as wearing face masks to prevent SARS-CoV-2 infection has been well established in controlled settings. However, evidence for the effectiveness of face masks in preventing SARS-CoV-2 transmission within real-world settings is limited and mixed. The present systematic review evaluated the effectiveness of face mask policies and mask wearing to prevent SARS-CoV-2 transmission and COVID-19 in real-world settings. Methods: Following PRISMA guidelines, scientific databases, and gray literature, were searched through June 2023. Inclusion criteria were as follows: (1) studies/reports written in or translated to English; (2) prospectively assessed incidence of SARS-CoV-2 or COVID-19; (3) assessed the behavior and/or policy of mask-wearing; and (4) conducted in community/public settings (i.e., not laboratory). Studies were excluded if they did not parse out data specific to the effect of mask wearing (behavior and/or policy) and subsequent SARS-CoV-2 transmission or COVID-19 disease or if they relied solely on statistical models to estimate the effects of mask wearing on transmission. A total of 2616 studies were initially identified, and 470 met inclusion and exclusion criteria for full-text review. The vote counting method was used to evaluate effectiveness, and risk of bias was assessed using JBI critical appraisal tools. Results: A total of 79 unique studies met the final inclusion criteria, and their data were abstracted and evaluated. Study settings included community/neighborhood settings (n = 34, 43%), healthcare settings (n = 30, 38%), and school/universities (n = 15, 19%). A majority of studies (n = 61, 77%) provided evidence to support the effectiveness of wearing face masks and/or face mask policies to reduce the transmission of SARS-CoV-2 and/or prevention of COVID-19. Effectiveness of mask wearing did not vary substantially by study design (67-100%), type of mask (77-100%), or setting (80-91%), while 85% of masking policies specifically reported a benefit. Conclusions: This systematic literature review supports public health recommendations and policies that encourage the public to wear face masks to reduce the risk of SARS-CoV-2 infection and COVID-19 in multiple real-world settings. Effective communication strategies are needed to encourage and support the use of face masks by the general public, particularly during peak infection cycles.

Keywords: SARS-CoV-2; masks; real-world settings.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
PRISMA diagram.
See this image and copyright information in PMC

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