Peer-Reviewed Medical Study Concludes "cloth masks should not be recommended."
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The following are excerpts from a peer-reviewed medical study on the use of cloth face masks. The results are very clear and speak for themselves. For the quick version, scroll down and read the parts highlighted in bold text:
Funding to conduct this study was received from the Australian Research Council (ARC) (grant number LP0990749).
14 secondary-level/tertiary-level hospitals in Hanoi, Vietnam.
1607 hospital HCWs aged ≥18 years working full-time in selected high-risk wards.
Further, there is a lack of high-quality studies around the use of facemasks and respirators in the healthcare setting, with only four randomised clinical trials (RCTs) to date.15 Despite widespread use, cloth masks are rarely mentioned in policy documents,16 and have never been tested for efficacy in a RCT. Very few studies have been conducted around the clinical effectiveness of cloth masks, and most available studies are observational or in vitro.6
Emerging infectious diseases are not constrained within geographical borders, so it is important for global disease control that use of cloth masks be underpinned by evidence. The aim of this study was to determine the efficacy of cloth masks compared with medical masks in HCWs working in high-risk hospital wards, against the prevention of respiratory infections.
This study is the first RCT of cloth masks, and the results caution against the use of cloth masks. This is an important finding to inform occupational health and safety. Moisture retention, reuse of cloth masks and poor filtration may result in increased risk of infection. Further research is needed to inform the widespread use of cloth masks globally. However, as a precautionary measure, cloth masks should not be recommended for HCWs, particularly in high-risk situations, and guidelines need to be updated.
the results of this study could be interpreted as partly being explained by a detrimental effect of cloth masks.
We have provided the first clinical efficacy data of cloth masks, which suggest HCWs should not use cloth masks as protection against respiratory infection. Cloth masks resulted in significantly higher rates of infection than medical masks, and also performed worse than the control arm. The controls were HCWs who observed standard practice, which involved mask use in the majority, albeit with lower compliance than in the intervention arms. The control HCWs also used medical masks more often than cloth masks. When we analysed all mask-wearers including controls, the higher risk of cloth masks was seen for laboratory-confirmed respiratory viral infection.
Laboratory tests showed the penetration of particles through the cloth masks to be very high (97%) compared with medical masks (44%) (used in trial) and 3M 9320 N95 (<0.01%), 3M Vflex 9105 N95 (0.1%).
The most common approach to washing cloth masks was self-washing (456/569, 80%), followed by combined self-washing and hospital laundry (91/569, 16%), and only hospital laundry (22/569, 4%). Adverse events associated with facemask use were reported in 40.4% (227/562) of HCWs in the medical mask arm and 42.6% (242/568) in the cloth mask arm (p value 0.450). General discomfort (35.1%, 397/1130) and breathing problems (18.3%, 207/1130) were the most frequently reported adverse events.
The trend for all outcomes showed the lowest rates of infection in the medical mask group and the highest rates in the cloth mask arm. The study design does not allow us to determine whether medical masks had efficacy or whether cloth masks were detrimental to HCWs by causing an increase in infection risk. Either possibility, or a combination of both effects, could explain our results. It is also unknown whether the rates of infection observed in the cloth mask arm are the same or higher than in HCWs who do not wear a mask, as almost all participants in the control arm used a mask. The physical properties of a cloth mask, reuse, the frequency and effectiveness of cleaning, and increased moisture retention, may potentially increase the infection risk for HCWs. The virus may survive on the surface of the facemasks,29 and modelling studies have quantified the contamination levels of masks.30 Self-contamination through repeated use and improper doffing is possible. For example, a contaminated cloth mask may transfer pathogen from the mask to the bare hands of the wearer. We also showed that filtration was extremely poor (almost 0%) for the cloth masks.
Observations during SARS suggested double-masking and other practices increased the risk of infection because of moisture, liquid diffusion and pathogen retention.31 These effects may be associated with cloth masks.
In the interest of providing safe, low-cost options in low income countries, there is scope for research into more effectively designed cloth masks, but until such research is carried out, cloth masks should not be recommended.
Pandemics and emerging infections are more likely to arise in low-income or middle-income settings than in wealthy countries. In the interests of global public health, adequate attention should be paid to cloth mask use in such settings. The data from this study provide some reassurance about medical masks, and are the first data to show potential clinical efficacy of medical masks. Medical masks are used to provide protection against droplet spread, splash and spray of blood and body fluids. Medical masks or respirators are recommended by different organisations to prevent transmission of Ebola virus, yet shortages of PPE may result in HCWs being forced to use cloth masks.38–40 In the interest of providing safe, low-cost options in low income countries, there is scope for research into more effectively designed cloth masks, but until such research is carried out, cloth masks should not be recommended. We also recommend that infection control guidelines be updated about cloth mask use to protect the occupational health and safety of HCWs.
Medical masks or respirators are recommended by different organisations to prevent transmission of Ebola virus, yet shortages of PPE may result in HCWs being forced to use cloth masks.38–40 In the interest of providing safe, low-cost options in low income countries, there is scope for research into more effectively designed cloth masks, but until such research is carried out, cloth masks should not be recommended. We also recommend that infection control guidelines be updated about cloth mask use to protect the occupational health and safety of HCWs.
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