Face masks in the community setting, as a protection against respiratory viruses (multiple reviews)

Added August 3, 2020

What is this?

Physical interventions to prevent the transmission of COVID-19 are important. Face masks are one of the methods being used to try to achieve this.

Several relevant systematic reviews have been done. More details, including citations and links to the full reviews, are available lower down this summary.

What was found:

MacIntyre et al. (2020) reported that community face mask use by people not displaying symptoms of COVID-19 may reduce community transmission. They also noted that mask use by symptomatic people in the community may be an important factor in universal community face mask use. Face mask use was effective with or without additional hand hygiene measures.

At the time of the Cowling et al. (2010) and bin-Reza et al. (2012) reviews, there was limited evidence to support the effectiveness of face masks in community settings. They noted that face masks are best used as part of a multi-faceted approach, including hand hygiene and environmental restrictions such as physical distancing.

These three reviews reported that:

  • early, correct, and consistent use of face masks may improve their effectiveness
  • face mask use may reduce secondary transmission of respiratory infections within households
  • face mask use by patients who are already infected by the virus may reduce onward respiratory spread
  • face mask use and hand hygiene measures may reduce respiratory infection transmission in university and college settings.

Barasheed et al. (2016) reported that wearing a facemask at mass gatherings may decrease the likelihood of developing a respiratory infection. Discomfort and difficulty breathing were the most common barriers reported in relation to facemask use at mass gathering events.

What are the reviews:

Citation: MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. International Journal of Nursing Studies. 2020 Aug:108;103629.

In this rapid review, the authors searched for randomized trials of respiratory protection by healthcare workers, sick patients and community members. They restricted their review to publications in English and did their searches up to 17 April 2020. They included 8 relevant trials based in community settings and 5 focused on source control (face mask use by sick patients).

Citation: Cowling BJ, Zhou Y, Ip DK, et al. Face masks to prevent transmission of influenza virus: a systematic review. Epidemiology and Infection. 2010;138(4):449–56.

In this systematic review, the authors searched for effectiveness studies evaluating face masks and respirators to reduce transmission of influenza viruses. They restricted their search to articles published in English up to August 2009. They included 6 randomized trials, 4 observational studies and 1 experimental volunteer study, across a range of settings (healthcare, community and experimental).

Citation: bin-Reza F, Lopez Chavarrias V, Nicoll A, et al. The use of masks and respirators to prevent transmission of influenza: a systematic review of the scientific evidence. Influenza and Other Respiratory Viruses. 2012;6(4):257–67.

In this systematic review, the authors searched for research evaluating masks and respirators in the prevention of transmission of influenza and other respiratory viruses. They searched for articles published in English up to January 2011. They identified 8 randomized trials and 9 observational studies.

Citation: Barasheed O, Alfelali M, Mushta S, et al. Uptake and effectiveness of facemask against respiratory infections at mass gatherings: a systematic review. International Journal of Infect Diseases. 2016;47:105–11.

In this systematic review, the authors searched for research evaluating face masks to prevent transmission of respiratory infections at mass gatherings. They limited their search to articles published in English up to February 2016. They identified 23 observational studies and 2 trials (including 1 randomized trial).

Other reviews of this topic:

Evidence Aid has also prepared combined summaries on respiratory protection for healthcare workers and face mask use by symptomatic individuals in the community.


Disclaimer: This summary has been written by staff and volunteers of Evidence Aid in order to make the content of the original document accessible to decision makers who are searching for the available evidence on the coronavirus (COVID-19) but may not have the time, initially, to read the original report in full. This summary is not intended as a substitute for the medical advice of physicians, other health workers, professional associations, guideline developers, or national governments and international agencies. If readers of this summary think that the evidence that is presented within it is relevant to their decision-making they should refer to the content and details of the original article, and the advice and guidelines offered by other sources of expertise, before making decisions. Evidence Aid cannot be held responsible for any decisions made about the coronavirus (COVID-19) on the basis of this summary alone.