A review on the effectiveness of various masks in protection against COVID-19


  • Remya Vinod
  • Swathi
  • Vinod Chandran




Mask, COVID19, pandemic, double mask, N95


As of June1st 2021, more than 17 crore people have been infected with COVID-19 across the globe, and almost 3 crore people have been infected in India. The virus can spread through even normal actions like talking with particle emission rates inversely correlating with word frequency and volume, which can be reduced by covering the mouth. However, there is debate concerning the effectiveness of the various face mask types in preventing respiratory infections. Many have reported that wearing a mask is uncomfortable, especially when worn for long hours and while performing strenuous activities. Another disease that has raised its head is mucormycosis. However, COVID-19 can be a serious infection in many, with many fatalities. It is not yet clear how much protection vaccines give, and in a hugely populated country like India, it may be very difficult to vaccinate the whole population. Moreover, the vaccination for pediatric groups has just started. So, it is imperative to wear masks that can be protective against infection. However, some people believe that a straightforward cotton mask is insufficient. We set out to analyze the efficacy of masks through this investigation. According to the results of this systematic review, there are no studies that give conclusive evidence that using face masks as recommended by current public health guidelines will stop this condition. This is a significant discovery that should be communicated to the scientific community and calls into question the rationale for inconsistent and differing public health recommendations.

Author Biographies

Remya Vinod

Department of Anatomy, K. S. Hegde Medical Academy, NITTE (Deemed to be University), Deralakatte, Mangalore, Karnataka, India.


Department of Anatomy, K. S. Hegde Medical Academy, NITTE (Deemed to be University), Deralakatte, Mangalore, Karnataka, India.

Vinod Chandran

Department of Biochemistry, Kasturba Medical College Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India


Eastwood, K., Durrheim, D., Francis, J. L., d’ Espaignet, E. T., Duncan, S., Islam, F., et al., Knowledge about pandemic influenza and complaints with containment measure amongst Australians. Bull Volt Health Organ 2009; 87: 588-594. DOI: https://doi.org/10.2471/BLT.08.060772

Kutter, J.S., Spronken, M.I., Fraaij, P.L., Fouchier, R.A, Herfst, S. Transmission routes of respiratory viruses among humans. Curr Opin Virol 2018; 28:142-151. DOI: https://doi.org/10.1016/j.coviro.2018.01.001

Ching, P., Harriman, K., Li ,Y. Infection prevention and control of epidemic-and pandemic-prone acute respiratory diseases in health care: WHO interim guidelines; World Health Organization (WHO): Geneva, Switzerland 2007; 1-90.

Van, D.N., Bushmaker, T., Morris, D.H., Holbrook, M. G., Gamble, A., Williamson, B.N., et al., Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV. N Engl J Med 2020; 382(16): 1564-1567. DOI: https://doi.org/10.1056/NEJMc2004973

Anfinrud, P., Stadnytskyi, V., Bax, C.E., Bax, A. Visualizing speech-generated oral fluid droplets with laser light scattering. N Engl J Med 2020; 382(21): 2061-2063. DOI: https://doi.org/10.1056/NEJMc2007800

Asadi, S., Wexler, A.S., Cappa, C.D., Barreda, S., Bouvier, N. M., Ristenpart, W. D. Aerosol emission and super emission during human speech increase with voice loudness. Sci Rep 2019; 9(1): 2348. DOI: https://doi.org/10.1038/s41598-019-38808-z

Stadnytskyi, V., Bax, C. E., Bax, A., Anfinrud, P. The airborne lifetime of small speech droplets and their potential importance in SARS-CoV-2 transmission. Proc Natl Acad Sci U S A 2020; 117(22): 11875-11877. DOI: https://doi.org/10.1073/pnas.2006874117

Li, T., Liu, Y., Li, M., Qian, X., Dai, S.Y. Mask or no mask for COVID-19: A public health and market study. PLoS One 2020; 15(8): e0237691. DOI: https://doi.org/10.1371/journal.pone.0237691

Bourouiba, L. Turbulent gas clouds and respiratory pathogen emissions: Potential implications for reducing transmission of COVID-19. JAMA 2020; 323 (18): 1837-1838. DOI: https://doi.org/10.1001/jama.2020.4756

Van, D. S. M., Teunis, P., Sabel, R. Professional and homemade face masks reduce exposure to respiratory infections among the general population. PLoS One 2008; 3(7): e2618. DOI: https://doi.org/10.1371/journal.pone.0002618

Tcharkhtchi, A., Abbasnezhad, N., Zarbini, S. M., Zirak, N., Farzaneh, S., Shirinbayan, M. An overview of filtration efficiency through the masks: Mechanisms of the aerosols penetration. Bioact Mater 2020; 6(1): 106-122. DOI: https://doi.org/10.1016/j.bioactmat.2020.08.002

Ippolito, M., Vitale, F., Accurso, G., Iozzo, P., Gregoretti, C., Giarratano, A., et al., Medical masks and respirators for the protection of healthcare workers from SARS-CoV-2 and other viruses. Pulmonology. 2020; 26(4): 204-212. DOI: https://doi.org/10.1016/j.pulmoe.2020.04.009

Zhou, S. S., Lukula, S., Chiossone, C., Nims, R.W., Buchmann, D. B., Ijaz, M. K. Assessment of a respiratory face mask for capturing air pollutants and pathogens including human influenza and rhinoviruses. J Thorac Dis 2018; 10(3): 2059-2069. DOI: https://doi.org/10.21037/jtd.2018.03.103

Yao, B. G., Wang, Y.X., Ye, X. Y., Zhang, F., Peng, Y. L. Impact of structural features on dynamic breathing resistance of healthcare face mask. Sci Total Environ. 2019; 689: 743-753. DOI: https://doi.org/10.1016/j.scitotenv.2019.06.463

Milton, D. K., Fabian, M. P., Cowling, B. J., Grantham, M.L., McDevitt, J.J. Influenza virus aerosols in human exhaled breath: particle size, culturability, and effect of surgical masks. PLoS Pathog. 2013; 9(3): e1003205. DOI: https://doi.org/10.1371/journal.ppat.1003205

Steinbrook, R. Filtration Efficiency of Face Masks Used by the Public During the COVID-19 pandemic. JAMA Intern Med. 2021; 181(4): 470. DOI: https://doi.org/10.1001/jamainternmed.2020.8234

Konda, A., Prakash, A., Moss, G.A., Schmoldt, M., Grant, G.D., Guha, S. Aerosol filtration efficiency of common fabrics used in respiratory cloth masks. ACS Nano 2020; 14(5): 6339-6347. DOI: https://doi.org/10.1021/acsnano.0c03252

Zhao, M., Liao, L., Xiao, W., Yu, X., Wang, H., Wang, Q., et al., Household materials selection for homemade cloth face coverings and their filtration efficiency enhancement with triboelectric charging. Nano Lett 2020; 20(7): 5544-5552. DOI: https://doi.org/10.1021/acs.nanolett.0c02211

Byambasuren., Dobler, C.C., Bell, K., Rojas, D.P., Clark, J., McLaws, M. L., et al., Estimating the sero prevalence of SARS-CoV-2 infections: a systematic review. medRxiv 2020. DOI: https: //doi.org/10.1101 /2020.07.13.

Fontanet, A., Cauchemez, S. COVID-19 herd immunity: where are we? Nat Rev Immunol. 2020; 20(10): 583-584. DOI: https://doi.org/10.1038/s41577-020-00451-5

MacIntyre, C.R., Chughtai, A.A. 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. Int J Nurs Stud 2020; 108:103629. DOI: https://doi.org/10.1016/j.ijnurstu.2020.103629

Hui, D.S., Chow, B.K., Chu, L., Ng, S.S., Lee, N., Gin, T., et al., Exhaled air dispersion during coughing with and without wearing a surgical or N95 mask. PLoS One 2012; 7(12): e50845. DOI: https://doi.org/10.1371/journal.pone.0050845

Dbouk, T., Drikakis, D. On coughing and airborne droplet transmission in humans. Phys. Fluids (1994) 2020; 32(5): 053310. DOI: https://doi.org/10.1063/5.0011960

Tang, J.W., Liebner, T. J., Craven, B.A., Settles, G. S. A schlieren optical study of the human cough with and without wearing masks for aerosol infection control. J R Soc Interface. 2009; 6 Suppl 6(Suppl 6): S727-S736. DOI: https://doi.org/10.1098/rsif.2009.0295.focus

Ma, Q. X., Chan, H., Zhang, H.L., Li, G. M, Yang, R. M., Chen, J. M. Potential utilities of mask-wearing and instant hand hygiene for fighting SARS-CoV-2. J Med Virol 2020; 92(9): 1567-1571. DOI: https://doi.org/10.1002/jmv.25805

Loeb, M., Dafoe, N., Mahony, J., John, M., Sarabia, A., Glavin, V., et al., Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA 2009; 302(17): 1865-1871. DOI: https://doi.org/10.1001/jama.2009.1466

Smith, J.D., MacDougall, C. C., Johnstone, J., Copes, R. A., Schwartz, B., Garber, G.E. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. CMA 2016; 188 (8): 567-574. DOI: https://doi.org/10.1503/cmaj.150835

Long, Y., Hu, T., Liu, L., Chen, R., Guo, Q., Yang, L., et al., Effectiveness of N95 respirators versus surgical masks against influenza: A systematic review and meta-analysis. J Evid Based Med 2020; 13(2): 93-101. DOI: https://doi.org/10.1111/jebm.12381

Iannone, P., Castellini, G., Coclite, D., Napoletano, A., Fauci, A.J., Iacorossi, L., et al., The need for health policy perspective to protect Healthcare Workers during COVID-19 pandemic. A GRADE rapid review on the effectiveness of the N95 respirator. PLoS One. 2020; 15(6): e0234025. DOI: https://doi.org/10.1371/journal.pone.0234025

Chughtai, A., Seale, H., MacIntyre, C., Use of cloth masks in the practice of infection control — evidence and policy gaps. Int. J. Infect. Control 2013; 9(3): DOI: https://doi.org/10.3396/ijic.v9i3.11366. DOI: https://doi.org/10.3396/IJIC.v9i3.020.13

Shubham, S., Roven, P., Abhishek, S., Sweta., P., Chaudhuri, S. B. On secondary atomization and blockage of surrogate cough droplets in single- and multilayer face masks. Sci.Adv 2021; 7(10): 1-11. DOI: https://doi.org/10.1126/sciadv.abf0452

Fikenzer, S., Swen, F.T., Lavall, D., Rudolph, U., Falz, R., Busse, M., et al., Effects of surgical and FFP2/N95 face masks on cardiopulmonary exercise capacity. Clin Res Cardiol 2020; 109(12): 1522-1530. DOI: https://doi.org/10.1007/s00392-020-01704-y

MacIntyre, C.R., Seale, H., Dung, T.C; Nguyen, T.H., Phan, T.N., Chungthai, A.A., et al., A cluster randomised trial of cloth masks compared with medical masks in healthcare workers BMJ Open 2015; 5: e006577.DOI: 10.1136/BMJ open-2014-006577 DOI: https://doi.org/10.1136/bmjopen-2014-006577

MacIntyre, C.R., Cauchemez, S., Dwyer, D.E., Seale, H., Cheung, P., Browne, G., et al., Face mask use and control of respiratory virus transmission in households. Emerg Infect Dis. 2009; 15(2): 233-241. DOI: https://doi.org/10.3201/eid1502.081166

Cowling, B.J., Ali, S.T., Ng, T.W.Y., Tsang, T.K., Li, J.C.M., Fong, M.W., et al., Impact assessment of non-pharmaceutical interventions against coronavirus disease 2019 and influenza in Hong Kong: an observational study. The Lancet 2020; 5(5): E279-E288. DOI: https://doi.org/10.1016/S2468-2667(20)30090-6




How to Cite

Vinod R, Swathi, Chandran V. A review on the effectiveness of various masks in protection against COVID-19. Biomedicine [Internet]. 2022 Nov. 14 [cited 2022 Nov. 27];42(5):870-6. Available from: https://biomedicineonline.org/home/article/view/1513

Plum Analytics 

Most read articles by the same author(s)