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 (), Savannah Shifflett, Kayla Kosta, Joelle M. Fornasier, Patricia Dionicio, Eric T. Hyde, Job G. Godino, Christian B. Ramers, John P. Elder and Corinne McDaniels-Davidson
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Noe C. Crespo: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Savannah Shifflett: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Kayla Kosta: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Joelle M. Fornasier: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Patricia Dionicio: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Eric T. Hyde: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Job G. Godino: Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA 92101, USA
Christian B. Ramers: Laura Rodriguez Research Institute, Family Health Centers of San Diego, San Diego, CA 92101, USA
John P. Elder: School of Public Health, San Diego State University, San Diego, CA 92123, USA
Corinne McDaniels-Davidson: School of Public Health, San Diego State University, San Diego, CA 92123, USA

IJERPH, 2025, vol. 22, issue 10, 1-32

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 (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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