There is a lot of confusion about who should use face mask during this serious COVID-19 pandemic. Irrational use of masks has caused serious shortage of mask availability for frontline health-care workers, who really require it. Therefore, the authors have carried out this comprehensive evidence-based review to guide policy-makers for the rational use of the face mask in this crisis. Social distancing, meticulous hand hygiene and respiratory etiquettes are more important in curbing the COVID-19 infection transmission rather than use of face mask alone but people may use multilayer cloth face covering especially in the areas of significant community-based transmission of SARS-CoV-2. Frontline health-care workers essentially require the full set of personal protective equipment, including gown, gloves, goggles or face shields, shoe covers, and mask, preferably N95 or equivalent respirator when exposed to aerosols. In case, N95 or equivalent equipment is not available, and then, surgical mask can also protect them adequately during non-aerosol generating procedures, provided meticulous hand hygiene is practiced.
Jeno M. CDC updates Guidelines on PPE for Health care Personnel. COVID-19 Declared a Pandemic; 11 March, 2020. Available from: https://www.aappublications.org/news/2020/03/11/coronavirus031120. [Last accessed on 2020 Apr 03].
Klompas M, Morris CA, Sinclair J, Pearson M, Shenoy ES. Universal masking in hospitals in the covid-19 era. N Engl J Med 2020. 3]. doi: 10.1056/NEJMp2006372.
Togoh I. Here's How Some of the Countries Worst hit by Coronavirus are Dealing with Shortages of Protective Equipment for Healthcare Workers; 31, Mar, 2020. Available from: https://www.forbes.com/sites/isabeltogoh/2020/03/31/heres-how-some-of-thecountries-worst-hit-by-coronavirus-are-dealing-with-shortages-ofprotective-equipment-for-healthcare-workers/#4111e4b52c13. [Last accessed on 2020 Apr 03].
Feng E, Cheng A. COVID-19 has Caused Shortage of Face Masks; but they are Surprisingly Hard to Make, 16, March, 2020. Available from: https://www.npr.org/sections/goatsandsoda/2020/03/16/814929294/covid-19-has-caused-a-shortage-of-face-masks-but-theyre-surprisingly-hard-to-mak. [Last accessed on 2020 Apr 03].
Liu J, Liao X, Qian S, Yuan J, Wang F, Liu Y, et al. Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis 2020;26. doi.org/10.3201/eid2606.200239.
Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: A study of a family cluster. Lancet 2020;395:514-23.
Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020;382:1199-207.
Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Lancet 2020;395:497-506. Available from: https://doi.org/10.1016/S0140-6736(20)30183-5. [Last accessed on 2020 Apr 03].
Burke RM, Midgley CM, Dratch A, Fenstersheib M, Haupt T, Holshue M, et al. Active monitoring of persons exposed to patients with confirmed COVID-19-United States, January-February 2020. MMWR Morb Mortal Wkly Rep 2020;69:245-6.
World Health Organization. Report of the WHO-China Joint Mission on Coronavirus Disease 2019 (COVID-19) 16-24 February 2020. Geneva: World Health Organization; 2020. Available from: https://www.who.int/docs/default-source/coronaviruse/whochina-joint-mission-on-covid-19-final-report.pdf. [Last accessed on 2020 Apr 03]
Ong SWX, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. JAMA 2020;323:1610-2.
van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med 2020. doi: 10.1056/NEJMc2004973.
World Health Organization. Mode of Transmission of Virus Causing COVID-19: Implications for IPC Permutation Recommondations. Scientific Brief. 29 March, 2020. Available from: http://WHO/2019-nCoV/Sci_Brief/Transmission_modes/2020.2. [Updated 2020 Mar 29; Last accessed on 2020 Apr 03].
Guo Z-D, Wang Z-Y, Zhang S-F, Li X, Li L, Li C, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards, Wuhan, China, 2020. Emerg Infect Dis 2020;84:44-8.
Wu D, Wu T, Liu Q, Yang Z. The SARS-CoV-2 outbreak: What we know. Int J Infect Dis 2020. S1201971220301235. doi: 10.1016/j. ijid.2020.03.004. [Epub ahead of print].
Li J, Leavey A, Yang W, O'Neil C, Wallance M, Boon A, et al. Defining aerosol generating procedures and pathogen transmission risks in healthcare settings. Open Forum Infect Dis 2017;4:S34-5.
Ng K, Poon BH, Kiat Puar TH, Shan Quah JL, Loh WJ, Wong YJ, et al. COVID-19 and the risk to health care workers: A case report. Ann Intern Med 2020;16:L20-0175. doi:10.7326/L20-0175.
World Health Organisation. Infection Prevention and Control Guidelines for Long Term care Facilities in the Context of COVID-19. Interim Guidelines; 21 March, 2020. Available from: http://WHO/2019-nCoV/IPC_long_term_care/2020.1. [Updated 2020 Mar 29; Last accessed on 2020 Apr 03].
Centers for Disease Control and Prevention. Strategies for Optimizing the Supply of Facemasks; 17 March, 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html. [Updated 2020 Mar 29; Last accessed on 2020 Apr 03].
Radonovich LJ Jr., Simberkoff MS, Bessesen MT, Brown AC, Cummings DA, Gaydos CA, et al. N95 Respirators vs Medical Masks for Preventing Influenza Among Health Care Personnel: A Randomized Clinical Trial. JAMA 2019;322:824-33.
Maclntyre CR, Dwyer D, Seal H, Fasher M, Booy R, Cheung P, et al. The first randomized controlled trials of mask use in household to prevent respiratory viruses transmission. Int J Infec Dis 2008;12:E328.
Centers for Disease Control and Prevention. Coronavirus Disease 2019 (COVID-19). Available from: https://www.cdc.gov/coronavirus/2019-ncov/hcp/healthcare-supply-ppe-index.html. [Updated 2020 Mar 29; Last accessed on 2020 Apr 03].
Howard J. WHO Stands by Recommendation to not Wear masks if you are not Sick or not Caring for Someone who is Sick. CNN World; 31 March, 2020. Available from: https://edition.cnn.com/2020/03/30/world/coronavirus-who-masks-recommendation-trnd/index.html. [Last accessed on 2020 Apr 03].
Rothe C, Schunk M, Sothmann P, Bretzel G, Froeschl G, Wallrauch C, et al. Transmission of 2019-nCoV infection from an asymptomatic contact in germany. N Engl J Med 2020;382:970-1.
Bai Y, Yao L, Wei T, Tian F, Jin DY, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. JAMA 2020. doi:10.1001/jama.2020.2565.
Pan X, Chen D, Xia Y, Wu X, Li T, Ou X, et al. Asymptomatic cases in a family cluster with SARS-CoV-2 infection. The Lancet Infectious diseases 2020. Available from: https://doi.org/10.1016/S1473-3099(20)30114-6. [Last accessed on 2020 Apr 03].
Kimball A, Hatfield KM, Arons M, James A, Taylor J, Spicer K, et al. Asymptomatic and Presymptomatic SARS-CoV-2 Infections in Residents of a Long-Term Care Skilled Nursing Facility — King County, Washington, March 2020. MMWR Morbidity and mortality weekly report 2020.
Wei WE LZ, Chiew CJ, Yong SE, Toh MP, Lee VJ. Presymptomatic Transmission of SARS-CoV-2 — Singapore, January 23–March 16, 2020. MMWR Morbidity and mortality weekly report 2020.
Centers for Disease Control and Prevention [Internet]. Coronavirus disease-19: Recommendation Regarding the Use of Cloth Face Coverings, Especially in Areas of Significant Community-Based Transmission. 2020 Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/cloth-face-cover.html#studies. [Last accessed on 2020 Apr 03].
Leung NHL, Chu DKW, Shiu EYC, Chan K, McDevitt JJ, Hau BJP et al. Respiratory virus shedding in exhaled breath and efficacy of face mask. Nat Med 2020. https://doi.org/10.1038/s41591-020-0843-2. [Last accessed on 2020 Apr 03].
World Health Organization [Internet]. Advice on the use of masks in the context of COVID-19. Available from: WHO-2019-nCov-IPC_Masks- 2020.3-eng.pdf. [Last accessed on 2020 Apr 03].