Systematic Review
Volume 4 Issue 8 - 2022
Which Type of Respiratory Mask Provides the Best Protection Against SARS-CoV-2 (COVID-19)? A Systematic Review of the Efficacy of Different Types of Respiratory Masks Against SARS-CoV-2 (surgical masks, cotton masks, N95, Kn95, FFP2, FFP3)
Dr. Deena Mohamed Abozena*
MSc Infection Control, M.B.B.S., Saudi Arabia
*Corresponding Author: Dr. Deena Mohamed Abozena, MSc Infection Control, M.B.B.S, Saudi Arabia.
Received: July 05, 2022; Published: July 19, 2022


Introduction: The COVID-19 pandemic has grasped the world since late 2019. With an infectivity rate (R0) of approximately 2.5, higher than that of Influenza, SARS-CoV and MERS-CoV, and its ease of transmission through droplets, it has burdened our world with disease. COVID-19 infections produce a wide range of symptoms with the more severe symptoms presenting as complications of the disease. The increased morbidities and mortalities brought unto us by the SARS-CoV-2 virus have earned the disease the position of a public health emergency.

Aim: The purpose of this systematic review is to provide more information on the protective efficacies of cloth and surgical masks, N95, KN95, FFP2 and FFP3 respirators against SARS-CoV-2 and similar particles. A total of 8 reputable databases (PubMed, JOSTOR Journals, CINAHL, MedLINE, ERIC, ScienceDirect, Google Scholar and The Directory of Open Access Journals) have been searched for articles as guided by a set inclusion and exclusion criteria. A program was utilized to maintain a detailed record of the articles. A total of 10 articles were included in this review..

Results: Masks have been proven to reduce infection rates of COVID-19 to an extent. Cloth masks composed of different blends of fabrics, in addition to numerous layers provide the wearer with a higher level of protection as compared to a cloth mask made of one material and one layer. Surgical masks provide better protection; however, this level of protection is significantly affected by the fit of the mask, and the masks’ certification of validity (NIOSH-approved, EN 14683). N95, KN95, FFP2 and FFP3 respirators all exceed the levels of protection provided by cloth and surgical masks. These respirators provide the highest levels of protection against SARSCoV- 2.

Conclusion: Cloth masks provide some protection against SARS-CoV-2, followed by the surgical mask then by respirators. Respirators in particular have been proven to reduce the transmission of SARS-CoV-2 in high-risk healthcare settings. Despite these promising conclusions, research targeting the understanding of proper mask fit, design, quantitative fit testing for cloth and surgical masks are areas that will re-shape our understanding of mask FE.

Keywords: Systematic Review; Efficacy; Efficiency; Respiratory Protection; SARS-Cov-2; COVID-19; Cloth, Fabric; Surgical; Mask; Respirator; N95; Kn95; Ffp2; Ffp3; Filtering Face Piece


  1. World Health Organization. WHO-Convened Global Study of Origins of SARS-CoV-2: China Part (2021).
  2. Petersen E., et al. “Comparing SARS-CoV-2 with SARS-CoV and Influenza Pandemics”. The Lancet Infectious Diseases 20 (2020): e238-244.
  3. World Health Organization. Q and A: How is COVID-19 Transmitted? (2021).
  4. Centers for Disease Control and Prevention. (2021) Symptoms of COVID-19 (2021).
  5. World Health Organization. Transmission of SARS-CoV-2: Implications for Infection Prevention Precautions (2020).
  6. Davidson JA and Warren-Gash C. “Cardiovascular Complications of Acute Respiratory Infections: Current Research and Future Directions”. Expert Review of Anti-Infective Therapy12 (2019): 939-942.
  7. Masic I., et al. “Public Health Aspects of COVID-19 Infection with Focus on Cardiovascular Diseases”. Materia Socio-Medica1 (2020): 71-76.
  8. Wilding T and Holt N. “The Neurological Symptoms of COVID-19: A Systematic Reviews, Comparison with Other Neurological Conditions and Implications for Healthcare Services”. Therapeutic Advances in Chronic Disease 12 (2021): 1-18.
  9. COVID-NET. A Weekly Summary of U.S. COVID-19 Hospitalization data (2021).
  10. Centers for Disease Control and Prevention. (2021b) COVID-19 Mortality Overview (2021).
  11. Statistics. COVID-19 Hospital Activity (2021).
  12. World Health Organization. Mask Use in the Context of COVID-19 (2020).
  13. World Health Organization. WHO Coronavirus (COVID-19) Dashboard (2022).
  14. Hegazy AA., et al. “Mass chemoprophylaxis with ivermectin against COVID-19 pandemic: review and authors’ perspective”. Acta Scientific Medical Sciences6 (2021): 47-51.
  15. Shoumann WM., et al. “Use of Ivermectin as a Potential Chemoprophylaxis for COVID-19 in Egypt: A Randomized Clinical Trial”. Journal of Clinical and Diagnostic Research2 (2021): OC27-OC32.
  16. Scobie HM., et al. “Monitoring Incidence of COVID-19 Cases, Hospitalizations, and Deaths, by Vaccination Statue-13 U.S. Jurisdictions, April 4-July17,2021”. Morbidity and Mortality Weekly Report (MMWR) 37 (2021): 1284-1290.
  17. Krenn S. To End Pandemic, Focus on Science of Human Behavior (2020).
  18. World Health Organization. The Effects of Virus Variants on COVID-19 Vaccines (2021).
  19. Siddiqui S and Qamar AH. “Risk Perception and Protective Behavior in the Context of COVID-19: A Qualitative Exploration”. Asian Bioethics Review 13 (2021): 401-420.
  20. Antonelli M., et al. “Risk Factors and Disease Profile of Post-Vaccination SARS-CoV-2 Infection in UK users of the COVID Symptom Study app: A Prospective, Community-Based, Nested, Case-Control Study”. The Lancet Infectious Diseases1 (2021): 45-55.
  21. World Health Organization. Modes of Transmission of Virus Causing COVID-19: Implications for IPC Precaution Recommendations (2020).
  22. Two Meters or One: What is the Evidence for Physical Distancing in COVID-19? (2020).
  23. Tellier R., et al. “Recognition of Aerosol Transmission of Infectious Agents: A Commentary”. BMC Infectious Diseases 19 (2019): 101.
  24. Tran K., et al. “Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review”. PLos One4 (2012): e35797.
  25. Centers for Disease Control and Prevention. Types of Masks and Respirators (2021).
  26. Centers for Disease Control and Prevention. The National Institute for Occupational Safety and Health (NIOSH) Respirators (2021).
  27. Centers for Disease Control and Prevention. Use of Respirators and Surgical Masks for Protection Against Healthcare Hazards (2018).
  28. Sharma SK., et al. “Efficacy of Cloth Face Mask in Prevention of Novel Coronavirus Infection Transmission: A Systematic Review and Meta-Analysis”. Journal of Education and Health Promotion 9 (2020): 192.
  29. Health Care Particulate Respirator and Surgical Mask 1860, N95 120 EA/Case (2021).
  30. Tsai P. “Performance of Masks and Discussion of the Inactivation of SARS-CoV-2”. Engineered Science 10 (2020): 1-7.
  31. Medical Face Mask Tests and Requirements (2020).
  32. Food and Drug Administration. Face Masks, Including Surgical Masks and Respirators for COVID-19 (2021).
  33. Yim W., et al. “KN95 and N95 Respirators Retain Filtration Efficiency despite a Loss of Dipole Charge During Decontamination”. ACS Applied Materials and Interfaces47 (2020): 54473-54480.
  34. Li KKW., et al. “FFP3, FFP2, N95, Surgical Masks and Respirators: What Should We Be Wearing for Ophthalmic Surgery in the COVID-19 Pandemic?” Graefe's Archive for Clinical and Experimental Ophthalmology 26 (2020): 1-3.
  35. Smereka J., et al. “Role of Mask/Respirator Protection Against SARS-CoV-2”. Anesthesia and Analgesia1 (2020): e33-e34.
  36. Dugdale CM and Walensky RP. “Filtration Efficiency, Effectiveness, and Availability of N95 Face Masks for COVID-19 Prevention”. JAMA Internal Medicine12 (2020): 1612-1613.
  37. Ippolito M., et al. “Medical Masks and Respirators for the Protection of Healthcare Workers from SARS-CoV-2 and Other Viruses”. Pulmonology4 (2020): 204-212.
  38. Centers for Disease Control and Prevention. Your Guide to Masks (2021).
  39. CSL Behring. Five Tips for Wearing a Face Mask (2020).
  40. Requirements for Medical Masks and Particulate Respirators (2020).
  41. Brochot C., et al. “How Effective is the Filtration of ‘KN95’ Filtering Facepiece Respirators During the COVID-19 Pandemic?” Annals of Work Exposures and Health3 (2020): 358-366.
  42. 3M Disposable Respirator, FFP2, Valved, 8822 (2021).
  43. 3M Aura Particulate Respirator, FFP2, Unvalved, 9320+ (2021).
  44. 3M Disposable Respirator, FFP3 Valved, 8833 (2021).
  45. 3M Aura Disposable Healthcare Respirator, FFp3 Valved, 1873V+ (2021).
  46. Eldawlatly A., et al. “Appearance of Population, Intervention, Comparison, and Outcome as Research Question in the Title of Articles of Three Different Anesthesia Journals: A Pilot Study”. Saudi Journal of Anaesthesia 2 (2018): 283-286.
  47. Eriksen MB. “The Impact of Patient, Intervention, Comparison, Outcome (PICO) as a Search Strategy Tool on Literature Search Quality: A Systematic Review”. Journal of the Medical Library Association4 (2018): 420-431.
  48. Bwanga O. “How to Conduct A Qualitative Systematic Review to Guide Evidence-Based Practice in Radiography”. International Journal of Sciences: Basic and Applied Research (IJSBAR)1 (2020): 205-213.
  49. Seers K. “Qualitative Systematic Reviews: Their Importance for Our Understanding of Research Relevant to Pain”. British Journal of Pain1 (2015): 36-40.
  50. Suri H. “Ethical Considerations of Conducting Systematic Reviews in Educational Research”. in: Zawacki-Richter,O., Kerres,M., Bedenlier,S., Bond,M. and Buntins,K. (editions) Systematic Reviews in Educational Research. Springer VS, Wiesbaden (2019).
  51. PRISMA Flow Diagram (2021).
  52. Wang Y., et al. “Reduction of Secondary Transmission of SARS-CoV-2 in Households by Face Mask Use, Disinfection and Social Distancing: A Cohort Study in Beijing, China”. BMJ Global Health 5 (2020): e002794.
  53. Ferris M., et al. “Efficacy of FFP3 Respirators for Prevention of SARS-CoV-2 Infection in Healthcare Workers”. eLife 10 (2021): e71131.
  54. Hill C., et al. “Testing of Commercial Masks and Respirators and Cotton Mask Insert Materials using SARS-CoV-2 Virion-Sized Particulates: Comparison of Ideal Aerosol Filtration Efficiency versus Fitted Filtration Efficiency”. Nano Letters 20 (2020): 7642-7647.
  55. Sterr CM., et al. “Medical Face Masks Offer Self-Protection Against Aerosols: An Evaluation Using a Practical In Vitro Approach on A Dummy Head”. PLoS One3 (2021): e0248099.
  56. Darby S., et al. “COVID-19: Mask Efficacy is Dependant on Both Fabric and Fit”. Future Microbiology1 (2021).
  57. Maurer L., et al. “Community Masks During the SARS-CoV-2 Pandemic: Filtration Efficacy and Air Resistance”. Journal of Aerosol Medicine and Pulmonary Drug Delivery1 (2021): 11-19.
  58. Tanisali G., et al. “Effectiveness of Different Types of Mask in Aerosol Dispersion in SARS-CoV-2 Infection”. International Journal of Infectious Diseases 109 (2021): 310-314.
  59. Aziz HA. “Comparison Between Field Research and Controlled Laboratory Research”. Archives of Clinical and Biomedical Research 2 (2017): 101-104.
  60. Ma Q., et al. “Global Percentage of Asymptomatic SARS-CoV-2 Infections Among the Tested Population and Individuals with Confirmed COVID-19 Diagnosis- A Systematic Review and Meta-Analysis”. JAMA Network Open12 (2021): e2137257.
  61. Johansson MA., et al. “SARS-CoV-2 Transmission From People Without COVID-19 Symptoms”. JAMA Network Open1 (2021): e2035057.
  62. Aydin O., et al. “Performance of Fabrics for Home-Made Masks Against the Spread of COVID-19 Through Droplets: A Quantitative Mechanistic Study”. Extreme Mechanics Letters 40 (2020): 100924.
  63. Leung NHL., et al. “Respiratory Virus Shedding in Exhaled Breath and Efficacy of Face Masks”. Nature Medicine5 (2020): 676-680.
  64. Pang H., et al. “Quantitative Evaluation Methods of Skin Condition Based on Texture Feature Parameters”. Saudi Journal of Biological Sciences 3 (2017): 514-518.
  65. Centers for Disease Control and Prevention. Your Guide to Masks (2021).
  66. Mboowa G., et al. “Efficacy of Face Masks Used in Uganda: A Laboratory-Based Inquiry during the COVID-19 Pandemic”. American Journal of Tropical Medicine and Hygiene5 (2021): 1703-1708.
  67. O’Kelly E., et al. “Comparing the Fit of N95, KN95, Surgical and Cloth Face Masks and Assessing the Accuracy of Fit Checking”. PLoS ONE1 (2021): e0245688.
  68. Grinshpun SA., et al. “Autoclave Sterilization and Ethanol Treatment of Re-Used Surgical Masks and N95 Respirators During COVID-19: Impact on their Performance and Integrity”. The Journal of Hospital Infection 4 (2020): 608-614.
  69. Faber J and Fonseca LM. “How Sample Size Influences Research Outcomes”. Dental Press Journal of Orthodontics 4 (2014): 27-29.
  70. Centers for Disease Control and Prevention. COVID-19 and IPC Overview (2021).
  71. Chang JC., et al. “Demystifying Theoretical Concerns Involving Respirators with Exhalation Valves During the COVID-19 Pandemic”. American Journal of Infection Control12 (2020): 1564-1565.
  72. Ueki H., et al. “Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2”. mSphere 5 (2020): e00637-20.
  73. Howard BE. “High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations”. Otolaryngology–Head and Neck Surgery1 (2020): 98-103.
  74. Jacot D., et al. “Viral Load of SARS-CoV-2 Across Patients and Compared to Other Respiratory Viruses”. Microbes and Infection10 (2020): 617-621.
  75. Clapp PW., et al. “Evaluation of Cloth Masks and Modified Procedure Masks and Personal Protective Equipment for the Public During the COVID-19 Pandemic”. JAMA Internal Medicine4 (2021): 463-469.
  76. Centers for Disease Control and Prevention. Why Are Annual Fit Tests Required?” OSHA Requires Annual Fit Testing: 29 CFR 1910.134 (2016).
  77. Centers for Disease Control and Prevention. Facial Hairstyles and Filtering Facepiece Respirators (2017).
  78. Hamed A., et al. “The Impact of Keeping a Religious Beard in the COVID-19 Pandemic: An Online Cross Sectional Survey Exploring Experiences of Male Medical Healthcare Professionals”. Med RXIV (2020).
Citation: Deena Mohamed Abozena. “Which Type of Respiratory Mask Provides the Best Protection Against SARS-CoV-2 (COVID-19)? A Systematic Review of the Efficacy of Different Types of Respiratory Masks Against SARS-CoV-2 (surgical masks, cotton masks, N95, Kn95, FFP2, FFP3)”. EC Nursing and Healthcare 4.9 (2022): 10-33.

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