Medical Masks vs N95 Respirators for COVID-19

Medical Masks Versus N95 Respirators to Prevent 2019 Novel Coronavirus Disease (COVID-19) in Healthcare Workers: A Randomized Trial

A randomized controlled trial in which health care workers will be randomized to either medical masks or N95 respirators when providing care to patients with COVID-19.

Study Overview

• Status: Completed
• Conditions: Coronavirus; N95; Medical Mask
• Intervention / Treatment: Device: Medical Mask; Device: N95 respirator

Detailed Description

A randomized controlled trial in which health care workers will be randomized to either medical masks or N95 respirators when providing medical care to patients with COVID-19. This multi-centre randomized controlled trial will assess whether medical masks are non-inferior to N95 respirators when health care workers provide care involving non-aerosol generating procedures. Health care workers will be randomized to either use of a medical mask or to a fit-tested N95 respirator when providing care for patients with febrile respiratory illness. Health care workers randomly assigned to the N95 respirator group will be instructed to use a fit-tested National Institute for Occupational Safety and Health-approved N95 respirator when providing routine care to patients with COVID-19 or suspected COVID-19. Participants will use the type of device they were allocated to, either a medical mask or an N95 respirator, for 10 weeks, however, health care workers can also use the N95 respirator at any time based on a point-of-care risk assessment. Universal masking is the policy implemented at each study site. Extended and re-use of N95 respirators will be permitted if the local situation requires it. The primary outcome is laboratory confirmed RT-PCR COVID-19 among participants.

A nasopharyngeal swab will be obtained if any one of the following symptoms or signs is present: fever (≥38 C), cough, or shortness of breath, or if 2 of the following are present: fatigue, myalgia, headache, dizziness, expectoration, sore throat, diarrhea, nausea, vomiting, abdominal pain, runny nose, altered taste or smell, conjunctivitis, or painful swallowing.

Participants that receive a COVID-19 vaccine after enrollment with efficacy of > 50% for the circulating strain will continue to be followed until 2 weeks after the first dose of the vaccine. All other participants will be followed for 10 weeks.

Self-reporting of hand hygiene and the use of external monitors, where feasible, will be used to collect basic hand hygiene data.

The sample size is 1,010 participants. This will allow 90% power at an alpha (one sided) of 0.05 and to account for participants who may not have completed 10 weeks because of COVID-19 mRNA vaccination.

Changes made to the protocol prior to May 4, 2020, which was prior to the start of enrollment:

• Eligibility criteria expanded from nurses who provide direct patient care to health care workers that provide direct patient care.
• Allowed extended and re-use of N95 respirators if the local situation required it.
• Added self-reporting of hand hygiene and the use of external monitors if feasible.
• Reduced the duration of follow up from 12 weeks to 10 weeks

Changes made on or after May 4, 2020:

• Expanded the criteria for the requirement of swabs to detect COVID-19 by adding runny nose, altered taste or smell, and conjunctivitis and also asked for a swab for fever, cough, or shortness of breath alone OR for two of the previously listed symptoms or signs (May 19, 2020).
• Added previously known COVID infection as an exclusion (October, 30, 2020).
• Added receipt of a COVID-19 vaccine with efficacy of > 50% as an exclusion (October 30, 2020).
• Allowed those participants that received a COVID-19 vaccine after enrollment with efficacy of > 50% for the circulating strain to continue to be followed until 2 weeks after the first dose of the vaccine (December 17, 2020).
• Increased the sample size to 1,010 participants to allow 90% power at an alpha (one sided) of 0.05 and to account for participants who may not have completed 10 weeks because of COVID-19 mRNA vaccination (July 26, 2021).
• Added wording to capture implementation since May 4th, 2020, "Where the policy of the healthcare setting has been universal use of a facemask, that is wearing a facemask at all times when in the hospital, then the facemask participants were randomized to will be used." (December 27, 2021)

• Study Type: Interventional
• Enrollment (Actual): 1009
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: Mark Loeb, MD; Phone Number: 9053340010; Email: loebm@mcmaster.ca

Study Locations

• Canada
  • Alberta
    • Calgary, Alberta, Canada, T2N 1N4
      • Foothills Medical Centre
    • Edmonton, Alberta, Canada
      • University of Alberta Hospital
  • Ontario
    • Brantford, Ontario, Canada
      • Brantford General Hospital
    • Hamilton, Ontario, Canada
      • Hamilton Health Sciences
    • Hamilton, Ontario, Canada
      • St. Joseph's Healthcare
    • Ottawa, Ontario, Canada, K1H 8L6
      • Ottawa Hospital
    • Ottawa, Ontario, Canada, K1K 0T2
      • Hopital Montfort
    • St. Catherines, Ontario, Canada
      • Niagara Health Services
    • Toronto, Ontario, Canada
      • St. Joe's Unity Health
    • Toronto, Ontario, Canada
      • St. Mike's Unity Health
  • Quebec
    • Montréal, Quebec, Canada
      • Montreal University Health Centre
    • Montréal, Quebec, Canada
      • The Jewish General Hospital
• Egypt
  • Fayoum, Egypt
    • Fayoum General Hospital
• Israel
  • Tzrifin, Israel
    • Golden Care LTCF
• Pakistan
  • Karachi, Pakistan
    • Dr. Ziauddin Hospital

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Health care workers who provide direct care to patients with suspected or confirmed COVID-19 in specialized COVID-19 units and in emergency departments, medical units, pediatric units, and long-term care facilities
• Health care workers are required to spend 60% or more of their time doing clinical work when enrolled.

Exclusion Criteria:

• Unable to pass or do not have a valid fit test within the past 24 months
• One or more high-risk comorbidities for COVID-19 (hypertension, cardiac disease, pulmonary disease, chronic kidney disease, diabetes, chronic liver disease, actively treated cancer, or immunosuppression due to illness or medications)
• Previous laboratory confirmed clinical diagnosis of COVID-19 at the time of
• Received 1 or more doses of a COVID-19 vaccine with greater than 50% efficacy for the circulating strain (for example, mRNA or vector-based COVID-19 vaccine against the original SARS-CoV-2 strain).
• working in intensive care units.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Medical Mask; Medical Mask worn when providing care to patient with febrile respiratory illness	Device: Medical Mask; Medical Mask (known also as Surgical Mask)
Active Comparator: N95 respirator; N95 respirator worn when providing care to patient with febrile respiratory illness	Device: N95 respirator; N95 respirator

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
RT-PCR confirmed COVID-19 infection	Number of participants with RT-PCR confirmed COVID-19 infection	10 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Acute respiratory illness	Number of participants with acute respiratory illness	10 weeks
Absenteeism	Number of participants with absenteeism	10 weeks
Lower respiratory infection	Number of participants with lower respiratory infection	10 weeks
Pneumonia	Number of participants with pneumonia	10 weeks
ICU admission	Number of participants with ICU admission	10 weeks
Mechanical ventilation	Number of participants needing mechanical ventilation	10 weeks
Death	Number of participants that died	10 weeks

Collaborators and Investigators

• Sponsor: McMaster University
• Collaborators: University of Alberta
• Investigators: Principal Investigator: Mark B Loeb, McMaster University

Publications and helpful links

General Publications

• Schunemann HJ, Akl EA, Chou R, Chu DK, Loeb M, Lotfi T, Mustafa RA, Neumann I, Saxinger L, Sultan S, Mertz D. Use of facemasks during the COVID-19 pandemic. Lancet Respir Med. 2020 Oct;8(10):954-955. doi: 10.1016/S2213-2600(20)30352-0. Epub 2020 Aug 3. No abstract available.

Study record dates

Study Major Dates

• Study Start (Actual): March 1, 2020
• Primary Completion (Actual): June 1, 2022
• Study Completion (Actual): December 8, 2022

Study Registration Dates

• First Submitted: March 3, 2020
• First Submitted That Met QC Criteria: March 3, 2020
• First Posted (Actual): March 5, 2020

Study Record Updates

• Last Update Posted (Actual): January 12, 2023
• Last Update Submitted That Met QC Criteria: January 11, 2023
• Last Verified: January 1, 2023

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Coronaviridae Infections; Nidovirales Infections; RNA Virus Infections; Virus Diseases; Infections; Coronavirus Infections
• Other Study ID Numbers: 20006014

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No