Universal masking during COVID-19 outbreaks in aged care settings: A systematic review and meta-analysis

Rosalie Chen; Shwetha G Kezhekkekara; Mohana P Kunasekaran; C Raina MacIntyre

doi:10.1016/j.arr.2023.102138

Universal masking during COVID-19 outbreaks in aged care settings: A systematic review and meta-analysis

Ageing Res Rev. 2024 Jan:93:102138. doi: 10.1016/j.arr.2023.102138. Epub 2023 Nov 23.

Authors

Rosalie Chen¹, Shwetha G Kezhekkekara², Mohana P Kunasekaran³, C Raina MacIntyre⁴

Affiliations

¹ Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia. Electronic address: Rosalie.chen@protonmail.com.
² Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; School of Population Health, The University of New South Wales, Sydney, NSW, Australia; Australian Centre for Integration of Oral Health (ACIOH), Western Sydney University, Sydney, Australia.
³ Kirby Institute, The University of New South Wales, Sydney, NSW, Australia.
⁴ Kirby Institute, The University of New South Wales, Sydney, NSW, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ, United States.

PMID: 38007047
DOI: 10.1016/j.arr.2023.102138

Abstract

Aged care facilities (ACF) are a high-risk COVID-19 transmission setting, and older residents are at greater risk of severe outcomes. This systematic review and meta-analysis assessed whether universal masking and COVID-19 vaccination reduce SARS-CoV-2 attack rates (ARs) in ACF. Articles published between 1 December 2019 and 28 February 2022 were screened across five databases (Medline, Embase, PubMed, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature (CINAHL)). Risk of bias was assessed using relevant Joanna Briggs Institute critical appraisal tools. Meta-analysis of single proportions, subgroup analysis, and meta-regression were performed to compare the effects of universal masking and vaccine doses on pooled SARS-CoV-2 ARs. Of 99 included articles, SARS-CoV-2 ARs for residents were available in 86 studies (representing 139 outbreaks), and for staff in 49 studies (78 outbreaks). Universal masking was associated with lower SARS-CoV-2 ARs in ACF outbreaks (AR = 34.9% [95% CI: 27.2-42.6%]) compared to facilities without universal masking (67.3% [54.2-80.4%], p < .0001). In ACF with universal masking prior to outbreak onset, facility-wide testing, and documentation of asymptomatic infection, the asymptomatic AR at time of testing was 11.4% (6.5-17.4%) in residents. Receipt of zero, one and two vaccination doses were associated with ARs of 64.9% (49.6-80.2%), 54.9% (33.7-76.1%) and 45.2% (29.2-61.3%), respectively. To protect residents from COVID-19, ACF should provide vaccination of residents and staff, universal masking for staff, and facility-wide testing during times of heightened community transmission.

Keywords: Aged care; COVID-19; Face mask; SARS-CoV-2; Universal masking.

Publication types

Meta-Analysis
Systematic Review
Review

MeSH terms

Aged
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Disease Outbreaks / prevention & control
Humans
Masks
SARS-CoV-2

Substances

COVID-19 Vaccines