Mask Usage in Healthcare Settings: Is It the Right Time for Easing Restrictions? A Narrative Review
-
Hosein Kouchaki
,
Reza Tabrizi
,
Parnia Kamyab
,
Mahya Pourrahimi
,
Amirhossein Ghanei
,
Shahriyar Goudarzi
,
Kamran Bagheri Lankarani
Abstract
Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment, particularly face masks, has been central to infection control and reducing associated mortality. Global mask mandates, combined with widespread vaccination, helped curb peak pandemic phases. In 2023, the WHO reclassified COVID-19 as an ongoing health priority rather than an emergency, prompting reassessment of mask policies in healthcare settings. Yet, hospitals remain high-risk, especially with the concurrent “triple epidemic” of COVID-19, influenza, and respiratory syncytial virus. This review summarizes current evidence on mask efficacy, adherence, and policy changes to determine whether, when, and under what conditions mask use can be safely eased in clinical settings.
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2. Worby CJ, Chang HH (2020). Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun, 11 (1):4049.
3. Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L (2020). Face masks for the public during the covid-19 crisis. BMJ, 369:m1435.
4. Howard J, Huang A, Li Z, et al (2021). An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A, 118(4):e2014564118.
5. Jacob JT, Baker JM, Fridkin SK, et al (2021). Risk Factors Associated With SARS-CoV-2 Seropositivity Among US Health Care Personnel. JAMA Netw Open, 4 (3):e211283.
6. Doroshenko A (2021). The Combined Effect of Vaccination and Nonpharmaceutical Public Health Interventions-Ending the COVID-19 Pandemic. JAMA Netw Open, 4 (6):e2111675.
7. Control CfD, Prevention (2021). Interim public health recommendations for fully vaccinated people. https://stacks.cdc.gov/view/cdc/105629
8. McLean G, Kamil J, Lee B, et al (2022). The Impact of Evolving SARS-CoV-2 Mutations and Variants on COVID-19 Vaccines. mBio, 13 (2):e0297921.
9. Wise J (2023). Covid-19: WHO declares end of global health emergency. BMJ, 381:1041.
10. Sah R, Zaman K, Mohanty A, et al (2023). Respiratory syncytial virus with ongoing COVID-19: is it an emerging threat? Ann Med Surg (Lond), 85 (1):67-70.
11. Organization WH WHO updates COVID-19 guidelines on masks, treatments and patient care.
12. Khan M, Adil SF, Alkhathlan HZ, et al (2020). COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules, 26 (1):39.
13. Wang Y, Tian H, Zhang L, et al (2020). 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 Glob Health, 5 (5): e002794.
14. Ohara H (2004). Experience and review of SARS control in Vietnam and China. Tropical Medicine and Health, 32 (3):235-240.
15. Davies A, Thompson KA, Giri K, et al (2013). Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep, 7 (4):413-8.
16. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, et al (2020). Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. mSphere, 5 (5): e00637-20.
17. Doung-Ngern P, Suphanchaimat R, Panjangampatthana A, et al (2020). Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand. Emerg Infect Dis, 26 (11):2607-2616.
18. WHO (2020) Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020. World Health Organization.
19. Badillo-Goicoechea E, Chang TH, Kim E, et al (2021). Global trends and predictors of face mask usage during the COVID-19 pandemic. BMC Public Health, 21 (1):2099.
20. Taylor M, Raphael B, Barr M, et al (2009). Public health measures during an anticipated influenza pandemic: Factors influencing willingness to comply. Risk Manag Healthc Policy, 2:9-20.
21. Stosic MD, Helwig S, Ruben MA (2021). Greater belief in science predicts mask-wearing behavior during COVID-19. Pers Individ Dif, 176:110769.
22. Warnock-Parkes E, Thew GR, Clark DM (2021). Belief in Protecting Others and Social Perceptions of Face Mask Wearing Were Associated With Frequent Mask Use in the Early Stages of the COVID Pandemic in the UK. Front Psychol, 12:680552.
23. Adjodah D, Dinakar K, Chinazzi M, et al (2021). Association between COVID-19 outcomes and mask mandates, adherence, and attitudes. PLoS One, 16 (6):e0252315.
24. Van Dyke ME, Rogers TM, Pevzner E, et al (2020). Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate - Kansas, June 1-August 23, 2020. MMWR Morb Mortal Wkly Rep, 69 (47):1777-1781.
25. Zaidan E, Cochrane L, Belal M (2025). Adapting to Change and Transforming Crisis into Opportunity-Behavioral and Policy Shifts in Sustainable Practices Post-Pandemic. Heliyon, 11(10):e42046.
26. Strasser BJ, Schlich T (2020). A history of the medical mask and the rise of throwaway culture. Lancet, 396 (10243):19-20.
27. Taubenberger JK, Morens DM (2020). The 1918 influenza pandemic and its legacy. Cold Spring Harb Perspect Med, 10 (10):a038695.
28. Ataei M, Shirazi FM, Nakhaee S, et al (2022). Assessment of cloth masks ability to limit Covid-19 particles spread: a systematic review. Environ Sci Pollut Res Int, 29 (2):1645-1676.
29. Das S, Sarkar S, Das A, et al (2021). A comprehensive review of various categories of face masks resistant to Covid-19. Clin Epidemiol Glob Health, 12:100835.
30. O'Kelly E, Arora A, Pirog S, et al (2021). Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking. PLoS One, 16 (1):e0245688.
31. De Silva AP, Niriella MA, de Silva HJ (2021). Masks in COVID-19: let's unmask the evidence. Expert Rev Respir Med, 15 (3):293-299.
32. Jain M, Kim ST, Xu C, Li H, Rose G (2020). Efficacy and Use of Cloth Masks: A Scoping Review. Cureus, 12 (9):e10423.
33. Desai AN, Mehrotra P (2020). Medical Masks. JAMA, 323 (15):1517-1518.
34. Wojtasz I, Cofta S, Czudaj P, et al (2022). Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center. Int J Environ Res Public Health, 19 (3): 1397.
35. Kisielinski K, Giboni P, Prescher A, et al (2021). Is a mask that covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards? Int J Environ Res Public Health, 18 (8):4344.
36. Vogel L (2022). Is one-way masking enough? CMAJ, 194(19):E682.
37. Jotz GP, de Matos FCM (2021). COVID-19: Priority Use of N95 Mask or Double Mask. Int Arch Otorhinolaryngol, 25 (2):e175-e176.
38. Andrejko K, Pry J, Myers J (2021). Does 'One-Way Masking' Work Against COVID-19?. https://www.health.com/condition/infectious-diseases/coronavirus/one-way-masking-covid-protection
39. Htwe YZN, Mamat H, Osman B, et al (2022). Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content. Arab J Sci Eng, 1-9.
40. O'Donohue LS, Fletcher-Gutowski S, Sidhu A, et al (2022). Mask use among health care workers and feelings of safety at work pre- and post- COVID-19 vaccine. Am J Infect Control, 50 (5):503-508.
41. Brüssow H, Zuber S (2022). Can a combination of vaccination and face mask wearing contain the COVID-19 pandemic? Microb Biotechnol, 15 (3):721-737.
42. Zhang N, Liu X, Jin T, et al (2021). Weakening personal protective behavior by Chinese university students after COVID-19 vaccination. Build Environ, 206:108367.
43. Kang YJ (2022). COVID-19 in South Korea: Proper Timing for Easing Mask Mandates After COVID-19 Vaccination. Disaster Med Public Health Prep, 16 (5):1832-1834.
44. Silk BJ, Scobie HM, Duck WM, et al (2023). COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR Morb Mortal Wkly Rep, 72 (19):523-528.
45. (CDC) CfDCaP (2024). Infection control: Severe Respiratory Disease Coronavirus 2 (SARS-CoV-2).
46. Olsen SJ, Winn AK, Budd AP, et al (2021). Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic - United States, 2020-2021. MMWR Morb Mortal Wkly Rep, 70 (29):1013-1019.
47. Li L, Liu B, Liu SH, et al (2021). Evaluating the Impact of New York's Executive Order on Face Mask Use on COVID-19 Cases and Mortality: a Comparative Interrupted Times Series Study. J Gen Intern Med, 36 (4):985-989.
48. Petersen F, Errore A, Karaca-Mandic P (2022). Lifting Statewide Mask Mandates and COVID-19 Cases: A Synthetic Control Study. Med Care, 60 (7):538-544.
49. Bennett NG, Bloom DE, Ferranna M (2022). Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption. PLoS One, 17 (9):e0274529.
50. Bartsch SM, O'Shea KJ, Chin KL, et al (2022). Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study. Lancet Public Health, 7 (4):e356-e365.
51. Ko Y, Mendoza VM, Mendoza R, et al (2023). Risk estimation of lifted mask mandates and emerging variants using mathematical model. Heliyon, 9 (6):e16841.
52. Wang X, Ferro EG, Zhou G, et al (2020). Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA, 324 (7):703-704.
53. Temkin E, Schwaber MJ, Vaturi A, et al (2022). Effect of a national policy of universal masking and uniform criteria for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposure on hospital staff infection and quarantine. Infect Control Hosp Epidemiol, 43 (6):757-763.
54. Bierrenbach AL, Ranzani OT (2025). Evaluating the accuracy of ICD-10 codes for syncytial respiratory virus diagnosis in hospitalized patients: A record-linkage study (2022-2023). PLoS One, 20 (3):e0319436.
55. Lui KL, Daher N, López D, Kim V, et al (2022). Surgical mask wearing behaviour in COVID-19 pandemic and influenza seasons: a cross-sectional study on healthcare professional students and staff's perspective in Southern California. BMJ Open, 12 (10):e064677.
56. Wong S-C, Chen JH-K, Chan BW-K, et al (2025). Viral load detection on surgical mask worn by patients with acute respiratory virus infection. Heliyon, 11 (6): e42913.
57. Zhang L, Long X, Yuan YJ, et al (2025). A Retrospective Analysis of Changes in Respiratory Pathogens During the Influenza Season Before and After the Relaxation of Non-Pharmaceutical Intervention Policies. Health Sci Rep, 8 (4):e70618.
2. Worby CJ, Chang HH (2020). Face mask use in the general population and optimal resource allocation during the COVID-19 pandemic. Nat Commun, 11 (1):4049.
3. Greenhalgh T, Schmid MB, Czypionka T, Bassler D, Gruer L (2020). Face masks for the public during the covid-19 crisis. BMJ, 369:m1435.
4. Howard J, Huang A, Li Z, et al (2021). An evidence review of face masks against COVID-19. Proc Natl Acad Sci U S A, 118(4):e2014564118.
5. Jacob JT, Baker JM, Fridkin SK, et al (2021). Risk Factors Associated With SARS-CoV-2 Seropositivity Among US Health Care Personnel. JAMA Netw Open, 4 (3):e211283.
6. Doroshenko A (2021). The Combined Effect of Vaccination and Nonpharmaceutical Public Health Interventions-Ending the COVID-19 Pandemic. JAMA Netw Open, 4 (6):e2111675.
7. Control CfD, Prevention (2021). Interim public health recommendations for fully vaccinated people. https://stacks.cdc.gov/view/cdc/105629
8. McLean G, Kamil J, Lee B, et al (2022). The Impact of Evolving SARS-CoV-2 Mutations and Variants on COVID-19 Vaccines. mBio, 13 (2):e0297921.
9. Wise J (2023). Covid-19: WHO declares end of global health emergency. BMJ, 381:1041.
10. Sah R, Zaman K, Mohanty A, et al (2023). Respiratory syncytial virus with ongoing COVID-19: is it an emerging threat? Ann Med Surg (Lond), 85 (1):67-70.
11. Organization WH WHO updates COVID-19 guidelines on masks, treatments and patient care.
12. Khan M, Adil SF, Alkhathlan HZ, et al (2020). COVID-19: A Global Challenge with Old History, Epidemiology and Progress So Far. Molecules, 26 (1):39.
13. Wang Y, Tian H, Zhang L, et al (2020). 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 Glob Health, 5 (5): e002794.
14. Ohara H (2004). Experience and review of SARS control in Vietnam and China. Tropical Medicine and Health, 32 (3):235-240.
15. Davies A, Thompson KA, Giri K, et al (2013). Testing the efficacy of homemade masks: would they protect in an influenza pandemic? Disaster Med Public Health Prep, 7 (4):413-8.
16. Ueki H, Furusawa Y, Iwatsuki-Horimoto K, et al (2020). Effectiveness of Face Masks in Preventing Airborne Transmission of SARS-CoV-2. mSphere, 5 (5): e00637-20.
17. Doung-Ngern P, Suphanchaimat R, Panjangampatthana A, et al (2020). Case-Control Study of Use of Personal Protective Measures and Risk for SARS-CoV 2 Infection, Thailand. Emerg Infect Dis, 26 (11):2607-2616.
18. WHO (2020) Advice on the use of masks in the context of COVID-19: interim guidance, 5 June 2020. World Health Organization.
19. Badillo-Goicoechea E, Chang TH, Kim E, et al (2021). Global trends and predictors of face mask usage during the COVID-19 pandemic. BMC Public Health, 21 (1):2099.
20. Taylor M, Raphael B, Barr M, et al (2009). Public health measures during an anticipated influenza pandemic: Factors influencing willingness to comply. Risk Manag Healthc Policy, 2:9-20.
21. Stosic MD, Helwig S, Ruben MA (2021). Greater belief in science predicts mask-wearing behavior during COVID-19. Pers Individ Dif, 176:110769.
22. Warnock-Parkes E, Thew GR, Clark DM (2021). Belief in Protecting Others and Social Perceptions of Face Mask Wearing Were Associated With Frequent Mask Use in the Early Stages of the COVID Pandemic in the UK. Front Psychol, 12:680552.
23. Adjodah D, Dinakar K, Chinazzi M, et al (2021). Association between COVID-19 outcomes and mask mandates, adherence, and attitudes. PLoS One, 16 (6):e0252315.
24. Van Dyke ME, Rogers TM, Pevzner E, et al (2020). Trends in County-Level COVID-19 Incidence in Counties With and Without a Mask Mandate - Kansas, June 1-August 23, 2020. MMWR Morb Mortal Wkly Rep, 69 (47):1777-1781.
25. Zaidan E, Cochrane L, Belal M (2025). Adapting to Change and Transforming Crisis into Opportunity-Behavioral and Policy Shifts in Sustainable Practices Post-Pandemic. Heliyon, 11(10):e42046.
26. Strasser BJ, Schlich T (2020). A history of the medical mask and the rise of throwaway culture. Lancet, 396 (10243):19-20.
27. Taubenberger JK, Morens DM (2020). The 1918 influenza pandemic and its legacy. Cold Spring Harb Perspect Med, 10 (10):a038695.
28. Ataei M, Shirazi FM, Nakhaee S, et al (2022). Assessment of cloth masks ability to limit Covid-19 particles spread: a systematic review. Environ Sci Pollut Res Int, 29 (2):1645-1676.
29. Das S, Sarkar S, Das A, et al (2021). A comprehensive review of various categories of face masks resistant to Covid-19. Clin Epidemiol Glob Health, 12:100835.
30. O'Kelly E, Arora A, Pirog S, et al (2021). Comparing the fit of N95, KN95, surgical, and cloth face masks and assessing the accuracy of fit checking. PLoS One, 16 (1):e0245688.
31. De Silva AP, Niriella MA, de Silva HJ (2021). Masks in COVID-19: let's unmask the evidence. Expert Rev Respir Med, 15 (3):293-299.
32. Jain M, Kim ST, Xu C, Li H, Rose G (2020). Efficacy and Use of Cloth Masks: A Scoping Review. Cureus, 12 (9):e10423.
33. Desai AN, Mehrotra P (2020). Medical Masks. JAMA, 323 (15):1517-1518.
34. Wojtasz I, Cofta S, Czudaj P, et al (2022). Effect of Face Masks on Blood Saturation, Heart Rate, and Well-Being Indicators in Health Care Providers Working in Specialized COVID-19 Center. Int J Environ Res Public Health, 19 (3): 1397.
35. Kisielinski K, Giboni P, Prescher A, et al (2021). Is a mask that covers the mouth and nose free from undesirable side effects in everyday use and free of potential hazards? Int J Environ Res Public Health, 18 (8):4344.
36. Vogel L (2022). Is one-way masking enough? CMAJ, 194(19):E682.
37. Jotz GP, de Matos FCM (2021). COVID-19: Priority Use of N95 Mask or Double Mask. Int Arch Otorhinolaryngol, 25 (2):e175-e176.
38. Andrejko K, Pry J, Myers J (2021). Does 'One-Way Masking' Work Against COVID-19?. https://www.health.com/condition/infectious-diseases/coronavirus/one-way-masking-covid-protection
39. Htwe YZN, Mamat H, Osman B, et al (2022). Performance Comparison of Single and Double Masks: Filtration Efficiencies, Breathing Resistance and CO2 Content. Arab J Sci Eng, 1-9.
40. O'Donohue LS, Fletcher-Gutowski S, Sidhu A, et al (2022). Mask use among health care workers and feelings of safety at work pre- and post- COVID-19 vaccine. Am J Infect Control, 50 (5):503-508.
41. Brüssow H, Zuber S (2022). Can a combination of vaccination and face mask wearing contain the COVID-19 pandemic? Microb Biotechnol, 15 (3):721-737.
42. Zhang N, Liu X, Jin T, et al (2021). Weakening personal protective behavior by Chinese university students after COVID-19 vaccination. Build Environ, 206:108367.
43. Kang YJ (2022). COVID-19 in South Korea: Proper Timing for Easing Mask Mandates After COVID-19 Vaccination. Disaster Med Public Health Prep, 16 (5):1832-1834.
44. Silk BJ, Scobie HM, Duck WM, et al (2023). COVID-19 Surveillance After Expiration of the Public Health Emergency Declaration - United States, May 11, 2023. MMWR Morb Mortal Wkly Rep, 72 (19):523-528.
45. (CDC) CfDCaP (2024). Infection control: Severe Respiratory Disease Coronavirus 2 (SARS-CoV-2).
46. Olsen SJ, Winn AK, Budd AP, et al (2021). Changes in Influenza and Other Respiratory Virus Activity During the COVID-19 Pandemic - United States, 2020-2021. MMWR Morb Mortal Wkly Rep, 70 (29):1013-1019.
47. Li L, Liu B, Liu SH, et al (2021). Evaluating the Impact of New York's Executive Order on Face Mask Use on COVID-19 Cases and Mortality: a Comparative Interrupted Times Series Study. J Gen Intern Med, 36 (4):985-989.
48. Petersen F, Errore A, Karaca-Mandic P (2022). Lifting Statewide Mask Mandates and COVID-19 Cases: A Synthetic Control Study. Med Care, 60 (7):538-544.
49. Bennett NG, Bloom DE, Ferranna M (2022). Factors underlying COVID-19 vaccine and booster hesitancy and refusal, and incentivizing vaccine adoption. PLoS One, 17 (9):e0274529.
50. Bartsch SM, O'Shea KJ, Chin KL, et al (2022). Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study. Lancet Public Health, 7 (4):e356-e365.
51. Ko Y, Mendoza VM, Mendoza R, et al (2023). Risk estimation of lifted mask mandates and emerging variants using mathematical model. Heliyon, 9 (6):e16841.
52. Wang X, Ferro EG, Zhou G, et al (2020). Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. JAMA, 324 (7):703-704.
53. Temkin E, Schwaber MJ, Vaturi A, et al (2022). Effect of a national policy of universal masking and uniform criteria for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposure on hospital staff infection and quarantine. Infect Control Hosp Epidemiol, 43 (6):757-763.
54. Bierrenbach AL, Ranzani OT (2025). Evaluating the accuracy of ICD-10 codes for syncytial respiratory virus diagnosis in hospitalized patients: A record-linkage study (2022-2023). PLoS One, 20 (3):e0319436.
55. Lui KL, Daher N, López D, Kim V, et al (2022). Surgical mask wearing behaviour in COVID-19 pandemic and influenza seasons: a cross-sectional study on healthcare professional students and staff's perspective in Southern California. BMJ Open, 12 (10):e064677.
56. Wong S-C, Chen JH-K, Chan BW-K, et al (2025). Viral load detection on surgical mask worn by patients with acute respiratory virus infection. Heliyon, 11 (6): e42913.
57. Zhang L, Long X, Yuan YJ, et al (2025). A Retrospective Analysis of Changes in Respiratory Pathogens During the Influenza Season Before and After the Relaxation of Non-Pharmaceutical Intervention Policies. Health Sci Rep, 8 (4):e70618.
| Files | ||
| Issue | Vol 54 No 10 (2025) | |
| Section | Review Article(s) | |
| DOI | https://doi.org/10.18502/ijph.v54i10.20137 | |
| Keywords | ||
| COVID-19 Personal protective equipment Healthcare setting Hospital Mask | ||
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Kouchaki H, Tabrizi R, Kamyab P, Pourrahimi M, Ghanei A, Goudarzi S, Bagheri Lankarani K. Mask Usage in Healthcare Settings: Is It the Right Time for Easing Restrictions? A Narrative Review. Iran J Public Health. 2025;54(10):2190-2198.
