Personal protective equipment in the siege of respiratory viral pandemics: strides made and next steps

ABSTRACT

Introduction: In December 2019, SARS-CoV-2 originated from China, and spread rapidly to several countries, bringing a frightening scarcity of personal protective equipment (PPE). The CDC recommends N95 or higher-level particulate filtering respirators as part of the PPE while caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. With new evidence about the efficacy of facemasks, knowledge gaps remain.

Areas covered: This reviews the history of respiratory viral pandemics and PPE use, exploring the influenza pandemics of the 20^th and 21^st century, and prior coronavirus pandemics. A literature search of PubMed and google was done between March 22^nd to May 2^nd, and on September 28, 2020. The evidence for PPE is described, to delineate their efficacy and ‘best safe’ practices. Solutions to ameliorate pandemic preparedness to meet surge-capacity to efficiently combat future pandemics, should they arise, are discussed.

Expert opinion: PPE, when used appropriately in addition to other infection control measures, is effective protection during respiratory viral pandemics. The current evidence suggests that wearing facemasks in the community is protective, especially if used consistently and correctly with other infection control measures such as hand hygiene.

KEYWORDS:

• Personal Protective Equipment
• pandemics
• respiratory viruses
• face masks
• face coverings
• N95
• respirators
• influenza
• coronaviruses

Article highlights

• The Centers for Disease Control and prevention recommend N95 or higher-level particulate filtering respirators as part of the personal protective equipment for health-care personnel caring for patients with COVID-19, with facemasks as an alternative; and cloth face-coverings in public where social distancing of at least 6 ft. is not feasible. However, the efficiency of face masks in preventing the transmission of respiratory viruses during pandemics is not established, and knowledge gaps remain.

• The current pandemic, COVID-19, influenza pandemics of recent history, as well as prior coronavirus pandemics - Severe Acute Respiratory Syndrome, Middle Eastern Respiratory Syndrome were critically reviewed in the context of personal protective equipment use in order to delineate their efficacy and ‘best safe’ practices during these unprecedented times.

• Use of appropriate PPE in the health-care setting is efficacious in preventing the transmission of viral respiratory pandemic pathogens. Health-care workers should use N95 or equivalent respirators and eye protection and not face masks based on the available evidence.

• While the benefit of face masks in the community is not well established during prior pandemics, particularly influenza, the recent data in the COVID-19 era is quite compelling, suggesting that face-mask use (disposable surgical masks or equivalent 12-16 layer reusable cotton masks) is associated with as high as a 67% reduction in the transmission of pandemic coronaviruses, including COVID-19.

• There is the need to recognize and adopt wearing face masks in populations heavily affected by COVID-19 until more definitive interventions like vaccines become available.

• Prospective and controlled studies are needed to determine which cloth face coverings would offer the best protection against respiratory viral pandemic pathogens, and create science-based requirements that manufacturers will adopt in order to meet these standards.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are an unpaid board member of GetUsPPE. Peer reviewers on this manuscript have no other relevant financial relationships or otherwise to disclose.