By Rebecca Weintraub, MD and Bill Rodriguez, MD
With rapidly rising numbers of COVID-19 cases around the world, there is growing concern about risks to the public health in the U.S. The impact of COVID-19 on front line health workers is even more distressing — some 1,700 health workers in Italy are known to have already been affected, decimating an overstretched workforce. This could happen here in the U.S. unless major changes are made. As an Infectious Disease specialist and a Hospitalist, we see and share our colleagues’ mounting fear. Public health measures have arrived too late to prevent surges of patients requiring hospitalized care for COVID-19 around the United States.
Is there really a shortage of N95 masks in hospitals?
YES.
Overwhelming evidence, pleas for help, and media reports point to critical shortages of masks and other personal protective equipment (PPE), including gowns, gloves, goggles, and face shields.
The shortage of masks, both the N95 type and standard surgical masks, is particularly urgent.
Every health care worker needs protection. At our institution, every provider and staff member in clinical spaces now wears a surgical mask to prevent the transmission of coronavirus. If an asymptomatic COVID-19 patient walks into the hospital, we’re all protected. Many U.S. health care facilities, however, are not yet prepared to provide these basic protections. In a recent national survey of nurses, only 44% reported that they had received information from their employer about coronavirus and how to respond to it.
We urge every facility in the country to ensure that all personnel who may come in contact with patients with respiratory symptoms are provided with the appropriate PPE — especially surgical masks. Any provider participating in aerosol-generating procedures requires an N95.
What can we do to fix these shortages?
The U.S. government has been sluggish to call on private industry to dramatically increase production of needed supplies. As a country, we need to put pressure on Congress and the president to properly utilize the Defense Production Act to produce the PPE that frontline healthcare personnel need, specifically N95 and surgical masks.
Even if the government acts today, however, it will take time to spool up production, reorganize the supply chains, and get additional masks to the frontlines of health care.
What about shortages of N95 masks right now?
And what about facilities that are already running perilously low on even basic PPE? We do have some options.
You can help preserve the supply of N95 masks for those who need them by wearing surgical masks for most patient care. While we lack conclusive evidence about COVID-19, we do have a clear evidence base about the protection provided by non-N95 masks for other respiratory illnesses.
For instance, while laboratory studies suggested that N95s provided better filtration of microscopic particles, in real-world clinical settings, there was no significant difference between the use of a surgical mask and an N95 mask in the incidence of respiratory, viral, or influenza-like illnesses.¹ ² ³ Similarly, a randomized, controlled trial demonstrated equal protection by surgical masks and N95 masks against laboratory-confirmed respiratory illnesses, including influenza.⁴
But what about COVID-19 specifically? Certainly, data are limited. Reassurance comes from a case report this week of a patient in Singapore who was cared for extensively by 41 health care personnel, and who later tested positive for COVID-19. The vast majority of the health workers who cared for this patient were exposed to aerosol-generating procedures at close distances while wearing only surgical masks, and none contracted the coronavirus.⁵
Additionally, the CDC has issued guidance on extending the life of or reusing masks. We also have compelling evidence that N95 masks can be safely sanitized and reused,⁶ which could also help facilities undergoing shortages. Amid scarcity, clinicians in Kentucky have adopted this practice.
Finally, in the past week, U.S. health care facilities have turned to the public with requests for mask donations, and some have even pursued DIY solutions.
We can protect health workers and the public. In a short time, we have expanded access to telemedicine, approved rapid diagnostic tests, and mobilized industry to produce more ventilators. Let’s make PPE available more widely and effectively.
Read More from Ariadne Labs: Clinical guidance for health care facilities on PPE conservation
Bibliography
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2. Offeddu V, Yung CF, Low MSF, Tam CC. Effectiveness of Masks and Respirators Against Respiratory Infections in Healthcare Workers: A Systematic Review and Meta-Analysis. Clin Infect Dis 2017;65(11):1934–1942.
3. Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber GE. Effectiveness of N95 respirators versus surgical masks in protecting health care workers from acute respiratory infection: a systematic review and meta-analysis. Can Med Assoc J 2016;188(8):567–574.
4. Radonovich LJ, Simberkoff MS, Bessesen MT, et al. N95 respirators vs medical masks for preventing influenza among health care personnel: A randomized clinical trial. JAMA 2019;322(9):824–833.
5. Ng K, Poon BH, Kiat Puar TH, et al. COVID-19 and the Risk to Health Care Workers: A Case Report. Ann Intern Med 2020;
6. Mills D, Harnish DA, Lawrence C, Sandoval-Powers M, Heimbuch BK. Ultraviolet germicidal irradiation of influenza-contaminated N95 filtering facepiece respirators. Am J Infect Control 2018;46(7):e49–e55.
Bill Rodriguez, MD MPHHeader illustration by Maltiase / iStock