N95 Respirators vs Medical Masks in Outpatient Settings-Reply

Rationale and process for N95 respirator sanitation and reuse in the coronavirus disease 2019 (COVID-19) pandemic

OBJECTIVE

The novel severe acute respiratory coronavirus virus 2 (SARS-CoV-2) was first reported in Wuhan, China, in December 2019 and is notable for being highly contagious and potentially lethal; and SARS-CoV-2 is mainly spread by droplet transmission. The US healthcare system's response to the COVID-19 pandemic has been challenged by a shortage of personal protective equipment (PPE), especially N95 respirators. Restricted use, reuse, and sanitation of PPE have been widely adopted to provide protection for frontline healthcare workers caring for often critically ill and highly contagious patients. Here, we describe our validated process for N95 respirator sanitation.

DESIGN

Process development, validation, and implementation.

SETTING

Level 1, urban, academic, medical center.

METHODS

A multidisciplinary team developed a novel evidence-based process for N95 respirator reprocessing and sanitation using ultraviolet (UV) light. Dose measurement, structural integrity, moisture content, particle filtration, fit testing, and environmental testing were performed for both quality control and validation of the process.

RESULTS

The process achieved UV light dosing for sanitation while maintaining the functional and structural integrity of the N95 respirators, with a daily potential throughput capacity of ∼12,000 masks. This process has supported our health system to provide respiratory PPE to all frontline team members.

CONCLUSIONS

This novel method of N95 respirator sanitation can safely enable reuse of the N95 respirators essential for healthcare workers caring for patients with COVID-19. Our high-throughput process can extend local supplies of this critical PPE until the national supply is replenished.

Face mask use among individuals who are not medically diagnosed with COVID-19: A lack of evidence for and against and implications around early public health

Aim: Since the beginning of the coronavirus disease 2019 (COVID-19) outbreak, public health professionals from around the world have been making decisions on face mask use among individuals who are not medically diagnosed with COVID- 19 or "healthy individuals" to limit the spread of COVID-19. While some countries have strongly recommended face masks for "healthy individuals", other countries have recommended against it. Public health recommendations that have been provided to this population since the beginning of the outbreak have been controversial, contradicting, and inconsistent around the world. The purpose of this paper is to understand available evidence around the effectiveness or ineffectiveness of face mask use in limiting the spread of COVID-19 among individuals who have not yet been diagnosed with COVID-19 and most importantly, to understand the state of knowledge early public health recommendations are based on. Materials and Methods: A systematic review was conducted to identify studies that investigated the use of face masks to limit the spread of COVID-19 among "healthy individuals" in order to understand available evidence using the databases Cochrane Library, EMBASE, Google Scholar, PubMed, and Scopus. Two groups of keywords were combined: Those relating to COVID-19 and face masks. Results: No studies were found, demonstrating a lack of evidence for and against face mask use suggesting implications around early public health recommendations provided to "healthy individuals". Conclusion: Three and a half months into the COVID-19 outbreak (December 2019-2nd week of April 2020), there are no peer-reviewed scientific studies that have investigated the effectiveness or ineffectiveness of face mask use among "healthy individuals" to limit the spread of COVID-19. Yet, very strong public health recommendations have been provided on whether "healthy individuals" should or should not wear face masks to limit the spread of COVID-19 since the beginning of the outbreak. A lack of scientific evidence for and against face mask use heavily questions the basis of public health recommendations provided at a very early, yet a crucial stage of an outbreak. This finding and a further look at early public health recommendations conclude that there is a clear need for more concentrated research around face mask use among healthy individuals and public health recommendations that are evidence-based; precautionary in the absence of evidence; based on benefit-risk assessment; transparent; and globally aligned to provide the most successful guidelines during an infectious disease outbreak.