(Source: DHS Science and Technology, Master Question List for COVID-19 (caused by SARS-CoV-2), Weekly Report, 18 March 2020)

 What PPE is effective, and who should be using it?

 What is known?

• The effectiveness of PPE for SARS-CoV-2 is currently not clearly understood; SARS is used as a surrogate.
• Healthcare worker illnesses (over 1,000) point to human-to-human transmission in spite of isolation, PPE, and infection control.¹
• US CDC does not recommend the use of facemasks for healthy people. Facemasks are for use by people exhibiting symptoms to reduce the risk of others getting infected. The use of facemasks is essential for health workers and people in close contact with infected patients (at home or in a healthcare facility).²  
• Healthcare personnel entering the room of SARS-CoV-2 patients should use standard precautions, contact precautions, airborne precautions, and use eye protection (such as goggles or a face shield).³  
• As per WHO, healthcare workers should wear clean, non-sterile, long-sleeve gowns as well as gloves.⁴
• Respirators (NIOSH-certified N95, EUFFP2 or equivalent) are recommended for those dealing with possible aerosols.⁵
• Additional protection, such as a Powered Air Purifying Respirator (PAPR) with a full hood, must be considered for high-risk procedures (i.e., intubation, ventilation).⁶
• SARS-CoV-2 transmission has been reported in hospitals inside⁷and outside of China, ⁸ including the US. ⁹
• Porous hospital materials, including paper and cotton cloth, can maintain infectious SARS-CoV for a shorter time than non-porous material.¹⁰
• Despite comprehensive environmental contamination, air sampling in patient rooms did not detect SARS-CoV-2.¹¹

What do we need to know?

• Mode of aerosol transmission. Effective distance of spread through droplet or aerosol
• Effectiveness of barriers such as N95 respirators or surgical masks
• What is the appropriate PPE for first responders? Airport screeners?
• Appropriate procedures for reducing spread in medical facilities/transmission rate in medical settings.

References

1. Schnirring, L., New coronavirus infects health workers, spreads to Korea. http://www.cidrap.umn.edu/news-perspective/2020/01/new-coronavirus-infects-health-workers-spreads-korea.
2. CDC, COVID-19 Frequently Asked Questions and Answers. https://www.cdc.gov/coronavirus/2019-ncov/faq.html.
3. CDC, Interim healthcare infection prevention and control recommendations for patients under investigation for 2019 novel coronavirus. https://www.cdc.gov/coronavirus/2019-ncov/infection-control.html.
4. WHO, Infection prevention and control during health care when novel coronavirus (nCoV) infection is suspected; 2020.
5. WHO, Laboratory testing for 2019 novel coronavirus (2019-nCoV) in suspected human cases.
6. Brosseau, L. M.; Jones, R., Commentary: Protecting health workers from airborne MERS-CoV - learning from SARS. http://www.cidrap.umn.edu/news-perspective/2014/05/commentary-protecting-health-workers-airborne-mers-cov-learning-sars.
7. Wang, D.; Hu, B.; Hu, C.; Zhu, F.; Liu, X.; Zhang, J.; Wang, B.; Xiang, H.; Cheng, Z.; Xiong, Y.; Zhao, Y.; Li, Y.; Wang, X.; Peng, Z., Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA 2020.
8. Guardian, New virus cases in UK are closely linked, official says – as it happened. The Guardian: 2020.
9. Boodman, E.; Branswell, H., First Covid-19 outbreak in a U.S. nursing home raises concerns. Stat 2020.
10. Lai, M. Y.; Cheng, P. K.; Lim, W. W., Survival of severe acute respiratory syndrome coronavirus. Clinical Infectious Diseases 2005, 41 (7), e67-e71.
11. Ong, S. W. X.; Tan, Y. K.; Chia, P. Y.; Lee, T. H.; Ng, O. T.; Wong, M. S. Y.; Marimuthu, K., Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient. Jama 2020.

Dr K K Aggarwal,

President Confederation of Medical Associations of Asia and Oceania