Sourcing Personal Protective Equipment During the COVID-19 Pandemic.

By E. Livingston, A. Desai, M. Berkwits. Journal of the American Medical Association (JAMA), 2020

594 citations recorded by the source corpus.

As the coronavirus disease 2019 (COVID-19) pandemic accelerates, global health care systems have become overwhelmed with potentially infectious patients seeking testing and care. Preventing spread of infection to and from health care workers (HCWs) and patients relies on effective use of personal protective equipment (PPE)—gloves, face masks, air-purifying respirators, goggles, face shields, respirators, and gowns. A critical shortage of all of these is projected to develop or has already developed in areas of high demand. PPE, formerly ubiquitous and disposable in the hospital environment, is now a scarce and precious commodity in many locations when it is needed most to care for highly infectious patients. An increase in PPE supply in response to this new demand will require a large increase in PPE manufacturing, a process that will take time many health care systems do not have, given the rapid increase in ill COVID-19 patients. In its current guidance to optimize use of face masks during the pandemic, the Centers for Disease Control and Prevention (CDC) identifies 3 levels of operational status: conventional, contingency, and crisis.1 During normal times, face masks are used in conventional ways to protect HCWs from splashes and sprays. When health care systems become stressed and enter the contingency mode, CDC recommends conserving resources by selectively canceling nonemergency procedures, deferring nonurgent outpatient encounters that might require face masks, removing face masks from public areas, and using face masks for extended periods if feasible. When health systems enter crisis mode, the CDC recommends cancellation of all elective and nonurgent procedures and outpatient appointments for which face masks are typically used, use of face masks beyond the manufacturerdesignated shelf life during patient care activities, limited reuse, and prioritization of use for activities or procedures in which splashes, sprays, or aerosolization are likely. When face masks are altogether unavailable, the CDC recommends use of face shields without masks, taking clinicians at high risk for COVID-19 complications out of clinical service, staffing services with convalescent HCWs presumably immune to SARSCoV-2 (severe acute respiratory syndrome coronavirus 2), and use of homemade masks, perhaps from bandanas or scarves if necessary. Many communities in the US and globally are rapidly entering crisis mode. Popular news outlets report unconventional solutions for PPE at local hospitals, such as plastic garbage bags for gowns and plastic water bottle cutouts for eye protection.2 Plans for resupply through the repurposing of industrial capacity and other means are welcome but seem unlikely to solve the shortage quickly enough as supply chains become more dysfunctional in the pandemic.3 The Department of Health and Human Services’ Strategic National Stockpile was created to solve precisely this problem, but its inventory is not transparent and news reports suggest its supplies are being distributed unevenly or are insufficient to meet demand.4 HCWs need supplies and solutions for these shortages now, and for that reason JAMA issued a call for ideas for how to address the impending PPE shortage.5 In the week since publication the article received more than 100 000 views and generated more than 250 comments. In addition, many additional ideas were sent directly to JAMA editors. The Box organizes the major themes of the contributions and the following discussion reviews several of them. A frequent proposal was to acquire PPE from existing supplies in non–health care industries and settings such as construction, research laboratories, nail salons, dentists, veterinarians, and farms, and redirect them to the health care system via charitable appeals, community organizing, financial incentives, or government mandate. One endeavor is Project N95, a national COVID-19 medical equipment clearinghouse to identify high-need regions and to source and distribute PPE and other equipment where it is needed most.6 Numerous proposals suggested sterilization of used PPE with agents ranging from ethylene oxide, UV or gamma irradiation, ozone, and alcohol. There were also novel proposals such as mask-fiber impregnation with copper or sodium chloride. These are not new ideas; work was performed after prior viral epidemics to determine the feasibility of sterilizing PPE.7 Most commenters acknowledged uncertainty about the effects of these sterilizing agents on the structural integrity of PPE, and there is some evidence the fibers in masks and respirators that filter viral particles can degrade and lose their efficacy with PPE reprocessing.7 A few people advocated for use of positive pressure airflow helmets; proposals ranged from creating devices from plastic bags insufflated using compressed air and nasal cannula tubing to adoption of commercially available devices used in the welding industry. An advantage of this approach is that by not relying on filters, positive airflow devices can be cleaned and reused indefinitely. Many proposals reflect an era when PPE was made of cloth and laundered.8 Health care might be made greener if reusable PPE was employed where feasible. Cloth gowns and masks are easily created and stored, and laundry capacity could easily be expanded by recruiting commercial launderers that service hotels and other large organizations who currently sit idle. Many contributors wrote of sewing masks, creating them out of clothing, using novel materials to make them, and using cloth Editorial Opinion

Subfields: Economics and Econometrics

View Paper: https://www.semanticscholar.org/paper/6bd14e710e51c8159ba5da425e731e4a3e459fff

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

Citations in the corpus

COVID-19 Detection Through Transfer Learning Using Multimodal Imaging Data (2020, background): “Both the PCR tests and CT scans are comparatively costly [13], [14] and with an overwhelming demand many countries are forced to perform selective testing for only high-risk population.”