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Abstract
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 manufacturer-designated 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 SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), and use of homemade masks, perhaps from bandanas or scarves if necessary.