Why N95 Should Be the Standard for All COVID-19 Inpatient Care
Authors: Nhu Quyen Dau, Harry Peled
Journal: Annals of Internal Medicine (2021)

LettersMay 2021Why N95 Should Be the Standard for All COVID-19 Inpatient CareFREENhu Quyen Dau, PharmD, BCCP, Harry Peled, MDNhu Quyen Dau, PharmD, BCCPMarshall B. Ketchum University College of Pharmacy Fullerton, California, Harry Peled, MDProvidence-St. Jude Medical Center Fullerton, CaliforniaAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1453 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We agree with Dr. Drekonja that the example provided focused on the point estimate and did not emphasize the uncertainty based on the wide CI. We would like to provide additional data to support our view. The meta-analysis by Bartoszko and colleagues (1) showed an odds ratio of 1.31 (95% CI, 0.95 to 1.85) for influenza-like illness and 1.49 (CI, 0.98 to 2.28) for clinical respiratory illness, both favoring N95 respirators. The meta-analysis by Long and associates (2) for laboratory-confirmed respiratory viral infection—without including data from Radonovich and coworkers' 2019 outpatient study (3) and Loeb and colleagues' 2009 targeted-use trial (4)—showed a risk ratio of 0.58 (CI, 0.43 to 0.78), also favoring N95 respirators. We thank Dr. Drekonja for giving us an opportunity to provide this clarification.Dr. Wilson emphasized the potential benefits of N95 respirators in various settings where prolonged exposure to SARS-CoV-2 may be expected. The World Health Organization (5) clarified that "short-range aerosol transmission, particularly in specific indoor locations, such as crowded and inadequately ventilated spaces over a prolonged period of time with infected persons cannot be ruled out." As production of N95 respirators ramps up, there would be tremendous value to performing the cluster randomized controlled trials of N95 respirators versus medical masks in the community settings that Dr. Wilson described. As for fit, a study did find that "fit testing did not improve the efficacy of N95 respirators" (6). However, this study had a small sample size, and its findings may not be extrapolated to other N95 respirators.Again, we strongly urge countries to allocate resources to ensure that personal protective equipment is easily available. Doing so will eliminate the difficulty of making appropriate recommendations for this equipment based on availability and resources. Until then, universal face mask use has been shown to reduce the spread of disease within the community setting (7). We also hope for wider acceptance of mask use during a pandemic.References1. Bartoszko JJ, Farooqi MAM, Alhazzani W, et al. Medical masks vs N95 respirators for preventing COVID-19 in healthcare workers: a systematic review and meta-analysis of randomized trials. Influenza Other Respir Viruses. 2020;14:365-73. [PMID: 32246890] doi:10 .1111/irv.12745 CrossrefMedlineGoogle Scholar2. Long Y, Hu T, Liu L, et al. Effectiveness of N95 respirators versus surgical masks against influenza: a systematic review and metaanalysis. J Evid Based Med. 2020;13:93-101. [PMID: 32167245] doi:10.1111/jebm.12381 CrossrefMedlineGoogle Scholar3. Radonovich LJ Jr, Simberkoff MS, Bessesen MT, et al; ResPECT investigators.. N95 respirators vs medical masks for preventing influenza among health care personnel: a randomized clinical trial. JAMA. 2019;322:824-33. [PMID: 31479137] doi:10.1001/jama.2019.11645 CrossrefMedlineGoogle Scholar4. Loeb M, Dafoe N, Mahony J, et al. Surgical mask vs N95 respirator for preventing influenza among health care workers: a randomized trial. JAMA. 2009;302:1865-71. [PMID: 19797474] doi:10.1001/jama CrossrefMedlineGoogle Scholar5. World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. 2020. Accessed at www.who.int/news-r oom/commentaries/detail/transmission-of-sars-cov-2-implications-for-infection-prevention-precautions on 22 July 2020. Google Scholar6. MacIntyre CR, Wang Q, Cauchemez S, et al. A cluster randomized clinical trial comparing fit-tested and non–fit-tested N95 respirators to medical masks to prevent respiratory virus infection in health care workers. Influenza Other Respir Viruses. 2011;5:170-9. [PMID: 21477136] doi:10.1111/j.1750-2659.2011.00198.x CrossrefMedlineGoogle Scholar7. MacIntyre CR, Chughtai AA. A rapid systematic review of the efficacy of face masks and respirators against coronaviruses and other respiratory transmissible viruses for the community, healthcare workers and sick patients. Int J Nurs Stud. 2020;108:103629. [PMID: 32512240] doi:10.1016/j.ijnurstu.2020.103629 CrossrefMedlineGoogle Scholar Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Nhu Quyen Dau, PharmD, BCCP; Harry Peled, MDAffiliations: Marshall B. Ketchum University College of Pharmacy Fullerton, CaliforniaProvidence-St. Jude Medical Center Fullerton, CaliforniaDisclosures: Authors have reported no disclosures of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M20-2623. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoWhy N95 Should Be the Standard for All COVID-19 Inpatient Care Nhu Quyen Dau , Harry Peled , Helen Lau , Julie Lyou , and Claudia Skinner Why N95 Should Be the Standard for All COVID-19 Inpatient Care Kenneth H. Wilson Why N95 Should Be the Standard for All COVID-19 Inpatient Care Dimitri Drekonja Metrics May 2021Volume 174, Issue 5Page: 734-735 ePublished: 18 May 2021 Issue Published: May 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...