Why N95 Should Be the Standard for All COVID-19 Inpatient Care
Authors: Dimitri Drekonja
Journal: Annals of Internal Medicine (2021)

LettersMay 2021Why N95 Should Be the Standard for All COVID-19 Inpatient CareFREEDimitri Drekonja, MD, MSDimitri Drekonja, MD, MSMinneapolis VA Health Care System and University of Minnesota Medical School, Minneapolis, MinnesotaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1451 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: I read Dau and colleagues' commentary (1) with interest. Many of us are wrestling with the issue of what personal protective equipment should be used in the management of patients with COVID-19. It is a difficult decision that requires navigating current personal protective equipment shortages and evaluating how much weight to give prior studies on SARS-CoV-2 or influenza, among other challenges.This difficult task is not made easier when viewpoints in such major journals as Annals state, “A 2016 meta-analysis evaluating the effectiveness of N95 respirators versus surgical masks in a health care setting found an odds ratio of 0.51 (95% CI, 0.19 to 1.41) for influenza-like illness. … This odds ratio shows the effectiveness of N95 respirators for reducing influenza-like illness and a compelling magnitude of protection against respiratory disease transmission with N95 respirators.”An odds ratio confidence interval that crosses 1 (and not just by a small amount) does not show the effectiveness of N95 respirators; instead, it tells us that there is a great deal of uncertainty around the effect, including that the effect may be harmful. Trial data—including those by Radonovich and associates (2), which Dau and colleagues cite—show no superiority of N95 respirators versus surgical masks. Early literature coming out of the COVID-19 experience similarly has yet to show an advantage to N95 respirator use outside of aerosol-generating procedures. Universal N95 respirator use may prove to be superior; however, there is the potential for harm. For example, proper and consistent use of an N95 respirator is not easy. Furthermore, if supplies mandate extended use or reprocessing, risks are increased.Science needs to drive our use of personal protective equipment. Claiming that a meta-analysis shows “the effectiveness of” and a “compelling magnitude of protection … with” N95 respirator use when the actual data state that the evidence is mixed and do not show either type of device to be clearly superior is misleading.References1. Dau NQ, Peled H, Lau H, et al. Why N95 should be the standard for all COVID-19 inpatient care [Editorial]. Ann Intern Med. 2020;173:749-51. [PMID: 32598163]. doi:10.7326/M20-2623 LinkGoogle Scholar2. 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 Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Dimitri Drekonja, MD, MSAffiliations: Minneapolis VA Health Care System and University of Minnesota Medical School, Minneapolis, MinnesotaDisclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1451. 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 Nhu Quyen Dau , Harry Peled Metrics May 2021Volume 174, Issue 5 Page: 733-734 ePublished: 18 May 2021 Issue Published: May 2021 PDF downloadLoading ...