Why N95 Should Be the Standard for All COVID-19 Inpatient Care
Authors: Kenneth H. Wilson
Journal: Annals of Internal Medicine (2021)

LettersMay 2021Why N95 Should Be the Standard for All COVID-19 Inpatient CareFREEKenneth H. Wilson, MDKenneth H. Wilson, MDDuke University, Durham, North CarolinaSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L20-1452 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR: Dau and colleagues' commentary (1) makes the important point that recommendations for respiratory protection of health care workers exposed to SARS-CoV-2 have often fallen short. The recommendation that surgical masks are adequate outside the setting of procedures believed to generate aerosols is described as “merely … a preference or a recommendation based on availability [of N95 respirators].” As noted, the superiority of N95 respirators in protecting against respiratory pathogens is supported by available literature and the performance characteristics of N95 respirators compared with that of surgical masks, given that SARS-CoV-2 seems to be transmissible by aerosols.I am writing this comment not to dispute Dau and colleagues' conclusions but to point out further implications. The current recommendation for the public to wear cloth masks is also based on availability. The problem lies not with the recommendation itself but with the rationale. Given health care workers' consistently intense exposure, they should have first priority for use of respirators that actually protect the wearer. However, respirator shortage—not lack of rationale—should be cited as the reason not to recommend N95 respirator use for the general public.If N95 respirators are more effective when worn in the health care setting, why would they not be more effective in other settings where the exposure can sometimes be just as intense? Why would they not be more effective for packing plant employees, extended-care workers, barbers, prison guards, prisoners, and many others? Given the variety of respirators used and the large number of wearers, many hospitals have used self-fit testing; as such, the fit test seems to be less of a barrier than once believed. Difficulties with the proper use of N95 respirators exist, but people are educable. Although the risk for contracting COVID-19 is lower for most non–health care workers, wider use of N95 respirators could make a big difference in the aggregate. In addition, I am sad to say, masks that protect the self as well as others might gain better acceptance in U.S. culture.At the very least, public health authorities should protect their eroding credibility by forthrightly stating that cloth masks are recommended only because of an N95 respirator shortage. As stated in Dau and colleagues' commentary, “Recognizing that … masks are substandard will empower our society to allocate resources to ensure the availability of N95 respirators.”Reference1. 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 Scholar Comments 0 Comments Sign In to Submit A Comment Author, Article, and Disclosure InformationAuthors: Kenneth H. Wilson, MDAffiliations: Duke University, Durham, North CarolinaDisclosures: The author has reported no disclosures of interest. The form can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L20-1452. 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 Nhu Quyen Dau , Harry Peled Why N95 Should Be the Standard for All COVID-19 Inpatient Care Dimitri Drekonja Metrics May 2021Volume 174, Issue 5 Page: 734 ePublished: 18 May 2021 Issue Published: May 2021 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...