Covid-19 taught us a great deal about respiratory Personal Protective Equipment (PPE) that is relevant for future global biological catastrophic risk (GCBR) events. For example, an equally infectious outbreak of MERS could have caused at least 28.5 million fatalities in the first year of the pandemic.Problems with PPE that arose during Covid-19 include insufficient protection, discomfort, and shortages. Healthcare workers and frontline workers were infected disproportionately often. Causes of discomfort among workers included skin reactions, headaches, and elaborate donning and doffing routines. Worldwide shortages increased this discomfort, as workers improvised with what was at their disposal.One possible solution would be creating strategic stockpiles of reusable, durable, and affordable PPE with high protection and comfort, universal fit, and ease of use. So far, such a product does not exist, but prototypes have been developed, and further innovation could be incentivized. Especially neglected is PPE supply and research for frontline workers not part of the healthcare system. When planning GCBR response, plans must include non-healthcare staff, to keep critical infrastructure from collapsing.
Ranney Megan L., Griffeth Valerie, Jha Ashish K.. Critical Supply Shortages — The Need for Ventilators and Personal Protective Equipment during the Covid-19 Pandemic. New England Journal of Medicine. Vol. 382(18)2020. Massachusetts Medical Society. [Cross Ref]
Sterr Christian M., Nickel Inga-Lena, Stranzinger Christina, Nonnenmacher-Winter Claudia I., Günther Frank. Medical face masks offer self-protection against aerosols: An evaluation using a practical in vitro approach on a dummy head. PLOS ONE. Vol. 16(3)2021. Public Library of Science (PLoS). [Cross Ref]
Howard Brittany E.. High-Risk Aerosol-Generating Procedures in COVID-19: Respiratory Protective Equipment Considerations. Otolaryngology–Head and Neck Surgery. Vol. 163(1):98–103. 2020. SAGE Publications. [Cross Ref]
Ju Jerry T.J., Boisvert Leah N., Zuo Yi Y.. Face masks against COVID-19: Standards, efficacy, testing and decontamination methods. Advances in Colloid and Interface Science. Vol. 292:2021. Elsevier BV. [Cross Ref]
Kampf G., Scheithauer S., Lemmen S., Saliou P., Suchomel M.. COVID-19-associated shortage of alcohol-based hand rubs, face masks, medical gloves, and gowns: proposal for a risk-adapted approach to ensure patient and healthcare worker safety. Journal of Hospital Infection. Vol. 105(3):424–427. 2020. Elsevier BV. [Cross Ref]
Talic Stella, Shah Shivangi, Wild Holly, Gasevic Danijela, Maharaj Ashika, Ademi Zanfina, Li Xue, Xu Wei, Mesa-Eguiagaray Ines, Rostron Jasmin, Theodoratou Evropi, Zhang Xiaomeng, Motee Ashmika, Liew Danny, Ilic Dragan. Effectiveness of public health measures in reducing the incidence of covid-19, SARS-CoV-2 transmission, and covid-19 mortality: systematic review and meta-analysis. BMJ. 2021. BMJ. [Cross Ref]
Smith Graeme D., Ng Fowie, Watson Roger. “Masking the evidence”: Perspectives of the COVID‐19 pandemic. Journal of Clinical Nursing. 2020. Wiley. [Cross Ref]
Blachere Francoise M., Lemons Angela R., Coyle Jayme P., Derk Raymond C., Lindsley William G., Beezhold Donald H., Woodfork Karen, Duling Matthew G., Boutin Brenda, Boots Theresa, Harris James R., Nurkiewicz Tim, Noti John D.. Face mask fit modifications that improve source control performance. American Journal of Infection Control. Vol. 50(2):133–140. 2022. Elsevier BV. [Cross Ref]
Mukerji Shohini, MacIntyre C. Raina, Seale Holly, Wang Quanyi, Yang Peng, Wang Xiaoli, Newall Anthony T.. Cost-effectiveness analysis of N95 respirators and medical masks to protect healthcare workers in China from respiratory infections. BMC Infectious Diseases. Vol. 17(1)2017. Springer Science and Business Media LLC. [Cross Ref]
Bessesen Mary T., Adams Jill C., Radonovich Lewis, Anderson Judith. Disinfection of reusable elastomeric respirators by health care workers: A feasibility study and development of standard operating procedures. American Journal of Infection Control. Vol. 43(6):629–634. 2015. Elsevier BV. [Cross Ref]
Chalikonda Sricharan, Waltenbaugh Hope, Angelilli Sara, Dumont Tiffany, Kvasager Curt, Sauber Timothy, Servello Nino, Singh Anil, Diaz-Garcia Rafael. Implementation of an Elastomeric Mask Program as a Strategy to Eliminate Disposable N95 Mask Use and Resterilization: Results from a Large Academic Medical Center. Journal of the American College of Surgeons. Vol. 231(3):333–338. 2020. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]
Chu Jacqueline, Ghenand Omkar, Collins Joy, Byrne James, Wentworth Adam, Chai Peter R., Dadabhoy Farah, Hur Chin, Traverso Giovanni. Thinking green: modelling respirator reuse strategies to reduce cost and waste. BMJ Open. Vol. 11(7)2021. BMJ. [Cross Ref]
Zhan Mingkun, Anders Robert L., Lin Bihua, Zhang Min, Chen Xiaosong. Lesson learned from China regarding use of personal protective equipment. American Journal of Infection Control. Vol. 48(12):1462–1465. 2020. Elsevier BV. [Cross Ref]
Leech Gavin, Rogers-Smith Charlie, Monrad Joshua Teperowski, Sandbrink Jonas B., Snodin Benedict, Zinkov Robert, Rader Benjamin, Brownstein John S., Gal Yarin, Bhatt Samir, Sharma Mrinank, Mindermann Sören, Brauner Jan M., Aitchison Laurence. Mask wearing in community settings reduces SARS-CoV-2 transmission. Proceedings of the National Academy of Sciences. Vol. 119(23)2022. Proceedings of the National Academy of Sciences. [Cross Ref]
Collins Andrew P., Service Benjamin C., Gupta Sunny, Mubarak Naser, Zeini Ibrahim Mamdouh, Osbahr Daryl C., Romeo Anthony A.. N95 respirator and surgical mask effectiveness against respiratory viral illnesses in the healthcare setting: A systematic review and meta‐analysis. Journal of the American College of Emergency Physicians Open. Vol. 2(5)2021. Wiley. [Cross Ref]
Nguyen Long H, Drew David A, Graham Mark S, Joshi Amit D, Guo Chuan-Guo, Ma Wenjie, Mehta Raaj S, Warner Erica T, Sikavi Daniel R, Lo Chun-Han, Kwon Sohee, Song Mingyang, Mucci Lorelei A, Stampfer Meir J, Willett Walter C, Eliassen A Heather, Hart Jaime E, Chavarro Jorge E, Rich-Edwards Janet W, Davies Richard, Capdevila Joan, Lee Karla A, Lochlainn Mary Ni, Varsavsky Thomas, Sudre Carole H, Cardoso M Jorge, Wolf Jonathan, Spector Tim D, Ourselin Sebastien, Steves Claire J, Chan Andrew T, Albert Christine M., Andreotti Gabriella, Bala Bijal, Balasubramanian Bijal A., Beane-Freeman Laura E., Brownstein John S., Bruinsma Fiona J., Coresh Joe, Costa Rui, Cowan Annie N., Deka Anusila, Deming-Halverson Sandra L., Elena Martinez Maria, Ernst Michael E., Figueiredo Jane C., Fortuna Pedro, Franks Paul W., Freeman Laura Beane, Gardner Christopher D., Ghobrial Irene M., Haiman Christopher A., Hall Janet E., Kang Jae H., Kirpach Brenda, Koenen Karestan C., Kubzansky Laura D., Lacey, Jr James V., Le Marchand Loic, Lin Xihong, Lutsey Pam, Marinac Catherine R., Martinez Maria Elena, Milne Roger L., Murray Anne M., Nash Denis, Palmer Julie R., Patel Alpa V., Pierce Eric, Robertson McKaylee M., Rosenberg Lynn, Sandler Dale P., Schurman Shepherd H., Sewalk Kara, Sharma Shreela V., Sidey-Gibbons Christopher J., Slevin Liz, Smoller Jordan W.., Steves Claire J., Tiirikainen Maarit I., Weiss Scott T., Wilkens Lynne R., Zhang Feng. Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. The Lancet Public Health. Vol. 5(9)2020. Elsevier BV. [Cross Ref]
Swerdlow David L., Finelli Lyn. Preparation for Possible Sustained Transmission of 2019 Novel Coronavirus. JAMA. Vol. 323(12)2020. American Medical Association (AMA). [Cross Ref]
Pople Diane, Monk Edward J M, Evans Stephanie, Foulkes Sarah, Islam Jasmin, Wellington Edgar, Atti Ana, Hope Russell, Robotham Julie, Hopkins Susan, Brown Colin S, Hall Victoria J. Burden of SARS-CoV-2 infection in healthcare workers during second wave in England and impact of vaccines: prospective multicentre cohort study (SIREN) and mathematical model. BMJ. 2022. BMJ. [Cross Ref]
Gordon Claire L., Trubiano Jason A., Holmes Natasha E., Chua Kyra Y.L., Feldman Jeff, Young Greg, Sherry Norelle L., Grayson M. Lindsay, Kwong Jason C.. Staff to staff transmission as a driver of healthcare worker infections with COVID-19. Infection, Disease & Health. Vol. 26(4):276–283. 2021. Elsevier BV. [Cross Ref]
Çelebi Güven, Pişkin Nihal, Çelik Bekleviç Arzum, Altunay Yurdagül, Salcı Keleş Ayşegül, Tüz Mehmet Ali, Altınsoy Bülent, Hacıseyitoğlu Demet. Specific risk factors for SARS-CoV-2 transmission among health care workers in a university hospital. American Journal of Infection Control. Vol. 48(10):1225–1230. 2020. Elsevier BV. [Cross Ref]
Jinadatha Chetan, Jones Lucas D, Choi Hosoon, Chatterjee Piyali, Hwang Munok, Redmond Sarah N, Navas Maria E, Zabarsky Trina F, Bhullar Davinder, Cadnum Jennifer L, Donskey Curtis J. Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System. Open Forum Infectious Diseases. Vol. 8(8)2021. Oxford University Press (OUP). [Cross Ref]
Licina Ana, Silvers Andrew. Use of powered air-purifying respirator(PAPR) as part of protective equipment against SARS-CoV-2-a narrative review and critical appraisal of evidence. American Journal of Infection Control. Vol. 49(4):492–499. 2021. Elsevier BV. [Cross Ref]
Zamora J. E.. Contamination: a comparison of 2 personal protective systems. Canadian Medical Association Journal. Vol. 175(3):249–254. 2006. CMA Joule Inc. [Cross Ref]
Licina Ana, Silvers Andrew, Stuart Rhonda L.. Use of powered air-purifying respirator (PAPR) by healthcare workers for preventing highly infectious viral diseases—a systematic review of evidence. Systematic Reviews. Vol. 9(1)2020. Springer Science and Business Media LLC. [Cross Ref]
Wilkinson Irene J., Pisaniello Dino, Ahmad Junaid, Edwards Suzanne. Evaluation of a Large-Scale Quantitative Respirator-Fit Testing Program for Healthcare Workers: Survey Results. Infection Control & Hospital Epidemiology. Vol. 31(9):918–925. 2010. Cambridge University Press (CUP). [Cross Ref]
Regli A., Sommerfield A., Ungern‐Sternberg B. S.. The role of fit testing N95/FFP2/FFP3 masks: a narrative review. Anaesthesia. Vol. 76(1):91–100. 2021. Wiley. [Cross Ref]
Chughtai Abrar Ahmad, Chen Xin, Macintyre Chandini Raina. Risk of self-contamination during doffing of personal protective equipment. American Journal of Infection Control. Vol. 46(12):1329–1334. 2018. Elsevier BV. [Cross Ref]
Cordeiro Luciana, Gnatta Juliana Rizzo, Ciofi-Silva Caroline Lopes, Price Amy, de Oliveira Naila Albertina, Almeida Rodrigo M.A., Mainardi Giulia M., Srinivas Shrinidhy, Chan Whitney, Levin Anna Sara S., Padoveze Maria Clara. Personal protective equipment implementation in healthcare: A scoping review. American Journal of Infection Control. Vol. 50(8):898–905. 2022. Elsevier BV. [Cross Ref]
Garrett Andrew L., Park Yoon Soo, Redlener Irwin. Mitigating Absenteeism in Hospital Workers During a Pandemic. Disaster Medicine and Public Health Preparedness. Vol. 3(S2)2009. Cambridge University Press (CUP). [Cross Ref]
Bharatendu Chandra, Ong Jonathan J.Y., Goh Yihui, Tan Benjamin Y.Q., Chan Amanda C.Y., Tang Jonathan Z.Y., Leow Aloysius S., Chin Amanda, Sooi Kenneth W.X., Tan Yi Lin, Hong Chiew S., Chin Benjamin Z., Ng Elizabeth, Foong Theng Wai, Teoh Hock Luen, Ong Shi Ting, Lee Pyng, Khoo Deborah, Tsivgoulis Georgios, Alexandrov Andrei V., Sharma Vijay K.. Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. Journal of the Neurological Sciences. Vol. 417:2020. Elsevier BV. [Cross Ref]
Köseoğlu Toksoy Cansu, Demirbaş Hayri, Bozkurt Erhan, Acar Hakan, Türk Börü Ülkü. Headache related to mask use of healthcare workers in COVID-19 pandemic. The Korean Journal of Pain. Vol. 34(2):241–245. 2021. Korean Pain Society. [Cross Ref]
İpek Sevcan, Yurttutan Sadık, Güllü Ufuk Utku, Dalkıran Tahir, Acıpayam Can, Doğaner Adem. Is N95 face mask linked to dizziness and headache? International Archives of Occupational and Environmental Health. Vol. 94(7):1627–1636. 2021. Springer Science and Business Media LLC. [Cross Ref]
Rebmann Terri, Carrico Ruth, Wang Jing. Physiologic and other effects and compliance with long-term respirator use among medical intensive care unit nurses. American Journal of Infection Control. Vol. 41(12):1218–1223. 2013. Elsevier BV. [Cross Ref]
Yu Jiade, Chen Jennifer K., Mowad Christen M., Reeder Margo, Hylwa Sara, Chisolm Sarah, Dunnick Cory A., Goldminz Ari M., Jacob Sharon E., Wu Peggy A., Zippin Jonathan, Atwater Amber Reck. Occupational dermatitis to facial personal protective equipment in health care workers: A systematic review. Journal of the American Academy of Dermatology. Vol. 84(2):486–494. 2021. Elsevier BV. [Cross Ref]
Kollie Erhuvwukorotu S., Winslow Betty J., Pothier Patricia, Gaede Donn. Deciding to work during the Ebola outbreak: The voices and experiences of nurses and midwives in Liberia. International Journal of Africa Nursing Sciences. Vol. 7:75–81. 2017. Elsevier BV. [Cross Ref]
Abaluck Jason, Kwong Laura H., Styczynski Ashley, Haque Ashraful, Kabir Md. Alamgir, Bates-Jefferys Ellen, Crawford Emily, Benjamin-Chung Jade, Raihan Shabib, Rahman Shadman, Benhachmi Salim, Bintee Neeti Zaman, Winch Peter J., Hossain Maqsud, Reza Hasan Mahmud, Jaber Abdullah All, Momen Shawkee Gulshan, Rahman Aura, Banti Faika Laz, Huq Tahrima Saiha, Luby Stephen P., Mobarak Ahmed Mushfiq. Impact of community masking on COVID-19: A cluster-randomized trial in Bangladesh. Science. Vol. 375(6577)2022. American Association for the Advancement of Science (AAAS). [Cross Ref]
Burki Talha. Global shortage of personal protective equipment. The Lancet Infectious Diseases. Vol. 20(7):785–786. 2020. Elsevier BV. [Cross Ref]
McMahon Devon E., Peters Gregory A., Ivers Louise C., Freeman Esther E.. Global resource shortages during COVID-19: Bad news for low-income countries. PLOS Neglected Tropical Diseases. Vol. 14(7)2020. Public Library of Science (PLoS). [Cross Ref]
Bong Choon-Looi, Brasher Christopher, Chikumba Edson, McDougall Robert, Mellin-Olsen Jannicke, Enright Angela. The COVID-19 Pandemic: Effects on Low- and Middle-Income Countries. Anesthesia & Analgesia. Vol. 131(1):86–92. 2020. Ovid Technologies (Wolters Kluwer Health). [Cross Ref]
Gaitens Joanna, Condon Marian, Fernandes Eseosa, McDiarmid Melissa. COVID-19 and Essential Workers: A Narrative Review of Health Outcomes and Moral Injury. International Journal of Environmental Research and Public Health. Vol. 18(4)2021. MDPI AG. [Cross Ref]
Fechter-Leggett Ethan D., Fedan Kathleen B., Cox-Ganser Jean M., Meltzer Martin I., Adhikari Bishwa B., Dowell Chad H.. Estimated N95 Respirator Needs for Nonhealthcare Essential Workers in the United States During Communicable Respiratory Infectious Disease Pandemics. Health Security. Vol. 20(2):127–136. 2022. Mary Ann Liebert Inc. [Cross Ref]
Blau Francine D., Koebe Josefine, Meyerhofer Pamela A.. Who are the essential and frontline workers? Business Economics. Vol. 56(3):168–178. 2021. Springer Science and Business Media LLC. [Cross Ref]
Elkington Paul, Dickinson Alexander, Mavrogordato Mark, Spencer Dan, Gillams Ric, De Grazia Antonio, Rosini Sebastian, Baquero Diana Garay, Diment Laura, Mahobia Nitin, Morgan Hywel. A Personal Respirator Specification for Health-care Workers Treating COVID-19 (PeRSo). Open Engineering Inc. [Cross Ref]
Brown J., Clifford M., Magana J., Salman M., Tran D.. Modular Printed Powered Air Purifying Respirator. Volume 13: Safety Engineering, Risk, and Reliability Analysis; Research Posters. 2021. American Society of Mechanical Engineers. [Cross Ref]
Jayan Vishnu, Ajan Ayyappan, Mohan Harish, Manikutty Gayathri, Sasi Deepu, Kappanayil Mahesh, Vijayaraghavan Sundeep, Bhavani Rao R. Design and development of a low-cost powered air-purifying respirator for frontline medical workers for COVID-19 response. 2020 IEEE 8th R10 Humanitarian Technology Conference (R10-HTC). 2020. IEEE. [Cross Ref]
Khoo Deborah, Yen Ching-Chiuan, Chow Wai Tung, Jain Pravar, Loh Ne-Hooi Will, Teo Wei Wei, Koh Calvin. Ultra-portable low-cost improvised powered air-purifying respirator: feasibility study. British Journal of Anaesthesia. Vol. 125(2)2020. Elsevier BV. [Cross Ref]
Vieira José Custódio Feres. Low Cost Equipment with Compressor System and Balanced Pressure to Protect the Professional Dentist Against Contaminated Aerosol During COVID-19 Pandemic. International journal of odontostomatology. Vol. 14(4):523–528. 2020. SciELO Agencia Nacional de Investigacion y Desarrollo (ANID). [Cross Ref]
Hamner Samuel, Narayan Vinesh, Rappin Nicole, Donaldson Krista. ReMotion Knee: Scaling of an Affordable Prosthetic Knee for Developing CountriesTechnologies for Development. p. 137–151. 2015. Springer International Publishing. [Cross Ref]
Karmacharya Mamata, Kumar Sumit, Gulenko Oleksandra, Cho Yoon-Kyoung. Advances in Facemasks during the COVID-19 Pandemic Era. ACS Applied Bio Materials. Vol. 4(5):3891–3908. 2021. American Chemical Society (ACS). [Cross Ref]
Crawford Matthew J., Ramezani Sepehr, Jabbari Roghaie, Pathak Pawan, Cho Hyoung J., Kim Brian N., Choi Hwan. Development of a novel self-sanitizing mask prototype to combat the spread of infectious disease and reduce unnecessary waste. Scientific Reports. Vol. 11(1)2021. Springer Science and Business Media LLC. [Cross Ref]
Stanislow Krista, Rothenberg Sandra, Leo Ezekiel, Esterman Marcos. Can Regulatory Efforts Motivate Innovation? The Case of Ventilator Innovations During COVID. IEEE Engineering Management Review. Vol. 49(4):30–40. 2021. Institute of Electrical and Electronics Engineers (IEEE). [Cross Ref]
Hines Stella E., Brown Clayton, Oliver Marc, Gucer Patricia, Frisch Melissa, Hogan Regina, Roth Tracy, Chang James, McDiarmid Melissa. User acceptance of reusable respirators in health care. American Journal of Infection Control. Vol. 47(6):648–655. 2019. Elsevier BV. [Cross Ref]