Summary Personal protective equipment has become an important and emotive subject during the current coronavirus (COVID-19) epidemic. COVID-19 is predominantly caused by contact or droplet transmission attributed to relatively large respiratory particles which are subject to gravitational forces and travel only approximately one metre from the patient. Airborne transmission may occur if patient respiratory activity or medical procedures generate respiratory aerosols. These aerosols contain particles that may travel much longer distances and remain airborne longer, but their infective potential is uncertain. Contact, droplet and airborne transmission are each relevant during airway manoeuvres in infected patients, particularly during tracheal intubation. Personal protective equipment is an important component, but only one part, of a system protecting staff and other patients from COVID-19 cross-infection. Appropriate use significantly reduces risk of viral transmission. Personal protective equipment should logically be matched to the potential mode of viral transmission occurring during patient care ? contact, droplet, or airborne. Recommendations from international organisations are broadly consistent, but equipment use is not. Only airborne precautions include a fitted high-filtration mask, and this should be reserved for aerosol-generating procedures. Uncertainty remains around certain details of personal protective equipment including use of hoods, mask type and the potential for re-use of equipment.
Summary Tracheal intubation in coronavirus disease 2019 (COVID-19) patients creates a risk to physiologically compromised patients and to attending healthcare providers. Clinical information on airway management and expert recommendations in these patients are urgently needed. By analysing a two-centre retrospective observational case series from Wuhan, China, a panel of international airway management experts discussed the results and formulated consensus recommendations for the management of t...
The COVID-19 outbreak has led to 80,409 diagnosed cases and 3,012 deaths in mainland China based on the data released on March 4, 2020. Approximately 3.2% of patients with COVID-19 required intubation and invasive ventilation at some point in the disease course. Providing best practices regarding intubation and ventilation for an overwhelming number of patients with COVID-19 amid an enhanced risk of cross-infection is a daunting undertaking. The authors presented the experience of caring for the...
Severe acute respiratory syndrome-corona virus-2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19), is highly contagious. Airway management of patients with COVID-19 is high risk to staff and patients. We aimed to develop principles for airway management of patients with COVID-19 to encourage safe, accurate and swift performance. This consensus statement has been brought together at short notice to advise on airway management for patients with COVID-19, drawing on published literatu...
#1Nancy H L Leung(Li Ka Shing Faculty of Medicine, University of Hong Kong)H-Index: 9
#2Daniel K.W. Chu(Li Ka Shing Faculty of Medicine, University of Hong Kong)H-Index: 33
Last. Benjamin J. Cowling(Li Ka Shing Faculty of Medicine, University of Hong Kong)H-Index: 88
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We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from ...
Last. Andrew Rhodes(St George’s University Hospitals NHS Foundation Trust)H-Index: 70
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BACKGROUND: The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the cause of a rapidly spreading illness, Coronavirus Disease 2019 (COVID-19), affecting thousands of people around the world. Urgent guidance for clinicians caring for the sickest of these patients is needed. METHODS: We formed a panel of 36 experts from 12 countries. All panel members completed the World Health Organization conflict of interest disclosure form. The panel proposed 53 questions that are relevan...
#1Lydia Bourouiba(MIT: Massachusetts Institute of Technology)H-Index: 22
This JAMA Insights Clinical Update discusses the need to better understand the dynamics of respiratory disease transmission by better characterizing transmission routes, the role of patient physiology in shaping them, and best approaches for source control in the context of the COVID-19 outbreak
Last. Wenjie Tan(CCDC: Chinese Center for Disease Control and Prevention)H-Index: 32
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An epidemic of respiratory disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began in China and has spread to other countries. Real-time reverse transcriptase–polymerase chain reaction (rRT-PCR) of nasopharyngeal swabs typically has been used to confirm the clinical diagnosis. However, whether the virus can be detected in specimens from other sites, and therefore potentially transmitted in other ways than by respiratory droplets, is unknown.
Background This systematic review and meta-analysis summarizes the safety and efficacy of high flow nasal cannula (HFNC) in patients with acute hypoxemic respiratory failure.
Global shortages of personal protective equipment (PPE) have been at the forefront of public attention throughout the recent crisis. Initial lack of information regarding the route of transmission of the virus fuelled panic buying of face masks and gloves, as well as shortages in healthcare facilities. Home-made cloth masks have become commonplace, and makers have seized upon opportunities to increase capacity by producing PPE with 3D printing. Mask designs typically incorporate flexible filamen...
Last. Gaetano Marrocco(University of Rome Tor Vergata)H-Index: 30
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The COVID-19 pandemic forced mankind to unprecedented global challenges, drastically changing our way of living. To minimize life losses, multi-level strategies requiring collective efforts were adopted, while waiting for researchers and Pharma companies to develop vaccines. The management of so complex processes has partly taken benefit from a network vision and from the rising framework of the Internet of Things (IoT). Among the several technologies converging to IoT, the Radiofrequency Identi...
Last. Terry L. Stentz(UNMC: University of Nebraska Medical Center)H-Index: 11
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Personal protective equipment used by healthcare workers to mitigate disease transmission risks while caring for patients with high-consequence infectious diseases can impair normal body cooling mechanisms and exacerbate physiological strain. Symptoms of heat strain (e.g., cognitive impairment, confusion, muscle cramping) are especially harmful in the high-risk environment of high-consequence infectious disease care. In this pilot study, the core body temperatures of healthcare workers were asse...
Last. Joy Sarkar(Dinabandhu Andrews College)H-Index: 1
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The science about the usage of face masks by the common public to avert COVID-19 transmission is proceeding swiftly. A primary route of transmission of COVID-19 is probably through small respiratory droplets, and it is transmissible from asymptomatic and pre-symptomatic individuals. According to the World Health Organization, wearing a mask in public can help reduce the transmission of the COVID-19 virus. Different categories and types of mask and their usage are reviewed in this work. In a nuts...
Last. Jacques Escarment('ENS Paris': École Normale Supérieure)H-Index: 5
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'We are at war', French President Emmanuel Macron said in an address to the nation on 16 March 2020. As part of this national effort, the French Military Medical Service (FMMS) is committed to the fight against COVID-19. This original report aimed to describe and detail actions that the FMMS has carried out in the nationwide fight against the COVID-19 pandemic in France, as well as overseas. Experts in the field reported major actions conducted by the FMMS during the COVID-19 pandemic in France....
Last. Nathalie Rommel(Katholieke Universiteit Leuven)H-Index: 29
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Since the World Health Organization declared the COVID-19 pandemic a Global Public Health Emergency, experts in swallowing are seeking guidance on service delivery and clinical procedures. The European Society for Swallowing Disorders provides considerations to support experts in swallowing disorders in clinical practice. During the COVID-19 pandemic, assessment and treatment of patients with oropharyngeal dysphagia should be provided, while at the same time balancing risk of oropharyngeal compl...