Use N95 Masks for All COVID-19 Inpatient Care. Period.

Healthcare professionals taking care of COVID-19 patients should wear N95 respirators at all times, versus medical or surgical masks, researchers argued, as N95 masks offer superior -- not just comparable -- protection.

Numerous organizational guidelines agree N95 respirators should be worn for aerosol-generating procedures for COVID-19 patients, but existing evidence indicates N95 respirators should be used for all aspects of COVID-19 inpatient care, wrote Harry Peled, MD, of St. Jude Medical Center in Fullerton, California, and colleagues.

"Guideline recommendations that do not support N95 use for all inpatient COVID-19 management should consider reevaluating the existing data or at least acknowledge the issues raised," they argued in an opinion piece in Annals of Internal Medicine.

They detailed how N95s are superior to medical masks, writing that N95 respirators "achieve better filtration of airborne particles than medical masks if used properly and continuously."

Peled and colleagues then pointed to prior research that has helped to shape policies about N95 respirators compared with medical masks, most of which focused on influenza transmission. They noted several of these studies "mixed outpatient and inpatient data" that underestimated the benefit of N95 respirators in inpatient settings. Moreover, existing guidelines do not take into account evolving evidence about aerosol transmission of SARS-CoV-2, the virus that causes COVID-19.

"It is apparent that the risk for [healthcare worker] infection is related to duration and magnitude of exposure," the authors wrote. "A COVID-19 inpatient unit with multiple patients coughing and breathing will have far higher exposure to droplets, re-suspended droplets, and aerosols than an outpatient setting."

Rather than guidelines "based on inappropriate extrapolation of studies," the authors recommended additional research to evaluate COVID-19 transmission in the inpatient setting. Specifically, they pointed to an ongoing randomized clinical trial where researchers are specifically evaluating N95 respirators versus medical masks for COVID-19.

The authors then noted the "dilemma of healthcare administrators," who have to work within these guidelines, which have claimed medical masks are acceptable for non-aerosol generating procedures in COVID-19 patients. They recommended industry-level changes, such as allocating resources to produce more N95 respirators, adding they are more cost-effective "over a wide range of reasonable assumptions." This would prevent healthcare professionals from having to work with "substandard protection," they said.

"Use of N95 respirators to protect [healthcare workers] should not merely be a preference or a recommendation based on availability," the authors concluded.

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