To N95 or Not to N95?

By Randolph Fillmore

Infection control specialist says CDC gave out impractical and misleading information on COVID-19 PPE advice.

N95Mask 1147102191Americans may lose faith in the U.S. Center for Disease Control (CDC) if they listen to a podcast from the Journal of Clinical Pathways on March 24.  Priya Sampathkumar, MD, infectious disease specialist and hospital epidemiologist at the Rochester, Minnesota Mayo Clinic, broke down truths and misconceptions about Personal Protective Equipment (PPE), such as masks, gowns and gloves needed for healthcare providers who are treating patients with COVID-19. 

According to Dr. Sampathkumas, the CDC gave out “impractical and misleading information” when they made the recommendation that all healthcare workers should don N95 masks when treating those testing positive for SARS-2 virus and/or those who are ill with the COVID-19 disease caused by that virus.

 “They did it during the H1N1 flu 'out of an abundance of caution' and they did it again regarding COVID-19,” she told the Journal of Clinical Pathways podcast host oncologist Chadi Nabhan, MD.

N95 masks, of which there is a great shortage now, are described on the US Food and Drug Administration’s (FDA) website as “a respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles. The 'N95' designation means that when subjected to careful testing, the respirator blocks at least 95 percent of very small (0.3 micron) test particles. If properly fitted, the filtration capabilities of N95 respirators exceed those of facemasks. However, even a properly fitted N95 respirator does not completely eliminate the risk of illness or death.”

Sampathkumas said that N95 masks are only needed during specific, invasive procedures, such as intubations and bronchoscopies. A bronchoscopy is a procedure that lets doctors look at your lungs and air passages, and is usually performed by a pulmonologist. During bronchoscopy, a thin tube (bronchoscope) is passed through your nose or mouth, down your throat and into your lungs. The invasive nature of these procedures may result in small particles of fluid to be released into the air, different from the large particles expelled when someone coughs.  Except for those procedures, a simple surgical mask will be protection enough from large, airborne droplets such as those seen when people with COVID-19 cough, she maintained. For us, an N95 or other mask is not necessary, just maintain at least six feet of distance from others.

If we had followed the CDC’s advice, she said, we would have used up all of the N95 masks. 

She added that her first red flag indicating this was serious came on February 9 when Delta airlines announced that it was closing flights to China through April 30.

“What did Delta know then that our government wasn’t telling us?” she asked.

According to Sampathkumar, this is the way it should be: A patient with confirmed or suspected COVID-19 should be in a room alone with no mask. The health care worker goes into the room wearing gloves, a gown, and a regular surgical mask with eye protection. When the health care worker leaves the room, they should take off that PPE, dispose of it, and wash up. 

“Regular masks are easy to make!” she said. “A third grader could make one.”

For her, the first big mistake was the U.S. government not taking supplies from the World Health Organization (WHO) and depending on CDC. “This is what happens when government agencies don’t react in a timely manner.”

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