Last Thursday, The EI Group’s blog addressed the importance of including the potential impact of the Wuhan coronavirus in your operation’s Business Contingency Plan. Since then, the number of confirmed coronavirus cases has nearly doubled from 28,000 to more than 50,000, with nearly 400 reported cases outside of China. The death toll has more than doubled from 560 to 1,310. The pathogen’s ability to spread in close quarters is especially concerning. A prime example, the 20 cases confirmed last week on the passenger cruise ship, Diamond Princess, docked off the coast of Japan, increased nearly 9-fold to 175 passengers. A Japanese Health Ministry employee who was donning PPE while screening passengers on the quarantined Diamond Princess, also became infected.
Surgical Masks vs. N95’s
As the virus (newly dubbed COVID-19 by the World Health Organization) accelerates and spreads beyond Chinese borders, businesses are deploying increasingly rigorous measures to limit the spread of the potential pandemic. Most news articles covering the spread of the virus include photos of travelers or government officials wearing surgical masks. But how effective will surgical masks for respiratory protection from the pathogen turn out to be? Is a surgical mask enough or is an N95 respirator needed?
As US businesses incorporate respiratory protection within their business continuity plans, consideration should be directed towards the effectiveness of donning surgical masks versus N95 respirators to more effectively prevent the spread of infection.
The surgical masks observed in news article photographs are primarily intended to prevent droplets and splatter from passing from the mouth or nose of the wearer to nearby surfaces and people. Historically, surgical mask protection has been used by healthcare providers to prevent spreading their own potential pathogens to patients. In contrast, N95 respirators are tight fitting on the face and filter out most airborne particles from the surrounding air. N95 respirators prevent wearers from breathing in particles as small as 0.3 microns in diameter. If you’ve ever wondered what that “N95” moniker designates, the N represents “Not resistant to oil” (as opposed to R – Resistant or P – Oil Proof), while the 95 refers to one of three levels of efficiency (95%, 99%, and 99.97%). A mask with an N95 designation from the National Institute for Occupational Safety and Health (NIOSH) would therefore mean an N-series filter that is at least 95% efficient.
The infographic to the right from the Centers for Disease Control (CDC) is a great tool to further understand the differences between surgical masks and N95 respirators. Some of these differences include filtration, leakage, efficacy, intended purpose, use and limitations. OSHA’s Respiratory Protection Standard (29 CFR 1910.134) is clear on workplace requirements when N95’s are required.
What Does the CDC Recommend?
Based on the current spread of the coronavirus, the lack of definitive data on routes of pathogen transmission and mortality, coupled with the rapidly dwindling world supplies of PPE (specifically respirators), the CDC has posted the following recommendations:
1) Patients with confirmed or possible coronavirus infection should wear a facemask (surgical mask) when being evaluated medically.
2) Healthcare personnel should adhere to “Standard, Contact and Airborne Precautions.” These precautions include the use of PPE, including NIOSH-approved N95 respirators, gowns, gloves, and face shield/eye protection.
In addition, the CDC has issued the following statement regarding the use of facemasks by the general public: “CDC does not currently recommend the general public use of facemasks. Instead, the CDC recommends following “everyday preventive actions,” such as washing your hands, covering your cough and staying home if you are sick.”
High Demand for N95’s
In 2009, when the H1N1 virus dominated headlines, David Lahoda, Managing Editor of OSHA Watch and contributor to OSHA Healthcare Advisor, blogged on the wake-up call many of us received as we rushed to get our respiratory protection plans up to speed. Organizations were left wondering, “Can we get enough N95 respirators to protect our employees and what steps are required in order for our employees to wear them?” Lahoda noted that time and planning were needed, both of which were in short supply then and now.
Have you tried to order an appreciable number of N95 respirators recently? Good luck! The CDC has noted that manufacturers of N95 respirators are reporting significant demand due to the outbreak and rapid spreadof COVID-19. This demand, coupled with the decrease in supply of N95 respirators from China, India and Taiwan, are providing significant challenges to manufacturers in meeting order demand.
Although manufacturers are ramping up production in response to the growing epidemic, distributors are struggling to keep up with the demand, with prices quickly becoming inflated on resale sites.
How Can You Prepare Now?
Although it is difficult to determine what level of respiratory protection may be recommended/required for businesses if the number of COVID-19 cases continues to rise in the US (14 at the time of this blog, up from 5 last week), the CDC guidelines currently specify N95 respirators for healthcare workers who are exposed to patients harboring the pathogen. The OSHA respiratory protection standard clearly tells employers to establish and maintain a written respiratory protection program for employees who don respiratory protection, including N95 respirators. These requirements include the following elements:
Program Administrator – The employer shall designate a program administrator who is qualified by appropriate training or experience that is commensurate with the complexity of the program.
Medical Evaluation – Employers must evaluate whether employees are able to wear respirators. Evaluation can be performed by a respirator clearance questionnaire or by medical examination.
Fit Testing – The OSHA Respiratory Standard requires employers to conduct annual fit testing on all employees required to wear respirators with tight-fitting facepieces (N95 respirators contain tight fitting facepieces).
Training and Information – Before requiring respirator use during work, employers must provide training on:
- How improper fit, usage, and maintenance can make respirators ineffective
- The limitations and capabilities of the selected respirator
- How to inspect, put on and remove, and check the seals of the respirator
- Proper respirator maintenance and storage procedures
- The general requirements of the respiratory protection standard
- Employers must also retrain employees annually and whenever there are changes in workplace conditions or respirator selection, or whenever there is evidence of improper respirator use.
The respirator medical evaluation component can easily be overlooked during the hectic pace of an outbreak like this, but its importance cannot be understated. In lieu of a medical exam, an effective clearance tool such as EI’s RespiratorAssessor® can be used to determine if an individual can tolerate the physiological burden associated with respirator use. Tools like these are designed to quickly identify medical conditions that place respirator wearers at risk of serious consequences.If an online questionnaire, like RespiratorAssessor® reveals no significant medical issues, Occupational Health Physicians can provide medical clearance for respirator use within hours, saving considerable time and expense in this quickly changing landscape surrounding the rapid spread of COVID-19.
Are you hustling to get a respiratory protection plan up and running now, or did you heed the advice of OSHA and the CDC years ago and plan ahead? Need help with medical evaluations or respirator fit testing for N95 respirators? For assistance with any aspect of your respiratory protection efforts, don’t hesitate to contact The EI Group at 800.717.3472.