Personal protective equipment during the COVID-19 pandemic (Letter #2)
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CORRESPONDENCE
Personal protective equipment during the COVID-19 pandemic (Letter #2) Orlando Hung, MD, FRCP(C) . Christian Lehmann, MD, FRCP(C) . Thomas Coonan, MD, FRCP(C) . Michael Murphy, MD, FRCP(C) . Ronald Stewart, OC, ONS, MD, FACEP
Received: 2 May 2020 / Revised: 5 May 2020 / Accepted: 5 May 2020 Ó Canadian Anesthesiologists’ Society 2020
To the Editor, We read with appreciation and great interest the ‘‘Personal protective equipment (PPE) for both anesthesiologists and other airway managers’’ by Lockhart et al.1 We are grateful for this thorough review, which defines a rational approach to PPE, including those specific individual elements such as masks, shields, and gowns. Nevertheless, we believe it is critically important to leverage the information that the authors have provided to address the broader issue of national and global preparedness.
This letter is accompanied by a reply. Please see Can J Anesth 2020; this issue. O. Hung, MD, FRCP(C) (&) Departments of Anesthesia, Surgery, and Pharmacology, Dalhousie University, Halifax, NS, Canada e-mail: [email protected] C. Lehmann, MD, FRCP(C) Departments of Anesthesia, Physiology and Biophysics, Pharmacology, Microbiology, Immunology, and Computer Science, Dalhousie University, Halifax, NS, Canada T. Coonan, MD, FRCP(C) Departments of Anesthesia and Surgery, Dalhousie University, Halifax, NS, Canada M. Murphy, MD, FRCP(C) Departments of Anesthesia and Emergency Medicine, Dalhousie University, Halifax, NS, Canada Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada R. Stewart, OC, ONS, MD, FACEP Department of Emergency Medicine, Dalhousie University, Halifax, NS, Canada
Key to the design and effectiveness of PPE is understanding how the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) responsible for coronavirus disease (COVID-19) gains access to the body. The SARSCoV-2 virus present in droplets cannot enter the body transdermally; it can only enter when contaminated droplets, aerosols, and hands come in contact with mucous membranes of the mouth, nose, and eyes.2 While it is helpful to use the size of viral-laden droplets (greater or smaller than 5 lm) as an index of transmissibility for infection control measures, it is also important for healthcare workers (HCWs) to take into consideration the complex dynamic nature and the site of deposition of infected droplets, and the critical pathogen load of droplets required for establishing infection in different airway regions.3 Hence, a distance of 2 m has been identified and recommended to prevent the large droplets projected by coughing from landing on the face or body; ‘‘smaller’’ droplets will likely be suspended, drifting about in the air. The kinetics of these ‘‘smaller’’ viral droplets has not been well-characterized. It is possible that the water content of the small droplets will evaporate, making the droplets even smaller and allowing them to drift farther, eventually exposing the virus, which releases its genetic material when its lipid envelop
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