Up until quite recently, I will admit I never thought much about the right personal protective equipment (PPE). On family-centered rounds, I would look at the sign on the door and follow its advice, donning a mask, gloves, and/or gown as advised. To the extent I thought about PPE, it was usually to see if we could safely remove precautions, saving a half-dozen gowns and perhaps slightly improving how we connect during a conversation with a likely sleep-deprived and stressed parent. Like it has with everything, COVID-19 has changed all of this. As illustrated in the Google Trends chart of “PPE" (Google trend search of "PPE" searches in United States during last 12 months), searches in the United States have increased 15- to 20-fold over long and stable rates, peaking one month ago.
We were delighted to receive—and publish first as a pre-print—a wonderful, thorough, and thoughtful article discussing the evidence behind the best PPE for this novel coronavirus. In a narrative review, Sud (10.1542/hpeds.2020-0135) combined a wealth of evidence from four distinct areas, including recent and early evidence into SARS-CoV-2 and related coronaviruses, particularly SARS-CoV-1, which caused Severe Acute Respiratory Syndrome, or SARS. Sud presents a wealth of observational and experimental evidence (those poor student nurses in the Hall and Douglas study of RSV transmission!), which health departments and hospitals have used to make decisions in four types of precautions: 1) contact precautions, 2) droplet precautions, 3) airborne precautions, and 4) extended use of N95 respirators.
The best science needs to drive the decisions we make, even in the setting of a novel virus. This well-written and well-referenced review demonstrates the wealth of science that has informed the complicated and controversial decisions on the best PPE for SARS-CoV-2.