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\begin{document}

\title{THE COVID-19 PANDEMIC, PERSONAL PROTECTIVE EQUIPMENT, AND RESPIRATOR: A
NARRATIVE REVIEW}



\author[1]{Jennifer Ha}%
\affil[1]{Affiliation not available}%


\vspace{-1em}



  
  \date{March 14, 2025}


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\selectlanguage{english}
\begin{abstract}
The coronavirus disease 2019 (COVID-19) pandemic has touched almost
every continent. Personal protective equipment (PPE) is the final line
of protection of healthcare workers (HCW). There is variation as well as
controversy of infection control recommendation with regards to the use
of PPE for HCW between institutions. The aim of this narrative review is
to of examine and summarise the available evidence to guide
recommendation for the safety of HCW. A literature search was conducted
on the PubMed, MedLine, and Embase databases with the keywords
``personal protective equipment'', ``COVID 19'', ``n95'', ``health care
worker'', and ``mortality''. SARS-nCoV-2 is highly contagious. 3.5-20\%
of HCW has been reported to be infected. The mortality ranges from
0.53-1.94\%. PPE is part of the measure within a package of prevention
and control of pandemic, rather than a replacement of. Respirators are
more effective than masks in preventing aerosol transmission to HCWs.
Extended use may be considered if guidelines are adhered. PAPRs if
available should be used in high risk procedures. Transmission of
viruses is multimodal, and in the setting of a novel pathogen with high
case fatality with no proven effective interventions, PPE that affords
the best protection should be available to HCWs.%
\end{abstract}%



\sloppy


\emph{KEYWORDS}

COVID-19, respirator, personal protective equipment, health care worker,
N95

\emph{INTRODUCTION}

The coronavirus disease 2019 (COVID-19) pandemic has touched almost
every continent. The transmission can be reduced through exposure
control by means of engineering, administrative, and environmental
controls.(1) Personal protective equipment (PPE) is the final line of
protection of healthcare workers (HCW) especially in the community
transmission phase of the COVID-19 pandemic.

The key to a public health emergency response lies in the abundance of
reserves, proper allocation of emergency medical supplies and rapid
distribution.(2) Some countries have a national medical stockpile of key
reserves of essential medications and equipment like PPE.(2) While this
is an indispensable element of public health emergency response, when
the system is tested, this has been found to be lacking. This was seen
during the H1N1, SARS-CoV-1, and now the SARS-CoV-2 pandemic. There is a
global shortage of PPE for HCW, resulting in transmission of the
disease, reducing the available frontline HCWs who care for these
patients, resulting in the transmission of disease to their families and
communities, as well as resulting in HCW mortality.

While financial considerations, PPE supply, and logistics are important,
healthcare systems also have occupational health and safety obligations
to their HCWs and reassurance that they are using the highest level of
protection and not putting themselves, their families or colleagues at
risk.(3)

Currently, there is variation as well as controversy of infection
control recommendation with regards to the use of PPE for HCW between
institutions (table 1).(4-11) The aim of this narrative review is to of
examine and summarise the available evidence to guide recommendation for
the safety of HCW in the current pandemic.

\emph{METHOD}

A literature search was conducted on the PubMed, MedLine, and Embase
databases, and updated on 30 March 2020 with the keywords ``personal
protective equipment'', ``COVID 19'', ``n95'', ``health care worker'',
and ``mortality''. Bibliographic search was also undertaken. The
abstracts were scanned to assess their appropriateness to be included in
this narrative review.

\emph{DISCUSSION}

\textbf{Transmission}

Respiratory droplet (5-50 \selectlanguage{greek}µ\selectlanguage{english}m) is the main route of transmission, and may
cause direct transmission via close contact (including the eye), or
surface contamination.(1, 11-18) SARS-nCoV-2 can be transmitted via
smaller aerosols with a droplet nuclei [?]5\selectlanguage{greek}µ\selectlanguage{english}m, which can travel long
distances and remain airborne for 2 -- 4 hours, depending on the ambient
conditions.(19-21)

Certain events (eg coughing or sneezing, cardiopulmonary resuscitation)
and aerosol generating procedures (AGP) (eg intubation, tracheostomy)
can generate aerosols composed of smaller virus containing particles
suspended in air.(17) SARS-nCoV-2 has been reported to remain infectious
on inanimate surfaces at room temperature for up to 9 days.(22)
SARS-CoV-2 is more stable on plastic and stainless steel than copper and
cardboard.(21) It is detected up to 72 hours after application onto
plastic, though the viral titre decayed exponentially.(21) The viral
half-life was 6.8 hours on plastic, 5.6 hours on stainless steel.(21)

SARS-nCoV-2 is contagious during the latency period.(14, 15, 20, 23-27)
Viral loads are highest in the first week (peaks at 3 to 5 days) after
symptoms began and decline over the second week, especially in the nose
than throat.(12, 15, 28-31) The viral loads in asymptomatic patients has
been found to be similar to symptomatic patients.(14, 28) As such, when
the COVID-19 status of patients is unknown, they are treated as if they
are COVID-19 positive.(32) Prolonged viral shedding after recovery has
also been reported.(26)

The transmission is reported to be between 2.1 and 4 cases per
exposure.(1, 12, 20, 33-35) Systematic effort is required to reduce the
transmission, which is influenced by various factors like: Pathogens,
ventilation, air filtration, sterilization and PPE.(36) Respiratory
protection is one of the key strategy for pandemic control, and to
sustaining the HCW.

\textbf{Infection Rates of HCW}

3.5-20\% of HCW has been reported to be infected.(1, 37-40)

Initially, during the index outbreak in Wuhan, 13 HCWs were
infected.(41) They became the vectors of transmission to their
colleagues and families, and 42 000 HCWs had to be brought in to treat
patients as HCWs succumbed to COVID-19.(41, 42)

Wang D et al found nosocomial infection rate of 41.3\%.(43) In a case
series of 138 patients, 29\% (n=40) of these were HCW: 31 (77.5\%)
worked on general wards, 7 (17.5\%) in emergency department, and 2 (5\%)
in intensive care unit.(43) They reported patient who presented with
abdominal symptom infected \textgreater{}10 HCW in the department.(43)

There was a report of a patient who was not identified as infected early
in the Wuhan outbreak and proceeded to infected 14 HCW during a stay for
transnasal pituitary surgery.(44) However, the patient was transferred
to 4 different wards and infected 10 neurosurgical nurses and 4 medical
staff who had no PPE, rather than the operating room team and
neurosurgeon.(29) Certain specialty like otolaryngology are
disproportionately affected in most countries affected by the COVID-19
pandemic.(44)

Wang X et al found none of the 278 staff in the quarantined area with
high exposure to the 28 patients with 2019-nCoV infection were
infected.(45) They wore N95 respirators, disinfected and performed hand
hygiene. Those in the Hepatobiliary Pancreatic Surgery, Trauma and
Microsurgery, and Urology departments wore no masks, but disinfected and
performed hand hygiene occasionally as there were not considered high
risk in the early days of the outbreak in January(45). 10 of the 213
staff were confirmed to be infected, despite their lower risk of
exposure.(45) The adjusted odds ration (OR) was 464.82.(45) The found no
infections in two other hospitals in the N95 respirators groups.(45)

The increasing evidence of aerosol transmission during routine care in
absence of AGPs, and concerns regarding efficient human transmission has
resulted in recommendation for airborne precautions with a fit-tested
N95 respirator and other PPE.(46, 47)

When the Chinese hospitals instituted full body PPE with goggles, head
coverings, N95 respirators, hazmat suits, and they were housed away from
their families, there was no new infections.(41) Since then, nosocomial
transmission has not been a major amplifier of transmission in China,
due to prevention and control.(31) It is believed that with the absence
of major nosocomial outbreaks, these are acquired in their families
where 85\% of human-to-human transmission occurred.(12, 14, 15, 24, 31,
48)

\textbf{Lessons from SARS}

During the 2003 SARS outbreak, airway management protocols were
developed by infection control experts who often lacked expertise in the
management of airway problems, experts in airway management who lacked
expertise in infection control, and caregivers with no experience in
treating SARS patients.(49) 51\% of the SARS cases were HCWs in Toronto
despite these safety protocol.(50) This was also the finding in
Singapore.(51) In other places, HCW accounted for 21\% of the cases.(52)
Oh M et al found institution of PPE prevented infections amongst
HCW.(51) Perhaps this experience underlies the aggressive implementation
of N95 respirators in some institutes regardless of the risk of exposure
for all HCW, due to the high risk of mortality with COVID-19.(11, 12,
16, 23)

\textbf{Mortality Rate of HCW}

The mortality rate ranges from 1.4-3.83\%.(20, 23, 25, 27, 35, 37, 38,
46, 53-59)

China reported 3387 infected HCWs in Hubei alone, with at least 18
deaths (0.53\%) in late February.(60) Philippine Medial Association
president reported ten doctors have died at the end of May, including
the president of the Philippine Paediatric Society, due to the lack of
PPE.(61) In Italy, on 28\textsuperscript{th} March 2020, 2629 (20\%)
were infected, with 51 deaths (1.94\%).(39, 62) The numbers may be
higher as those who died suddenly were not tested for the disease.

Once community spread of virus is confirmed, the hospital should
institute guidelines for airborne and contact precautions during all
AGPs.(1, 29)

\textbf{General Hygiene}

High degree of personal caution, and diligence in infection control
procedure (hand and respiratory hygiene etc) are necessary. PPE is part
of the measure within a package of prevention and control of pandemic,
rather than a replacement of.

The education or re-training of proper selection and fit testing of PPE,
training on donning, doffing and disposal of PPE training is vital, as
up to 90\% of staff do not use the correct doffing sequence or
technique.(18, 63-65)

\textbf{Gowns and Gloves}

Guidance to the level of PPE depends on prevalence of COVID-19 in the
community, the degree of community spread, availability, timeliness and
accuracy of COVID-19 testing, and availability of PPE.(29)

A recent Cochrane review has found gown to be more protective than
aprons against contamination (MD -1.36, 95\% CI -1.78 - -0.94). Double
gloving leads to less contamination compared to single gloving (RR 0.36,
95\% CI 0.16 -- 0.78).(65) Alcohol-based hand rub during doffing may not
lead to less contamination than the use of a hypochlorite base solution
(MD 4, 95\% CI 0.47 -- 34.24).(65) This has led to the recommendation of
an assistant who guides the HCW through the process while watching for
breaches and spraying chlorine as each item is removed during
doffing.(65)

\textbf{Eye Protection}

Bischoff et al first reported direct evidence of transocular delivery of
influenza virus in airborne form.(66) This trend was found in the
current COVID-19 pandemic. One of the expert taskforce who visited Wuhan
was infected despite fully gowned with protective suit and the N95
respirator.(12) His first symptom was unilateral conjunctivitis.(12)
Safety glasses and or face shield has been recommended.(16)

\textbf{Masks and Respirators}

\textbf{1.1 Surgical Masks}

Surgical masks are fluid resistant. They filter particulate, droplets
and bacteria. They are not designed for a tight seal, thus will allow
unfiltered air to flow around the sides. The materials are not regulated
for their ability to filter small particles and vary between models.

They are not considered respiratory protection. They are worn to protect
HCWs from large droplets or sprays of infectious body fluids from
patients that may be directly transmitted to the mucus membrane in the
wearer's nose or mouth. When worn by patients, they reduce the
concentration and amount of large infectious particles released when
coughing, talking or sneezing, and thus infection risk to others.(67)

They have a reported failure rate of 10-90\%, which is inadequate for
droplet nuclei protection.(68) Birschoff et al conducted a pilot study
testing surgical masks against N95 respirators using a human exposure
model, and they only protected 1 in 4 participants with influenza.(66)

\textbf{1.2 Respirators}

Respirators either filter the airborne particles and respiratory
aerosol; or supply clean air to the respirator wearer; air-purifying, or
atmosphere-supplying respirators. The most common respirators are
filtering facepiece respirators and powered air-purifying respirators
(PAPR).

The National Institute for Occupational Safety and Health (NIOSH) tests
filters for the effects of loading (particle burden), temperature, and
relative humidity and requires minimum filtration efficiency of 95\%,
99\%, or 99.97\% using neutralized 0.075\selectlanguage{greek}µ\selectlanguage{english}m count median diameter solid
aerosols at 85L/min.(68) NIOSH evaluates the fit performance of some
respiratory protective devices using human panels with specified facial
dimensions.

\textbf{1.2.1 N95 Respirator}

These require certification by the NIOSH based on filter efficiencies
with an assigned protection factor (APF) of 10.(69) They must have less
than 5\% penetration for aerosol with a mass median aerodynoamic
diameter of 0.3 microns.(68) When the air is forced through the
filtering material, contaminants are captured, which reduce the exposure
to large droplets and small infectious particles in both directions.(67)

The two types are filtering facepiece respirator where the entire
facepiece is made of filtering material, or elastomeric respirators that
have replaceable filters or cartridges.(67)

Air-purifying respirators are further classified according to the
efficiency at which they remove particles (95\%, 99\% or 100\%), and the
resistance to oil.(36) N-series are not resistant to oil, R-series are
resistant to oil, while P-series are oil proof.(36, 68)

N95 is currently recommended for HCW who work within 2 meters of
patients known to be, or suspected of being infected with SARS-CoV-2 and
those performing AGP by most institutions (table 1).(10, 70-74)

Effectiveness

Birschoff et al found N95 respirators protected 4 of 5 participants in
their influenza exposure model.(66) Birschoff et al's second study of
live attenuated influenza vaccine strain (LAIV) in subjects wearing N95
respirators in addition to goggles to prevent transocular transmission,
was 90\% effective (26 of 29 were PCR negative).(69)

A surgical mask overlay has been recommended to provide barrier
protection in order to diminish contamination and attrition.(75, 76)
This increases the breathing resistance and discomfort.(76, 77) However,
the increased CO2 has not been shown to be clinically relevant after a
12-hour shift.(78) Increasing layers of PPE not only increase risk for
confusion and contamination, it also increase the complexity of patient
care.(79)

Evaluation of the deterioration of the filtration efficacy is difficult.
Safety is affected by multiple variables that impact respirator function
and contamination over time. Other factors than can potentially
influence this include viral aerosol concentration, wearer's breathing
rate, time of patient interaction, effect of humidity, diffusion, and
particle retention efficiency of the mask. Research on the physiologic
impacts of the long term N95 respirator use has been limited, and most
are laboratory based. There is inadequate understanding of the number,
size and dispersion of droplets containing live, infectious particles or
aerosol.(6)

Respiratory pathogens may remain infectious on respirator surfaces for
extended period, with the influenza A and B model surviving 8-12 hours
on porous substrates, compared to 24-28 hours on non-porous
surfaces.(80-82) Some pathogens transfer well in high relative
humidity.(83) However porous surfaces have a lower transfer rates due to
entrapment of organisms within their matrix and the greater surface area
in the recesses for attachment, hence less accessible to human
hands.(83, 84) More than 99\% pf pathogens remained trapped in the
respirator after handling or following simulated cough or sneeze.(85-87)
Respirators may be contaminated with other pathogens that have prolonged
environmental survival (eg methicillin-resistant Staphylococcus aureus)
resulting in the risk of self-inoculation.(88) The studies on the
transfer efficiency of pathogens from mask to skin and other surfaces is
limited to the lab setting, which may be different in clinical setting.
Nevertheless, this can be mitigated by performing hand hygiene.

MacIntyre CR et al's randomised control trial (RCT) of HCW in the
surgical masks, targeted N95 (intermittent use only in high risk
procedure) and N95 arm (continuous use throughout shift) over 4 weeks
found less respiratory infection (HR 0.56, 95\% CI 0.32 -- 0.98),
influenza (RR 0.34, 95\% CI 0.1 -- 1.11) in the N95 arm, followed by the
targeted N95 arm.(47, 89) This benefit persisted after adjusting for
confounders by influenza vaccination and hand washing.(89) This is a
more powerful study compared to Loeb M et al who had only 446 subjects,
who found a trend towards increased protection with N95 from SARS
thought it was not statistically significant.(90) The influenza rate
found in their study (24\%) is the same as rates of influenza documented
in nosocomial outbreaks in HCW without preventative interventions, and
higher than other studies in unprotected HCW.(89-92) This was also found
in MacIntyre CR et al's earlier study, where surgical mask group had
double the infection outcomes compared to the N95 group.(93)

However, a recent systemic review and meta-analysis by Smith JD et al
reported that there is insufficient data to determine the advantage of
N95 over surgical masks.(6) Similarly Long Y et al's systemic review and
meta-analysis found no statistically significant differences in
preventing influenza (RR 1.09, 95\% CI 0.92 -- 1.28), influenza-like
illness (RR 0.61, 95\% CI 0.33 -- 1.14) and viral respiratory infection
(RR 0.89, 95\% CI 0.7 -- 1.11).(7) However, when Loeb M et al's study
was excluded, there was a significant effect on N95 preventing viral
respiratory infections.(7) This should be interpreted with caution, as
while laboratory studies confirmed it confer superior protection, there
is often issues with compliance in real-world practice. This again
defers in a pandemic situation.

Extended Use or Limited Re-Use

CDC advocated extended use (wearing the same N95 respirators for
repeated close contact encounters with several patients without removing
the respirator between patient encounters), over limited re-using to
conserve supplies.(1, 82, 88) The decision is made by each institution,
taking into account the characteristic of the respiratory pathogen and
local conditions.(88) If no manufacturer guidance is available, limiting
the number of reuse to no more than 5 uses per device to ensure an
adequate safety margin.(82, 88, 94) The filtration efficiency is reduced
to below 95\% for filters after 9 and 13 weeks of simulated reuse.(82)

A Dutch study reported that the polypropylene masks (3M type 8822
masks), which do not contain cellulose can be used three times when
sterilised twice with hydrogen peroxide in between use.(95) The mask is
reported to be safe to be treated in hot air at 70*C for 30 minutes, or
125*C for 3 minutes but 90*C heat and 134*C steam deformed the mask.(95,
96)

Most HCW can tolerate wearing N95 for up to 8 to 12 hours.(1, 82) Ang et
al reported staff using it for the entire shift without removing it to
conserve supply, unless soiled during the H1N1 pandemic.(97) However,
most HCW are unwilling to wear N95 for the entire 8-hour work shift, as
most need to take breaks, thus extended use beyond 4 hours is
unlikely.(1, 78)

N95 respirators should be discarded when grossly contaminated, damaged
or difficult to breathe through.(1) Storage is in a clean, dry location,
or in a single-use breathable container to avoid contamination and
maintain the integrity.(1) In confirmed or highly suspected SARS-nCoV-2
cases, N95 respirators should be single-use only due to the risk of
droplet spray contamination, degradation of filtration efficacy and mask
fit, cross contamination during storage, doffing and donning of the
respirator.(1)

Issues

N95 respirators are associated with diminished communication acuity,
head and facial discomfort due to facial heat, pressure or pain,
headache, itch and burning eyes. Some experience nausea, dizziness,
difficulty concentration and issues with mechanical interference with
duties.(75) J Wong et al reported 20\% of their anaesthetist failed the
fit-testing for the N95 respirator.(1) Eczema is a frequent complication
of prolonged use, requiring medicated creams or ointments, or even
adhesive bandage which may affect the fit of the mask. The irritation
may increase the likelihood of inadvertent PPE protocol breach like mask
touching or adjustment in an unconscious effort to relieve a source of
irritation.(98) All these may impact on compliance over time, placing
HCW at risk of infection.

On average, noncompliance in terms of adjusting the N95 respirator,
touching the respirator or under it, face, or eye has been found to be
25.7 times per 12-hour shift.(78) Compliance is worst in those with
higher BMIs.(78) Body movement when performing medical procedures by HCW
may increase the risk of seal leakage.(99)

\textbf{1.2.2 Powered Air-Purifying Respirators (PAPR)}

PAPRs have a battery powered motor that draw air through a filter (for
particles), catridges or canisters (for gases or vapours), then deliver
filtered air under positive pressure to a hood or face piece. This
positive pressure inside the facepiece reduces inward leakage of
potentially contaminated air.(67) They may have a tight fitting half or
full facepiece or a loose fitting facepiece, hood or helmet.

Effectiveness

Compared to N95 respirator, PAPRs have a higher protection factor with
an APF of 25.(67) They filters 99.97\% of particles 0.3 \selectlanguage{greek}µ\selectlanguage{english}m and are oil
proof, is more comfortable for prolonged periods, eliminates the fit
problem and can be worn with eyewear and facial hair, and provides full
face \& head coverage.(1, 23, 100)

While this the recommended respirator for AGPs, it is controversial due
to a lack of evidence.(23) Bischoff et al's influenza exposure model
found no detectable level of virus in all (n=29) subjects with PAPR
use.(69) Based on HCWs becoming infected during AGPs of patients with
SARS despite the use of accepted universal precautions with gowns, caps,
gloves, eye protections and N95 masks, PAPR has been recommended for
high risk procedures on suspected or confirmed COVID-19 patients.(101,
102) DT Wong reported their institutional use of PAPR resulted in no
infection during the SARS outbreak in Toronto.(102) Verbeek JH et al's
2019 Cochrane review found PAPR better than a PPE without such
respirator (RR 0.27, 95\% CI 0.17-0.43).(65)

Concurrent use with the N95 respirator to prevent transmission of
infection is controversial.(77, 79) N95 in addition to PAPR during AGP
has been recommended to supplement the respiratory protection, prevent
passage of unfiltered exhalation gases from wearer to the immediate
environment, and serve as a backup in the event of a PAPR mechanical
failure, or over breathing which may create negative pressure in the
PAPR and entrains unfiltered outside air.(103) This was found to
multiplicatively increase the mean protection factor of the functioning
PAPR, and even in a non-functioning PAPR.(103)

Issues

The main concern is the higher cost, challenges in training HCWs to
safely remove PAPRs without contamination, the need for re-training if
infrequently use, inability to re-use disposable filters between
patients, the need for explicit decontamination and recycling of blower
units, potential compromise of disposable components through
inappropriate attempts to sterilise and reuse to conserve supply leading
to infection risk, communication challenges due to the fan noise, and
increased risk of infection from doffing the additional layers of
PPE.(1, 23, 100, 104)

\emph{CONCLUSION}

During a pandemic, transmission may not be elucidated especially early
on. Transmission of viruses is multimodal, and in the setting of a novel
pathogen with high case fatality with no proven effective interventions,
policy makers should not be dogmatic about pathogens and their presumed
mode of transmission. PPE that affords the best protection should be
available for HCWs who risk their lives during the pandemic.

There is much to learn from this pandemic. We need to enhance the
reserve medical supplies program, improve the system for allocation,
distribution and utilisation of PPE. They should also be properly
implemented to ensure we are ready for the next pandemic.\selectlanguage{english}
\begin{longtable}[]{@{}llllllllllll@{}}
\toprule
\begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Situation\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Respiratory Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Respiratory Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Respiratory Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Respiratory Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Respiratory Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Whole Body Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Whole Body Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Whole Body Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Whole Body Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Whole Body Protection\strut
\end{minipage} & \begin{minipage}[b]{0.06\columnwidth}\raggedright\strut
Eye Protection\strut
\end{minipage}\tabularnewline
\midrule
\endhead
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Surgical Mask}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Surgical Mask}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Respirator equivalent to N95}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Respirator equivalent to N95}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{PAPR}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Disposable Gloves}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Disposable Gloves}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Disposable Long Arm Gown}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Disposable Long Arm Gown}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Whole Body Protective Clothing including Slippers, Caps or
Hoods}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\textbf{Safety Glasses and or Face Shield}\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Quarantine\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\^{}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\^{}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{} \selectlanguage{ngerman}×\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Triage\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{} \selectlanguage{greek}\textbf{α}\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{} \selectlanguage{greek}\textbf{α}\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}*\selectlanguage{ngerman}×\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{} \selectlanguage{greek}α\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{} \selectlanguage{greek}α\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\selectlanguage{greek}α\selectlanguage{english}*\selectlanguage{english}\#\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
Transport -- Ambulance Driver Transport -- Medical Personnel\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
* *\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
* *\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
* *\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.08\columnwidth}\raggedright\strut
*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Disinfection of Ambulance\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Contact with Suspected Case\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
[?]\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}\textbf{α} µ\selectlanguage{ngerman}×\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}\textbf{α} µ\selectlanguage{ngerman}×\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{ngerman}×\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}\#\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{ngerman}×\#\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Aerosol Generating Procedures\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}\textbf{α} \selectlanguage{ngerman}×\selectlanguage{greek}µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}\textbf{α} \selectlanguage{ngerman}×\selectlanguage{greek}µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}µ\selectlanguage{english}*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}µ\selectlanguage{english}*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{english}\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\^{}\textasciitilde{}+ \selectlanguage{greek}α µ\selectlanguage{english}[?]\selectlanguage{english}*\selectlanguage{ngerman}×\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Radiological Exams\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
* \selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
* \selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Respiratory Sampling (Laboratory)\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
[?]\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Transport of Well Packaged Specimens\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Transport of Cadavers\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Cleaning \& Disinfection of Hospital Rooms inc Handling of Medical
Waste\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
[?]\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*[?]\selectlanguage{ngerman}×\strut
\end{minipage}\tabularnewline
\begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
Transport of Medical Waste\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage} & \begin{minipage}[t]{0.06\columnwidth}\raggedright\strut
*\strut
\end{minipage}\tabularnewline
\bottomrule
\end{longtable}

Table 1: Summary of Recommended Personal Protective Equipment

* Huh S. How to train the health personnel for protecting themselves
from novel coronavirus (COVID-19) infection during their patient or
suspected case care. J Educ Eval Health Prof. 2020;17:10.

Double gloves should be worn considering the risk of tear or risk of
exposure to infections in suspected and confirmed patient areas. If
driver's seat not shielded or if there is a chance of contact with
suspected or confirmed patient, wear whole body protective clothing.

advice guideline for the diagnosis and treatment of 2019 novel
coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med
Res. 2020;7(1):4.

\textasciitilde{} Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al.
Preparing for a COVID-19 pandemic: a review of operating room outbreak
response measures in a large tertiary hospital in Singapore. Can J
Anaesth. 2020.

+ Interim Infection Prevention and Control Recommendations for Patients
with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in
Healthcare Settings. CDC. 19 March 2020.

\selectlanguage{greek}α \selectlanguage{english}Yaneza M. ENTUK Guidelines for Changes in ENT During COVID-19
Pandemic. ENTUK. 2020.

Risk assessment re gloves. Shoe covers are not recommended. FFP3 rather
than N95 for \selectlanguage{greek}α \selectlanguage{english}in bold, otherwise FFP2 ie N95 equivalent for outpatients
and areas with no direct patient contact.

\selectlanguage{greek}µ \selectlanguage{english}Prunty S, HInton-Bayre A. Western AustralianENTRecommendations for PPE
for Aerosol GeneratingProcedures during COVID-19 Pandemic. 25 March
2020.

[?] Rational use of personal protective equipment (PPE) for coronavirus
disease (COVID-19). WHO. 19 March 2020.

For triage, apart from maintaining 1 mtre distance, no PPE is required.
In the outpatient area, patients with respiratory symptoms are provided
with medical mask if tolerated.

* Guidance for Health Care Workers Performing Aerosol Generating Medical
Procedures During the COVID-10 Pandemic. CSO-HNS. 26 March 2020.

Level 2 PPE even in COVID negative patients. For COVID positive, 2
layers of protectivec qeuipment consisting of a first layer of globes,
fluid repellent surgical gown, head cover that covers the neck and N95,
followed by a seoncd laryer of all three with a second mark being a
regular surgical mask. Eye protection that seals the face is preferred.

\selectlanguage{ngerman}× Handbook of COVID-19 Prevention and Treatment. Zhejiang University. 24
March 2020.

All staff must wear surgical masks. Full face respiratory protective
devices or PAPR for level 3 protection.

\# Guidelines for Otolaryngologists, Head and Neck Surgeons on Personal
Protection Equipment in the COVID-19 Pandemic. NZSOHNS. 2020.

Surgical cap in addition to gown.

Ti LK, Ang LS, Foong TW, Ng BSW. What we do when a COVID-19 patient
needs an operation: operating room preparation and guidance. Can J
Anaesth. 2020.

\emph{REFERENCES}

1. Wong J, Goh QY, Tan Z, Lie SA, Tay YC, Ng SY, et al. Preparing for a
COVID-19 pandemic: a review of operating room outbreak response measures
in a large tertiary hospital in Singapore. Can J Anaesth. 2020.

2. Wang X, Zhang X, He J. Challenges to the system of reserve medical
supplies for public health emergencies: reflections on the outbreak of
the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
epidemic in China. Biosci Trends. 2020;14(1):3-8.

3. MacIntyre CR, Chughtai AA, Seale H, Richards GA, Davidson PM.
Respiratory protection for healthcare workers treating Ebola virus
disease (EVD): are facemasks sufficient to meet occupational health and
safety obligations? Int J Nurs Stud. 2014;51(11):1421-6.

4. Chughtai AA, Seale H, MacIntyre CR. Availability, consistency and
evidence-base of policies and guidelines on the use of mask and
respirator to protect hospital health care workers: a global analysis.
BMC Res Notes. 2013;6:216.

5. Australian Health Management Plan for Pandemic Influenza. Australian
Government Department of Health. August 2019.

6. Smith JD, MacDougall CC, Johnstone J, Copes RA, Schwartz B, Garber
GE. Effectiveness of N95 respirators versus surgical masks in protecting
health care workers from acute respiratory infection: a systematic
review and meta-analysis. Cmaj. 2016;188(8):567-74.

7. Long Y, Hu T, Liu L, Chen R, Guo Q, Yang L, et al. Effectiveness of
N95 respirators versus surgical masks against influenza: A systematic
review and meta-analysis. J Evid Based Med. 2020.

8. CADTH Rapid Response Reports. Respiratory Precautions for Protection
from Bioaerosols or Infectious Agents: A Review of the Clinical
Effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and
Technologies in Health

Copyright © 2014 Canadian Agency for Drugs and Technologies in Health.;
2014.

9. Chung SJ, Ling ML, Seto WH, Ang BS, Tambyah PA. Debate on MERS-CoV
respiratory precautions: surgical mask or N95 respirators? Singapore Med
J. 2014;55(6):294-7.

10. Guidance on Preparing Workplaces for COVID-19. OSHA. 2020.

11. Rational use of personal protective equipment (PPE) for coronavirus
disease (COVID-19). WHO. 19 March 2020.

12. Jin YH, Cai L, Cheng ZS, Cheng H, Deng T, Fan YP, et al. A rapid
advice guideline for the diagnosis and treatment of 2019 novel
coronavirus (2019-nCoV) infected pneumonia (standard version). Mil Med
Res. 2020;7(1):4.

13. Schwartz J, King CC, Yen MY. Protecting Health Care Workers during
the COVID-19 Coronavirus Outbreak -Lessons from Taiwan's SARS response.
Clin Infect Dis. 2020.

14. Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial
cluster of pneumonia associated with the 2019 novel coronavirus
indicating person-to-person transmission: a study of a family cluster.
Lancet. 2020;395(10223):514-23.

15. Yu P, Zhu J, Zhang Z, Han Y, Huang L. A familial cluster of
infection associated with the 2019 novel coronavirus indicating
potential person-to-person transmission during the incubation period. J
Infect Dis. 2020.

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