CDC issues guidance on N95 respirator shortages, school closings during COVID-19 outbreaks

Editor's note: For the latest news on coronavirus disease 2019, visit https://www.aappublications.org/news/2020/01/28/coronavirus.

Health officials are offering guidance to help health care personnel optimize their supply of N95 respirators and assist educators in deciding whether to close schools during the coronavirus disease 2019 (COVID-19) outbreak.

The advice comes as President Donald J. Trump declared a national health emergency Friday.

Optimizing N95 respirators

Earlier this week, the Centers for Disease Control and Prevention (CDC) said when there is a shortage of N95 respirators, health care personnel can use face masks for certain low-risk situations while prioritizing N95 respirators for aerosol-generating procedures. It also provided a checklist with other ways to protect personnel at http://bit.ly/2wWebjE.

“Health care organizations should plan for increased demand and decreased supply of PPE (personal protective equipment),” said Capt. Lisa Delaney, M.S., CIH (USPHS), a member of the CDC’s COVID-19 Response Worker Health and Safety Team. “Organizations should use existing preparedness plans, plus knowledge about current PPE at your facility. Also, assess the ability of your vendors to fill orders and local conditions as they pertain to COVID-19 when making decisions about which options and strategies to use.”

Conventional strategies include using physical barriers such as glass or plastic windows at reception areas, properly maintaining ventilation systems, limiting patients going to hospitals, excluding personnel not directly involved in patient care, excluding visitors with known or suspected COVID-19, putting face masks on ill patients, housing patients with COVID-19 in the same hospital unit and allowing limited re-use of respirators for training and then fit testing.

Contingency capacity strategies could change daily practices without having a major effect on patients or safety. These include decreasing the length of hospital stay for patients who are stable, using N95 respirators beyond their shelf life for training and fit testing, and extending the use of N95s by wearing the same one while seeing multiple patients without removing it.

When supplies of N95 respirators are low or gone, clinicians may have to use crisis strategies that are not commensurate with U.S. standards such as reusing N95 respirators beyond their shelf life. They also may have to reuse respirators by wearing them, removing them and wearing them again. Capt. Delaney noted this is one of the more extreme options and emphasized the importance of properly taking the respirator on and off, storing it, and washing one’s hands.

Additional guidance is at http://bit.ly/2U2Qsqa.

School closings

The CDC also has provided a new decision tree to help school districts take the proper actions based on whether there is a case in one of its buildings and the level of spread in the community. In addition, it has laid out pros and cons of short-, medium- and long-term school closures at http://bit.ly/2IQA6LP.

“Most people don’t think about how well the public school systems really support the health of our children and that closing schools can have significant unintended consequences that need to be addressed,” said Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases. “But you also have to take into consideration the likelihood that keeping schools open may support continued transmission.”

The CDC said short closings early in an outbreak will not be effective to stop the disease from spreading or the health care system from being overwhelmed, while longer closures later in the outbreak may help.

“But that modelling also shows that other mitigation efforts (e.g. handwashing, home isolation) have more impact on both spread of the disease and health care measures,” according to the guidance.

Still, the CDC said closures of varying lengths are appropriate in certain situations. If schools close, education officials will need to consider academic and economic impacts. They also should support vulnerable students who need meals or mental health services and students whose parents are not able to take time off from work.

The CDC offers additional steps that kindergarten through 12th-grade schools and child care centers can take to prepare for and respond to an outbreak beyond closing the doors. That guidance is available at http://bit.ly/2TLPa3Q.

Additional COVID-19 news

• Assistant Secretary for Health Admiral Brett P. Giroir, M.D., a four-star general trained in pediatric critical care, has been appointed to coordinate COVID-19 diagnostic testing efforts among Public Health Service agencies.
• The AAP has set up a webpage for pediatricians with information about COVID-19, including a blog from AAP President Sara “Sally” H. Goza, M.D., FAAP, http://www.aap.org.
• AAP members can email the AAP with questions or comments on the outbreak at COVID-19@AAP.org.