CDC chided for equipment guidelines recommending face masks as substitutes for respirators

The Centers for Disease Control and Prevention is facing criticism for its updated guidelines on personal protective equipment that recommend face masks as an acceptable alternative when there is a shortage of respirators.

Criticism from the American Nurses Association comes amid worries over the safety of health care workers and shortages of medical supplies as more U.S. hospitals tend to patients diagnosed with COVID-19.

“We acknowledge the challenges of ensuring an adequate supply of personal protective equipment, but we need to make sure our nurses are protected,” said Kendra McMillan, ANA senior policy advisor for nursing practice and work environment. “And with that, that’s why we are strongly urging Congress and our administration to increase the supply chain with deployment of personal protective equipment, the necessary lab equipment and tests and preparedness supplies that are needed to respond.”

Ms. McMillan said medical workers, who she described as the front lines of the outbreak response, have to stay healthy in order to care for infected patients.

“We also need to make sure we’re protecting our nurses and our health care workers because they have families, too,” she said.

More health care workers are catching the respiratory ailment as coronavirus infections in the U.S. surpass 5,200 with hot spots in Washington state, New York and California.

On Monday, the CDC confirmed its first case of the novel coronavirus disease in an employee. It said the individual is in good condition and isolated to prevent spread of infection. The individual was not involved in the COVID-19 response.

The National Institutes of Health reported its first known case in a staff member Sunday, which it called an “unfortunate development” but unsurprising. It said it expects more cases of infection among staff.

The NIH employee was not involved in patient care and is quarantined at home and doing well. Both CDC and NIH employees were asymptomatic while at work, which is believed to lower risk of transmission.

The ANA is calling on the CDC for a “more definitive statement” about the transmission of coronavirus, noting nurses must feel confident that a medical mask is appropriate for providing care for patients infected with the coronavirus.

“The whole point is if you haven’t gotten enough respirators you do the next best thing,” Dr. William Schaffner, Vanderbilt University infectious disease specialist, said of the updated CDC guidelines. “Clearly the N95 [respirators] provide better protection, but the question always is is there enough supplies. … So if your best option becomes unavailable or reduced in availability, you just have to move to the next best option.”

The association expressed concern that the CDC recommendations were based solely on supply chain and manufacturing issues. It said the CDC should include strategies that address limited manufacturing and supply chain of personal protective equipment.

The CDC did not respond to a request for comment.

Dr. Tom Frieden, president of Resolve to Save Lives and former CDC director, said the best information reveals that the coronavirus spreads by droplets, not by aerosols, except in certain situations such as during a bronchoscopy and other procedures.

“In these potentially aerosol-generating situations, as the CDC recommends, N95 respirators or above are needed. In other situations, it’s likely that regular surgical masks will be protective,” Dr. Frieden said. “One area that needs urgent assessment is the use and supply of reusable N95 respirators known as elastomeric and PAPR models, which can be sanitized between uses and could address supply chain problems, although may impede patient-provider communication.”

Last week, President Trump declared a national emergency, freeing up billions of dollars in resources for states and localities.

Mr. Trump said Monday the federal government would order more medical supplies such as respirators and ventilators, but urged states to try to get a hold of equipment on their own.