Jeanne Noble

The use of face masks has been widely promoted and at times mandated to prevent coronavirus disease 2019 (COVID-19). The 2023 publication of an updated Cochrane review on mask effectiveness for respiratory viruses as well as the unfolding epidemiology of COVID-19 underscore the need for an unbiased assessment of the current scientific evidence. It appears that the widespread promotion, adoption, and mandating of masking for COVID-19 were based not primarily on the strength of evidence for effectiveness but more on the imperative of decision-makers to act in the face of a novel public health emergency, with seemingly few good alternatives. Randomized clinical trials of masking for prevention of COVID-19 and other respiratory viruses have so far shown no evidence of benefit (with the possible exception of continuous use of N95 respirators by hospital workers). Observational studies provide lower-quality evidence and do not convincingly demonstrate benefit from masking or mask mandates. Unless robust new evidence emerges showing the effectiveness of masks in reducing infection or transmission risks in either trials or real-world conditions, mandates are not warranted for future epidemics of respiratory viral infections.

Frontline health care workers are at high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease 2019 (COVID-19).¹ Personal protective equipment (PPE), including N95 respirators (N95s), is essential for prevention of COVID-19. The Centers for Disease Control and Prevention recommends that health care workers dispose of N95s after a single patient encounter. However, it recommends N95 extended use (wearing the same N95 for multiple patient encounters) and limited reuse (storing an N95 between encounters for use over multiple encounters) during critical PPE shortages.^2,3 There are limited data regarding N95 reuse and extended use. Existing studies were conducted in laboratories, not clinical environments.^4,5 Inadequate supplies of N95s have forced many emergency departments to implement various N95 reuse and extended use policies but without empirical evidence of their effectiveness. We examined the prevalence of N95 fit test failure while reusing 2 common types of N95 masks.

As of March 30th, 2020 there were 161,807 total cases and 2,953 total deaths of SARS-CoV-2 in the United States, with the number of cases expected to rise. Other than supportive care, there are no SARS-CoV-2 specific treatments available for patients discharged from the emergency department (ED) or those admitted to the hospital. In addition, there are no vaccines available to protect our at-risk healthcare workers. The National Institutes of Health is conducting a Phase 1 clinical trial to evaluate for a potential vaccine and the recipients have started to receive the investigational vaccine.2 We present a brief overview of the potential prophylactic and treatment agents under investigation, some which could be initiated in the ED if proven effective.