COVID-19: Personal Protective Equipment

Photograph: Jon Super/AP

Personal Protective Equipment and COVID-19

Compiled by Frank Rosenthal and Ben Batorsky for Science for the People
Last updated: June 13, 2020

What is Personal Protective Equipment and Who Needs It?

The Occupational Health and Safety Administration (OSHA) defines Personal Protective equipment (PPE) as “equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.”  In the context of COVID-19 this refers mainly to gloves, gowns, respirators (e.g. N95 masks) and various other coverings.  Employers are responsible for providing and maintaining this equipment as well as training staff in its use.

PPEs are considered by the National Institute for Occupational Safety and Health (NIOSH) and CDC as essentially the last line of defense in protecting people from illness.  This is based on a model called the “hierarchy of controls,” in which the highest and most effective interventions involve administrative and engineering controls such as air filtration.  PPEs constitute the lowest and least effective segment of this hierarchy. However, for workers who must come into contact with infectious or potentially infectious persons, there may be no other practical means of protection.

CDC and OSHA Guidance on PPE

CDC’s guidance on PPE for healthcare professionals includes recommendations for PPE,(including N95 masks) depending on the particular healthcare setting. CDC also recommends PPE for first responders, correctional workers, and others who may come into contact with known or suspected cases of COVID-19. As of 3/21/2020, CDC’s guidance for businesses and employers in “non-healthcare settings”, to respond to COVID-19, does not recommend PPE. However, OSHA’s “Guidance on Preparing Workplaces for COVID-19” (as of 5/7/2020) specifies that “medium risk” workers (including many in non-healthcare settings) may need PPE. CDC has made recommendations recently for people in public settings to wear “face coverings” (other than surgical or N95 masks) to “slow the spread of COVID-19” but does not consider these face-coverings PPE. NOTE: These guidelines were identified on 5/6/2020. They have changed since the pandemic began and may change again.

Protecting Workers with PPE

Guidelines for protecting workers from COVID-19, issued by OSHA and other agencies usually emphasize high risk workers, primarily in healthcare; however, many other workers may be exposed and need to be protected.(a recent example is meatpackers). Although OSHA has acknowledged that PPE may be needed, for protection against COVID-19 in non-healthcare settings, it has also stated that it will not normally inspect a workplace in response to a complaint about COVID hazards at a workplace it considers “medium risk”. In general, OSHA enforcement of workplace health and safety standards is very limited. OSHA guidelines likely don’t apply to contract workers, workers classified as “self-employed”, domestic workers, state employees, or inmates. And since OSHA has been significantly weakened in recent years, it’s unlikely PPE standards are being enforced even among workers that fall under OSHA’s regulation.

The AFL-CIO’s “Working People’s Plan for Re-opening the Economy the Right Way” includes recommendations for PPE for workers currently on the job and those returning to work.

Face Coverings for the General Public

In recommending that people wear face coverings (other than surgical masks and N95 masks) in public settings, CDC states that the purpose of doing this is to “slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others“. CDC does NOT state that these face coverings provide protection to the wearer from COVID-19. In fact, face-coverings, other than surgical or N95 masks, may provide some protection against COVID-19. However the extent of protection is limited and is likely considerably less than that provided by surgical masks or N95 masks.

These face coverings should never be used as a substitute for other important protective measures such as social distancing, handwashing and isolation. Here is a more complete discussion of the use of face masks in various settings.

The PPE Shortage in the USA

A survey in April by Time found that only 10-15% of healthcare facilities had sufficient PPE to last them until the end of the month. Many were already out of PPE like N95 masks, thermometers and face shields. This shortage not only threatens the lives of healthcare providers but threatens to diminish the US healthcare system’s capacity to deal with sick patients. This is the line often seen in “flatten the curve” visuals, cases above which are much more likely to result in death.

There are a few reasons for this shortage. For one, prior to the pandemic, China produced more than half of the world’s supply of N95 masks. When the outbreak began there, China sharply reduced its exports, opting instead to keep the masks in the country, similar to what the Trump administration has done in the USA.

Another reason is that the Federal government has yet to invoke the Defense Production Act (DPA) for the purposes of producing additional PPE. The government has already used the DPA for production of ventilators, but has hesitated to use it to produce additional PPE.

Not only has there been limited Federal involvement in distribution of PPE, they have recently been commandeering PPE shipments to states and redirecting them to national stockpiles or private companies. This has caused some states to enact policies to evade federal oversight of shipments in order to get them delivered.

To address this shortage, several companies have begun retooling in order to produce PPE.  Companies formerly producing parts for Formula One, outdoors equipment and even pet products have begun contributing to supplies. Additionally, many local maker spaces have contributed their equipment and members to the cause.

There may also be ways to extend the life of PPE. The CDC recommends reducing the number of non-urgent procedures and appointments and using some N95 respirators that may be past their expiry date.

If you’re interested in contributing supplies or support to combat this PPE shortage, either reach out to your local healthcare facilities or contact to find out how you can get involved.