Indications for Intubation in COVID-19

Intubation and invasive mechanical ventilation are often unavoidable in most severe cases of COVID-19 pneumonia;however, deciding the optimum timing and best practices of intubation is challenging. The decision to proceed with intubation should be based on an integrated patient evaluation and not limited to the assessment of the severity of hypoxemia alone. Intubation is a maneuver exposing the operator to a high risk of contamination, therefore adequate personal protection equipment is mandatory. Benefits of intubation over noninvasive respiratory support include reduction or suppression of the respiratory drive, reduction of the basal metabolism and allowance of maintaining protective mechanical ventilation. On the other hand, risks are related to the need for sedation, the presence of an artificial airway and exposure to mechanical ventilation, which may result in overlapping ventilator-associated bacterial pneumonia and ventilator-induced lung injury. Balancing between risks and benefits of intubation in this context is challenging and the optimum timing of intubation remains largely an open question. This chapter discusses the clinical, technical, and safety aspects that deserve to be considered when considering intubation in patients with severe COVID-19-related acute respiratory failure. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2022.

Resilience in healthcare supply chains: a review of the UK's response to the COVID19 pandemic

PurposeThe purpose of this explorative research is to analyse the resilience of the United Kingdom's (UK) healthcare supply chains from a customer's perspective in the light of the coronavirus pandemic.Design/methodology/approachUsing the capabilities of preparedness, robustness, recovery and adaptability as the foundational percept for supply chain resilience, 22 healthcare professionals in 17 of the UK's National Health Scheme (NHS) Trusts were interviewed to explore their personal and organisational approaches adopted relative to the provision of eye protection, gloves, gowns, aprons, masks and respirators. The Dynamic Capabilities View is mapped to the resilience capabilities and used to analyse the data from a transformational supply chain research perspective.FindingsThe supply chains were largely unprepared, which was not particularly surprising even though the availability of gloves was significantly better compared to the other personal protective equipment (PPE). Techniques adopted to ensure robustness and recovery revealed the use of unsanctioned methods such as extended use of PPE beyond recommended use, redefinition of guidelines, protocols and procedures by infection control and the use of expired PPE – all of which compromised customer well-being.Research limitations/implicationsAs the paper views resilience through the lens of customers, it does not provide the perspectives of the supply chain practitioners as to the reasons for the findings and the challenges within these supply chains.Practical implicationsThe compromise of the well-being of healthcare workers due to the vulnerabilities of healthcare supply chains is highlighted to managers and prescriptions for post-disruption adaptability are made.Originality/valueThis paper introduces transformative research to supply chain resilience research by uniquely looking at resilience from the customers' well-being perspective.

Improved face mask testing system

A new way to measure the penetration efficiency of a face mask is introduced. It has a number of advantages over the currently used measurement systems in which a stationary mask is impacted with a moving aerosol during which the upstream and downstream particle concentrations are compared. The equivalent system described here instead moves a mask through a stationary aerosol in a closed chamber and compares the particle concentrations before and after the movement of the mask. This system provides many advantages, such as greater simplicity, greater accuracy, an exact constant aerosol flow speed through a mask, more easily made concentration measurements, more realistic impacts, more controlled averaging, the absence of the need for preliminary impacts during flow stabilization, and a lower cost. A laboratory prototype of the system has been fabricated and seen to perform as expected. Data obtained from this prototype are displayed, analyzed, and used to demonstrate the consistency and repeatability of the system. A portable fully-automated compact prototype has also been designed and fabricated. This device can be easily operated, and the total time required to test a mask, from material insertion to result display, is only a few minutes.

Dentists Perception to Personal Protection Equipment Use during the COVID-19 Pandemic (Analytical Study)

Background: It has been demonstrated that the use of personal protective equipment (PPE) by health care workers, including dentists, reduces the transmission of COVID-19. PPE lowers patient morbidity and death as well as illness and absenteeism. Aim: The purpose of the study was to evaluate the impact of dentists' perceptions of personal infection control and their level of trust in PPE as part of the dental profession's response to the COVID-19 pandemic. Materials and Method: The sample size was (388) participants distributed as specialist, general dental practitioners, dental branch practitioners, and rotators. Google form prepared with specific questions;demographical and knowledge questions translated to the mother language (Arabic Language). Structured and distributed online by sharing the link through electronic platforms. Two responses were used in a statistical analysis using the SPSS version (SPSS Package version (21). Significant p value of 0.05 or less was used. Descriptive statistics were used in the data analysis to analyze the percentage, and mean values. All questions employ the spearman test to determine correlations. Kruskal-Wallis for comparing differences between groups including qualification and experience period between participants. Result: Significant results were shown in both rotators and general practitioners for comparison of different qualification levels between dentists. All dentists had good knowledge regarding the PPE. Conclusions: Overall, dentists in the current study had good knowledge of the PPE used for COVID-19 protection. However, it was discovered that knowledge is important for rotators and general practitioners in the majority of the PPE questions. © 2022, Ain Shams University Faculty of Medicine. All rights reserved.

High class filtering facepiece (FFP) are fundamental and effective in protection of emergency health care workers: an observational cohort study in a German community.

BACKGROUND: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a highly contagious airborne virus inducing pandemic coronavirus disease 2019 (COVID-19). This is most relevant for medical staff working under harmful conditions in emergencies often dealing with patients and an undefined SARS-CoV-2 status. We aimed to measure the effect of high-class filtering facepieces (FFP) in emergency medical service (EMS) staff by analyzing seroprevalence and history of positive polymerase chain reaction (PCR) for SARS-CoV-2. METHOD: This observational cohort study included workers in EMS, who were compared with hospital staff (HS) and staff, which was not directly involved in patient care (NPC). All direct patient contacts of EMS workers were protected by FFP2/N95 (filtering face piece protection class 2/non-oil-based particulates filter efficiency 95%) masks, whereas HS was protected by FFP2/N95 exclusively when a patient had a proven or suspected SARS-CoV-2 infection. NPC was not protected by higher FFP. The seroprevalence of SARS-CoV-2 antibodies was analyzed by immunoassay by end of 12/2020 together with the history of a positive PCR. In addition, a self-assessment was performed regarding the quantity of SARS-CoV-2 positive contacts, about flu symptoms and personal belief of previous COVID-19 infections. RESULTS: The period in which contact to SARS-CoV-2 positive patients has been possible was 10 months (March to December 2020)-with 54,681 patient contacts documented for EMS-either emergencies (n = 33,241) or transportation services (n = 21,440). Seven hundred-thirty (n = 730) participants were included into the study (n = EMS: 325, HS: 322 and NPC: 83). The analysis of the survey showed that the exposure to patients with an unknown and consecutive positive SARS-CoV-2 result was significantly higher for EMS when compared to HS (EMS 55% vs. HS 30%, p = 0.01). The incidence of a SARS-CoV-2 infection in our cohort was 1.2% (EMS), 2.2% (HS) and 2.4% (NPC) within the three groups (ns) and lowest in EMS. Furthermore, the belief of previous COVID-19 was significant higher in EMS (19% vs. 10%), CONCLUSION: The consistent use of FFP2/N95 in EMS is able to prevent work-related SARS-CoV-2 infections in emergency situations. The significance of physical airway protection in exposed medical staff is still relevant especially under the aspect of new viral variants and unclear effectiveness of new vaccines.

Study on airway assessment practices for elective procedures during pre-anesthetic evaluation in COVID-19 pandemic- A national online survey (SAFE PAC Survey).

Background and Aims: A pilot study among anesthesiologists, revealed a wide variation among individual practices including skipping pre-anesthetic airway assessment during COVID-19 pandemic because of the fear of getting infected. Risk of infection during pre-anesthetic airway assessment has not been studied. The primary objective of the survey was to evaluate the practices of airway examination by anesthesiologists during this pandemic period. Secondary objectives were to study the effects of institutional factors and other individual practices on risk modification and the incidence of COVID-19 infection among anesthesiologists. Material and Methods: A survey was conducted using a pre-validated questionnaire comprising of 35 questions. The questionnaire was circulated among 4676 members of the Indian Society of Anaesthesiologists (ISA) through Google Forms by email. Results: Of the 4676 members contacted via email, 470 were returned undelivered. From the remaining 4206 questionnaire recipients, 456 completed responses were obtained giving a response rate of 10.8%. Percentage, mean and standard deviation were calculated using EZR software. The conduct of pre-anesthetic airway assessment has decreased by 31.7% during the pandemic, leading to 5.2% of participants encountering unanticipated difficult airway. Among the respondents, eight percent were infected. Conclusion: Avoidance of preoperative airway assessment by anesthesiologists during the COVID-19 pandemic has led to rising unanticipated difficult airway undermining the patient safety. Adherence to recommended practices ensures safety from risk of COVID-19 infection.

Efficacy of facemasks in mitigating respiratory exposure to submicron aerosols.

We designed a novel experimental set-up to pseudo-simultaneously measure size-segregated filtration efficiency (ηF), breathing resistance (ηP) and potential usage time (tB) for 11 types of face protective equipment (FPE; four respirators; three medical; and four handmade) in the submicron range. As expected, the highest ηF was exhibited by respirators (97 ± 3%), followed by medical (81 ± 7%) and handmade (47 ± 13%). Similarly, the breathing resistance was highest for respirators, followed by medical and handmade FPE. Combined analysis of efficiency and breathing resistance highlighted trade-offs, i.e. respirators showing the best overall performance across these two indicators, followed by medical and handmade FPE. This hierarchy was also confirmed by quality factor, which is a performance indicator of filters. Detailed assessment of size-segregated aerosols, combined with the scanning electron microscope imaging, revealed material characteristics such as pore density, fiber thickness, filter material and number of layers influence their performance. ηF and ηP showed an inverse exponential decay with time. Using their cross-over point, in combination with acceptable breathability, allowed to estimate tB as 3.2-9.5 h (respirators), 2.6-7.3 h (medical masks) and 4.0-8.8 h (handmade). While relatively longer tB of handmade FPE indicate breathing comfort, they are far less efficient in filtering virus-laden submicron aerosols compared with respirators.

Resilience in healthcare supply chains: a review of the UK’s response to the COVID19 pandemic

Purpose: The purpose of this explorative research is to analyse the resilience of the United Kingdom's (UK) healthcare supply chains from a customer’s perspective in the light of the coronavirus pandemic. Design/methodology/approach: Using the capabilities of preparedness, robustness, recovery and adaptability as the foundational percept for supply chain resilience, 22 healthcare professionals in 17 of the UK's National Health Scheme (NHS) Trusts were interviewed to explore their personal and organisational approaches adopted relative to the provision of eye protection, gloves, gowns, aprons, masks and respirators. The Dynamic Capabilities View is mapped to the resilience capabilities and used to analyse the data from a transformational supply chain research perspective. Findings: The supply chains were largely unprepared, which was not particularly surprising even though the availability of gloves was significantly better compared to the other personal protective equipment (PPE). Techniques adopted to ensure robustness and recovery revealed the use of unsanctioned methods such as extended use of PPE beyond recommended use, redefinition of guidelines, protocols and procedures by infection control and the use of expired PPE – all of which compromised customer well-being. Research limitations/implications: As the paper views resilience through the lens of customers, it does not provide the perspectives of the supply chain practitioners as to the reasons for the findings and the challenges within these supply chains. Practical implications: The compromise of the well-being of healthcare workers due to the vulnerabilities of healthcare supply chains is highlighted to managers and prescriptions for post-disruption adaptability are made. Originality/value: This paper introduces transformative research to supply chain resilience research by uniquely looking at resilience from the customers' well-being perspective. © 2022, Emerald Publishing Limited.

Influence of different protection levels of PPE on nurses' physical fatigue during the COVID-19 pandemic.

BACKGROUND: The continuous spread of COVID-19 globally has led to busier medical practices and nurses are having to provide medical services to patients while suffering from high levels of fatigue. OBJECTIVE: This study experimentally investigated the influence of different levels of personal protection equipment (PPE) on nurses' physical fatigue. METHODS: We collected data from 12 participants by simulating a series of nursing tasks. The participants wore one of three different protection levels of PPE, and data recording their heart rate (HR), oral temperature, task completion time, and subjective fatigue were collected. Following this, relationship models between subjective fatigue and objective fatigue indices was established using multiple linear regression analysis. RESULTS: By analyzing the variation trends of single indices of HR, oral temperature, task completion time, and subjective fatigue, it was found that the higher the level of protection levels of PPE worn by the participants, the higher the degree of fatigue experienced by them. In addition, taking subjective fatigue variation as the dependent variable and objective fatigue indices as independent variables, relationship models of the three different protection levels of PPE were established. CONCLUSIONS: The results confirmed the influence of different protection levels of PPE on nurses' physical fatigue levels. They also provide a basis for medical administrators to monitor the degree of fatigue experienced by nurses, attempt to arrange nurses' work content accordingly, and schedule suitably to combat and manage recorded increases in fatigue.

PPE kit to bio-oil: an experimental investigation

Covid 19 is a highly infectious disease caused by SARS-CoV-2 that can spread from an infected person’s nose, mouth during coughing & sneezing. One of the warriors against Covid-19 is personal protection equipment (PPE), which is indispensable for everyone working closely with Covid-19 patients. The kits are made of different types of plastics and their disposal is going to be a serious menace, if not taken care of properly. The sustainable alternative to handle cast-off PPE kit is to convert them into pyrolysis oil using a thermochemical process. In the present paper, pyrolysis of PPE kit is done in a lab scale reactor to get the pyrolysis oil that has the potential to be used as alternate fuel in the neat or in blended form with conventional fuels. GC-MS of the obtained oil shows the presence of (C-7 to C-32) hydrocarbon fraction. FTIR analysis of the oil is also done for functional group composition. The results obtained also support the application of pyrolyisis oil as an alternate fuel. Physico-chemical characteristics of the pyrolysis oil sample are also comparable to the commercially available fuel with exception of viscosity as the fuel obtained has not been fractionated and has both light and heavy naphtha. © 2022 Informa UK Limited, trading as Taylor & Francis Group.

Headache related to personal protective equipment in healthcare workers during COVID-19 pandemic in Mexico: baseline and 6-month follow-up.

BACKGROUND AND AIM: Headaches related to the use of personal protective equipment (PPE) could affect performance at work in healthcare personnel. Our aim was to describe the prevalence and risk factors for headaches related to PPE, in the personnel of a specialized coronavirus disease 2019 (COVID-19) tertiary hospital. METHODS: In this cross-sectional survey study, we invited healthcare workers from COVID-19 referral center in Mexico (May 22-June 19, 2020) to answer a standardized structure questionnaire on characteristics of new-onset PPE-related headache or exacerbation of primary headache disorder. Participants were invited regardless of whether they had a current headache to avoid selection bias. This is the primary analysis of these data. RESULTS: Two hundred and sixty-eight subjects were analyzed, 181/268 (67.5%) women, 177/268 (66%) nurses, mean age 28 years. The prevalence of PPE-related headache was 210/268 (78.4%). Independent risk factors were occupation other than physician (OR 1.59, 95% CI 1.20-2.10), age > 30 years (OR 2.54, 95% CI 1.25-5.14), and female sex (OR 3.58, 95% CI 1.86-6.87). In the 6-month follow-up, 13.1% of subjects evolve to chronic headache, with stress as predictive risk factor. CONCLUSION: The frequency of PPE-associated headache is high, and a subgroup could evolve to chronic headache. More studies are necessary to improve the knowledge about this condition.

A Global Sharing Mechanism of Resources: Modeling a Crucial Step in the Fight against Pandemics.

To face crises like the COVID-19 pandemic, resources such as personal protection equipment (PPE) are needed to reduce the infection rate and protect those in close contact with patients. The increasing demand for those products can, together with pandemic-related disruptions in the global supply chain, induce major local resource scarcities. During the first phase of the COVID-19 pandemic, we witnessed a reflex of 'our people first' in many regions. In this paper, however, we show that a cooperative sharing mechanism can substantially improve the ability to face epidemics. We present a stylized model in which communities share their resources such that each can receive them whenever a local epidemic flares up. Our main finding is that cooperative sharing can prevent local resource exhaustion and reduce the total number of infected cases. Crucially, beneficial effects of sharing are found for a large range of possible community sizes and cooperation combinations, not only for small communities being helped by large communities. Furthermore, we show that the success of sharing resources heavily depends on having a sufficiently long delay between the onsets of epidemics in different communities. These results thus urge for the pairing of a global sharing mechanism with measures to slow down the spread of infections from one community to the other. Our work uses a stylized model to convey an important and clear message to a broad public, advocating that cooperative sharing strategies in international resource crises are the most beneficial strategy for all. It stresses essential underlying principles of and contributes to designing a resilient global supply chain mechanism able to deal with future pandemics by design, rather than being subjected to the coincidental and unequal distribution of opportunities per community that we see at present.

Prevalence of SARS-CoV-2 Infection Among COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) Laboratory Workers in Bangladesh.

BACKGROUND: Healthcare workers (HCWs) at the frontline are confronting a substantial risk of infection during the COVID-19 pandemic. This emerging virus created specific hazards to researchers and laboratory staff in a clinical setting, underlined by rapid and extensive worldwide transmission. OBJECTIVES: This study aimed to investigate the prevalence of SARS-CoV-2 infection among COVID-19 reverse transcription-polymerase chain reaction (RT-PCR) laboratory health workers in Bangladesh. MATERIALS AND METHODS: This retrospective study was conducted between October 2 to December 2, 2020. A total of 508 participants, including doctors, scientific officers, medical technologists, and cleaners working in several COVID-19 RT-PCR laboratories, were included in this study. Data were collected from each participant using a semi-structured questionnaire prepared in the format of an anonymous Google form. All statistical analyses were performed using SPSS, version 25.0 (SPSS Inc., Chicago, IL, USA). RESULTS: Out of the 508 participants, 295 tested positive for SARS-CoV-2 RT-PCR. Among the positive cases, 202 were men, and 93 were women, with a median age of 30 years. The most positive cases were medical technologists (53.22%) followed by doctors (28.8%). Out of the 271 symptomatic positive cases, the most typical symptoms were fever (78.5%), fatigue (70%), loss of smell and taste (65%), and cough (64%). Hypertension, obesity, and diabetes were found in 8.8%, 8.8%, and 7.1% positive cases. A + blood group was present in 37% of the positive cases, followed by the B+ blood group (27%) and O+ blood group (25%). Inadequate supply of personal protective equipment (PPE), absence of negative pressure ventilation, laboratory contamination, and no training on molecular test methods were found in 13.8%, 67.8%, 44.7%, and 40.6% of positive cases, respectively. CONCLUSION: Evaluating the infection status of laboratory HCWs is crucial for drawing attention from the public, providing practical suggestions for government agencies, and increasing protective measures for laboratory HCWs.

The health effects of quarantine during the COVID-19 pandemic

Background: Quarantine is considered as an effective solution in the early stages of an epidemic. In the case of the coronavirus epidemic, quarantine was also recommended and implemented as a significant guideline to prevent the disease. However, despite the benefits of quarantine, there are also complications and problems. Objective: The present study aimed to investigate the health effects of quarantine during the COVID-19 pandemic. Methods: This study was conducted as a literature review through searching the databases Google Scholar, PubMed, and Science Direct for papers published before July 2020. The research was conducted based on the keywords "Coronavirus," "COVID-19," and "quarantine." The references of the papers were also reviewed to find the ones not found in the databases. The guidelines published by reputable organizations such as the World Health Organization (WHO) and Centers for Disease Control and Prevention (CDC) were used in this study. Results: Although quarantine is applied as an important and primary solution in the outbreak of epidemics, in cases of pandemics, it may not be free of negative effects on individuals and public health. However, because of the need to reopen and restart social and economic activities, some changes should be made in lifestyles and work activities. Using cyberspace and telework can be helpful. As the findings showed, COVID-19 bubbles can be used to restore social communications. Conclusion: Using masks, avoiding unnecessary gatherings, complying with personal and social hygiene, and respecting social distancing can be valuable solutions that, if implemented properly, can decrease the rate of the disease significantly. It is also emphasized that quarantine is still necessary and important as the best solution for sick people and individuals who are suspected carriers of the disease. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Risk of Dehydration Due to Sweating While Wearing Personal 2 Protective Equipment in COVID-19 Clinical Care: A Pilot Study.

OBJECTIVE: The objectives of this study were (a) to determine the physical impact of the personal protective equipment (PPE) used in COVID-19 care, specifically the impact on the hydration state of the temperature and the comfort of the healthcare workers who use it, and (b) to show the high-fidelity simulated environment as an appropriate place to test the experimental designs to be developed in real environments for COVID-19. BACKGROUND: All healthcare staff use full PPE in the care of COVID-19 patients. There are problems, such as excessive sweating, which have not been quantified thus far. METHODS: A descriptive pilot design was used in a simulated high-fidelity setting. There was paired activity, with mild-moderate physical activity, between 45 and 60 min continuously, with the COVID-19 PPE. Sixteen intensive care nurses were selected. The before-after differential of weight, thirst, weight use of the PPE, body temperature, thermal body image, general and facial warmth sensation, and perspiration sensation were measured. RESULTS: All subjects lost weight in the form of sweat with both PPEs during the simulation scenario, with a mean of 200 g (0.28% of initial weight), and increased thirst sensation. Body thermal image increased by 0.54 °C in people using the full COVID-19 PPE. CONCLUSIONS: The use of PPE in the management of critically ill COVID-19 patients generates weight loss related to excessive sweating. The weight loss shown in this pilot test is far from the clinical limits of dehydration. The use of ventilated PPE, such as PAPR, reduce the body temperature and heat sensation experienced by the users of it; at the same time, it improves the comfort of those who wear it. The simulated environment is a suitable place to develop the piloting of applicable research methodologies in future studies in a real environment.

Comparison of an Air-Fed Mask System with Hospital-Issued Personal Protection Equipments for Dental Aerosol Protection During the COVID-19 Pandemic

Aim: A pilot study was conducted with the aim of developing a system to protect the eyes, nose, and mouth from the aerosol generated from a high-speed dental handpiece during the COVID-19 pandemic. Background: The SARS-CoV-2 virus is known to be present in the saliva of an infected individual during the contagious viral shedding phase of the disease. The use of rotary dental instruments places oral health practitioners at risk of contracting COVID-19 from infected individuals. In particular, it is very difficult to protect the mucous membranes of the face against the extremely fine aerosol produced from a high-speed dental handpiece. Objectives: This study aimed to develop and test a novel PPE system for use during the COVID-19 pandemic. An air-fed spray-painting mask was used under a plastic hood to protect against the aerosol from a high-speed dental handpiece. This was found to be superior compared to hospital-issued N-95 masks and eye protection in our test model. Methods: Subjects donned various forms of PPE whilst using a high-speed dental handpiece in a confined cubicle. The efficacy of each form of PPE was evaluated by adding fluorescein to the water coolant supply line of a high-speed dental handpiece before checking for facial contamination with an ophthalmology slit lamp. Results: Under our test conditions, the N-95 mask did not prevent nasal and mouth contaminations, but the combination of an air-fed mask with a sealed hood prevented these contaminations. Although goggles worn tightly did prevent contamination, the air-fed mask system was far more comfortable and did not fog up. Discussion: Under the rigorous test conditions of our model, we found hospital-issued PPE ineffective. We also found the single strategy of using positive airflow into a face mask ineffective, even with extremely high levels of airflow. Complete protection was only achieved reliably by the combination of physically sealing off the face from the surrounding airspace and using the air-fed system to provide an external source of air to breathe. We effectively made the clinical equivalent of a dive bell helmet. The air-fed mask is supplied by a standard dental air compressor and is simple to install for someone familiar with the technical aspects of compressors. The compressor does not rely on a filter and proves effective with cheap and easily accessible disposable items. Conclusion: Under rigorous testing conditions, the developed air-fed mask system with a sealed hood on low flow performed better than hospital-issued PPE against high-speed dental aerosol protection. The developed system protects the operators from the air of the room contaminated with aerosol and brings in safe air from the outside for them to breathe.

Restoring the medical supply Chain from below: The role of social entrepreneurship in the production of face masks during the COVID-19 crisis

The COVID-19 pandemic affected societies worldwide, compromising socio-technical systems across geographical, judicial, and administrative borders. It therefore a cross-border, transboundary crisis. It also exposed the global medical supply chain's vulnerability. Authorities' inability to restore it quickly caused serious problems in crisis response, but private initiatives provided unexpected bottom-up solutions. How social entrepreneurs respond to a crisis alongside the formal crisis governance system and generate resources related to product development and logistics deserves more attention. We therefore present a case study about a Dutch social enterprise (Refugee Company) engaged with the cross-border dimension of the COVID-19 crisis. We show it is possible to establish a supply chain and domestically produce personal protection equipment using a bottom-up approach. Policy and crisis governance should not overlook the potential of entrepreneurial activities to strengthen supply chains during crises, as they make supply chains more sustainable and crisis-resilient. © 2021 Information Systems for Crisis Response and Management, ISCRAM. All rights reserved.

The source control effect of personal protection equipment and physical barrier on short-range airborne transmission.

In order to control the spread of Covid-19, authorities provide various prevention guidelines and recommendations for health workers and the public. Personal protection equipment (PPE) and physical barrier are the most widely applied prevention measures in practice due to their affordability and ease of implementation. This study aims to investigate the effect of PPE and physical barriers on mitigating the short-range airborne transmission between two people in a ventilated environment. Four types of PPE (surgical mask, two types of face shield, and mouth visor), and two different sizes of the physical barrier were tested in a controlled environment with two life-size breathing thermal manikins. The PPE was worn by the source manikin to test the efficiency of source control. The measurement results revealed that the principles of PPE on preventing short-range droplet and airborne transmission are different. Instead of filtering the fine droplet nuclei, they mainly redirect the virus-laden exhalation jet and avoid the exhaled flow entering the target's inhalation region. Physical barriers can block the spreading of droplet nuclei and create a good micro environment at short distances between persons. However, special attention should be paid to arranging the physical barrier and operating the ventilation system to avoid the stagnant zone where the contaminant accumulates.