References

Aerosol generating procedures (AGPs). 2019. https//www.baaudiology.org/app/uploads/2020/06/1_tbp-lr-agp-v1.21.pdf (accessed 2 November 2020)

In: Brown SN, Kumar DS, James C, Mark J (eds). Bridgwater: Class Professional Publishing; 2019

Centers for Disease Control and Prevention. Healthcare infection prevention and control FAQs for COVID-19. 2020. https//www.cdc.gov/coronavirus/2019-ncov/hcp/infection-control-faq.html (accessed 27 October 2020)

Chughtai AA, Seale H, MacIntyre CR. Availability, consistency and evidence-base of policies and guidelines on the use of mask and respirator to protect hospital health care workers: a global analysis. BMC Res Notes. 2013; 6 https://doi.org/10.1186/1756-0500-6-216

Cook TM. Personal protective equipment during the coronavirus disease (COVID) 2019 pandemic—a narrative review. Anaesthesia. 2020; 75:(7)920-927 https://doi.org/10.1111/anae.15071

Contini C, Di Nuzzo M, Barp N, Bonazza A, De Giorgio R, Tognon M, Rubino S. The novel zoonotic COVID-19 pandemic: An expected global health concern. J Infect Dev Ctries. 2020; 14:(3)254-264 https://doi.org/10.3855/jidc.12671

Cui J, Li F, Shi ZL. Origin and evolution of pathogenic coronaviruses. Nat Rev Microbiol. 2019; 17:(3)181-192 https://doi.org/10.1038/s41579-018-0118-9

da Costa VG, Moreli ML, Saivish MV. The emergence of SARS, MERS and novel SARS-2 coronaviruses in the 21st century. Arch Virol. 2020; 165:(7)1517-1526 https://doi.org/10.1007/s00705-020-04628-0

Donoghue M, Hsieh F, Baronas E A novel angiotensin-converting enzyme-related carboxypeptidase (ACE2) converts angiotensin I to angiotensin 1–9. Circ Res. 2000; 87:(5)1-9 https://doi.org/10.1161/01.RES.87.5.e1

Du L, He Y, Zhou Y, Liu S, Zheng BJ, Jiang S. The spike protein of SARS-CoV—a target for vaccine and therapeutic development. Nat Rev Microbiol. 2009; 7:(3)226-236 https://doi.org/10.1038/nrmicro2090

Elkholy AA, Grant R, Assiri A, Elhakim M, Malik MR, Van Kerkhove MD. MERS-CoV infection among healthcare workers and risk factors for death: retrospective analysis of all laboratory-confirmed cases reported to WHO from 2012 to 2 June 2018. J Infect Public Health. 2020; 13:(3)418-422 https://doi.org/10.1016/j.jiph.2019.04.011

European Centre for Disease Prevention and Control. Infection prevention and control and preparedness for COVID-19 in healthcare setting. Second update—31 March 2020. 2020. https//tinyurl.com/yxn474zg (accessed 27 October 2020)

CDC Revises guidelines as coronavirus spreads in US. 2020. https//tinyurl.com/y5mj9xuj (accessed 27 October 2020)

Ferretti L, Wymant C, Kendall M Quantifying SARS-CoV-2 transmission suggests epidemic control with digital contact tracing. Science. 2020; 368:(6491) https://doi.org/10.1126/science.abb6936

Garcia-Castrillo L, Petrino R, Leach R European Society for Emergency Medicine position paper on emergency medical systems' response to COVID-19. Eur J Emerg Med. 2020; 27:(3)174-177 https://doi.org/10.1097/MEJ.0000000000000701

Harding H, Broom A, Broom J. Aerosol-generating procedures and infective risk to healthcare workers from SARS-CoV-2: the limits of the evidence. J Hosp Infect. 2020; 105:(4)717-725 https://doi.org/10.1016/j.jhin.2020.05.037

He F, Deng Y, Li W. Coronavirus disease 2019: what we know?. J Med Virol. 2020; 92:(7)719-725 https://doi.org/10.1002/jmv.25766

Health and Safety Authority. Risk group classification for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). 2020. https//tinyurl.com/yyvbe3ko (accessed 27 October 2020)

Health and Safety Executive. Rapid evidence review. 2020. https//tinyurl.com/y2udbq6g (accessed 27 October 2020)

Hoehl S, Rabenau H, Berger A Evidence of SARS-CoV-2 infection in returning travelers from Wuhan, China. N Engl J Med. 2020; 382:(13)1278-1280 https://doi.org/10.1056/NEJMc2001899

Jin Y, Yang H, Ji W Virology, epidemiology, pathogenesis, and control of COVID-19. Viruses. 2020; 12:(4) https://doi.org/10.3390/v12040372

Lam TT, Jia N, Zhang YW Identifying SARS-CoV-2-related coronaviruses in Malayan pangolins. Nature. 2020; 583:(7815)282-285 https://doi.org/10.1038/s41586-020-2169-0

Lee SA, Hwang DC, Li HY, Tsai CF, Chen CW, Chen JK. Particle size-selective assessment of protection of European standard FFP respirators and surgical masks against particles-tested with human subjects. J Healthc Eng. 2016; 2016 https://doi.org/10.1155/2016/8572493

Li Q, Guan X, Wu P Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020; 382:(13)1199-1207 https://doi.org/10.1056/NEJMoa2001316

Lu R, Zhao X, Li J, Niu P Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding. Lancet. 2020; 395:(10224)565-574 https://doi.org/10.1016/S0140-6736(20)30251-8

Lui J, Liao X, Qian S Community transmission of severe acute respiratory syndrome coronavirus 2, Shenzhen, China, 2020. Emerg Infect Dis. 2020; 26:(6)1320-1323 https://doi.org/10.3201/eid2606.200239

Mahase E. Coronavirus covid-19 has killed more people than SARS and MERS combined, despite lower case fatality rate. BMJ. 2020; 368 https://doi.org/10.1136/bmj.m641

New and Emerging Respiratory Virus Threats Advisory Group. NERVTAG consensus statement on cardiopulmonary resuscitation (CPR) as an AGP. 2020. https//tinyurl.com/y4ggckt7 (accessed 27 October 2020)

Occupational Safety and Health Administration. Particulate respirators certified under 42 CFR part 84. 1996. Washington (DC): United States Department of Labor. https//tinyurl.com/y3w3wjd2 (accessed 27 October 2020)

Ong SWX, Tan YK, Chia PY Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020; 323:(16)1610-1612 https://doi.org/10.1001/jama.2020.3227

Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome—coronavirus-2 (SARS-CoV-2; coronavirus disease-19). Clin Exp Pediatr. 2020; 63:(4)119-124 https://doi.org/10.3345/cep.2020.00493

Perlman S. Another decade, another coronavirus. N Engl J Med. 2020; 382:(8)760-762 https://doi.org/10.1056/NEJMe2001126

Petrosillo N, Viceconte G, Ergonul O, Ippolito G, Petersen E. COVID-19, SARS and MERS: are they closely related?. Clin Microbiol Infect. 2020; 26:(6)729-734 https://doi.org/10.1016/j.cmi.2020.03.026

Public Health England. COVID-19 guidance for ambulance trusts. 2020a. https//www.gov.uk/government/publications/covid-19-guidance-for-ambulance-trusts/covid-19-guidance-for-ambulance-trusts#section3PPE (accessed 27 October 2020)

Public Health England. PHE statement regarding NERVTAG review and consensus on cardiopulmonary resuscitation as a aerosol generating procedure (AGP). 2020b. https//tinyurl.com/y29ghbgy (accessed 27 October 2020)

Resuscitation Council UK. RCUK statement on PHE PPE guidance. 2020. https//tinyurl.com/y8e3jcua (accessed 27 October 2020)

Reynolds MG, Anh BH, Thu VH Factors associated with nosocomial SARS-CoV transmission among healthcare workers in Hanoi, Vietnam, 2003. BMC Public Health. 2006; 6:(1)

Shaban RZ. Paramedic knowledge of infection control principles and standards in an Australian emergency medical system (EMS). Aust Infect Control. 2006; 11:(1)13-19 https://doi.org/10.1071/HI06013

Sohrabi C, Alsafi Z, O'Neill N World Health Organization declares global emergency: a review of the 2019 novel coronavirus (COVID-19). Int J Surg. 2020; 76:71-76 https://doi.org/10.1016/j.ijsu.2020.02.034

Swerdlow DL, Finelli L. Preparation for possible sustained transmission of 2019 novel coronavirus: lessons from previous epidemics. JAMA. 2020; 323:(12)1129-1130 https://doi.org/10.1001/jama.2020.1960

Tran K, Cimon K, Severn M, Pessoa-Silva CL, Conly J. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One. 2012; 7:(4) https://doi.org/10.1371/journal.pone.0035797

Wang D, Hu B, Hu C Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. JAMA. 2020; 323:(11)1061-1069 https://doi.org/10.1001/jama.2020.1585

World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003. 2004. https//tinyurl.com/y64pp9ob (accessed 27 October 2020)

World Health Organization. Infection prevention and control of epidemic-and pandemic prone acute respiratory infections in health care. 2014. https//www.who.int/publications/i/item/infection-prevention-and-control-of-epidemic-and-pandemic-prone-acute-respiratory-infections-in-health-care (accessed 2 November 2020)

World Health Organization. Naming the coronavirus disease (COVID-19) and the virus that causes it. 2020a. https//tinyurl.com/t82w9ka (accessed 27 October 2020)

World Health Organization. Coronavirus disease 2019 (COVID-19). 2020b. https//tinyurl.com/y43dqnq9 (accessed 27 October 2020)

World Health Organization. 2020 COVID-19 weekly surveillance report. Data for the week 8–14 June 2020 (epi week 24). 2020c. https//www.euro.who.int/__data/assets/pdf_file/0006/458916/Week-30-COVID-19-surveillance-report-eng.pdf (accessed 2 November 2020)

World Health Organization. Rational use of personal protective equipment (PPE) for coronavirus disease (COVID-19). Interim guidance. 2020d. https//tinyurl.com/qvofaf5 (accessed 27 October 2020)

World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations. 2020e. https//www.who.int/news-room/commentaries/detail/modes-of-transmission-of-virus-causing-covid-19-implications-for-ipc-precaution-recommendations (accessed 2 November 2020)

World Health Organization. WHO coronavirus disease (COVID-19) dashboard. 2020f. https//covid19.who.int/ (accessed 27 October 2020)

World Health Organization. Middle East respiratory syndrome coronavirus (MERS-CoV). 2020g. https//www.who.int/emergencies/mers-cov/en/ (accessed 27 October 2020)

Wrapp D, Wang N, Corbett KS Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020; 367:(6483)1260-1263 https://doi.org/10.1126/science.abb2507

Xiao J, Fang M, Chen Q, He B. SARS, MERS and COVID-19 among healthcare workers: a narrative review. J Infect Public Health. 2020; 13:(6)843-848 https://doi.org/10.1016/j.jiph.2020.05.019

Yi Y, Lagniton PNP, Ye S, Li E, Xu RH. COVID-19: what has been learned and to be learned about the novel coronavirus disease. Int J Biol Sci. 2020; 16:(10)1753-1766 https://doi.org/10.7150/ijbs.45134

Zhang YZ, Holmes EC. A genomic perspective on the origin and emergence of SARS-CoV-2. Cell. 2020; 181:(2)223-227 https://doi.org/10.1016/j.cell.2020.03.035

Zhai P, Ding Y, Wu X, Long J, Zhong Y, Li Y. The epidemiology, diagnosis and treatment of COVID-19. Int J Antimicrob Agents. 2020; 55:(5) https://doi.org/10.1016/j.ijantimicag.2020.105955

Zhonghua Liu Xing Bing Xue Za Zhi The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. 2020. 2020; 41:(2)145-151 https://doi.org/10.3760/cma.j.issn.0254-6450.2020.02.003

Zhu N, Zhang D, Wang W A novel coronavirus from patients with pneumonia in China, 2019. N Engl J Med. 2020; 382:(8)727-733 https://doi.org/10.1056/NEJMoa2001017

guidelines
infection
professional
paramedic
prehospital

Challenges of SARS-CoV-2 and conflicting PPE guidelines

02 November 2020
Features
02 November 2020
Volume 12 · Issue 11

Abstract

During the coronavirus disease 2019 (COVID-19) pandemic, personal protective equipment (PPE) has become a contentious issue in healthcare settings, no more so than in the prehospital environment. The current severe acute respiratory syndrome 2 virus (SARS-CoV-2) has pathogenic and transmission similarities to previous coronaviruses, severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV). There are differences in global and domestic PPE guidelines concerning SARS-CoV-2.

On 11 February 2020, the International Committee on Taxonomy of Viruses (https://talk.ictvonline.org) named the current novel coronavirus as SARS-CoV-2 (World Health Organization (WHO), 2020a). The name was chosen owing to its genetic similarity to the virus SARS-CoV that was responsible for the SARS outbreak of 2003 (WHO, 2020a). While SARS-CoV-2 has similarities with SARS-CoV, the viruses are different (WHO, 2020a). On the same day, the WHO named COVID-19 as the disease caused by SARS-CoV-2 virus (WHO, 2020a).

At the beginning of the 21st century, two highly pathogenic and transmissible novel coronaviruses emerged: severe acute respiratory syndrome (SARS-CoV) and Middle Eastern respiratory syndrome (MERS-CoV), which probably originated from bats (Cui et al, 2019). Phylogenetic analysis shows that SARS-CoV-2 shares 50% of its genetic sequence identity with MERS-CoV and 79.5% with SARS-CoV (Zhu et al, 2020). Zhu et al (2020) suggest that there are similarities between SARS-CoV-2 and certain betacoronaviruses detected in bats—although a clear role of bats in the zoonotic origin of this novel virus has yet to be established (Zhang and Holmes, 2020).

Subscribe to get full access to the Journal of Paramedic Practice

Thank you for visiting the Journal of Paramedic Practice and reading our archive of expert clinical content. If you would like to read more from the only journal dedicated to those working in emergency care, you can start your subscription today for just £48.

What's included

  • CPD Focus

  • Develop your career

  • Stay informed

Register
Or continue by

Signing in with your registered email address

Pandemic
Aerosol-generating procedures
COVID-19
SARS-COV-2
Personal protective equipment (PPE)