COVID-19 Resources by Topic

The COVID-19 pandemic is a major health crisis straining the healthcare system and affecting us all. The IARS is committed to supporting our members who are addressing this illness on the front lines in any way we can.

IARS has assembled a content base with the latest peer-reviewed articles on COVID-19 from leading medical journals, sorted by topic and chronologically. In the COVID-19 Resource Newsletter healthcare professionals on the frontlines are given access to global peer experiences and education from publications hand-selected and reviewed by the IARS COVID-19 Scientific Advisory Board. All of these articles are openly available without login.

Click on a phrase below to see resources on that topic. To search by keyword, select Ctrl + F on a PC and Command + F on a Mac. Then, enter keyword and Enter.

VI. Equipment and Potential Modification

November 8, 2021

  • Elastomeric Respirators for COVID-19 and the Next Respiratory Virus Pandemic: Essential Design Elements. 10/19/21. Bowdle TA. Anesthesiology.
    Although healthcare workers have relied primarily on disposable filtering facepiece respirators (such as N95) during the COVID-19 pandemic, reusable elastomeric respirators (typically used for industrial purposes) have potential advantages for the COVID-19 and future respiratory virus pandemics. These advantages include improved fit, better inspiratory filtration and less waste. However, currently available elastomeric respirators were not designed primarily for healthcare or pandemic use and require further development to improve their suitability for this application. This article explores the advantages of elastomeric respirators, and the adaptations needed (such as eliminating the expiratory valve) to make them useful for healthcare providers. Table 1 (Respiratory Protection Terminology) and good photos provide an excellent background for understanding respirators.

December 16, 2020

  • Decontamination and Reuse of N95 Filtering Facepiece Respirators: Where Do We Stand? 12/15/20. Cassorla L. Anesth Analg.
    Interest in decontamination methods for N95 respirators increased during the COVID-19 pandemic along with shortages and altered practices in health care facilities. This is a well-referenced review of available science. Best-supported methods are based upon time, heat, microwave-generated steam, hydrogen peroxide, or UV-C (ultraviolet germicidal irradiation, UVGI). Many require special equipment and most require procedures to prevent cross-contamination and return each respirator to its original user due to the potential for residual organisms other than SARS-CoV-2. Tables include reference websites, a summary of methods, and current FDA emergency use authorizations.

October 7, 2020

September 25, 2020

July 15, 2020

June 29, 2020

  • Ventilator Sharing During an Acute Shortage Caused by the COVID-19 Pandemic. June 9. Beitler JR. Am J Respir Crit Care Med.
    Detailed report discussing a 2 patient on one ventilator sharing strategy, with results and lessons learned from 3 pairs of patients with COVID-19 ARDS at NY-Presbyterian/Columbia University Irving Medical Center who shared ventilators for 2 days without adverse events.
    • Pre-specified criteria shown in Table 1 were used to identify compatible patient pairs.
    • Minimizing between-patient driving pressure differences was prioritized.
    • Deep sedation and neuromuscular blockade were maintained.
    • Ventilators were set to pressure-control.
    • After determining average identical ventilator settings while on separate machines, patients were transitioned to a shared ventilator with the same settings.
    • An unused rescue ventilator was available.
    • Single patient ventilators are needed for weaning and individualized support.
    • ICU ventilators are superior to anesthesia machines for sharing.
    • Multiple antimicrobial filters and matching by pathogen decreases risk of sharing infection.
    • Frequent changing of CO2 absorbent and heat moisture exchange filters was needed.

    Since the safety and utility of sharing > 48 hours is not known, the authors suggest that ventilator sharing is most reasonable as a stopgap to allow relocating of ventilators or patients to meet demand.

June 15, 2020

  • Ventilator Sharing During an Acute Shortage Caused by the COVID-19 Pandemic. June 9. Beitler JR. Am J Respir Crit Care Med.
    Detailed report discussing a 2 patient on one ventilator sharing strategy, with results and lessons learned from 3 pairs of patients with COVID-19 ARDS at NY-Presbyterian/Columbia University Irving Medical Center who shared ventilators for 2 days without adverse events.
    • Pre-specified criteria shown in Table 1 were used to identify compatible patient pairs.
    • Minimizing between-patient driving pressure differences was prioritized.
    • Deep sedation and neuromuscular blockade were maintained.
    • Ventilators were set to pressure-control.
    • After determining average identical ventilator settings while on separate machines, patients were transitioned to a shared ventilator with the same settings.
    • An unused rescue ventilator was available.
    • Single patient ventilators are needed for weaning and individualized support.
    • ICU ventilators are superior to anesthesia machines for sharing.
    • Multiple antimicrobial filters and matching by pathogen decreases risk of sharing infection.
    • Frequent changing of CO2 absorbent and heat moisture exchange filters was needed.

    Since the safety and utility of sharing > 48 hours is not known, the authors suggest that ventilator sharing is most reasonable as a stopgap to allow relocating of ventilators or patients to meet demand.

June 9, 2020

  • Effectiveness of N95 Respirator Decontamination and Reuse against SARS-CoV-2 Virus
    June 3. Fischer RJ. Emerging Infectious Diseases.
    Opinion from SAB Member: Dr. Lydia Cassorla
    Using SARS-CoV-2, this study sponsored by the US government builds on the knowledge needed to evaluate the efficacy of decontamination methods that are being used around the world to extend the life of N95 masks due to shortages of new masks. N95 fabric discs and some whole masks were studied following treatments with ethanol, vaporized hydrogen peroxide (VHP), UV-C irradiation (UVGI), and dry heat. Data was modeled and extrapolated to calculate expected 3-log (threshold considered decontamination) and 6-log (threshold considered sterilization) reductions in viral load. For 3-log reduction, dry heat at 70°C took 46.3 min and UVGI took a dose of 2J/cm2, delivered to one side only. SARS-CoV-2 virus was undetectable after the initial treatment time for VHP, so no modeling was done. Mask fit and filtration performance was tested on 6 whole N95 masks per method for 3 cycles using a quantitative fit test that results in a fit score. Mask fit and filter function (tested in 6 masks/method after wearing for 2 hours) was good following 3 cycles of VHP and UVGI, but began to decline following the 3rd cycle of heat (note: their conditions were drier than some recommend). While ethanol sterilized well, it caused mask function failure and is not recommended. Control data with no treatment showed a median viral half-life of 78.5 min at 21-23°C with 40% relative humidity and a calculated 3-log reduction in 13 hrs. Despite limitations, this work adds important data regarding SARS-CoV-2 viability on N95 fabric along with measures of N95 fit and function under control and after test conditions. VHP provided the best combination of effectiveness and speed with good retention of fit and filtration function for 3 cycles (all that was tested) but requires proprietary equipment (note, some companies providing VHP equipment have received Emergency Use Authorizations from the FDA during the pandemic). UVGI and heat require care to take the time required to achieve the desired reduction in viral load and ensure procedures are followed to prevent cross-contamination, as they are not necessarily sterilizing techniques. Readers will also find data regarding stainless steel surfaces (not discussed in this summary). The CDC continues to provide some guidance regarding this issue on its website, where the publication is currently posted in pre-print form.

May 27, 2020

May 13, 2020

May 7, 2020

  • Can N95 Respirators Be Reused after Disinfection? How Many Times?
    May 5. Liao. ACS Nano.
    Opinion from SAB Member: Dr. Lydia Cassorla
    Due to shortages of PPE, individuals and groups are seeking effective methods to decontaminate N95 masks designed for single use. While this report in the basic science literature from the Stanford-4C Air group does not include confirmatory testing of SARS-CoV-2 decontamination, it adds to current information about the effects of decontamination methods on the fabric of N95 masks. Based on their work, heat in a range of 70-85 degrees C in a static air oven for 30 min with varying degrees of relative humidity does not degrade the structure and function of the filter layer of masks up to 50 cycles. These are temperatures that have been shown in referenced work to be effective in inactivating SARS-CoV-2. The authors suggest that this is a potentially safe and relatively simple technique to decontaminate N95 masks for re-use by the same individual during the current pandemic. UVGI was a secondary option, with adequate retention of function for up to 10 cycles. Their work mostly involved fabric samples, using only a few whole masks due to shortages, and highlights the importance of ongoing fit evaluation, especially after 5 rounds of donning and doffing.

May 2, 2020

  • Institution of a Novel Process for N95 Respirator Disinfection with Vaporized Hydrogen Peroxide in the setting of the COVID-19 Pandemic at a Large Academic Medical Center. May 1. Grossman. J Am Coll Surg.
    A multi-disciplinary team from Washington University School of Medicine, Barnes Jewish Hospital, and BJC Healthcare created a vaporized hydrogen peroxide (VHP) disinfection facility within their institution and developed a logistical framework to provide just-in-time large volume disinfection of N95 masks, returning each mask to its original wearer. In-house experience with the technique was leveraged, using Bioquell VHP and aeration equipment. They built a designated facility with separate areas for receiving used masks, disinfection, and off-gassing. Their first facility processes up to 1500 masks per cycle. Subsequent facilities were created in affiliated medical centers, scaled to local needs. Organizational and operational details are well described, including control processes to verify both sterilization and off gassing. Each user bags and labels his or her own mask, and masks from each work unit remain grouped throughout the process to facilitate timely return of batches to each work site for individuals to retrieve.

April 28, 2020

April 25, 2020

April 21, 2020

  • Category: Infection Control: An Interim Solution to the Decreased Availability of Respirators against COVID-19
    Apr 15. Saggese. Anesthesia & Analgesia.
    Opinion from SAB Member: Dr. Barry Perlman
    In NYC, N95 respirator shortages have led healthcare workers to use substandard or unapproved options. Letter from NYC oral/maxillofacial surgeons in response to “Utility of Substandard Face Mask Options for Health Care Workers During the COVID-19 Pandemic” http://dx.doi.org/10.1213/ANE.0000000000004841 describes a do-it-yourself reusable respirator made from an anesthesia mask, inline ventilator or HEPA filter, and elastic straps. This has minimal leakage around the edge and N100 filtration efficiency. It can be washed with soap and water or disinfectant. For non-aerosol generating procedures, they suggest eye protection and a Level 3 surgical mask with a “surgical mask brace” using rubber bands or tourniquets to create a better seal.

April 13, 2020

April 8, 2020

April 5, 2020

  • A Framework for Rationing Ventilators and Critical Care Beds During the COVID-19 Pandemic. Mar 27. White. JAMA.
    COVID-19 SAB Opinion from: Dr. Philip Lumb
    This is an excellent discussion regarding scarce resource management in constrained circumstances. Unrestricted ventilator management has equated with successful weaning and/or terminal event; when constrained, choice of assignment requires triage. The discussion focuses on essential requirement for multidisciplinary preplanning and triage committee creation. The attached supplement from University of Pittsburgh serves as an informative and well-reasoned approach and protocol. There is a good discussion regarding setting patient and family expectations and the possibility of ventilator “reassignment” in triage situations.

April 2, 2020

April 1, 2020

March 30, 2020

March 28, 2020

March 27, 2020

March 26, 2020

March 24, 2020

AAMSE Award
Disclaimer
The material on this website is provided for informational purposes and does not constitute medical advice. New knowledge is added daily and may change over time. Opinions expressed should not be construed as representing IARS policy or recommendations. References and links to third parties do not constitute an endorsement or warranty by IARS.

Thank you IARS COVID-19 Scientific Advisory Board and Content Reviewers!

The IARS would like to recognize the COVID-19 Scientific Advisory Board and the Content Reviewers for sharing their expertise and time to help curate and evaluate the most relevant information coming out about COVID-19 for our members. The COVID-19 SAB meet regularly to discuss articles, provide reviews and determine what information would be most valuable to those on the frontline. The Content Reviewers review a list of articles daily to determine their topic areas and relevance to the audience. We greatly appreciate the commitment they have made to help during this major health crisis!

Encourage, stimulate, and fund ongoing anesthesia-related research projects that will enhance and advance the specialty, and to disseminate current, state-of-the-art, basic and clinical research data in all areas of clinical anesthesia, including perioperative medicine, critical care, and pain management. The IARS is focused solely on the advancement and support of education and scientific research related to anesthesiology..

International Anesthesia Research Society
90 New Montgomery Street, Suite 412
San Francisco, CA 94105