Personal Protective Equipment Supply Chain: Lessons Learned from Recent Public Health Emergency Responses

An emerging source of plastic pollution: Environmental presence of plastic personal protective equipment (PPE) debris related to COVID-19 in a metropolitan city

The COVID-19 pandemic has resulted in an unprecedented surge of production, consumption, and disposal of personal protective equipment (PPE) including face masks, disposable gloves, and disinfectant wipes, which are often made of single use plastic. Widespread public use of these items has imposed pressure on municipalities to properly collect and dispose of potentially infectious PPE. There has been a lack of structured monitoring efforts to quantify the emerging trend of improperly disposed of PPE debris. In this study, we present a baseline monitoring survey to describe the spatial distribution of PPE debris during the COVID-19 pandemic from the metropolitan city of Toronto, Canada. Our objectives were to: (1) quantify PPE debris types among surveyed areas and; (2) identify PPE debris densities and accumulation of surveyed areas. A total of 1306 PPE debris items were documented, with the majority being disposable gloves (44%), followed by face masks (31%), and disinfecting wipes (25%). Of the face masks, 97% were designed for single use while only 3% were reusable. Of the surveyed locations, the highest daily average densities of PPE debris were recorded in the large and medium-sized grocery store parking lots and the hospital district (0.00475 items/m², 0.00160 items/m², and 0.00133 items/m² respectively). The two surveyed residential areas had the following highest PPE densities (0.00029 items/m² and 0.00027 items/m²), while the recreational trail had the lowest densities (0.00020 items/m²). Assuming a business-as-usual accumulation, an estimated 14,298 PPE items will be leaked as debris in just the surveyed areas annually. To facilitate proper disposal of PPE debris by the public we recommend development of municipal efforts to improve PPE collection methods that are informed by the described PPE waste pathways.

Respiratory Protection in a Time of Crisis: NIOSH Testing of International Respiratory Protective Devices for Emergency Use

National Institute for Occupational Safety and Health (NIOSH)-approved respirators are required by the Occupational Safety and Health Administration (OSHA) when personal respiratory protection is used in US occupational settings. During the COVID-19 pandemic, the demand for NIOSH-approved N95 filtering facepiece respirators overwhelmed the available supply. To supplement the national inventory of N95 respirators, contingency and crisis capacity strategies were implemented and incorporated a component that endorsed the use of non-NIOSH-approved respiratory protective devices that conformed to select international standards. The development and execution of this strategy required the collaborative effort of numerous agencies. The Food and Drug Administration temporarily authorized non-NIOSH-approved international respiratory protective devices through an emergency use authorization, OSHA relaxed their enforcement guidance concerning their use in US workplaces, and NIOSH initiated a supplemental performance assessment process to verify the quality of international devices. NIOSH testing revealed that many of the non-NIOSH-approved respiratory protective devices had filtration efficiencies below 95% and substantial inconsistencies in filtration performance. This article reports the results of the NIOSH testing to date and discusses how it has contributed to continuous improvement of the crisis strategy of temporarily permitting the use of non-NIOSH-approved respirators in US occupational settings during the COVID-19 pandemic.

Hospital-Wide SARS-CoV-2 seroprevalence in health care workers in a Spanish teaching hospital

INTRODUCTION

Hospital-wide SARS-CoV-2 seroprevalence is rarely explored and can identify areas of unexpected risk. We determined the seroprevalence against SARS-CoV-2 in all health care workers (HCW) at a hospital.

METHODS

Cross-sectional study (14-27/04/2020). We determined SARS-CoV-2 IgG by ELISA in all HCW including external workers of a teaching hospital in Madrid. They were classified by professional category, working area, and risk for SARS-CoV-2 exposure.

RESULTS

Among 2919 HCW, 2590 (88,7%) were evaluated. The mean age was 43.8 years (SD 11.1), and 73.9% were females. Globally, 818 (31.6%) workers were IgG positive with no differences for age, sex or previous diseases. Of these, 48.5% did not report previous symptoms. Seropositivity was more frequent in high- (33.1%) and medium- (33.8%) than in low-risk areas (25.8%, p=0.007), but not for hospitalization areas attending COVID-19 and non-COVID-19 patients (35.5 vs 38.3% p>0.05). HWC with a previous SARS-CoV2 PCR-positive test were IgG seropositive in 90.8%. By multivariate logistic regression analysis seropositivity was significantly associated with being physicians (OR 2.37, CI95% 1.61-3.49), nurses (OR 1.67, CI95% 1.14-2.46), nurse assistants (OR 1.84, CI95% 1.24-2.73), HCW working at COVID-19 hospitalization areas (OR 1.71, CI95% 1.22-2.40), non-COVID-19 hospitalization areas (OR 1.88, CI95% 1.30-2.73), and at the Emergency Room (OR 1.51, CI95% 1.01-2.27).

CONCLUSIONS

Seroprevalence uncovered a high rate of infection previously unnoticed among HCW. Patients not suspected of having COVID-19 as well as asymptomatic HCW may be a relevant source for nosocomial SARS-CoV-2 transmission.

National preparedness survey of pediatric intensive care units with simulation centers during the coronavirus pandemic

BACKGROUND

The coronavirus disease pandemic caught many pediatric hospitals unprepared and has forced pediatric healthcare systems to scramble as they examine and plan for the optimal allocation of medical resources for the highest priority patients. There is limited data describing pediatric intensive care unit (PICU) preparedness and their health worker protections.

AIM

To describe the current coronavirus disease 2019 (COVID-19) preparedness efforts among a set of PICUs within a simulation-based network nationwide.

METHODS

A cross-sectional multi-center national survey of PICU medical director(s) from children’s hospitals across the United States. The questionnaire was developed and reviewed by physicians with expertise in pediatric critical care, disaster readiness, human factors, and survey development. Thirty-five children’s hospitals were identified for recruitment through a long-established national research network. The questions focused on six themes: (1) PICU and medical director demographics; (2) Pediatric patient flow during the pandemic; (3) Changes to the staffing models related to the pandemic; (4) Use of personal protective equipment (PPE); (5) Changes in clinical practice and innovations; and (6) Current modalities of training including simulation.

RESULTS

We report on survey responses from 22 of 35 PICUs (63%). The majority of PICUs were located within children’s hospitals (87%). All PICUs cared for pediatric patients with COVID-19 at the time of the survey. The majority of PICUs (83.4%) witnessed decreases in non-COVID-19 patients, 43% had COVID-19 dedicated units, and 74.6% pivoted to accept adult COVID-19 patients. All PICUs implemented changes to their staffing models with the most common changes being changes in COVID-19 patient room assignment in 50% of surveyed PICUs and introducing remote patient monitoring in 36% of the PICU units. Ninety-five percent of PICUs conducted training for donning and doffing of enhanced PPE. Even 6 months into the pandemic, one-third of PICUs across the United States reported shortages in PPE. The most common training formats for PPE were hands-on training (73%) and video-based content (82%). The most common concerns related to COVID-19 practice were changes in clinical protocols and guidelines (50%). The majority of PICUs implemented significant changes in their airway management (82%) and cardiac arrest management protocols in COVID-19 patients (68%). Simulation-based training was the most commonly utilized training modality (82%), whereas team training (73%) and team dynamics (77%) were the most common training objectives.

CONCLUSIONS

A substantial proportion of surveyed PICUs reported on large changes in their preparedness and training efforts before and during the pandemic. PICUs implemented broad strategies including modifications to staffing, PPE usage, workflow, and clinical practice, while using simulation as the preferred training modality. Further research is needed to advance the level of preparedness, support staff assuredness, and support deep learning about which preparedness actions were effective and what lessons are needed to improve PICU care and staff protection for the next COVID-19 patient waves.

Contributing factors to personal protective equipment shortages during the COVID-19 pandemic

This study investigates the forces that contributed to severe shortages in personal protective equipment in the US during the COVID-19 crisis. Problems from a dysfunctional costing model in hospital operating systems were magnified by a very large demand shock triggered by acute need in healthcare and panicked marketplace behavior that depleted domestic PPE inventories. The lack of effective action on the part of the federal government to maintain and distribute domestic inventories, as well as severe disruptions to the PPE global supply chain, amplified the problem. Analysis of trade data shows that the US is the world's largest importer of face masks, eye protection, and medical gloves, making it highly vulnerable to disruptions in exports of medical supplies. We conclude that market prices are not appropriate mechanisms for rationing inputs to health because health is a public good. Removing the profit motive for purchasing PPE in hospital costing models, strengthening government capacity to maintain and distribute stockpiles, developing and enforcing regulations, and pursuing strategic industrial policy to reduce US dependence on imported PPE will help to better protect healthcare workers with adequate supplies of PPE.

Efficacy and safety of disinfectants for decontamination of N95 and SN95 filtering facepiece respirators: a systematic review

BACKGROUND

Decontaminating and reusing filtering facepiece respirators (FFRs) for healthcare workers is a potential solution to address inadequate FFR supply during a global pandemic.

AIM

The objective of this review was to synthesize existing data on the effectiveness and safety of using chemical disinfectants to decontaminate N95 FFRs.

METHODS

A systematic review was conducted on disinfectants to decontaminate N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined study eligibility and extracted predefined data fields. Original research reporting on N95 FFR function, decontamination, safety, or FFR fit following decontamination with a disinfectant was included.

FINDINGS AND CONCLUSION

A single cycle of vaporized hydrogen peroxide (H₂O₂) successfully removes viral pathogens without affecting airflow resistance or fit, and maintains an initial filter penetration of <5%, with little change in FFR appearance. Residual hydrogen peroxide levels following decontamination were within safe limits. More than one decontamination cycle of vaporized H₂O₂ may be possible but further information is required on how multiple cycles would affect FFR fit in a real-world setting before the upper limit can be established. Although immersion in liquid H₂O₂ does not appear to adversely affect FFR function, there is no available data on its ability to remove infectious pathogens from FFRs or its impact on FFR fit. Sodium hypochlorite, ethanol, isopropyl alcohol, and ethylene oxide are not recommended due to safety concerns or negative effects on FFR function.

Microwave- and heat-based decontamination of N95 filtering facepiece respirators: a systematic review

BACKGROUND

In pandemics such as COVID-19, shortages of personal protective equipment are common. One solution may be to decontaminate equipment such as facemasks for reuse.

AIM

To collect and synthesize existing information on decontamination of N95 filtering facepiece respirators (FFRs) using microwave and heat-based treatments, with special attention to impacts on mask function (aerosol penetration, airflow resistance), fit, and physical traits.

METHODS

A systematic review (PROSPERO CRD42020177036) of literature available from Medline, Embase, Global Health, and other sources was conducted. Records were screened independently by two reviewers, and data was extracted from studies that reported on effects of microwave- or heat-based decontamination on N95 FFR performance, fit, physical traits, and/or reductions in microbial load.

FINDINGS

Thirteen studies were included that used dry/moist microwave irradiation, heat, or autoclaving. All treatment types reduced pathogen load by a log₁₀ reduction factor of at least three when applied for sufficient duration (>30 s microwave, >60 min dry heat), with most studies assessing viral pathogens. Mask function (aerosol penetration <5% and airflow resistance <25 mmH₂O) was preserved after all treatments except autoclaving. Fit was maintained for most N95 models, though all treatment types caused observable physical damage to at least one model.

CONCLUSIONS

Microwave irradiation and heat may be safe and effective viral decontamination options for N95 FFR reuse during critical shortages. The evidence does not support autoclaving or high-heat (>90°C) approaches. Physical degradation may be an issue for certain mask models, and more real-world evidence on fit is needed.

3D-printed snorkel mask adapter for failed N95 fit tests and personal protective equipment shortages

Personal protective equipment (PPE) shortages persist amidst increasing COVID-19 caseloads. These shortages encouraged some to pursue 3D printing to produce stopgap N95 alternatives. The design presented is an adapter for a commercially available snorkel mask to serve as a full-face respirator, used in dire PPE shortages or in individuals who failed fit testing. Masks were fit tested at The University of Kansas Health System in Kansas City, KS. The mask was fit tested on 22 individuals who previously failed fit testing, and all passed qualitative fit testing with the snorkel mask, adapter and viral filter apparatus. The authors endorse this design as a stopgap measure, proven to be effective in situations of dire PPE shortage or for individuals who have failed fit testing with conventional PPE.

Availability, Use, and Satisfaction of Personal Protective Equipment Among Healthcare Workers: A Cross-Sectional Assessment of Low- and Middle-Income Countries

OBJECTIVE

To assess the discrepancy among and within low- and middle-income countries (LMICs) regarding PPE availability, use, and satisfaction.

METHODS

The study population consisted of healthcare workers from LMICs who partook in the questionnaire survey from March 1, 2020, until April 15, 2020.

RESULTS

In the bivariate analysis, gender (P = 0.05), HCWs (P < 0.01), and level of care (P < 0.01) were associated with the public or private sector (P < 0.05). Using multivariate analysis, PPE factors were associated with the health sector (p < 0.05). The multivariate logistic regression model determined a Pearson's χ value of 706.736 (df = 726, P = -0.689) and a c-statistic of 0.592, indicating a good model.

CONCLUSION

In LMICs, huge discrepancies are present in PPE provision to HCWs, especially among the public healthcare sectors. Efforts at national and international levels ought to be addressed to protect frontline HCWs at higher risk of contracting COVID-19.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

Social Media Survey and Web Posting Assessment of the COVID-19 Response in China: Health Worker Attitudes Toward Preparedness and Personal Protective Equipment Shortages

BACKGROUND

Understanding health worker awareness, attitudes, and self-confidence in the workplace can inform local and global responses toward emerging infectious threats, like the coronavirus disease 2019 (COVID-19) pandemic. Availability of accessible personal protective equipment (PPE) is vital to effective care and prevention.

METHODS

We conducted a cross-sectional survey from February 24 to 28, 2020, to assess COVID-19 preparedness among health workers. In addition, we assessed trends from search engine web crawling and text-mining data trending over the Sina Weibo platform from January 1 to March 3, 2020. Data were abstracted on Chinese outbreak preparedness.

RESULTS

In the survey, we engaged 6350 persons, of whom 1065 agreed to participate, and after an eligibility logic check, 1052 participated (16.6%). We accessed 412 internet posts as to PPE availability. Health workers who were satisfied with current preparedness to address COVID-19 were more likely to be female, to obtain knowledge about the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak from government organizations, and to consider their hospital prepared for outbreak management. Health workers with more confidence in their abilities to respond were those with more faith in their institution's response capacities. Elements of readiness included having airborne infection isolation rooms, visitor control procedures, and training in precautions and PPE use. Both survey and web post assessments suggested that health workers in need were unable to reliably obtain PPE.

CONCLUSIONS

Health workers' self-confidence depends on perceived institutional readiness. Failure to maintain available PPE inventory for emerging infectious diseases preparedness suggests a failure to learn key lessons from the 2003-2004 SARS outbreak in China.

Decontamination interventions for the reuse of surgical mask personal protective equipment: a systematic review

BACKGROUND

The high demand for personal protective equipment during the novel coronavirus outbreak has prompted the need to develop strategies to conserve supply. Little is known regarding decontamination interventions to allow for surgical mask reuse.

AIM

To identify and synthesize data from original research evaluating interventions to decontaminate surgical masks for the purpose of reuse.

METHODS

MEDLINE, Embase, CENTRAL, Global Health, the WHO COVID-19 database, Google Scholar, DisasterLit, preprint servers, and prominent journals from inception to April 8^th, 2020, were searched for prospective original research on decontamination interventions for surgical masks. Citation screening was conducted independently in duplicate. Study characteristics, interventions, and outcomes were extracted from included studies by two independent reviewers. Outcomes of interest included impact of decontamination interventions on surgical mask performance and germicidal effects.

FINDINGS

Seven studies met eligibility criteria: one evaluated the effects of heat and chemical interventions applied after mask use on mask performance, and six evaluated interventions applied prior to mask use to enhance antimicrobial properties and/or mask performance. Mask performance and germicidal effects were evaluated with heterogeneous test conditions. Safety outcomes were infrequently evaluated. Mask performance was best preserved with dry heat decontamination. Good germicidal effects were observed in salt-, N-halamine-, and nanoparticle-coated masks.

CONCLUSION

There is limited evidence on the safety or efficacy of surgical mask decontamination. Given the heterogeneous methods used in studies to date, we are unable to draw conclusions on the most efficacious and safe intervention for decontaminating surgical masks.

A Qualitative Study of Barriers to Personal Protective Equipment Use among Laundry Workers in Government Hospitals, Hawassa, Ethiopia

Background

The need to reduce the transmission of infectious diseases makes the use of personal protective equipment and safety medical devices compulsory among hospital laundry staff. The practice, however, remains to be low among hospital laundry staff members. Globally, not many studies seem to have been carried out to sufficiently tell us about the barriers to personal protective equipment use among hospital laundry workers. Related studies in Ethiopia are even fewer. This study assessed the barriers to personal protective equipment use among laundry staff of government hospitals in Hawassa City, Southern Ethiopia, 2019.

Methods

Two qualitative data-gathering methods—focus group discussions and key informant interviews—were used to collect data for this study. Eight focus group discussions were conducted with hospital laundry workers. Similarly, six key informant interviews were held with Infection Prevention and Patient Safety Officers. Thematic analysis was performed using Open Code 4.02.

Result

Organizational- and individual-level barriers such as unavailability of essential personal protective equipment, a disharmonious work environment, low perception of susceptibility, and belief about personal protective equipment interference with work performance were identified as the major barriers to personal protective equipment use in the present study.

Conclusion

Organizational- and individual-level barriers have been identified as causes for the low level of personal protective equipment use among hospital laundry workers. Therefore, improving institutional supplies in quantity and quality may have a positive implication for the improvement of infection prevention practices in the study area. Also, designing sustainable strategies and raising laundry workers' awareness of a safe work environment may lead to the improvement of infection prevention practices.

Decontaminating N95 and SN95 masks with ultraviolet germicidal irradiation does not impair mask efficacy and safety

Inadequate supply of filtering facepiece respirators (FFRs) for healthcare workers during a pandemic such as the novel coronavirus outbreak (SARS-CoV-2) is a serious public health issue. The aim of this study was to synthesize existing data on the effectiveness of ultraviolet germicidal irradiation (UVGI) for N95 FFR decontamination. A systematic review (PROSPERO CRD42020176156) was conducted on UVGI in N95 FFRs using Embase, Medline, Global Health, Google Scholar, WHO feed, and MedRxiv. Two reviewers independently determined eligibility and extracted predefined variables. Original research reporting on function, decontamination, or mask fit following UVGI were included. Thirteen studies were identified, comprising 54 UVGI intervention arms and 58 N95 models. FFRs consistently maintained certification standards following UVGI. Aerosol penetration averaged 1.19% (0.70-2.48%) and 1.14% (0.57-2.63%) for control and UVGI arms, respectively. Airflow resistance for the control arms averaged 9.79 mm H₂O (7.97-11.70 mm H₂O) vs 9.85 mm H₂O (8.33-11.44 mm H₂O) for UVGI arms. UVGI protocols employing a cumulative dose >20,000 J/m² resulted in a 2-log reduction in viral load. A >3-log reduction was observed in seven UVGI arms using >40,000 J/m². Impact of UVGI on fit was evaluated in two studies (16,200; 32,400 J/m²) and no evidence of compromise was found. Our findings suggest that further work in this area (or translation to a clinical setting) should use a cumulative UV-C dose of 40,000 J/m² or greater, and confirm appropriate mask fit following decontamination.

Respiratory protection for health care workers: A 2020 COVID-19 perspective

As the US health care system began to respond to the coronavirus disease‐2019 pandemic, demand for respiratory personal protective equipment (PPE) increased precipitously, as did the number of users. This commentary discusses ensuing deviations from accepted respiratory PPE program practices, which potentially increased risk to health care workers. Such lapses included omitting user training and fit testing, provision of unapproved devices, and application of devices in settings and ways for which they were not intended. The temporary compromise of professionally accepted standards due to exigencies must not become the new normal. Rather, the current attention to PPE should be leveraged to enhance practice, motivate vital research, and strengthen professional, governmental, and institutional capabilities to control health care worker exposures to infectious hazards.

Obstetricians on the Coronavirus Disease 2019 (COVID-19) Front Lines and the Confusing World of Personal Protective Equipment

As health care systems struggle to maintain adequate supplies of personal protective equipment, there is confusion and anxiety among obstetricians and others about how to best protect themselves, their coworkers, and their patients. Although use of personal protective equipment is a critical strategy to protect health care personnel from coronavirus disease 2019 (COVID-19), other strategies also need to be implemented on labor and delivery units to reduce the risk of health care-associated transmission, including screening of all pregnant women who present for care (case identification), placing a mask on and rapidly isolating ill pregnant women, and minimizing the number of personnel who enter the room of an ill patient (physical distancing). Although the mechanism of transmission of COVID-19 is not known with certainty, current evidence suggests that COVID-19 is transmitted primarily through respiratory droplets. Therefore, strict adherence to hand hygiene and consistent use of recommended personal protective equipment are cornerstones for reducing transmission. In addition, it is critical that health care professionals receive training on and practice correct donning (putting on) and doffing (removing) of personal protective equipment and avoid touching their faces as well as their facial protection to minimize self-contamination.

Trends and applications of resilience analytics in supply chain modeling: systematic literature review in the context of the COVID-19 pandemic

The increasingly global context in which businesses operate supports innovation, but also increases uncertainty around supply chain disruptions. The COVID-19 pandemic clearly shows the lack of resilience in supply chains and the impact that disruptions may have on a global network scale as individual supply chain connections and nodes fail. This cascading failure underscores the need for the network analysis and advanced resilience analytics we find lacking in the existing supply chain literature. This paper reviews supply chain resilience literature that focuses on resilience modeling and quantification and connects the supply chain to other networks, including transportation and command and control. We observe a fast increase in the number of relevant papers (only 47 relevant papers were published in 2007–2016, while 94 were found in 2017–2019). We observe that specific disruption scenarios are used to develop and test supply chain resilience models, while uncertainty associated with threats including consideration of “unknown unknowns” remains rare. Publications that utilize more advanced models often focus just on supply chain networks and exclude associated system components such as transportation and command and control (C2) networks, which creates a gap in the research that needs to be bridged. The common goal of supply chain modeling is to optimize efficiency and reduce costs, but trade-offs of efficiency and leanness with flexibility and resilience may not be fully addressed. We conclude that a comprehensive approach to network resilience quantification encompassing the supply chain in the context of other social and physical networks is needed to address the emerging challenges in the field. The connection to systemic threats, such as disease pandemics, is specifically discussed.

Training and Fit Testing of Health Care Personnel for Reusable Elastomeric Half-Mask Respirators Compared With Disposable N95 Respirators

This study examines the feasibility of rapidly training and fit testing health care workers to use elastomeric half-mask respirators (EHMRs), widely used in construction and manufacturing, as an alternative to N95 respirators during periods of shortage.

Germicidal Ultraviolet Light Does Not Damage or Impede Performance of N95 Masks Upon Multiple Uses

The COVID-19 pandemic is increasing the need for personal protective equipment (PPE) worldwide, including the demand for facial masks used by healthcare workers. Disinfecting and reusing these masks may offer benefits in the short term to meet urgent demand. Germicidal ultraviolet light provides a nonchemical, easily deployable technology capable of achieving inactivation of H1N1 virus on masks. Working with N95-rated masks and nonrated surgical masks, we demonstrated that neither 254 nor 265 nm UV-C irradiation at 1 and 10 J/cm2 had adverse effects on the masks' ability to remove aerosolized virus-sized particles. Additional testing showed no change in polymer structure, morphology, or surface hydrophobicity for multiple layers in the masks and no change in pressure drop or tensile strength of the mask materials. Results were similar when applying 254 nm low-pressure UV lamps and 265 nm light-emitting diodes. On the basis of the input from healthcare workers and our findings, a treatment system and operational manual were prepared to enable treatment and reuse of N95 facial masks. Knowledge gained during this study can inform techno-economic analyses for treating and reusing masks or lifecycle assessments of options to reduce the enormous waste production of single-use PPE used in the healthcare system, especially during pandemics.

Trends and applications of resilience analytics in supply chain modeling: systematic literature review in the context of the COVID-19 pandemic

The increasingly global context in which businesses operate supports innovation, but also increases uncertainty around supply chain disruptions. The COVID-19 pandemic clearly shows the lack of resilience in supply chains and the impact that disruptions may have on a global network scale as individual supply chain connections and nodes fail. This cascading failure underscores the need for the network analysis and advanced resilience analytics we find lacking in the existing supply chain literature. This paper reviews supply chain resilience literature that focuses on resilience modeling and quantification and connects the supply chain to other networks, including transportation and command and control. We observe a fast increase in the number of relevant papers (only 47 relevant papers were published in 2007-2016, while 94 were found in 2017-2019). We observe that specific disruption scenarios are used to develop and test supply chain resilience models, while uncertainty associated with threats including consideration of "unknown unknowns" remains rare. Publications that utilize more advanced models often focus just on supply chain networks and exclude associated system components such as transportation and command and control (C2) networks, which creates a gap in the research that needs to be bridged. The common goal of supply chain modeling is to optimize efficiency and reduce costs, but trade-offs of efficiency and leanness with flexibility and resilience may not be fully addressed. We conclude that a comprehensive approach to network resilience quantification encompassing the supply chain in the context of other social and physical networks is needed to address the emerging challenges in the field. The connection to systemic threats, such as disease pandemics, is specifically discussed.

Low-tech solutions for the COVID-19 supply chain crisis

A global effort is ongoing in the scientific community and in the maker movement, which focuses on creating devices and tinkering with them, to reverse-engineer commercial medical equipment and get it to healthcare workers. For these 'low-tech' solutions to have a real impact, it is important for them to coalesce around approved designs.