Healthcare workers who have normal daily interactions with medically compromised or sick elders in skilled nursing and hospital settings should be prioritized to receive N95 masks over providers who deliver aerosol-generating procedures or work in intensive care units, some experts are now saying.

New evidence suggests that providers who perform intubations — singled out to receive N95s first during the pandemic when equipment is scarce — do not have the greatest risk of contracting COVID-19, according to a new report by Kaiser Health News. Instead, it appears that front-line workers are at the highest risk of exposure due to more time spent with disease-spreading patients early in their illness while using “sub-par protective gear,” the news outlet reported. 

A recent study by Harvard and Tulane scientists, for example, found that the profile of a COVID-19 super-spreader, “the 20% of people who emit 80% of the tiny particles,” overlaps with the profile of eldercare facility residents and hospital patients. This underscores the risky situation of nursing home workers during the pandemic, according to KHN, and investigators contend that the most effective protection should be directed to these providers.

“When highly infectious, such patients emit three times more tiny aerosol particles (about a billion a day) than younger people. A sick super-spreader who is simply breathing can pose as much or more risk to health workers as a coughing patient,” study author David Edwards, of Harvard, told the news outlet.

Aerosol-generating procedures, meanwhile, may not actually spread that many droplets, according to new studies conducted by UK anesthesiologists. They found that intubation emits about 20 times fewer aerosols than a cough, and extubation emits the same amount as a cough — probably because patients cough when the tube is removed, they said.

“The whole thing is upside down the way it is currently framed,” Michael Klompas, M.D., a Harvard Medical School associate professor, told KHN.

The full story is available here.