IOWA CITY — Three University of Iowa epidemiology and infectious disease experts are urging widespread use of face shields in the community as a strategy to “safely and significantly reduce transmission” of the novel coronavirus as the state and nation begin to reopen.
“Now is the time for adoption of this practical intervention,” according to a recently published opinion piece in the Journal of the American Medical Association from UI College of Medicine professors Eli N. Perencevich, Daniel J. Diekema and Michael B. Edmond.
The JAMA piece acknowledges calls to reopen businesses and return Americans to work — given immense economic and social consequences of COVID-19-related shutdowns — but also notes the country can’t rely on tests for a safe reopening because “necessary testing capacity may not be available for weeks to months.”
Likewise, according to the UI experts, the nation’s ability to track, trace and quarantine is unclear — making personal protective equipment key in any reopening strategy. And, given findings on how the novel coronavirus spreads, face masks and shields appear paramount pieces of equipment.
“Could a simple and affordable face shield, if universally adopted, provide enough added protection when added to testing, contact tracing and hand hygiene to reduce transmissibility below a critical threshold?” the piece asks in highlighting the face shield’s potential to serve as a bridge between today’s resources and “longer lasting measures, such as vaccines.”
Iowa is among states eyeing a reopening of sorts, with Gov. Kim Reynolds easing restrictions on dozens of counties — even as she daily announces hundreds more confirmed COVID-19 cases and as deaths near the 300 mark.
Experience and evidence suggest — the UI experts said — that properly equipped health care workers rarely acquire infections while caring for patients, even during this pandemic. Rather, most infected health care workers contract an illness in their respective communities, where protective equipment often isn’t worn.
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“This implies that simple and easy-to-use barriers to respiratory droplets, along with hand hygiene and avoidance of touching the face, could help prevent community transmission when physical distancing and stay-at-home measures are relaxed or no longer possible,” according to the UI professors.
Many health care providers nationally and locally have started requiring employees to wear shields instead of or in addition to masks — including the UI Hospitals and Clinics, which has strict and extensive guidelines around mandatory face shields and is providing them to workers.
Face shields in the broader community setting may be a better option than masks, according to the UI piece in JAMA, because medical-grade masks are in short supply and homemade cloth masks have proved less effective, although testing shows “cloth masks provide some filtration.”
Additionally, face shields don’t require special materials and can be mass produced with the help of repurposed production lines, according to the article, which noted companies like Apple, GM and John Deere have started churning out the shields.
“These shields can be made from materials found in craft or office supply stores,” according to the article. “Thus, availability of face shields is currently greater than that of medical masks.”
Other face shield advantages, according to the experts, include:
• Durability, in that they can be “reused indefinitely” and easily cleaned.
• Comfort, reducing the chance the wearer will touch his or her face.
• Broad protection, in that they block portals of viral entry.
• Clarity, as people wearing masks often have to remove them to communicate.
“The use of a face shield is also a reminder to maintain social distancing but allows visibility of facial expressions and lip movements for speech perception,” according to the article. “Most important, face shields appear to significantly reduce the amount of inhalation exposure to influenza virus, another droplet spread respiratory virus.”
Although the UI professors noted policy recommendations should include evaluation of clinical research, they noted little chance any randomized trial on face shields could wrap in time to meet the urgent national need.
Although no clinical trial has assessed the efficacy of widespread testing and contract tracing, many have adopted or promoted that approach “based on years of experience,” the professors argue.
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“The COVID-19 pandemic arrived swiftly and found many countries unprepared,” according to the article. “To minimize the medical and economic consequences, it is important to rapidly assess and adopt a containment intervention bundle that drives transmissibility to manageable levels.”
And, they argue, face shields should be included in that bundle.
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