Why do Chinese health-care workers wear a full set of personal protective equipment?

CIKD | Updated: 2020-04-02 14:25

It is important to note that the information provided in this Series is intended for your general knowledge only and is not a substitute for professional medical advice or treatment.

Medical staff check on patients as they exercise together in the "Wuhan Livingroom" makeshift hospital in Wuhan, Central China's Hubei province, on Feb 15, 2020. [Photo by Zhu Xingxin/China Daily]

After Wuhan lockdown, what we could see on the television is that Chinese health-care workers wore full body personal protective equipment (PPE). The equipment includes N95 masks, gloves, goggles and hazmat-like suits. Even though COVID-19 has been declared pandemic now, an expert published an article in the New Yorker saying that Chinese health-care workers are over-protected, and suggested that they only need to wear surgical masks, gloves and gowns following Singaporean and Hong Kong practices. Then why have Chinese health-care workers been armed to the teeth?

Because of inadequate protection, health-care workers were infected in the early stage of the outbreak in Wuhan. Over the early stage, more than 1,100 health-care workers in Wuhan had been infected with COVID-19. Most of them did not wear the standard infectious disease PPE. Moreover, a member of the Expert Group of the National Health Commission of China, was infected with COVID-19 after investigating the heavily infected areas in Wuhan. This was probably due to his close contact with patients in the fever clinic without goggles. On the contrary, a respiratory team of a provincial hospital in Wuhan equipped N95 protective masks and protective suits for their staffs from the early stage of the epidemic. None of the team members were infected.

Because of the "full armor", none of the tens of thousands of medical workers assisting Hubei had been infected. On January 20, the State Council of China authorized the National Health Commission (NHC) to classify the COVID-19 as a Category B infectious disease but to administer it as a Category A infectious disease. On January 22, NHC issued the Technical Guidelines for the Prevention and Control of Novel Coronavirus Infection in Medical Institutions (First Edition). The Guideline requires health-care service providers and health-care workers to improve personal protection. It suggests the medical professionals to implement the required hand hygiene practices, take strict protective isolation measures against droplet, contact and airborne infections, and wear proper protective equipment such as goggles, medical surgical masks, medical protective masks, protective gowns, and hazmat-like suits. As of March 8, none of the 42,000 medical staff who assisted Hubei had been infected.

The extra cautious protection, or the principle of additional protection, was a result of the perception of uncertainty and higher risks associated with COVID-19. This principle also applies to other workers who are at a similar level of risks. Additional protection is the stronger protection on top of the standard protection. Whether to put on extra protection is based on the evaluation of the actual risks medical workers may be exposed to at work. Generally, the PPE of health-care workers are surgical masks, gowns and so on. However, when the risk of infection exposure is increased, all relevant workers not limited to medical staff, such as cleaners of medical wastes, should wear a full set of personal protective equipment. The circumstances include:

• possibility of contact with blood, body fluids or virus specimens of patients with infectious diseases,

• need to enter infected areas or transfer infectious patients.

When the risk of infection is particularly severe, such as operating on patients with Category A infectious disease, new and recurrent infectious diseases and unknown infectious diseases, more stringent protection would be taken, such as wearing positive pressure respiratory protective hood.

In short, the configuration of PPE for Chinese health workers is based on the experience and lessons of practice. It is a more deliberate, reliable and safer protection strategy.

Author: Dong Dandan

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