Workers and the general public need separate frameworks for respiratory protection: report

Washington — The National Academies of Sciences, Engineering and Medicine is calling for two separate respiratory protection frameworks – one for workers, and one for the public – amid the COVID-19 pandemic and beyond, in a recently published report.

“Although workers are members of the general population when they go home from their jobs, there are many members of the public that are not workers – children, elderly adults with chronic diseases who have specific needs – and may require advice from [the National Academies] on respiratory protection that might be different from other members of the public,” Mary Rice, report co-author and pulmonary disease specialist at Boston’s Beth Israel Deaconess Medical Center, said during a Feb. 10 webinar.

Jon Samet, dean of the University of Colorado School of Public Health and chair of the National Academies committee that authored the report, noted that respiratory protection programs outlined in OSHA’s standard on respiratory protection (1910.134) cover only select workers. This issue, Samet said, is exacerbated by a variety of exposure scenarios and diversity in individual demographics, vulnerabilities and susceptibilities.

The National Academies offers multiple recommendations to meet worker respiratory protection needs, including that OSHA coordinate the facilitation of that framework. Other recommendations:

• Ensure OSHA respiratory protection requirements apply to all workers by urging Congress to revise the Occupational Safety and Health Act of 1970 to address gaps in agency coverage and asking OSHA to revise statutory interpretations regarding definitions of employers and employees.
• Ensure state legislatures enact legislation and regulations requiring employers to protect workers not currently under OSHA jurisdiction from inhalation hazards.
• Establish comprehensive workplace exposure standards that serve to trigger respiratory protection program requirements. “We recommend that deadlines be set so that these efforts are not stalled,” Samet said, “and clearly there’ll be the need for expanding the technical system’s capacity and development of comprehensive guidelines.”
• Expand NIOSH’s National Personal Protective Technology Laboratory and use consensus standards and third-party testing to improve timeliness of respirator approvals and surge capacity.
• Prepare to meet expanded worker respiratory protection needs.
• Support the development of targeted and tailored guidance and training for workers.

Additionally, experts recommend Congress establish a coordinating entity within the Department of Health and Human Services to oversee the framework for respiratory protection for the public. This entity would work with federal stakeholders, including the Centers for Disease Control and Prevention and the Environmental Protection Agency, to create standardized scientific review and evaluation protocol to identify inhalation hazards that warrant public use of respiratory protection devices.

Further, the entity would collaborate with the White House and various agencies to ensure availability of and access to respiratory protective devices. The National Academies also recommends that CDC lead the development of “culturally appropriate guidance and training” covering use of respiratory protection devices by the public.

“We have this long history of respiratory protection in industry and, [notably] in my field, construction,” said Bruce Lippy, president of consulting firm The Lippy Group LLC. “But the public is really at a loss for understanding such things as N95s, quite often, without some kind of training. And quite often, the instructions that come with these devices are not necessarily understandable. So there’s a lot of room we can improve upon, so I think the committee recognized that.”

Samet said he and his colleagues acknowledge the frameworks for workers and the public “should not be siloed” and that they’re “pursuing many common functions.” The report includes several recommendations covering collaboration and cooperation between coordinating entities.

Stephanie Holm, assistant clinical professor at the University of California, San Francisco and co-director of the Western States Pediatric Environmental Health Specialty Unit, expressed optimism that the report recommendations will foster ongoing feedback intended to continually identify and address research gaps.

“So that this isn’t a static, one-time, ‘Here’s the gap and here’s the problem,’ but rather, ‘Here’s how we figure out what the gaps are now, make them better and continue to refine that going forward,’” Holm said.