key: cord-0803031-po31w52s
authors: Morgan, Elizabeth A.; Rodriguez, Diana
title: Why “good enough” isn’t good enough: scientific data, not supply chain deficiencies should be driving CDC recommendations.
date: 2020-06-25
journal: Am J Obstet Gynecol MFM
DOI: 10.1016/j.ajogmf.2020.100165
sha: 4bb57a490180e3cc96a85ef96eec3762a2a7e8a7
doc_id: 803031
cord_uid: po31w52s

Abstract: Obstetricians and clinicians previously requested clarification from the Centers for Disease Control and Prevention (CDC) on the need for full personal protective equipment including N95 respirators during the second stage of labor. The CDC responded with new guidance excluding the second stage of labor from its list of aerosol generating procedures (AGPs), based on research from which experience on labor and delivery units was notably absent. Additional literature that explores other modes of aerosol generation, such as coughing, vomiting, passing flatus and loud vocalization, all of which are prevalent during the labor course, was notably omitted. It is clear that the CDC based their guidance not from the application of scientific principles but pragmatism due to the lack of equipment, and our colleagues were urged to follow suit. If we replace recommendations based on scientific principles with recommendations based on supply chain deficiencies, we become complacent with that which is “good enough under the circumstances.” This is a dangerous precedent on which to base our Professional Society guidelines. We should continue to address these inadequate responses even as CDC guidelines evolve and the pandemic winds down. We will certainly face similar conflict again, whether during a fall resurgence of the current pandemic or future infectious disease outbreak.

Title: Why "good enough" isn't good enough: scientific data, not supply chain 1 deficiencies, should be driving CDC recommendations. It is clear that the CDC based their guidance not from the application of scientific 22 principles but pragmatism due to the lack of equipment, and our colleagues were urged 23 to follow suit. If we replace recommendations based on scientific principles with 24 recommendations based on supply chain deficiencies, we become complacent with that 25 which is "good enough under the circumstances." This is a dangerous precedent on 26 which to base our Professional Society guidelines. We should continue to address these 27 inadequate responses even as CDC guidelines evolve and the pandemic winds down. 28 We will certainly face similar conflict again, whether during a fall resurgence of the 29 current pandemic or future infectious disease outbreak. CoV epidemic, many of these conditions remain unclear. [1] 45 Past research indicates that transmission not only depends on mode (e.g. droplet vs. 46 airborne) but also on the duration of time spent in close proximity to an infected person. 47 The U.S. Department of Labor Occupational Safety and Health Administration (OSHA) 48 recognize this, and recommend N95 use for all those who, "work within 6 feet of 49 patients known to be, or suspected of being, infected with SARS-CoV-2." [2] This has led 50 many obstetricians and their parent organizations to question their occupational 51 infection risk on labor and delivery. indicated for labor and delivery." [3] Though the CDC's guidance is continuously 65 changing, and ACOG is continuing to review this recommendation with the government, 66 the underlying motivation for the guidance regrettably remains the same. Pragmatism 67 due to lack of equipment, rather than recommendations based on scientific data, 68 continue to guide our pandemic response. their members that may be misconstrued as evidence-based best practices for "optimal" 94 staff protection when in fact, the protections are most likely "inadequate" based on the 95 available data regarding the increased risks of spread from comparable behaviors that 96 occur during labor and delivery. 97 

Transmission of Emerging Viruses via Aerosol-Generating Medical 119

Guideline by the Department of Labor and 121 Department of Health and Human Services

Clinical Questions about COVID-19: Questions and Answers. Section on Obstetrical-Care. cdc

Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A 126 Systematic Review

Aerosol emission and 128 superemission during human speech increase with voice loudness

If we replace recommendations based on science with recommendations based on 99 supply chain, we become complacent with that which is "good enough under the 100 circumstances", a concept known as satisficing. Satisficing under these circumstances 101 is dangerous because it hampers our response.