Outpatient clinic
The use of PPE for COVID-positive or suspected patients in the outpatient setting may be dictated by the nature of the patient interaction. As previously noted, the CDC advises airborne-level precautions (i.e. N95 or higher-level respirator, eye protection, gloves, and gown), and consideration of negative-pressure room, when performing aerosol-generating procedures.7 Some in vitro evidence has been interpreted to suggest that flexible nasal endoscopy, for example, while not intrinsically an AGP, may lead to aerosol generation via coughing or sneezing.31 As previously mentioned, however, the WHO classifies coughing and sneezing as droplet-generating, not aerosolizing, events. However, nasal endoscopy with suctioning would be classified as an AGP by the CDC, warranting airborne-level precautions.22 Standard head and neck physical examinations of putative or positive COVID-19 patients require droplet-level precautions, ensuring appropriate eye protection, given the need for close inspection of the nasal and/or oral cavities and potential proximity to droplet transmission with expectoration. (Table 1)