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Infographic. Cooling strategies to attenuate PPE-induced heat strain during the COVID-19 pandemic
  1. Coen CWG Bongers1,2,
  2. Johannus Q de Korte1,
  3. Milene Catoire3,
  4. Job Greefhorst3,
  5. Maria T E Hopman1,
  6. Boris Kingma3,4,
  7. Thijs M H Eijsvogels1
  1. 1 Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
  2. 2 Faculty of Health Sciences, Thermal Ergonomics Laboratory, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 The Netherlands Organization for Applied Sciences, Unit Defence, Safety and Security, TNO, Soesterberg, The Netherlands
  4. 4 Department of Nutrition, Exercise and Sports, Section for Integrative Physiology, University of Copenhagen, Copenhagen, Denmark
  1. Correspondence to Dr Coen CWG Bongers, Department of Physiology, Radboud University Medical Center, Nijmegen, The Netherlands; coen.bongers{at}

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COVID-19 healthcare personnel (HCP) use personal protective equipment (PPE; ie, isolation gowns, eye protection, facemasks and respirators) to safely perform their medical duties. However, PPE creates a microenvironment around the skin due to a higher thermal resistance and lower water vapour permeability of the materials being used compared with the normal clothing ensemble of HCP.1 Consequently, heat loss capacity via the skin surface is greatly reduced. The metabolic energy expenditure from regular working activities could, therefore, not be completely lost to the surrounding environment, leading to heat strain, thermal discomfort, excessive sweating, faster dehydration and an increased cardiovascular strain. To accommodate heat loss, blood redistribution from central organs and skeletal muscle to the skin occurs, which will further exacerbate the physiological strain, ultimately leading to shorter work tolerance times and a reduced physical …

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  • Twitter @BongersCoen, @YannickdeKorte, @BorisKingma, @ThijsEijsvogels

  • Correction notice This article has been corrected since it published Online First. The funding and twitter statements have been corrected.

  • Contributors CCWGB and TE designed the study. CCWGB, JQdK, JG and MC created the infographic. CCWGB, MTEH and BK drafted the manuscript, while JQdK, JG, MC and TE critically revised the manuscript. All authors gave their final approval of the version published.

  • Funding This infographic was funded by the VIMP impulse of ZonMW (5460010031) and the Innovation impuls “Brains4Corona” grant “MedicalHeatStress”.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.