Why “good enough” is not good enough: scientific data, not supply chain deficiencies, should be driving Centers for Disease Control and Prevention recommendations

Obstetricians and clinicians previously requested clarification from the Centers for Disease Control and Prevention on the need for full personal protective equipment including N95 respirators during the second stage of labor. The Centers for Disease Control and Prevention responded with new guidance excluding the second stage of labor from its list of aerosol-generating procedures 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 Centers for Disease Control and Prevention based their guidance not from the application of scientific principles but from pragmatism owing 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 Centers for Disease Control and Prevention guidelines evolve and the pandemic winds down. We will certainly face similar conflict again, whether during a fall resurgence of the current pandemic or a future infectious disease outbreak.