Physiologists evaluated many heat stress mitigation measures to improve athlete and military performance in challenging ambient conditions. Cooling interventions are known to improve exercise performance, decrease heat stress and enhance post-exercise recovery. Translating these concepts and solutions to medical science may attenuate heat stress and improve occupational performance for COVID-19 HCP. Similar knowledge transfer has previously been applied to minimise heat stress and extend work tolerance times in other occupational workers wearing protective clothing. Indeed, a previous study demonstrated that that cooling devices worn under PPE can decrease the physiological and subjective strain in a simulated hot and humid laboratory environment. Cooling for HCP can be applied prior to (precooling), during (percooling) and after (postcooling) working activities with PPE, but it is important to note that there is less evidence for the benefits of postcooling compared with precooling and percooling. Precooling and postcooling strategies can be applied at home, during work breaks or on arrival at the hospital, while percooling strategies should be worn underneath PPE during the work shift. Ideally, a combination of precooling, percooling and postcooling strategies would be used to accumulate the beneficial effects of cooling on work tolerance time and physiological strain.
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