In conclusion, whilst EV is predominantly spread by contact with blood and body fluids, there is some uncertainty about the potential for aerosol transmission. There is RCT evidence for respirators (but not masks) providing protection against non-aerosolised infections, (MacIntyre et al., 2013) and an abundance of evidence that transmission of pathogens in the clinical setting is rarely unimodal. Where uncertainty exists, the precautionary principle (that action to reduce risk should not await scientific certainty) should be invoked and guidelines should be consistent and err on the side of caution. Moreover, a clear description of risk should be provided to HCWs (Jackson et al., 2014). Given the predominant mode of transmission, every HCW death from Ebola is a potentially preventable death. It is highly concerning that a recent commentary suggests HCWs do not need a mask at all ‘‘to speak with conscious patients, as long as a distance of 1–2 metres is maintained’’(Martin-Moreno et al., 2014). This fails to consider the changeability and unpredictabili-ty of the clinical environment and disregards the rights of the HCW. It is also unrealistic to believe a HCW can constantly keep track of their distance from a patient in the hectic acute care setting. We accept that cost, supply and logistics may, in some settings, preclude the use of respirators, but guidelines should outline best practice in the ideal setting, with discussion about contingency plans should the ideal recommendation be unfeasible. Importantly, in the absence of sufficient evidence, recom-mendations should be conservative and estimation of risk considered. Recommendations should be developed using a risk analysis framework, with the occupational health and safety of HCWs being the primary consideration.