PPE is a generic name for the protective covers professionals use to do their job, healthcare workers included. Welders use gloves and welding masks. Electricians use protection goggles, rubber boots and fall protection harnesses. Construction workers use helmets. Adult movie stars use condoms. For all, using PPE is mandatory, otherwise safety officers will throw them off the job.
Healthcare workers have their own specific PPE. Gloves and gowns, sometimes sterile, prevent contact transmitted diseases, like scabies and C. Diff. Diarrhea. N95 respirators are unique masks preventing the spread of airborne germs like TB. Surgical masks prevent droplet-transmitted diseases like the flu.
What’s the difference between droplets and airborne? Droplets are heavy and fall to the ground, though a sneeze can project them up to sixteen feet. In church, that’s about four rows away. Airborne germs are smaller, lighter, and they can float in the air for hours. If your neighbor sneezed in the elevator before breakfast, you can still catch it after dinner. Surgical masks will prevent you from projecting droplets, but not from breathing airborne germs. Your surgical mask will mostly protect others.
A few weeks ago safety officers all over the US guarded Code Rooms, denying access to those lacking appropriate PPE and healthcare workers were getting fired for providing patient care without adequate equipment. Patient safety was paramount.
The worst pandemic of a century slammed the earth like a freight train striking a wagon of hay, and PPE became a luxury. Instead of changing PPE not only after each patient, but even between encounters with the same patient, healthcare workers were told to reuse equipment for multiple patient encounters.
By “healthcare workers” I mean everybody in contact with patients and their stuff: Nurses, doctors, EMTs, CNAs, RTs, Radiology techs, environmental workers, etc.
All of a sudden, it’s OK to use the same PPE for this possible COVID patient to that one with Norwegian scabies, then the other one with CD diarrhea, before holding grandma’s hand.
Surgical masks don’t do much for COVID. As per this study in The Annals of IM: “both surgical and cotton masks seem to be ineffective in preventing the dissemination of SARS–CoV-2 from the coughs of patients with COVID-19 to the environment and external mask surface.”
Let’s talk scarfs. Some bright political minds opined that they’re better than PPE, since they’re thicker. Not really. You should go for a good quality pillow case, or a coffee filter instead.
Driven away by the scarcity of PPE, concerns about patient safety vanished. It’s OK, required even, for masks to hold for a whole week. That’s a lot of patients, even on slow days, and these days aren’t slow. It’s OK to wash your hands with your gloves on and reuse them, patient after patient. For pelvic and rectal exams too, I wonder?
To put things into perspective, just imagine what would happen if condoms became scarce. What would porn stars do? Wash condoms between encounters to reuse them for a week? Staple them if they fell apart? Craft home-made condoms out of utility gloves and glue, and tie them around their waist so they won’t come off? Duct tape maybe, since that can fix anything?
People got creative. The ingenious crafted masks out of old sheets and lined them with toilet paper, since that’s the one thing we have plenty of. Grandmas knitted masks; grandkids glued them for craft. These days, home-made masks are hotter than home-made bread. Scientists got on the band-wagon too. There’s how you can make a mask out of a vacuum cleaner bag. Or masks from elastomers respirators.
Hospitals didn’t like it. How professional would your hospital look if the surgeons sport home-made masks with Sponge Bob and Dora? They banned them.
“No asymptomatic HW should wear a mask to see an asymptomatic patient.” As in, unless you’re coughing and sneezing like you got hit with chlorine gas, you shouldn’t wear a mask, even if you brought it from home.
Healthcare workers got angry. They know that sending them to care for patients without appropriate PPE is like asking adult stars to perform without condoms. Worse, really, since HIV takes many years to kill you. COVID will kill you in days. They complained and shared their concerns through social media.
Hospitals fired the whistleblowers.
Healthcare workers got sick. Some died.
In New Jersey, Dr. Frank Gabrin, 60, was the first Emergency doc to die from COVID. So did Kious Kelly, a 48-year-old nurse in NY, Israel Tolentino, a 33-year-old EMT in NJ and Chris Firlit, a 37-year-old PGY6 Maxillo-Facial surgery resident in Detroit, who died three months before his graduation, leaving behind a wife and three kids.
They’re just the tip of the iceberg. A disproportionate number of COVID victims are healthcare workers, since they’re sitting ducks. They are stressed, overworked and they can’t socially distance. They see nothing but sick people every shift.
They live in fear of getting sick. Even worse, they are worried of infecting their families. Many quarantine themselves from their loved ones, adding to their burden of suffering and loneliness. Some can’t, since they are single parents or caretakers.
Infected HW infect patients. To those coming for reassurance, a sprained ankle, or a med refill: If your nurse has been wearing the same mask for a week, you may be safer staying home.
If that wasn’t bad enough, the same people who work with inadequate PPE and are supposed to make it last, got accused of stealing it. How else can you explain this exponential increase in PPE use?
By the same logic, NY morgues are overfilled because of people bringing bodies from home.
For some, the penury of PPE is an opportunity. They hoard it to sell it to the highest bidder, setting states against each other and the Federal government. Others manufacture fake N95 respirators and sell them to the public. The buyers think they are protected, but they aren’t. They get sick and infect others.
What do healthcare workers say?
“Why are we expected to just accommodate to what’s available? Because “we knew what we were getting into being a healthcare worker”? Bullshit. The best two things EMS taught me are BSI and Scene Safety. If they are aren’t both in place…peace out. I’m always the priority.”
“In a broken health care system, the lack of PPE in this situation magnifies two things for me. 1: the corporate greed is now coming to fruition, and 2: that greed has been successful on the backs of caring professionals that are now being sacrificial lambs. Millions are being spent, but the money is not going to medicine. It goes to those managing it.”
“Why aren’t we deciding the PPE we need versus administrators with no medical background?”
“As a healthcare worker, you are a force multiplier. Your training and experience are invaluable in this crisis. You have to put your needs first. I’m speaking about PPE and your safety. If you become infected, not only are you out of the game, but your replacements could be people without your expertise. When short-staffed, your co-workers are more likely to make mistakes and become ill. You stop being a force multiplier and start using resources. You may save that one patient, but you can’t save any patients as you lay in the hospital using a vent yourself. People are going to die. Do not become one of them. There is no emergency in a pandemic. During the Ebola outbreak, people were dying. But at no point did we rush in. We took the 10 minutes to put on our PPE with our spotter. If we didn’t have proper PPE, we did NOT go in. There is no emergency in a pandemic.”
Your doctors, your nurses, and all the other healthcare folks work hard to keep you alive. They forgo their sleep, their food, their safety and their families to serve you.
Some die for you.
What do they want you to do?
- Stay home.
- Wash your hands.
- Don’t buy N95s. They’re either fake, and they won’t protect you, or real, and they belong in the hospitals.
- Don’t use the PPEs that they need more.
- Don’t go to the ER unless you must.
- Listen to the experts.
I’ll end with one exhausted doctor’s words:
“Hold your cheering. I don’t need it. Just think long and hard before you vote.”
Rada Jones is an ER doc in Upstate NY. She lives with her husband and his deaf black cat Paxil. She authored three ER thrillers, Overdose, Mercy and Poison, and “Stay Away From My ER,” a collection of medical essays.
I tremendously enjoy reading your blogs.These are tough times but this too shall pass. You are doing a great job,but take care of yourself as well.
Best Wishes. Please keep on writing
Just a small request. Abbreviations in your specialty are obvious to people in your specialty. Sometimes they are relatively unfamiliar to doctors in other specialties. Please spell out the abbreviations the first time you use them, then have at it with the alphabet soup from then on. Thanks.
Nice information !!
Actually, most poem actors do not use condoms (at least heterosexual ones. ) Instead they rely on robust testing to make sure they are limiting exposure to STD’s.
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