Dorothy R. Novick is a pediatrician in Philadelphia.
If we needed to reenter a room for any reason, back on went the garb. If we accidentally touched the front of our masks while gingerly peeling the strings away from our ears, back to the sink we went. It was nonnegotiable. We understood that these measures were not only for our own protection but also for the protection of our patients: If we missed one step, we could distribute microbes far and wide across the hospital.
This is why, as a pediatrician, my blood ran cold when I was instructed to conserve personal protective equipment in the fight against covid-19. Masks and other supplies are severely limited. Rather than following deeply ingrained safety standards, health-care providers across the country are switching to what the Centers for Disease Control and Prevention calls “strategies that are not commensurate with U.S. standards of care.”
These strategies include wearing face masks only when caring for patients with known exposures — even though we understand that anyone could have this disease, and that undiagnosed covid-19 infections are rampant and may be responsible for the majority of contagion. They include reusing face masks while moving from room to room — even though covid-19 is spread by droplets that can land and remain on surfaces.
And “as a last resort,” they include creating masks from homemade materials and wearing scarves and bandanas from home — even though studies show that cloth masks do not offer sufficient protection against similar respiratory infections.
The shortage of protective equipment is not only a crisis for health-care providers on the front lines. It is also a potential disaster for patients. If we become infected and have no symptoms, we can unknowingly spread this disease. And if we test positive or fall ill, we leave the workforce at precisely the time we are needed most of all.
It does not have to be this way. We know how to keep ourselves and our patients safe. We have been training for this our whole lives.
When an illness is challenging to detect, we limit its spread by assuming that every patient could be infectious. This is what we mean by universal precautions. For covid-19, universal precautions would entail, quite simply: using a clean surgical mask for each patient visit; adding gowns and gloves for patients with respiratory symptoms; and using a less permeable N95 mask for high-risk procedures such as nebulizer treatments. It would entail following these precautions for every patient, regardless of known exposure or risk.
Practicing universal precautions would protect health-care providers, as well as our patients, from covid-19. But doing this requires a steady supply of personal protective equipment (PPE).
We need manufacturers to step up production of face masks, N95 masks, gowns and gloves. We need every organization that uses these supplies to donate them to local hospitals immediately. We need healthy individuals to stop hoarding. And we need our government to mobilize. Yes, the Defense Department is promising to release millions of masks. This is excellent news and a move in the right direction. But the Defense Department announcement came last week, and our supply continues to dwindle. Any PPE the government still controls must filter down to frontline providers, and it must filter down now.
Three days ago, Esther Choo, an emergency room physician, started a campaign on Twitter. The idea was for medical providers to tweet stories of the gear they are being forced to ration, with the hashtag #GetMePPE. The results are heartbreaking:
NYC. Mother of two, double frontline MD couple. Don’t make us orphan our two toddlers. Running out of masks, eye protection and gloves at work. @VP @NYGovCuomo #GetMePPE @choo_ek pic.twitter.com/siI9TegNOL
— Cornelia Griggs (@CorneliaLG) March 18, 2020
#GetMePPE @SenStabenow @RepDebDingell @SenGaryPeters
— Vidya Kumar Ramanathan, MD (@RamanathanVidya) March 17, 2020
Reusing the same mask all day, so I had covid all over my neck (we clean the shield & reuse - it's the only one I get). We're running out of sanitizer wipes for our shields, so people saying we may need to go to soap/water. pic.twitter.com/mmUY6kEM9v
Or, as @AmySilvermaRN tweeted: “PPE under lock and key. This is all our nurses get to protect themselves. These are single use surgical masks. We’re wearing them for days or weeks. We can’t save your life if we can’t protect our own. #GetMePPE.”
There is a crisis of monumental proportions on the front line of this battle. There is a fire smoldering, about to burst open and take over this country, and we are the firefighters, running straight toward it in street clothes. Without personal protective equipment, we will get this virus, we will give it to others, and we will be unavailable to care for the people who need us most of all — our patients.
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