Growing evidence suggests that the novel COVID-19 virus can be aerosolized. To adequately protect employees, providers require not just “droplet,” but “airborne” precautions and the appropriate healthcare worker personal protective equipment (PPE).
Appropriate PPE mandates an N95 mask. News reports for weeks have described hospitals working without the necessary protection for health care providers.
This is the case in Boston-area hospitals, which are running short on these masks. One of the city’s largest hospitals will have exhausted its supplies of N95 masks by the end of this week if shipments don’t arrive as promised.
Despite this, non-urgent and non-emergent surgeries and procedures are still being done in the operating rooms at one of the main Harvard teaching hospitals. These include procedures known to cause aerosolization of the virus and require that everyone present wear an N95 mask.
Counting the surgeons, anesthesiologists, nurses, and scrub techs, an average of 5 masks are consumed per surgery. Surgical protocol requires that every health care provider in the surgery wear an N95 mask. In one area teaching hospital, at least ten truly elective surgeries were performed on March 30. These surgeries occurred despite the guidance from Centers for Medicare and Medicaid Services (CMS) published nearly two weeks ago outlining how and why “elective” or non-essential procedures needed to be canceled: to protect healthcare providers and patients and to preserve our ever-dwindling supply of PPE.
Thus, while five N95 masks per procedure are being used in the ORs for non-emergent procedures, staff in the dedicated coronavirus Intensive Care Units are being asked to wear standard surgical masks or to reuse a single N95 mask for days. No one would consider this acceptable for a member of their family.
Businesses and people in the Boston area have offered to donate N95 masks for front-line health workers fighting the coronavirus. These masks routinely are used by construction workers, house painters, mechanics, and other non-medical professionals.
Physicians and other health care workers have been instructed that they are not permitted to use N95 masks donated by the community because these donated masks will not have been vetted by the hospital.
As the pandemic advances, we hardly complain when asked to work 28-hour shifts. It’s what we do. In the time of this global pandemic, when healthcare workers around the globe are contracting this new coronavirus, all we ask is that hospitals consider the safety of employees rather than giving priority to the bottom line. Elective surgical procedures are big revenue sources for hospitals.
As a doctor, I ask our CEOs and presidents who are directing these efforts as they shelter in place from the safety of their own homes to reconsider their decisions to continue non-emergent surgeries and deny the use of donated masks, when the alternative they provide is nearing no mask at all.
My partner and I are both physicians at major Boston hospitals. We see this first hand. We are seeing the continuation of elective surgeries that siphon off necessary PPE supplies for those of us fighting the coronavirus. We need N95 masks.
The author is an anonymous physician.
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