The work of health care workers is not luxurious in the best of times. It is always risky and physically and mentally demanding. In a pandemic, it is outright dangerous. Our front liners during COVID-19 will suffer unimaginable physical and mental harm as they bravely respond to this health crisis. The casualties of COVID-19 will include not only those who get sick and die, but also those who watch them die and are unable to do anything about it because they do not have the appropriate personal protective equipment (PPE) to proceed. The casualties of insufficient PPE are on all of us – not on the health care worker who is sent to the trenches without a helmet.
“Personal protective equipment” – a term that usually conjures images of construction workers in steel toe boots and hard hats – is now the hottest commodity in the world. Everyone seeks it, buys it, makes it, makes videos about making it, comments on it, memes about it, and wants to wear it.
PPE in the context of COVID-19 refers to face protection (eye shield and mask), gown, and gloves that help keep a health care worker (HCW) safe when they treat an infected patient. It is important to use PPE correctly, and in conjunction with other measures like religious hand washing, otherwise, the risk of infection is very high. We use such PPE for other infections such as influenza. Like influenza, COVID-19 spreads by droplet when someone with it coughs or sneezes, and by contact with contaminated surfaces. In certain situations, the droplets with virus particles become much smaller and aerosolize, traveling farther than regular droplets would. This only happens with certain medical procedures. In those cases, a special mask that can filter out tiny particles is necessary. These masks, called N95 masks, can only be used with appropriate fitting and training.
PPE during a pandemic is not unlike personal protective equipment worn by soldiers at war. But the soldiers of a pandemic don’t carry fire guns. They have swabs and extensive medical knowledge and skill. Buildings and cars are not blown up. Instead, HCWs see each and every one of their patients every day, meet their families, and keep them comfortable when they die. When an army has insufficient personal protective equipment, they don’t go in the line of fire. What do health care workers do? Herein lies the dilemma of each and every health care professional amidst the COVID-19 pandemic. It is perhaps easy to think that if PPE is not available, than HCWs do not treat that patient. But what if that patient was you? In reality, that scenario is heart-wrenching.
What are our soldiers to do when they are faced with these difficult decisions? What do we expect of our health care force when we ignore public health experts and raid the stores so we can go for walks in N95s? If you would not take away a soldier’s protective vest, then why is it acceptable to buy N95s for your entire family when those who truly need them are lacking? Why is it ethical for stores to sell it? Why is it acceptable for non-medical organizations to hoard them when we are bleeding for them in hospitals? It is our collective obligation to support the preservation of PPE and to use it only when it is necessary, based on evidence, not anecdotes. It is also our obligation to see where N95s are used inappropriately, and demand that they be donated to hospitals. If the private sector and the public give in to panic and ignore the advice of established public health organizations, then they have murder on their hands.
Anca Matei is an obstetrics-gynecology physician.
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