Personal fears and frustrations on PPE for hospital healthcare workers – a doctor’s spouse speaks out
Concern is mounting among ASMS members and other health professionals about the adequacy of the current guidelines on personal protective equipment as the Covid-19 crisis develops. Their families are also worried. This heartfelt piece was sent in by the partner of one of our members.
Today, Sunday 29 March 2020, the prime minister announced at the government’s by now familiar and riveting daily 1pm national briefing, that sadly, New Zealand had recorded its first death from the novel coronavirus COVID-19; a woman in her 70s with underlying health issues being treated in a public hospital for influenza.
The director-general of health, at the same briefing, informed us that hospital staff did not suspect she was infected with the virus; apparently she was known to them as a person with a history of respiratory illness. Yes, they had used some PPE (Personal Protection Equipment), but they had not worn protective eye wear. Result: personal anguish for a family, the communal marking of a milestone in New Zealand’s struggle with this new pathogen, and 21 healthcare workers stood down for 14 days’ isolation. Reporters and the nation were reassured that there were plenty of other staff to take their places.
Today the director-general also reported that New Zealand has 63 new cases of COVID-19, making 514 in total, most traced directly or indirectly to international travel. Such a link in today’s reported fatality, and in increasing numbers of cases, has not yet been established. The good news is that as of today 56 people have recovered. We must wait for answers about levels of community transmission and the infection status of the 21 healthcare workers.
Today I read Dr Scott M Kelly’s account of his experience of COVID-19. Kelly is a doctor at a Mississippi hospital where 75% of ordinary beds and all 26 ICU beds are occupied by virus patients. Much of the medical jargon went over my head. What I understood, however, was:
1) most infected people develop flu-like symptoms such as fever, headache, dry cough, myalgia, nausea, abdominal discomfort, loss of smell, anorexia, and fatigue. About five days later some develop shortness of breath and bilateral viral pneumonia. Those really unlucky will then develop ‘cytokine storm’, acute respiratory distress syndrome, and multiorgan failure – ‘worldwide 86% of COVID-19 patients that go on vent [sic] die’.
2) some infected people are asymptomatic. This virus can hide in plain sight. It makes surprise appearances on the chest x-rays of people admitted with dislocated shoulders; in the CT scans of those suffering multiple trauma.
Dr Kelly says ‘essentially if they are in my ER, they have it’. And (as in the case above, perhaps) it overwhelms patients also diagnosed with influenza – ‘Somehow this ***** [sic] has told all other disease processes to get out of town’.
For lack of hospital beds, each shift Kelly sends a dozen patients with multifocal pneumonia home with oxygen and minimal support. He doesn’t expect them all to survive. His 31 year-old colleague has the virus and an oxygen saturation of 92% – ‘She will be the first [colleague] of many’. He describes some of the protective measures he takes: a high-spec mask, undressing in his garage, an immediate shower, and isolation; his wife has ‘fled’ with their children.
Today I emailed three medical supply companies to beg for masks. I told them my spouse is a doctor in their 50s working without PPE in close contact with hospital patients of unknown COVID-19 status. I did not tell them that, like Kelly, they leave their clothes outside the house and shower immediately on entering. That they have their own bedroom and bathroom, are banned from the kitchen, and deprived of all physical contact with their family. I did explain their lack of protection at work. Their hospital says it is following Ministry of Health PPE guidelines for those caring for people not suspected to be infected with the virus. These guidelines place my spouse in the lowest priority category for PPE, along with many other doctors and nurses, pharmacists, phlebotomists, and vaccinators. They, and the daily government briefings, make no allowance for the risks associated with hospital healthcare workers caring for asymptomatic, sub-clinical, or clinically obscured COVID-19 cases. This seems to go directly against government directives made to the general population to maintain a two-metre distance from all those outside their isolation ‘bubble’; to be suspicious of everyone, even themselves – ‘Act like you have the virus’.
Instead, the hospital tells their staff in my spouse’s ‘low risk’ group that they are not to wear a mask when caring for apparently noninfectious patients, not even one from their personal supply, if they have one. The hospital explains: ‘inappropriate’ use of masks creates a false sense of security, and, conversely, it frightens patients.
Today I told the medical supply companies that I am frightened for my spouse’s life. They may be considered replaceable at work – at least in the short term – but they are irreplaceable to me.