EXPERT REVEALS TRUTH ABOUT MASKS: Why Healthcare Workers Are Catching COVID-19
Hey guys. I’m Dr Ishtiaq. Today we’ll be tackling an issue that’s very important these days. And that’s healthcare providers who have contracted COVID-19. Out of all the patients 10-15% of them are healthcare workers. So are we just not protecting ourselves properly? We’re gonna tackle this question head on and I have invited My esteemed colleague
Dr. Mujeeb Ullah Makki (B.Sc, MBBS, MBA, MPH, MRCP (UK), MRCP (Ireland)
There are many factors that go into why health care providers are catching COVID-19. One of the most important ones is how much virus the person is exposed to. So your body has natural defense mechanisms. And if you’re exposed to a small amount of virus, you have a better chance of fighting off that infection. Let’s see what Dr. Mujeeb Ullah Makki had to say about this.
“In general, especially younger, healthier health care workers, shouldn’t be getting sick at these levels. But they are around people that are very sick, are literally in so many cases coughing in their face. And they are getting repeated inoculants. So I might get a high inoculant from person A, a medium from person B, another high one from person C. By the end of the day I have had maybe 10 inoculants. So that night I’m dealing with something that is far different than the casual grocery store visitor, who might have wiped an apple and caught a little bit of virus off that apple because 2 days ago someone coughed on it. It’s a totally different ball of wax. And so the amount of virus that I’m getting as a health care worker is therefore gonna put me at much higher risk. So clearly we need to reduce the exposure, the number of exposures that health care providers have to the virus. And that’s where PPE comes on board: Personal Protective Equipment. That’s everything from gloves, goggles, masks, gowns. It’s what keeps us safe.
There has been a lot of discussion about Personal Protective Equipment in the media and the big questions are: What kind of masks should we be wearing? And what do we do with these shortages that we’re seeing. It’s so heartbreaking to see health care providers that aren’t properly equipped. Especially seeing nurses in Pakistan (Different Hospital) wearing garbage bags. So if you have health care workers out there because their hospital said: ‘Go out there and use this one mask for the week or for the month”, and that’s all they have. They are wearing it. Maybe there is a leak; maybe that thing is starting to break down. Maybe it’s soiled; it’s not even working right. And yet they’re forced to wear it day in day out. It’s not like they are just getting these high inoculants, they are getting them on top of not having right, adequate protection. There has been a debate about whether we need surgical masks or N95 masks. And this all comes down to whether we think the Coronavirus is transmitted by droplet or aerosolized procedure.
Let me explain! The difference between droplets and aerosols is just about the size. So droplets are bigger and then they fall faster out of the air. Whereas aerosols are small and they can stay suspended in the air. So surgical masks were originally designed to prevent surgeons from contaminating patients and reducing wound infections. But now we’re using the surgical mask to protect ourselves. And that’s something that we actually haven’t studied that much. But overall we know that it stops bigger particles. On the other hand N95s are designed to stop 95% of particles in the air. And that includes the small particles. Science tells us that infections can easily be put into boxes, like droplets or aerosols. It’s probably somewhere in between, a combination of both. We know from some studies that Coronavirus is found in the air around sick people.
So what we don’t know is: Will those viruses found in the air… Are they able to infect people? We don’t know if they are still viable and that’s why we need more research. This explains why health authorities like the the World Health Organization have created a list of medical procedures that are most likely to create those tiny particles. And we’re using N95 masks in those scenarios, because they’re such a scarce resource. For me, I mean right now, often what’s being seen in the hospital is you wear a surgical mask and unless there is an aerosolizing procedure, then you put on an N95. I can’t help but wonder sometimes when I’m walking into a room if a patient has just coughed or sneezed. It could have been seconds before. And if you walk in, how is that not an aerosolized procedure?! Or do you think that is aerosolized in coughing and sneezing? Yeah of course, obviously. I mean… Put it this way. It doesn’t make any sense to think: ‘Oh an N95 is necessary for intubation.’ But if someone is coughing and sneezing one minute before you enter. Maybe you don’t even know that! In fact they have been coughing and sneezing for the last hour. And before they were in that room, 10 other patients were in that room coughing and sneezing. You can walk in there and think a surgical mask if sufficient. It’s absolutely not. It’s a joke. And so I think we absolutely need N95 masks at all times for health care professionals that are working with COVID-19 patients. Their lives are at risk and it’s just an absolute tragedy that we don’t have that as a mandate.
What a great discussion. I mean… The reality is: We face these types of decisions every single day. Not just during a pandemic. And definitely not just in health care. I wish that every single person in this world had the opportunity to go to university, but that’s not the case. I wish that we all had a personal trainer and a chef, so that we could make a difference in the rates of obesity. But we know those resources aren’t there. So every day we are making decisions based on limited resources. And I’m hoping that out of this pandemic we can start thinking about resources and which ones we never ever want to compromise on.
Another way the virus is probably spreading is through asymptomatic carriers. So people who have the virus, but who have no symptoms and have no idea. I mean, it could be me. I wouldn’t know. You can actually spread it asymptomatically. In fact, one of the things that have become very evident with COVID-19 is that you can spread it through conversation. You don’t need to cough on someone; you can just talk to someone. And that goes through your airways and gets out into the space. We also know that if you touch your nose and your mouth and if it’s there, now I touch stuff, that I’m getting it on objects. You know I’m not coughing; I’m actually getting it there with my hands. This is likely why many hospitals are moving towards universal masking, so everyone is wearing a surgical mask. In the hospital where I work, when you get there in the morning you’re given a little paper bag. And there are 2 surgical masks inside it that you can use for your shift. There are some cool studies that have been done about surgical masks and Coronavirus. They took patients who were sick with Coronavirus and they just had them sit there and breathe. They weren’t coughing, they weren’t talking. And it turned out that they were spreading droplets and aerosols around them. They took the same patients, put on a surgical mask and those patients did not spread the virus. But again, they weren’t coughing. Another study looked at patients wearing surgical masks, but they were coughing. And it turns out that the virus was escaping the mask and still getting into the air. So this is why it’s really important to still do physical distancing, even though people are wearing masks. Physical distancing. Okay, we know that it’s working. We’re seeing that the curve is flattening in many parts of the world. But it’s really hard to do in the hospital. I want to say like even in hospitals it’s hard to have social distancing. I don’t know if you have had the same experience. But you know, you’re at a nursing station and you’ve got to reach for things. It’s almost impossible. You try to wait your turn, but you’ll never get anything done. And people have to talk to each other, consult each other. It’s been a real challenge in the last couple of weeks, personally anyway.
So I wonder if that… Yeah, I totally agree. Distancing in the hospital is a joke. I mean… It’s not… It’s not real. It doesn’t happen. It can’t happen for a lot of practical reasons. I think what we need is better PPE (Personal Protective Equipment). So you can see there are a lot of issues at play here. Trying to balance new scientific research with real limitations to our resources. But the good news is that our strategies and all of our efforts are really working.
I’m hoping that this article will get us to start thinking about how to better protect our health care providers. We know there will be pandemics in the future, so will we be better prepared next time? I think we should start thinking about it now.”
Thank you for reading this article and special thanks to Dr. Mujeeb Ullah Makki for his detailed opinion on this highly important matter
Stay safe, continue to do your physical distancing.
Good work sir gee
In LRBT eye hospital Karachi every 3rd doctor and medical staff person got covid 19 positive
Thanks dr ishtiaq and dr dr mujeebullah for such and elaborate article..
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