MERYL NASS, MD, merylnass at gmail.com
Available for a limited number of interviews, Dr. Nass blogs at Anthrax Vaccine, which includes her own analysis as well as resources from around the world, including a just-completed English translation of the Chinese guidebook for care of COVID-19, which has a section on “Isolation Area Management.”
She notes that in a recent JAMA interview, an Italian doctor, Maurizio Cecconi, talks about having tried to “separate our patients” on different floors as “much as possible.”
Her most recent posting is “An Important Proposal That Ameliorates Our Lack of Protective Equipment and Spares Both Patients and Healthcare Workers,” which states: “There is a huge disconnect between the personal protective equipment healthcare workers (HCWs) should be wearing to protect themselves from coronavirus, and what actually exists right now for them to use. The White House has told the governors to find their own supplies. The equipment market is in chaos. Nurses and doctors deserve congratulations for their bravery and commitment to continue working, even without adequate protective equipment. CDC is now telling them to make their own equipment. But Kaiser Permanente threatened to fire nurses for wearing their own N95 respirators.
“Having doctors and nurses work under these conditions is extremely shortsighted. Given the tremendous propensity of the virus to spread — U.S. deaths are doubling every three days, and are believed to lag infection by a month — healthcare workers will be infected disproportionately, as in Wuhan and northern Italy. But worst of all, HCWs may become viral spreaders, transmitting infection to patients who are in their healthcare facility for other reasons. Doctors in Italy have warned that hospitals might be ‘the main’ source of COVID-19 transmission. …
“There is only one solution: keeping patients with COVID-19 in facilities that treat only COVID-19. And treating other patients in separate facilities. This requires government to take control of a very messy situation: Hospitals and clinics are about to become, if they are not already, the locations that put their patients at highest risk. Hospitals will not suddenly create separate COVID facilities by themselves. Government needs to step in to make this happen.
“Creating designated COVID-19 facilities would allow healthcare workers to put on a complete set of protective garments: masks, goggles, face shields and head to toe gowns and shoe covers, at the beginning of their shift. They would then not change out of the garments between patients, since all the patients are already infected. It would save tremendous amounts of equipment and time, since HCWs would not have to change up their gowns, gloves, etc. between each patient, and would have enough protective equipment to work in safety.
“How do you identify the COVID patients, when PCR [polymerase chain reaction] tests have again slowed due to lack of reagents and swabs?
“In Italy and China, ultrasound exams of the lungs, or CT scans, have been used to differentiate the specific lung pattern caused by this coronavirus (a bilateral ground glass appearance, especially in the lung periphery) from other infections. This can provide a faster diagnosis than a lab test, with almost as much accuracy, at the point of patient contact. Ultrasound machines may be portable and inexpensive.” See full posting, with extensive links.
