Diary of a (secondline) clinicianMuch ink has been spilled on whether 'tis nobler in the mind to suffer the droplets and aerosols of SARS-CoV-2, or to mask up against a sea of potentially infective community members and by opposing end it. But mangled Shakespearean monologues aside it is a crucial question and one to which there does not appear to be a clear answer. To be sure wearing a mask as part of droplet precautions when caring for someone who is potentially or confirmed infected with SARS-CoV-2 definitely protects the wearing healthcare professional. What is less certain is what members of the general public who are not confirmed or suspected of being infectious should do. China says yes, Australia says no, and the US CDC says yes, but don't wear those meant for health professionals. All have presumably similar evidence available yet have come to significantly different conclusions. Some say it's because of supply constraints, that the Governments recommending against use by the general public are purely trying to conserve supply for where it's needed most. Others says it's to do with rights and liberties, that a Government must limit force to compel its citizens as much as possible in order to preserve trust. "All have presumably similar evidence available yet have come to significantly different conclusions." As I walk the 2km to my place of work every morning, past 3 other hospitals, 2 petrol stations, a primary school, and a large half-way house for homeless people, I notice a curious thing. No healthcare workers, or at least who I presume to be by their scrubs or hospital ID tags, if not by recognition (healthcare's a small world), wear face masks while out in public. Petrol station attendants universally do. Others walking on the street vary significantly with no clear discernible pattern, while the primary school is appropriately deserted for school holidays.
But the homeless shelter is the most curious. Signs with information on social distancing and hand hygiene plaster the outer walls and windows while the almost universally masked clients sit or stand outside waiting for 0800 breakfast to be served. This too is not served in the (now emptied of tables and chairs) large mess hall inside but from a window by (masked) social workers. Perhaps if anyone should wear masks it should be they; they're some of the most vulnerable people in our community, one's own right to left position on the political spectrum notwithstanding. Maybe they've been given masks for free by a Government agency or generous donors, so are wearing what somone at least thought was a good idea. When I reach my hospital, greeting colleagues in the entrance hall, we stand in line, little green X's denoting 1.5m lengths from those in front and behind us so we can stay appropriately social distanced. At the line's front a masked and gowned nurse ("Good morning!" she says cheerily, it's always a she) aims a gun thermometer at my forehead while a masked security guard stands watch impassively. The device telling her what she wants to see she ushers me in to the eerily quiet lobby, and so it begins again... For more information on the use, effectiveness, fit-testing and more of personal protective equipment (PPE), head to the ClinicFire PPE page.
2 Comments
H
13/4/2020 16:27:43
That's still a remarkable set of precautions - must say that we have no masks available for the homeless, and we have no gowned up nurses with thermometers at entrances. Neither do we have tests!
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Rahul
13/4/2020 18:24:29
Indeed, it all comes down to availability, which is concerningly heterogeneous. We can only hope that the powers that be learn from this experience.
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