How Is A Doctor Handling SARS-CoV-2 (Coronavirus)

The short answer is: not well.

I’m stressed out, is the answer. Initially, I warned my followers to take things seriously, learn how to properly disinfect surfaces and wash their hands. Then, as we learned more about the virus, I updated in a video that the most important thing was not to panic. I was frustrated with media outlets for their sensational headlines because I felt they were causing people to panic-buy everything off the shelves, leaving no products for the elderly or those who really needed things that others were hoarding. But what the media IS doing very well is giving us up to date information as we find it. I have to commend them for that.

Improvising.

Monday, Mar 16 2020

Surgeon General has recommend cessation of all non-elective cases. So far, my leadership is having meetings throughout the day trying to figure out the best course of action. Remember, for some of us who work in the OR’s, it is our livelihood, so it isn’t an easy decision to make. They had to weigh the facts, along with the loss in income it would cause for a lot of people, as well as the denial of access to healthcare that would result for a lot of people waiting for surgery. No N-95 masks being handed out at this time.

Tuesday, Mar 17 2020

I’m having difficulty finding an N95 mask. These are masks that filter out 95% of contagions and particles measuring as small as 0.1micron in diameter. It’s small enough to filter out a virus that could get aerosolized. I don’t have any, because they aren’t commonly used. I asked around and my best friend had a few left over from Hurricane Harvey and drove 15 miles to my place of work to give me 3. I gave one to HB, one to my coworker that day, and one to myself. I intubated all of my patients myself instead of the CRNA, because I felt that I was the one best protected in the event of a shedding patient (asymptomatic, but contagious).

Woman wears N-95 mask
So happy to have an N-95.

Wednesday, Mar 18 2020

I’m given one N-95 mask and fit-tested for universal one (and failed the up and down motion) which means I leak when I nod my head. What the general public doesn’t know is that one size does not fit all. You can put on an N-95 and leak massively around portions of the mask and you are NOT protected. It depends on face shape, size, nasal bridge. You cannot have a beard and wear an N-95 properly. So those of the public at home with N-95’s who haven’t been fit tested…they’re useless for you. But we desperately need them.

Woman wears N-95 testing mask with valve and tubing attached

Why do healthcare workers need N-95s but the public doesn’t?

Because walking around, going to the grocery store, and normal social distancing doesn’t infect you with the virus. The virus spreads by droplet contrary to what people think they read in the NEJM article. If you read the newly released report correctly, the virus can be aerosolized, yes, but we’ve always known that–about any virus. We wear special masks when performing laser surgery on HPV warts in the OR – because we know about viruses aerosolizing. What you have to look closely on that study, is that it used a rotating drum to keep the virus floating. It does not fly around on its own. It, like all other aerosolized droplets, is vulnerable to gravity when not being deliberately manipulated to remain flying around in the air for an experiment. What is helpful, is knowing how long it survives on various surfaces, which is surprisingly long.

Medical professionals that manipulate a patient’s airways need N-95 masks because they cause aerosolization of the droplet particles. We’re causing the aerosols and need to protect ourselves from them. Intubation, extubation, sinus surgery, dental surgery, deep suctioning of the nose and mouth and airway…all these things and other manipulations cause aerosol particles to float in the air around our nose and mouth and normal surgical masks don’t stop the viral particle when it’s an aerosolized (micro-mini-droplet) form. But they do protect you from droplets. And normal day to day activities don’t cause droplets. So, yes, when in close contact with others, you can wear a surgical mask. You should also wear one in public if you are immunocompromised and unable to socially distance.

But the best thing you can do is wash your hands, and not touch your face. It’s a superhighway for the virus to get onto your mucus membranes. Don’t give it a free ride.

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