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Furious in the hospital about how COVID attacks and kills


Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center..

Front-line healthcare professionals are trapped in fierce controversy with many infection control professionals and hospital managers about how the new coronavirus spreads and therefore what level of protective equipment is appropriate. I am.

The problem is the extent to which the virus is floating in the air, that is, small particles of aerosol can spread in the air, or mainly large, fast-falling droplets such as sneezing and coughing. It is only transmitted through. This bizarre and meaningful controversy affects the real world as to what protective measures healthcare companies need to take to protect patients and workers.

The Centers for Disease Control and Prevention confused Friday’s debate, refocusing on aerial transmission, and providing guidance that small aerosol particles and large droplets are “the main way the virus spreads.” By Monday the language was gone From that website, And explained that the authorities mistakenly posted a “draft version of the proposed changes” and that experts are still working on updating the “Recommendations for Airborne Transmission”.

Dr. Anthony Fauci, a leading infectious disease expert in the United States, September 10th webcast Harvard Medical School pointed out that aerosol scientists claimed that the CDC “really made mistakes over the years.”

“The bottom line is that there are far more aerosols [transmission] More than I expected. “

The topic is deep within the hospital, as the question of whether the condition is spread by droplets or aerosols promotes two different protective measures, affecting everything from airflow in the hospital to patient isolation and selection of protective equipment. I am in conflict. Enhanced protection is destructive and expensive for many industries, especially hospitals that have fought to maintain low levels of “droplet” protection.

Hospital managers and epidemiologists claim that the virus is primarily a citation study of droplet spread, indicating that the virus spreads to a small number of people, such as colds and the flu. Therefore, routine care of COVID-19 patients does not require N95 ventilator and strict patient isolation practices, these officials say.

Meanwhile, many occupational safety experts, aerosol scientists, front-line healthcare professionals and their unions quickly pointed out that the new corona virus is far more deadly than influenza, and science is of high quality. Claims to suggest that there is. The more expensive N95 ventilator is needed for routine patient care for COVID-19.

Highly protected ventilators are in short supply nationwide, with prices skyrocketing from about $ 1 to $ 7, respectively. Meanwhile, studies have shown a high prevalence of asymptomatic viruses, increasing demand for N95 among front-line healthcare professionals in virtually all situations.

Controversy in hospitals has been struck by the findings that studies have shown that living viruses are stagnant in the rooms of COVID-19 patients without “aerosol-generating” procedures (such as intubation and respiratory treatment). I have it. Contributes to outbreaks in Nursing home, Shuttle bus And Chorus practice..

KHN and The Guardian US Checking it up More than 1,200 healthcare workers died from COVID-19. This includes many reported that family members and colleagues worked with inappropriate personal protective equipment.

However, some front-line workers and managers are accurately divided on how and why healthcare professionals get sick.

Hospital infection control and epidemiology leaders cite studies suggesting that many healthcare professionals are infected with the virus Other than work And at a rate that reflects what’s happening in their community.

Group of Penn Medical Epidemiologist In late July, studies on aerosol transmission were unconvincing and were cited as “widely published evidence from around the world,” with the “overwhelming majority” of coronavirus spreads “through large breathing droplets.” Showed that there is.

But trade unions, occupational health researchers, aerosol scientists, health care workers Hit much harder Than the average person-and The study shown Active viral particles can float in the air up to 15 feet from the patient in the room. Such particles can hang in the air Up to 3 hours..

July 6th to support their concerns Signed letter 239 scientists have called on the medical community and the World Health Organization to recognize “the potential for Covid-19 to spread in the air.”

The letter points to a study that speaking, vomiting, and coughing releases small particles that remain suspended in the air for much longer than droplets, “at the risk of exposure.”

In one ward of a Dutch nursing home with circulating air, researchers found that 81% of residents were diagnosed with COVID-19. Half of the workers in the ward-all wore surgical masks during patient care but did not wear masks during breaks-were also virus positive.

Researchers could not rule out infection by other means, but “almost simultaneous detection” of the virus among almost all residents pointed to the spread of aerosols.

The idea that the virus is spread by either droplets or aerosols is oversimplified, said Dr. Schultigohill, Associate Director of Epidemiology and Infection Prevention at the University of California, Irvine Medical School.

Gohill said it was more of a spectrum and the virus was also infected by some droplets and some large aerosol particles.

However, one of the hottest indicators in hospital infection control is the number of people infected by one sick person. In the case of COVID-19, the number is about 2, which is similar to a cold or flu. For overt aerial infections such as measles, the number is close to 12-18.

Measles is “in the air [transmission] “If this really was a primary aerosol-transmitting disease, we would be in a hurt world,” Gohill said.

Hospital epidemiologists are also focusing on the household spread rate of the new coronavirus. Dr. Rachel Lee, a hospital epidemiologist and assistant professor at the University of Alabama and the University of Birmingham, states that in the case of measles, members of unvaccinated households are at an 85% risk of getting sick. For COVID-19, she said the risk is close to 10%.

According to Lee, UAB University Hospital staff are wearing N95 ventilators as an additional protective layer, although droplets are thought to spread the virus rather than aerosol particles. “

Such practices are not universal. At Iowa University hospitals, healthcare professionals use N95 and face shields for aerosol generation procedures, but surgical masks and face shields are used for routine care of COVID patients, who are responsible for the infectious disease department. Dr. Daniel Diego Kema said. University.

He said such “enhanced drop “Notes” working.. Places that workers use regularly and correctly Medical mask Face shield found It does not matter Spread of illness among staff One such report Focused on spread from one patient.

Elsewhere, patients were safe even on floors where COVID-19 patients and virus-free patients were placed in adjacent rooms. Don’t support..

“It’s not an aerial infection like measles or tuberculosis,” said Dr. Shira Delon, an epidemiologist at Tufts Medical Center in Boston and an assistant professor at Tufts Medical Center. “We know that there are no large-scale infections affecting multiple patients on the floor.”

Origin of the discussion

The CDC helped set the stage for the current discussion. In March, the agency issued a revised guidance, basically stating that it is “acceptable” for healthcare professionals to use surgical masks instead of the N95 for routine care. guidance He said that respiratory droplets are the most likely source of infection and N95 is recommended only for aerosol development procedures.

“The contribution of small, breathable particles, sometimes called aerosols or liquid drops, to proximity propagation is currently unknown, but there is little human-to-human aerial propagation over long distances,” the guidance said.

The California Hospital Association has sent a letter to the delegation of the state legislature requesting that the revised guidance be permanent.

“We need a CDC to clarify airborne and droplet precautions for patients and healthcare professionals, not conditionally,” he said. In doing so, hospitals can protect the supply of PPE and limit the use of special isolation rooms for COVID patients.

A spokesperson for the association told KHN that the group was not looking at science, but simply wanted to clarify the rules.

Christopher Friese, a professor of nursing, health care, and policy at the University of Michigan, is one of the experts who believes these rules endanger healthcare professionals.

“We lost a tremendous amount of time, and frankly, the initial guidance was to wear the N95 only for those particular steps,” Friese said.

Family and union leaders Missouri To Michigan To California Has expressed concern about a nurse dying from COVID-19 after caring for a viral patient without an N95 respirator. In such cases, the hospital states that it follows the CDC guidance.

Freeze told some occupational safety experts that stronger guidance on the CDC’s call for airborne infections could have had an impact, perhaps introducing the Defense Production Act to President Donald Trump. He pressured to increase supply, saying, “Where we need it, where we may have it.”

According to national surveys, many healthcare facilities still lack personal protective equipment.

The CDC guidance released on Friday would have pressured some hospitals to strengthen their protection measures. Reportedly.. He said the virus could spread when a person sings, talks, or breathes.

“These particles can be inhaled into the nose, mouth, respiratory tract and lungs and cause infections,” the site said. “This is believed to be the main way the virus spreads.”

By monday morning website Recognizing that the draft language was posted incorrectly, he said the virus spreads primarily through droplets.

The University of Nebraska Medical Center has taken so-called aerial precautions from the beginning. There, James Roller, a doctor and director of the university’s Global Security Center, said he documented that the virus could float in the air and live on surfaces far away from patients.

He said the hospital would test all inpatients for the virus and keep COVID-19 patients away from the general population. He said they pay close attention to cleaning common spaces and monitoring airflow inside restricted access units. The worker also had an N95 mask or PAPRS. These are fitted with hoods that deliver filtered air.

As a result of all this, the infection rate of healthcare workers is “very low”.

Betsy Marville, a nurse organizer at 1199 SEIU UnitedHealth Workers East Union in Florida, said “best possible” protection as more healthcare workers die than ever before in viral uncertainty. He said that adopting the form is the best policy.

This represents a deviation from the CDC guidelines that healthcare professionals now require N95 masks only for “aerosol generation” procedures such as intubation and other respiratory treatments. When a patient urgently needed such treatment, she said the rules left her representative nurse seeking protective equipment-or unprotected-in Florida.

“You don’t leave the patient in pain and go looking for a mask,” she said. “It’s crazy.”


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