Editor’s Note: Find the latest COVID-19 news and guidance from Medscape Coronavirus Resource Center..
Since the beginning of the pandemic, the most horrifying task in health care has been thought to be when doctors place the respiratory tract in the trachea of critically ill patients.
According to the Centers for Disease Control and Prevention guidelines, those who perform these “aerosol generation” procedures often have the best protective equipment in the intensive care unit, even if they cannot get around enough. I put it in. And until a month ago, a surgical mask was considered sufficient for anyone else dealing with covid patients.
A new wave of research shows that some of these steps were the least dangerous. Recent studies have shown that a basic cough produces about 20 times more particles than an intubation. This is a procedure that compares the risk of a doctor being next to you. Reactor..
According to other new studies, patients who simply speak or breathe, even in a well-ventilated room, can ill workers with a CDC-approved surgical mask. Studies show that the overall risk of infection was highest for front-line workers (mostly colored workers), with patients and most of the time in the early stages of illness, substandard protective equipment. I spent time at, not a worker working at covid. ICU.
Dr. Michael Crompas, an associate professor at Harvard Medical School, who called the aerosol production procedure a “misnomer,” said: Recent treatises It is published in the Journal of the American Medical Association.
“That’s a big mistake,” he said.
Increasing research has shown the aerosol diffusion of covid-19 in baths, restaurants and gyms during choral practice, attracting the public’s attention and leading to widespread interest in better masks and ventilation.
Still, this topic is highly controversial within the healthcare industry. Leader of international and US nurse unions for over a year Called For healthcare professionals who care for potential or identified covid patients, including N95 masks, receive the highest level of protection.
However, an extensive group of experts said that the N95 is reserved for those who perform aerosol production procedures, and it is safe for frontline workers to take care of patients wearing weakly protected surgical masks. I have long insisted that.
Such skepticism about common aerosol exposure in the medical setting has driven the CDC guidelines. Whole country And California Hospital Association.
In the guidelines, workers are “ExposureAfter taking care of a sick covid patient while wearing a surgical mask, to covid-19. ” However, in recent months, Israeli Klompas and researchers have documented that workers using surgical masks and face shields caught covid during routine patient care.
“The respiratory system continues to be preferred over face masks when caring for suspicious or identified patients or residents,” the CDC said in an email.
New arrival the study According to scientists at Harvard University and Tulane University, people who tend to be covid superspreaders (20% of those who release 80% of small particles) are prone to obesity or aging and live in elderly care. Most likely or hospitalized.
When highly infectious, such patients release three times as small aerosol particles (about 1 billion per day) as young people. Superspreaders with simply breathing illnesses can pose the same or greater risk to healthcare professionals as coughing patients, are associates and authors of the study at Harvard University’s Faculty of Bioengineering. David Edwards said.
Chad Roy, a co-author of primatology studies at covid, said that when monkeys are most contagious around the sixth day of infection, the size of the released aerosols shrinks. Roy, a professor of microbiology and immunology at Tulane University School of Medicine, said these particles are more likely to hang in the air longer and are more likely to be inhaled deep into the lungs.
The study reveals the significant risks faced by nursing home workers, who have died more than 546,000 and 1,590, according to a nursing home report submitted to the Medicare & Medicaid Center since mid-May. ..
Taken together, this study suggests that medical exposure is “much greater” than what the CDC defined when prioritizing the protection of people performing the “aerosol production” procedure. Of that.
“The result is the inhalation of small air particles that lead to infection,” said Milton, a professor of public health at the University of Maryland, who is studying how the respiratory virus spreads. .. “
February 10th, CDC was updated That guidance Healthcare professionals were encouraged to remove the suggestion that wearing a surgical mask while caring for a nifty patient was acceptable and wear an N95 or “fit face mask” ..
Still, as documented by KHN and The Guardian, updates were made after most of at least 3,500 US healthcare workers had already died of covid. Lost on the front line business.
This project is more comprehensive than the US government’s aggregation of health care worker deaths.Current CDC data Shows the deaths of 1,391 healthcare workers. This is 200 less than the total number of staff deaths reported by Nursing Homes to Medicare.
More than half of the deceased workers of known profession were in the role of nurses or medical support. Such staff often have contact with the widest range of patients, take care of their IVs, and direct them to hospital beds. Brush your hair, wash with a sponge, or take a bath in a nursing home. Many of them (2 in 3) were colored workers.
Two British anesthesiologists (ICU intubators) see data showing that non-ICU workers are dying at a very high rate, and the “aerosol generation” procedure is the most dangerous. I began to question the idea.
Dr. Tim Cook, an anesthesiologist at Royal United Hospitals Bath, said the guidelines for selecting these procedures were based on studies from the first SARS outbreak in 2003. The framework includes those that are widely cited. 2012 survey It warned that those early studies were of “very low” quality and that there were “significant research gaps” that needed to be filled.
However, no research was done before the advent of covid-19, and Cook said there was an important difference between SARS and covid-19. In the first outbreak of SARS, patients were most contagious the moment they arrived at a hospital that required intubation. But for this pandemic, he said, early summer studies began to show that the peak of infection occurred a few days ago.
Cook and his colleague jump in, It’s been found Dr. Jules Brown, a British anesthesiologist and another author of the study, said in October that the horrific practice of intubation released about one-twentieth of the aerosol from a cough. Extubation, also considered an “aerosol production” procedure, produced slightly more aerosol, because the patient may cough when the tube is removed.
Since then, Scottish and Australian researchers have validated these findings in a pre-published treatise on February 10. Show it The other two aerosol production procedures were not as dangerous as speaking, strenuous breathing, and coughing.
Brown said the initial supply shortage of PPE led to rations, providing anesthesiologists and intensive care specialists like himself with the best respiratory protection. Now that workers in emergency rooms and nursing homes have also been found to be at great risk, he said he does not understand why the old guidelines are primarily valid.
“It was all a big card house. The foundation was unstable and everything fell down in my mind,” he said.
When asked about the study, a CDC spokesperson said in an email:As studies accumulate and findings are replicated, the CDC will update the list of procedures considered. [aerosol-generating procedures].. “
Cook also intubated and found that doctors working in the ICU were at lower risk than doctors who worked in the general medical setting and encountered patients in the early stages of their illness.
In Israel, a doctor in a children’s hospital Documented virus spread From the mother of a 3-year-old patient to 6 staff. The mother was presymptomatic, and the authors said in a January 27 study that the case may be “evidence of aerial transmission.”
Harvard University’s Klompas made a similar discovery after he taught him thoroughly. Survey It occurred in September between patients and staff at Brigham and Women’s Hospital in Boston.
There, patients who were tested for covid for two consecutive days developed the virus with a negative result, infecting a large number of staff and patients. Among them were two patient care technicians who treated patients with surgical masks and face shields. Klompas and his team used genomic sequencing to link sick workers and patients to the same outbreak.
The CDC guidelines take care of patients wearing surgical masks.exposure, “Therefore, the technician’s case and other cases may have been dismissed as not related to the work.
The focus of the guidelines on the dangers of the “aerosol generation” procedure is that hospital managers assume that ICU people get sick at work and people working elsewhere are exposed in the community. That’s what it means, said Tyler Kissinger, the organizer of the National Union. Percentage of health workers in Northern California.
“There is this disparity in which exposure is taken seriously,” he said. “Phlebotomists, environmental service workers, or nursing assistants who came into contact with the patient simply by wearing a surgical mask instead of the N95 were not. They were treated as exposed. They came to work. I had to continue. “
Anesthesiologist Dr. Claire Lesbian scrutinizes the web Tweet out An account of a healthcare professional who died in covid for nearly a year. Many were color workers. And fortunately, she said she’s finding far fewer cases now that many workers have been vaccinated.
“I think it’s pretty clear that we did a very poor job of recommending proper PPE standards to all healthcare professionals. I think we missed the boat,” she said. ..
Samantha Young, a political correspondent at the California Healthline, contributed to this report.
