COVID-19 and PPE: Some of Us Will Die

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"I have to remind the American doctor that life is changing.… It's not a normal life. It's a #COVID19 life. It's a pandemic life."

With these words, spoken March 18, during a joint webinar of the Chinese Cardiac Society and the American College of Cardiology, Professor Bin Cao, MD, from China, jolted healthcare workers across the world. And while China reported good news this week, with its first day of no new local infections in Wuhan province, the United States and other countries face the beginning of the surge.

I've heard and sensed that many nurses and docs are ready for the challenge. But the new fear is the shortage of personal protective equipment (PPE).

The analogy of a coming storm is apt. It's as if we can now feel the winds and see the dark clouds. But even as we begin to see patients with COVID-19, and some hospitals in hot spots feel the surge, we won't be fully protected against the contagious virus.

Numerous colleagues have direct messaged (DM) me on Twitter that their hospital is rationing PPE and supplies are running short. C. Michael Gibson, MD, tweeted that he has received 10 DMs about shortages of masks. In a Twitter poll with more than 300 votes, a third of respondents said their hospital had no masks, and nearly half said they were allowed only one mask.

Another chilling message received through the privacy of direct messaging: many doctors have been expressly told by their administration not to speak publicly about conditions. And few will go against their employer out of fear of being fired. That means the stories about PPE shortages likely underestimate the problem.

Adding to the shortages of PPE and the muzzling of frontline clinicians is the lack of testing. We simply don't know who is infected. And if you don't know that, you don't know who to isolate.

If we were to follow Cao's advice—that it's a pandemic life—we would use masks and PPE routinely, and we would test patients immediately so that those infected can be put on isolation wards. These seemingly simple actions would protect caregivers. But we can't do that because we don't have access to rapid testing or PPE.

Perhaps the most dire message came when Gibson tweeted a screenshot from the Centers for Disease Control and Prevention with recommendations for use of homemade masks if a facility runs out of masks: "HCP [health care provider] might use homemade masks, such as a bandana or scarf, for the care of patients with COVID19. However homemade masks are not considered PPE."

Bandanas? Are they serious? In the richest country in the world?

To be clear, hospital administrators did not cause PPE shortages. Leadership at my hospital has not told me to shut up. I see them working hard to help us. While administrators are less likely to be exposed, they have a huge role to play in getting us PPE, changing policies on the move, and keeping the hospital financially solvent. Indeed, we want administrators to succeed.

On an e-group with colleagues, most of whom are young and healthy, a friend wrote, "Every time I read about a person with no comorbidities on a ventilator, my heart sinks."

I remember these sensations from the 1990s, when we placed lines in patients with HIV. But at least then we could identify infected patients; we can't do that with COVID-19. And this week, the New England Journal of Medicine reports the virus can be passed through the air.

It's weird: the feeling that your job could take your life.

A month ago, we were providers tapping on our electronic health records and marching to the whims of administrators. Now, nurses and doctors report to work knowing that we will likely become infected.

While we don't know the exact virulence of this disease, the evidence is clear that some of us will become ill and die. It's a numbers game.

Be safe and be lucky, colleagues. Respect to you all.

John Mandrola practices cardiac electrophysiology in Louisville, Kentucky, and is a writer and podcaster for Medscape. He espouses a conservative approach to medical practice. He participates in clinical research and writes often about the state of medical evidence.

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