Update: 3/8/2020
Since publishing this article, I came upon this correspondence from the New England Journal of Medicine titled, SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients. The writers of the letter studied the number of viruses from asymptomatic patients using nasal and throat swabs. They found:
The viral load that was detected in the asymptomatic patient was similar to that in the symptomatic patients, which suggests the transmission potential of asymptomatic or minimally symptomatic patients.
That information is further supported by this study, Transmission of 2019-nCoV Infection from an Asymptomatic Contact in Germany, where someone with Covid-19 but with no symptoms from China infected her German business associate.
The bottom line is that patients with Covid-19, even if they are asymptomatic, still have the same amount of virus in their nose and throats. Which means that they are as highly infective as the ones who are obviously sick.
In ordinary life, any individual may unknowingly spit some saliva while talking. If Covid-19 positive, then that saliva will be full of viruses.
I have since changed my position concerning the use of masks and go against the recommendation of the CDC and the WHO. The World Health Organization and the Centers for Disease Control currently do not recommend wearing a mask if you don’t have symptoms.
The reason why my position is different from the CDC is that the current laboratory and clinical evidence show that asymptomatic carriers can spread the Covid-19.
Who should wear a mask?
- Anyone who wants to wear a mask.
- Anyone with symptoms (coughing, sneezing, fever)
- Especially if you are:
- visiting an elderly
- with someone with other medical illnesses like diabetes, cancer, heart, and lung disease.
- in a health care facility
People should purchase masks for their own use and supply and not resell at exorbitant prices.
Now that my position has been clarified, the following is the original article about health care workers and why they should have personal protection. My apologies for any confusion.
Health Care Workers
Who are the health care providers, and why is there a preference for them to have masks?
A healthcare worker is one who delivers care and services to the sick and ailing either directly as doctors, nurses, 911 responders, aides, helpers, laboratory technicians, or even medical waste handlers.
Health Care should Flow. Not back up.
There is a flow of patients from the community to the emergency rooms (E.R.s) to the hospital. That flow should be running smoothly. To work well, different professionals are needed to be there in the right number.
Many doctors’ offices, E.R.s, hospitals, and nursing homes are stretched even before the Covid-19 epidemic. Even a slight decrease can cause a back-up. Add to that a surge in volume as more people need to be checked.
This article describes the different health care workers. It will explain how the lack of one worker can slow down the whole system of health delivery.
911 Responders
911 first responders include the police, firemen, and paramedics. All of them respond to a 911 call even if someone has an infection.
Paramedics sometimes need to wait in the E.R. until a bed for their patients is available, and they will need a mask. Meanwhile, patients in the community waiting for an ambulance will have to wait.
If they get sick, the 911 response will slow down.
Housekeeping
In a hospital or any medical facility, the housekeeping staff keeps the rooms clean. Once a patient gets discharged from an emergency room or in-patient room, housekeeping is needed to get the rooms cleaned right away.
If housekeeping is understaffed because someone is sick, there may be a vacant room in the hospital, but it will not be available for the next patient because the place is still dirty. An admitted patient from the E.R. will then have to stay in the E.R. and use a bed that could otherwise be used for the next patient from the waiting rooms or from the paramedics’ gurney.
Secretaries
The secretaries are essential to make the phone calls so that E.R. doctors can talk to another doctor about their patients. That communication is crucial for the continuation of care. The doctors must be on the same page regarding the patients.
Nurses also need to talk to doctors outside the E.R. to get admission orders. For admitted patients in the E.R. waiting for a bed, communication with hospitalists are essential for medical instructions, and if there is a change in the status of the patients.
A lack of secretary slows down the E.R. significantly.
Transporters
Patients in the E.R. need carriers to move them for ultrasound, CT-scans, MRIs, or to the in-patient rooms. If they are lacking, it can cause delays or an aide or a nurse or a doctor may have to transport the patients themselves.
EKG technicians
Anyone who presents to the E.R. who with chest pains, upper abdominal pain, complaints of passing out, or cardiac patients need an EKG to make a proper disposition.
Nurses Aides
Nurses’ aides monitor vital signs, draw blood, assist patients in going to the bathroom, provide bedpans. If they are not around, nurses will have to pick up the slack.
Imaging Technicians
Imaging technicians include x-ray, ultrasound, C.T. scan, and MRI. Imaging needs teamwork. Usually, there are two “techs” in each. If one is missing, imaging gets delayed. Techs not only “shoot” the films, but they also do the processing of the images before it gets sent to the radiologists.
The E.R. can significantly back-up if they are short since almost all patients need imaging.
Medical or Laboratory Technicians
Med techs run all the blood and urine samples. Some are in chemistry, others in hematology, and some in the blood bank. They process hundreds if not thousands of tests a day. Sometimes they are called to draw blood.
If they are short, tests get delayed. Delayed lab results lead to delays in medical decision making. Doctors need lab results to support their diagnosis and decide whether to admit or discharge a patient.
Physician Assistants (PA) and Nurse Practitioners (NP)
The shortage of doctors and the continuing rise of sick people in the U.S. has prompted the need for P.A.s. A PA usually sees a patient that requires a lower level of care like ankle sprains or superficial lacerations. P.A.s are not totally independent in making medical decisions. If they saw a “sick” patient because the doctors are overwhelmed, they have to discuss it with a supervising physician.
If P.A.s or N.P.s are short, then the patients who need a lower level of care may need to wait longer in the waiting room and potentially get exposed to someone with an infection.
The other consequence will be the E.R. doctor will spend more time suturing instead of seeing another who needs a higher level of care.
Nurse practitioners also help the doctors but have more independence in making medical decisions and can see sicker patients.
Doctors
Doctors are central to health care. If anyone gets sick, whether they are family practitioners, emergency doctors, or cardiologists will create a severe strain in health delivery.
In China, during this epidemic, some doctors who have died were an ophthalmologist, a neurosurgeon, and a gastroenterologist. All were called upon to handle an infectious disease patient.
Different Kinds of Emergency Rooms
Not all E.R.s are the same. There are Urgent cares, Trauma E.R.s, Pediatric E.R.s, and Cardiac and Stroke E.R.s. These are specialty hospitals. If one of them slows down or closes because of quarantine, the patients will be diverted to other E.R.s that may not have the specialists to address their specific needs.
Work-Related Risk of Infection
Health care workers in their facilities are regularly exposed to many sick patients in close quarters. Some infected patients may be in the same area with them for hours. Asymptomatic carriers may be accompanying a patient and may not be wearing a mask. The risk of exposure is very high.
That is why health care workers need masks.
During the SARS outbreak in 2002, health care workers accounted for 20% of the infected globally. In China, as of Feb 14, more than 1,700 health care workers got infected. Some of the doctors died in their 30s, like Dr. Li Wenliang.
We all need a well-functioning health care system. More so in this time of the Covid-19 epidemic.
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