In the last few days I’ve seen a growing number of people turning on others they perceive cutting the vaccine line. Most of the people complaining of line cutting are not healthcare workers but community members. I’m sure many mean well are are trying to be supportive of physicians, nurses, and other frontline workers while some come across as angry.
I understand that many people are justifiably frustrated with those politicians that either directly said or through their behavior made clear they thought COVID-19 was a hoax, but were first in line for the vaccine. Then there were those people who are not healthcare workers at all, but hold positions of privilege like religious leaders. Finally, there were healthcare administrators who do not have direct patient contact but managed to be in the first group. Of course, there are also people like me that volunteered to give vaccines and as a result of being present at the end of the day when they needed to use up the vaccines that would expire was lucky enough to be given one.
I don’t think we should be frustrated or angry with any of these people. Let me begin with the politicians that promoted COVID-19 as a hoax and or acted in ways that were irresponsible by not wearing masks, social distancing, and encouraged others to do the same. By taking the vaccine and rushing the line they are clearly admitting they were wrong. Their vaccine selfies are their public confession of misleading the public, errors, and/or dishonesty. We should accept it as the statement it is and recognize that the. people that voted for them would never listen to someone like me. However, they may follow the example of that person they trust. If that gets people in communities to line up for the vaccine that is good.
One person who was the brunt of public outrage was a 70 year old Bishop. I agree by any current criteria he was not on the list of first in line, but the reality is there are a lot of people that will see him getting vaccinated and follow his example. We need people in positions of leadership (political, medical, religious) to be examples and show their belief in the vaccines. I think it is especially important for the Bishop since there have been a couple of Bishops that were very negative with weak arguments about abortion that were refuted by moral theologians. Thus seeing a Bishop getting vaccinated sends a strong message that the claim that getting vaccinated is complicity with abortion is inconsistent with Catholic teaching.
As for the hospital administrators that never touch patients getting vaccinated ahead of front line providers it is important to remember they are part of the structure that keeps hospitals going. The average clinician has no idea how the supply chain works or how to keep the facilities going. Administrators are as critical to the a well functioning hospital as the facilities staff and custodians. A hospital is a team activity. It will not function well or long with only physicians and nurses.
As a country we are tired, frustrated, and honestly a little scared. We have made it this far together and will make it to herd immunity by working as a country. We need to pull together and support vaccinations because vaccinations are the solution to COVID-19. If anything we need to focus our efforts toward better vaccination plans, getting the vaccines out into the communities, and arranging mass vaccination clinics. This may mean we need to make people more responsible for their record keeping and get shots in arms rather than time consuming computer data entry tasks. My experience was the paperwork was taking much longer than the vaccinations and thus slowing the process.
I don’t care how much you denied that COVID-19 was real or dangerous. If you are willing to get a vaccine I’m willing to volunteer my time to give it and thank you for showing up. Please don’t let this divide us. Remember, some of those people being criticized have been asked to get vaccinated as a show of public support, others because of the federal continuity of operations plans, and others maybe out of fear. Let’s support everyone with a compassionate heart.
Over the last few weeks, I have been angered by the large number of hospitals threatening nurses and physicians for wearing masks and telling the truth. Nurses have primarily been told to remove their mask or be fired. While physicians seem to be told to remain silent about shortages and conditions or be fired and while at the same time to remove their masks. I’ve collected a large number of such stories from people I know and trust. They have come from nurses and physicians. One physician, a friend of a friend, was working in an ER and the administration told him to take off his mask or be fired. He quit on the spot rather than take off the mask. The husband of another friend is also an ER physician and he actually had to go to his car and get a mask when a symptomatic patient came in because they had absolutely no N95 masks in the rural hospital.
This was sent to me by a friend who has spent her entire career at the beside.
I can’t speak out publicly and be identified because I cannot afford to lose my job. I can tell you that nurses are being bullied not to use their own PPE especially if they are working in areas that it was previously not routinely necessary. Even nurses and therapists with asthma, COPD, immunosuppression and/or recommendations from their personal physicians are being bullied about not wearing an N95/PPE that they provided themselves. My area was recently told we “can” but are not required to wear a surgical mask after repeated complaints from the Radiation Therapists we work with that their professional body (ASTRO) is recommending they wear a mask during all patient care. However, the administration here has been “working around” the nurses in administration to roll back that protection in the name of not “wasting masks”. None of them wear masks when they come through the clinic. Combined they’ve spent almost no time in the clinic before or after this began. They act as if we are overreacting when we wear masks to work with our patients, but in the same breath tell us to stay out of the clinic if at all possible and “protect ourselves” as if our front line staff is disposable. With the transition to no visitors we have folks that counted on caregivers coming in with them that are now upset and unable to do their own intake paperwork and needing more hands on care. But the culture coming down from the top is that the front end staff are overreacting if they want to protect themselves and patients by wearing masks. I feel like we are a pressure cooker ready to go off. We have young folks that are going home to families and roommates (that are working in Walmart’s and driving busses) and they are the ones helping immunosuppressed patients with their paperwork (so much more because now they can’t have a family member to help them) and when they use a physical barrier mask they get side eye from our nurse manager (whose boss is non clinical and was on the Hoax train up until last week and still makes flippant “just wash your hands, you’ll be fine, comments”) and others. They along with the rest of the management team are hoping/thinking they will “roll back” the decision to allow our folks wear masks this week… all of this from the big executive suite where a few folks, all sitting in private offices are dictating what the hands on people can do to protect themselves. It’s just wrong. They are intentionally talking amongst themselves to reach a consensus against protecting our folks before including equally/higher ranking nurses on any conversations. At a time when nurses should be at the forefront of decision making we are being railroaded and overridden. I am the only one that seems to understand the magnitude of what we are facing. Since our doctors are a separate group they can do what they want for themselves and although they can ask that we protect the patients and employees, they have no sway.
I have been working to make sure we have local seamstresses lined up and donations of fabric surgical masks so that we have some protection. However our hospital system will not allow employees to wear them, even/especially when we are in areas that they don’t deem masks “necessary” which is almost all our front line folks in non COVID19 treatment areas. It’s incredibly short sighted. One of our employees was sent to employee health after they developed a nasty cough this week. They were told no test needed, no quarantine needed, no mask needed, they could go back to work, the cough alone was not concerning.
The guidance on the use of masks needs to be clear for both clinicians and the public. While CDC says it has been updated that does not appear to be the case and remains so vague that there is great flexibility for facilities to do what they want. Fortunately, the Joint Commission has now been clear in their recommendation that not only should staff be allowed to wear their own PPE if they have it and the hospital is not providing it, but they refute the CDC guidance and cite evidence while admitting it is incomplete. The Joint Commission confirmed that they are receiving reports from across the country of hospitals refusing to let staff bring their own N95, surgical, and homemade masks.
Use of Mask for the Public
As bad as the CDC guidance has been for healthcare personnel it has been equally bad for the general public. Statements have ranged from it isn’t need and handwashing is adequate to masks can increase a person’s risk of contracting the disease. Both are clearly misleading. The rational was first:
We need to conserve the PPE for healthcare personnel and the general public is at low risk. Because the virus is spread through droplets from coughing or sneezing you would need to be within 6 feet of the person that is sick.
When it became clear that many cases were actually being spread by asymptomatic people and that the virus may linger in the air longer than they first thought they still did not change their recommendation. They did change their approach.
People do not need to wear a mask when outside because they will wear them improperly and may increase their risk because they will be more likely to touch their faces and it will give them false confidence.
Obviously, we all know that we need to conserve N95 and surgical masks for healthcare personnel. They are our front line and deserve all we can do to protect them. However, the government is now telling us that a minimum of 100,000 to 240,000 Americans will die and 50% to 70% of the country may contract COVID-19. Spare us the rhetoric that the risk is low. Also, don’t insult people. No one thinks a mask is a protective forcefield. What the average person feels is that even a homemade mask is better than no mask. When a homemade mask or other non N95 mask is worn and combined with social distancing, handwashing, and not touching one’s face it decreases an individual’s risk when a person must venture outside.
As the nation’s leading public health organization, the CDC should remember that education is critical. If they believe that putting on a mask makes the average citizen suddenly forgets that they should social distance, wash their hands, and not touch their face then the answer is a public service campaign to remind people. If they believe that people will wear masks improperly again education is critical and they should immediately make an infographic or short video demonstrating how to properly put on a mask, take it off, and clean it or dispose of it. The real risk would be people reusing disposable masks and/or not cleaning masks. Of course, this ignores the fact we are asking healthcare personnel to do just that. This is public health 101. Treating the public as if they lack any reasonable amount of intelligence is insulting and not helpful.
What Does the Research Show
In a Lancet article that reviewed different countries’ use of masks and the available evidence they pointed out that “there is an essential distinction between absence of evidence and evidence of absence.” They concluded, “community transmission might be reduced if everyone, including people who have been infected but are asymptomatic and contagious, wears face masks.” A cluster randomised trial of cloth masks compared with medical masks in healthcare workersfound that medical mask are significantly better and should be preferred during a pandemic for healthcare providers. However, they also pointed out that medical masks are not always an option. It was suggested that cloth mask with multiple layers and tighter weaves would be more effective than the current cloth masks that they tested. Testing the Efficacy of Homemade Masks: Would They Protect in an Influenza Pandemic provides some insight into what materials may be best for a homemade mask. Smart AIR took the information and put it into a useful graphic that compares homemade masks to surgical masks.
While the graphic below also isn’t evidence it makes clear that places that routinely do wear masks have fewer cases of COVID-19. Of course, there are other confounding variables and this is just one piece of data.
Information on Making Your Own Mask
I think everyone should take the time to make their own mask. It will serve as a reminder that we are in a battle to save lives. It will remind us that in many poor countries this is all they have when they care for patients. It will give children a craft project while they are out of school that can be used to teach science, health, public safety, social responsibility, and even math. And most importantly, it may give you just a little extra protection when you absolutely must go out.
Making your own mask is not that difficult for anyone with basic sewing skills. I’ve provided a couple of links that have instructions.
I received a free copy of Voices of the Dead by John Babb, a retired U.S. Public Health Service, Rear Admiral. I read his first book Orphan Hero which I enjoyed, but this one is different. It is a historical novel set in 1878 and tells of Yellow Fever in Memphis and New Orlean. I could feel the humidity as I read of the nurses and physicians responding to the deadly virus and risking their lives to serve others.
There are plenty of nurse heroes in this book, but also everyone from physicians to Sisters, from Priests to Madames stepped up to help their neighbors and some lost their lives in the effort. Whether you are a lover of historical novels, or epidemiological investigations, or an infectious disease nerd this is a great book.
Of course, it could be that I liked it because it had all the things that fascinate me, steamy southern cities, infectious diseases, legislation like the Quarantine Act, selfless physicians and nurses, and the Marine Hospital Service which lead to the Commissioned Corps of the U.S. Public Health Service. It dealt effectively with the fears of quarantine and what citizens do when quarantine is ordered. In many ways, it is a case study of epidemics prior to modern healthcare.
I don’t want to spoil the book, but if you are a public health worker I think you will love it.