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Tuesday, March 17, 2020

BREAKING NEWS: Ways EPs and ED Staff Can Flatten the COVID-19 Curve

Ways EPs and ED Staff Can Flatten the COVID-19 Curve

BY MARK MOSLEY, MD

COVID-19, if nothing else, will encourage us all to be more vigilant about infection control, at least for now. Most of this is not new; it just has a new motivation. I thought I would share a few things to consider. Heightened awareness is critical to the health of those who are at increased risk (people with underlying lung disease, etc.).

This enhanced attention can protect not only our loved ones but also the at-risk populations (elderly, immunocompromised, serious comorbidity) with whom your loved ones can come into contact. This may seem overboard for your personal risk, but think of your parents, your spouse’s parents, your friend’s parents, and your children’s friend’s grandparents. Apparently, you don’t have to worry about your pets.

I am not a germaphobe, and I am not sure what everyone else’s habits are when they leave work and come home, but I have scrubs that I wear to and from work and hospital shoes I change out of in my garage. I confess that I have on occasion worn scrubs while picking up something from the grocery store on the way home. I keep my white coats at work, and I carry a bag of books and papers into my home, into my car, and to work. When I come home, I leave my shoes at the door and go straight to my bathroom, shed my scrubs, and put them in the dirty laundry hamper. That has been my habit for more than 25 years.

Here is what I will be doing differently:

1. I will stop wearing my watch during my shifts, so I can effectively use soap and water to wash my hands and wrists.

2. I will not snitch cookies, chips, or any goodies in the ED breakrooms.

3. I will wipe down my work phone before and after my shift and my cell phone religiously everywhere.

4. I will start keeping my hospital shoes at the hospital. I could also carry them in a shoe box, and change into them at work.

5. I will start changing out of my scrubs at the hospital after my shift. I will wash my hands with soap and water after I take off my scrubs. I will wear street clothes and a designated pair of street shoes home. (This avoids wearing dirty scrubs in the car in which I pick up my kids.)

6. I will put my hospital bag in my trunk and avoid putting my bag on the seats. I will keep it in the trunk and not bring it into my home.

7. I will shed my street shoes at my garage entry door.

8. At home, I will immediately shed my street clothes and dry them in the dryer for 30 minutes (that kills viruses) before putting them in the dirty clothes hamper.

9. I will take a shower after each shift.

10. I will put on home clothes after my shower.

11. I will wash my hands before emptying the dishwasher.

12. I will teach everyone in my home how to wash their hands for 20 seconds (including sayings, songs, or prayers to ensure 20 seconds).

I will implement these precautions until we have more data:

1. I will ask daily that the frontline personnel get high-priority regular (weekly?) surveillance testing: respiratory therapists first, followed by ED personnel, ICU personnel, EMS, and housekeeping.

2. I will refrain from going to the gym and church and from meeting with friends until I can be tested regularly. I will write to my friends and family and tell them why, including my mother, who is in a nursing home.

3. There will be no playdates or sleepovers for my kids, no gatherings in my house for school projects, no hanging out, and no dinners or parties.

4. I will use a separate bedroom and my own bathroom, separate from the others in my home.

5. I will avoid family members who are elderly or others who take care of the elderly.

I am blessed to be healthy. I do not fear getting infected with COVID-19, but I am afraid of becoming a vector. I honor my professional responsibility. I am also aware of my unique social responsibility.

You and I are unique in this pandemic with a high probability of contracting COVID-19. We are needed on the front line. We are the best prepared to help others in emergencies, but we cannot be responsible for more deaths in spite of good intentions.

Unfortunately, as I write this in mid-March, we are uncertain whether we are vectors. This requires fortified personal vigilance to protect ourselves, our patients, our families, our friends, and the friends and contacts of family members.

As soon as possible, we frontline providers need regular surveillance screening so we can take the positive COVID-19 staff out of the line-up and flatten the curve of frontline human resource losses. We cannot afford to lose half of our staff when half of the community is coming to our doors.

Dr. Mosley is an emergency physician in Wichita, KS.

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