I have an N-95 mask.  Because one of my partners had the foresight to buy a pack on amazon a few weeks ago.  

The shortage of protection for doctors and nurses and people taking care of patients is real.  The DMHC maintains that patients may be offered virtual visits, but if they request to be seen in person they must be accommodated.  #flattenthecurve except for us.  And them.  There are reasons that patients need to continue to be seen by an orthopaedic surgeon in person: new fractures, infections, tendon injuries are a few examples.  But knee arthritis and trigger fingers can wait until the other side of this pandemic crisis.  We can guide effectively over the phone.  

My office is full of people making phone calls and fielding video visits, answering emails and messages.  We are trying to keep orthopaedic patients out of the emergency room and urgent care.  We are doctors and nurses working to serve our patients while we help #flattenthecurve.  

The medical field is short on supplies.  Specifically, gear that protects us as we take care of patients is running low and even being rationed.  We have learned from China and Italy that doctors and clinicians who are not protected get sick.  And then we can’t safely take care of patients anymore.  

The construction industry has begun to voluntarily donate their N-95 masks.  My husband just received an email on behalf of a local Children’s Hospital asking for mask donations (he is on an email list for builders).  Nail salons are being asked for their masks.  Yes.  Nail salons.  

Times are scary and unprecedented.  We were down to ONE roll of toilet paper in my home.  I did a back alley trade for wipes with one of my partners, and we now have enough for the week in my house.  The world is upside down.  Gloves and our short supply of sani-wipes were swiped from our patient exam rooms, and are now under lock and key.  

Like any team that works hard in close quarters, our team of doctors, nurses, orthopaedic techs, medical assistants, and others usually bicker and quarrel a bit.  But not this week.  This week we stand together, have each other’s backs.  We check in on each other.  True colors are coming through vibrantly.  But know this.  The front lines are scared.  We want to trust that we are taking whatever means possible to keep ourselves and our families as safe as possible in unsafe times.  And with the shortage of protective gear we know this is not possible.  

The evidence changes on us every day.  Is the virus airborn?  Do we follow workflows and safety procedures for “droplet precautions?”  This means that the virus spreads through droplets from our noses and mouths, and spreads with coughing and sneezing in addition to  touching. For example, MRSA usually spreads by touch, so hand washing is very effective.  The CDC tells us that Covid-19 spreads “through respiratory droplets produced when an infected person coughs or sneezes.”  (cdc.org)  This mainly happens when patients show symptoms, but the virus is also thought to be transmissible before people have symptoms.  The World Health Organization is considering results from a new study showing that the virus can stay suspended in the air in some states of humidity and temperature.  (cnbc.com)  This would increase precaution recommendations to “airborn”.  

Most front line physicians and nurses and clinicians cannot get an N-95 mask, the kind that protects pretty well (95% of the time), unless we are doing a procedure around an airway or secretions.  Right now the evidence is NOT clear.  We do not know if Covid-19 can live in the air.  If it turns out that it does, we are not equipped to protect ourselves.  

We function with a lot of “just in case” precautions in the hospital.  We wear masks and caps and gowns to protect patients from us and us from patients.  The data is not clear that the lengths that we take on a routine basis are necessary.  But an abundance of precaution is our culture, and we are proud of that.  Today we just don’t know.  The evidence is not clear.  But I do know this, we do not have the supplies to support us in an abundance of precaution.  Just like in China and Italy and Seattle, doctors and nurses and front line medical professionals will get sick.  And if we go down, there won’t be enough people to take care of everyone else.  We are here.  We are working.  We are following our moral and ethical obligation and sworn oaths.  We know that we are not protected.  We want you to know too.  So that you can help us by social distancing, supporting our efforts to obtain protective gear, and flattening that dang curve.  

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