Confusion and Unease. That's what I would say is going on now out here in EMS land.
First the government told us we had to wear N95 masks when faced with a potential COVID patient. Then we were told a simple face mask was fine. The CDC then issued more revised guidelines that defined risk, saying as long as you did not have "prolonged contact" with a patient without wearing a mask, you were okay.
Interim U.S. Guidance for Risk Assessment and Public Health Management of Healthcare Personnel with Potential Exposure in a Healthcare Setting to Patients with Coronavirus Disease (COVID-19)
Now a hospital in our area has defined prolonged contact as 15 minutes. They are saying, if you are without a mask for the first fifteen minutes, it doesn't count as an exposure.
Read this for yourself:
Once on the scene, and as soon as possible, a patient with suspected infection as per the most current CDC recommendations and guidelines should be provided with an isolation (surgical) type mask to wear. Responders should likewise don an isolation mask. If an isolation mask is worn by EMS providers within 15 minutes of initial contact, they will not be considered as having been exposed even with contact to a patient who has tested positive.
Where does that 15 minutes come from? What science is that based on? Are they saying it takes 15 minutes of exposure for someone to get COVID? We can get coughed on and respiratory dropletted upon for up to 15 minutes and we will be okay? Come on.
We have also heard that at several services, even if you are exposed, you should keep working until you are symptomatic, even though it is known you can spread the disease on to others before you yourself show symptoms.
Many people are angry about this relaxing of restrictions because the relaxing seems more linked to the supplies and the need to keep a sufficient health force working than true safety.
Add that to our understandable paranoid belief that EMS worker safety might not be the top concern with higher ups and throw that against the onslaught of news describing the terrors of COVID, "the perfect killing machine," and people are rattled.
Here is what I believe:
Most Americans (70-80%) are going to get COVID eventually. (This includes many who have or have had it or will get it and not know.)
The effort at social distancing and closings are geared to flatten the curve (spread the sickness out over time) and keep the health care system from being overwhelmed, enabling it to save more COVID patients as well as other sick patients who will need ICU level care.
These efforts will fall short, but will be better than no effort at all.
We will have a true period where the shit hits the fan. Likely beginning in May.
The ever changing guidance to EMS reflects the need to find a balance between safety and not exhausting the supply of PPE and the supply of EMS responders. If you insist on the proper level of safety, too many of us will have to be self-isolated and there will not be enough PPE to make it through.
We are given a limited supply of PPE and told to only put it on when we encounter someone with a fever and symptoms of respiratory illness and possible contact with a positive patient. Yet we walk into a hospital and everyone is wearing masks, everyone except EMS. You see pictures in the paper of nurses gowned up in space suits to do COVID testing, wearing full body gear that looks nothing like the paper napkin gowns they give us for the most extreme cases, a gown that in my case doesn't even reach my knees. You can see why people feel uneasy.
Many like me are resigned to getting it. I hope that my 15 day January/February illness was COVID, but I fear waking up each morning with a raging fever. I'm 61 and am in good health for the most part. I have read enough to understand most of those dying are old and with comorbidities that I do not have. I want to work. I love being a paramedic, and have always been and am still willing to be on the front lines. Like those I work with, I will take the risk. Just be honest with us about them.
For many more posts on the COVID epidemic, go to:
Street Watch: Notes of a Paramedic