Investigation indicates that cough is more dangerous for medical workers of Covid-19 than intubation

“It’s a big mistake,” he said.

The growing number of studies showing the distribution of covid-19 aerosol during choir rehearsals, in a bus, in a restaurant and at gyms has attracted the public’s attention and led to a wide interest in better masks and ventilation.

But a wide range of experts have long insisted that N95s be reserved for those performing aerosol-generating procedures and that it be safe for front-line workers to care for patients with less protective surgical masks.

The CDC says in an email that N95 “respirators have remained preferred over face masks in caring for patients or residents with a suspected or confirmed” covid “, but unfortunately respirators are not always available to healthcare professionals due to lack of supplies not.”

When highly contagious, such patients emit three times as many small aerosol particles (about a billion a day) as younger people. A sick super-distributor who just breathes can pose as many risks to health care workers as a cough patient, said David Edwards, an associate of the Harvard Faculty of Bioengineering and author of the study.

Chad Roy, a co-author who studied primates with covid, said the emitted aerosols shrink in size when the monkeys are infected at about six days of infection. These particles probably hang in the air longer and are easier to inhale deep into the lungs, said Roy, a professor of microbiology and immunology at Tulane University School of Medicine.

The study explains the serious risks facing nursing home workers, of whom more than 546,000 people got covid and 1,590 died, according to reports submitted to the Centers for Medicare & Medicaid since mid-May.

Collectively, the research indicates that on-the-job exposure in healthcare was “much greater” than what the CDC defined when it gave priority to those who protect “aerosol-generating” procedures, said Dr. Donald Milton, who reviewed the studies but was not involved in any of them.

“The result is that it’s inhalation ‘of small particles into the air that leads to infection, says Milton, a professor at the University of Maryland School of Public Health who studies how respiratory viruses are spread,’ which means loose surgical masks is not sufficient. . “

More than half of the deceased workers whose occupation was known were nurses or in supportive roles in health care. Such staff members often have the most extensive patient contact, caring for their IVs and turning into hospital beds. brush their hair and sponge them in nursing homes. Many of them – 2 out of 3 – were colored.

Two UK anesthetists – doctors doing intubations in the ICU – are seeing data showing non-ICU workers dying at excessive doses and have begun to question the idea that ‘aerosol-generating’ procedures are the most dangerous.

But the investigation never took place before covid-19 emerged, Cook said, and the main differences between SARS and covid-19 emerged. In the first outbreak of SARS, the patients were infected at the moment when they arrived at a hospital in need of intubation. But for this pandemic, he said, studies in early summer began to show that peak infestation had occurred days before.

Brown said the initial shortage of PPE led to rationing and sent the best respiratory protection to anesthetists and intensivists like him. Now that it is known that emergency and nursing home workers are also at extreme risk, he said, he cannot understand why the old guidelines largely exist.

“It was all a big house of cards,” he said. “The foundation was shaky and I think it all fell apart.”

A CDC spokesman said in an email: “We are encouraged by the publication of new studies aimed at addressing this issue and better identifying what procedures in healthcare settings can generate aerosol. As studies accumulate and findings repeated, CDC will update its list of procedures under consideration [aerosol-generating procedures]. “

Cook also found that doctors who do intubations and work in the ICU have a lower risk than those who worked on general medical floors and encountered patients in earlier stages of the disease.

A patient who was tested for two consecutive days – with negative results – developed the virus and infected numerous staff members and patients. Among them were two patient care technicians who treated the patient while wearing surgical masks and face shields. Klompas and his team used genome sequencing to connect the sick workers and patients with the same outbreak.

The guidelines’ strong focus on the dangers of “aerosol-generating” procedures has led hospital administrators to assume that those in the ICU become ill at work and those working elsewhere are exposed in the community, said Tyler Kissinger, an organizer of the National Union, said. health workers in Northern California.

“What plays out there is the difference in whose exposure is taken seriously,” he said. “A phlebotomy or environmental service worker or nursing assistant with patient contact – only with a surgical mask and not an N95 – is not considered exposed. They had to keep coming to work.”

“I think it’s pretty obvious that we did a very poor job of recommending adequate PPE standards for all health workers,” she said. “I think we missed the boat.”