"I feel like I'm in some kind of movie where you are screaming for help and nobody is understanding you. Coming to work every day fills me with overwhelming dread."
These are the words of a nurse anesthetist who works at a large hospital in the Northeast. (She asked that her name and precise location be withheld, because she fears losing her job.) Her darkest fear right now, she said, is that she'll unwittingly contract the novel coronavirus and bring it home to her family.
"I only go to work and home because I'm afraid I'll be exposed or a carrier at any time without knowing," she told VICE. "I'm a hazard to my friends and family. I am not seeing any of them. I feel completely isolated."
She's tried, she said, to take some bleak comfort in statistics. "I know statistically it's almost impossible that we both will die," she says, referring to herself and her partner. "But life is so grim for us in hospitals right now. And it's only the beginning."
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It's understandable that medical professionals in the age of coronavirus are stressed and fearful, but this person occupies an unusual position. She doesn't work in an emergency department, which are being strained to the breaking point all over the country by coronavirus cases. But as someone who administers anesthesia—even for patients who aren't known to be infected with COVID-19—she's at extraordinarily high risk, and one of the people most affected by the nationwide shortage of masks and personal protective equipment (PPE).
Anesthesia providers, including physicians, nurse anesthetists, and physician assistants, are on one of the hidden front lines of the coronavirus pandemic. Administering anesthesia, a common procedure, puts these medical providers at risk of coming into contact with aerosols, fine mists of suspended particles that come from the patient's throat and lungs. Also dangerous: any "aerosol-generating procedures," broadly defined as anything that might induce coughing and produce aerosols, like intubating and extubating a patient. Those respiratory droplets are thought to be the primary way that coronavirus is transmitted.
"Certain specialties are at the highest risk," explained a board-certified anesthesiologist in New York, who also asked that his name be withheld. "That includes emergency room doctors and critical care intensivists, because they manage many of the ICU units where there are patients on ventilators." As for anesthesiologists, he said, "We are experts of the airway. We manage the airway for surgeries, and we help in intubating patients who need respiratory support." This puts them directly in the path of COVID-19.
The sickest coronavirus patients have needed to go on ventilators to help them breathe when they're unable to do it on their own. (These devices are running short all over the country.) Anesthesia providers know that as more cases develop—and as more of them become serious, requiring hospitalization and intubation—"we may be called in to help much more," the New York anesthesiologist said. "We're at the front lines for sure. We're literally looking at coronavirus as we're managing the airways. We definitely need to have the proper protective equipment."
Medical providers who are routinely exposed to aerosols, in other words, are painfully aware of their terrifying levels of risk. In several secret Facebook groups, they're coming together to try to figure out how to reduce their exposure, keeping themselves and their patients safer, all while dealing with a supply shortage unlike anything they could have ever imagined.
"It's very common for people to post, 'What are we going to do? How are we supposed to take care of patients if we don't even have the proper amounts of N95 masks or other PPE, how can we be doing this safely?" a nurse and anesthetist who works at a community hospital in Ohio told VICE, describing one Facebook group for anesthesia providers. "Some people say, 'Should I even come to work?"
The CDC recommends that in order to perform any aerosol-generating procedure, medical professionals should wear N95 masks, eye protection, gloves, and a gown. That's not happening right now, due to the nationwide shortage of N95s and other medical equipment.
"Anesthesia providers all over the country discussing on a shared Facebook group how to fabricate your own respirator because we are not being given any," the nurse anesthetist in the Northeast told VICE. The CDC loosened its face mask guidelines earlier this month, stating that in the absence of N95s, "facemasks are an acceptable alternative when the supply chain of respirators cannot meet the demand." During that time, the agency added, "respirators should be prioritized for procedures that are likely to generate respiratory aerosols, which would pose the highest exposure risk" for healthcare professionals. Gowns, too, "should be prioritized for aerosol-generating procedures," the CDC added, "care activities where splashes and sprays are anticipated, and high-contact patient care activities that provide opportunities for transfer of pathogens to the hands and clothing" of medical professionals.
Those guidelines strike many healthcare professionals as insufficient. "They just amend the guidelines to suit what hospitals want, despite all of the data we have about transmission," the nurse anesthetist said.
"We have a duty to take care of patients," the Ohio anesthesia provider told VICE. "It's really important to be able to do that." And so, he said, he's doing what so many other medical providers are doing, all over the country and all over the world: He's figuring out how to make his own mask, something he's stunned he has to do.
"This is America," he said. "It's not a developing country. This is just showing how flawed everything is." For himself, he found a mask left over from a household painting project—a P100, usually only used for industrial work—and started wearing it. "I found a respirator in our house and cleaned it off," he said, "and I made sure the filter is appropriate and started wearing this mask two days ago."
Other medical professionals, he said, have discussed stuffing tissues into a cloth mask to make it more particle-resistant. "Or cutting apart furnace filters or putting them in the mask. Vacuum cleaner bags. And some people, like myself, have looked at respirators like painters wear or people who remodel houses." They've also discussed using plastic masks, usually used to help patients breathe before they're intubated, and putting HEPA filters on them that are normally placed between the disposable ventilator circuits for each patient and the machine. (The Ohio professional gave permission for VICE to use a photo of him wearing his self-sourced mask: "It conveys the seriousness of the situation.")
While there have been a number of grassroots groups springing up to sew masks for healthcare workers, that won't work for anesthesia providers and others who come into contact with aerosols. They need N95s, at the very least, and the only way the public can help make those available is not to hoard them.
"Don't buy the masks," the Ohio anesthesia provider said. "If you have N95s at your house, donate them to the hospital." Government officials are asking companies to do the same, particularly fields that sometimes use respirator masks, like nail salons, woodworkers, and autobody shops, among others. The website GetUsPPE was launched by a group of physicians to call attention to the desperate shortage of masks and other protective gear, and it contains resources for how you can donate a mask in your area. There are also instructions on how to 3D print N95s from Copper 3D, a manufacturer of 3D printing materials.
"Laypeople don't need N95s, people who are at most risk do," the Ohio provider added. "If you spread COVID to a healthcare provider, it can also go to their families. If healthcare providers get sick, who's going to care for the patients? If healthcare providers are working beyond their normal hours and are exhausted, their immune systems might be exhausted and they might be more susceptible to COVID patients."
Despite all of this, healthcare providers aren't planning to stop going to work.
"We will continue to show up despite this," the medical professional in the Northeast told VICE. "All of us."
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