Amid the Coronavirus Crisis, A Regimen for Re-Entry
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Health-care workers have been on the job throughout the pandemic. What can they teach us about the safest way to lift a lockdown? Here's an article by Dr. Atul Gawande, a general and endocrine surgeon.

"In places around the world, lockdowns are lifting to various degrees. Experts have identified a few indicators that must be met to begin opening nonessential businesses safely:
• Rates of new cases should be low and falling for at least two weeks;
• Hospitals should be able to treat all coronavirus patients in need; and
• Capacity to test everyone with symptoms.

But then what? What are the rules for re-entry?

The five pillars of combination therapy of hygiene measures, screening, distancing, masks, and culture to stop coronavirus; when taken together, and taken seriously, can shut down the virus. We need to understand these elements properly if we’re going to make them work outside health care.

1. Hygiene

The key is washing or sanitizing your hands every time you go into and out of a group environment, and every couple of hours while you’re in it, plus disinfecting high-touch surfaces at least daily.

2. Physical distancing

We have all now learned the six-foot rule for preventing transmission of contagion-containing droplets. In my hospital system, observers gently remind us to stand the prescribed distance apart on escalators and in the elevator line; turned many internal meetings, patient visits, and team huddles into video meetings, even if someone is right across the hall. But, the six-foot rule goes a long way to shutting down this risk.

3. Screening

At the right point in the illness, under the right environmental and social conditions, one person can produce a disaster. Hence, the practices adopted by my health system, to institute daily screening of all employees, patients, and visitors for symptoms of covid-19. Any time I want to enter a hospital building, I have to log in and confirm that I have not developed a single sign of the disease—a new fever, cough, sore throat, shortness of breath, loss of taste or smell, or even just nasal congestion or a runny nose. Otherwise, I can’t work. This self-screening is obviously far from foolproof.

4. Masks

That’s why we combined distancing with masks. They provide “source control”—blocking the spread of respiratory droplets from a person with active, but perhaps unrecognized, infection.

Cloth and surgical masks do not fit tightly. You can breathe air coming in around the sides & are designed to safeguard others, not the wearer. The basic logic is: I protect you; you protect me. N95 respirators designed to fit tightly around the nose and mouth, so that the air you breathe comes entirely through the mask, not around it. I protect you and I protect me.
But supplies of N95 are scarce even in hospitals, so we reserve N95s for respiratory therapists, intensive-care staff on covid-19 units, and other clinicians whose work exposes them to high levels of airborne sars-CoV-2.

5. Culture

It’s one thing to know what we should be doing; it’s another to do it, rigorously and thoroughly. People tend to focus on two desires: safety and freedom; keep me safe and leave me alone. We need both staff and residents—to embrace is the desire to keep others safe, not just themselves. That is the culture of the operating room. It’s about wanting, among other things, never to be the one to make someone else sick.

The combination therapy isn’t easy. It requires an attention to detail that simply staying in lockdown does not. There is still much more to learn, such as whether we can safely work at less than six feet apart if everyone has masks on (the way nurses and patients do with one another) and for how long. But answers will come only through a commitment to abiding by new norms and measuring results, not through wishful thinking."

Dr. S●●●●y M●●●●●●●●i and 12 others like this11 shares