It’s clear that the people with the chronic conditions caused by obesity and those who are confined to nursing homes because of chronic sedentary neglect are at the highest risk. I started this blog several years ago to help my patients with weight loss (as you can see from the other posts), but right now I sit at the beginning of this insane time and I’m right at the front of it all waiting for the onslaught. I work as an ICU doctor and, based on all the reports, this disease puts lots of people in the ICU.
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My COVID Journey 
thank you for sharing. Hope you have a speedy recovery and can resume helping the humanity survive this. Igor Meystelman (Machon Yaakov 2005-2006)
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Dr. Dan,
I’m sorry to hear that you have it, that you have to suffer through the symptoms and the isolation, and that you can’t be there helping those on ventilation etc.
Wishing you a refua sheleima. So like you to turn your experience into public service.
Get well soon!
Julie Merrill (formerly Julie Dubosky)
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Hi Dr. Grove,
I am a Med-Surg nurse and during my hospital’s virtual Town Hall Meeting on Friday, I posted the following question: Why are hospitals currently recommending the use of face masks over N95 respirators when caring for confirmed or suspected COVID-19 patients during non-aerosolized procedures? There wasn’t enough time for my question to be answered so I forwarded the question and the information that follows in an email to the IDs at my hospital. While I await their reply, I was wondering if you have any thoughts on this subject?
When you have a chance, please take a look at this statement from the CDC, which was updated on 3/10/2020.
“Respirator or Facemask
Put on a respirator or facemask (if a respirator is not available) before entry into the patient room or care area.
N95 respirators or respirators that offer a higher level of protection should be used instead of a facemask when performing or present for an aerosol-generating procedure (See Section 4). See appendix for respirator definition. Disposable respirators and facemasks should be removed and discarded after exiting the patient’s room or care area and closing the door. Perform hand hygiene after discarding the respirator or facemask. For guidance on extended use of respirators, refer to Strategies to Optimize the Current Supply of N95 Respirators
If reusable respirators (e.g., powered air purifying respirators [PAPRs]) are used, they must be cleaned and disinfected according to manufacturer’s reprocessing instructions prior to re-use.
When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators for patients with known or suspected COVID-19. Those that do not currently have a respiratory protection program, but care for patients with pathogens for
which a respirator is recommended, should implement a respiratory protection program.” https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html
Essentially, the CDC is stating that N95 respirators should be worn when caring for confirmed or suspected COVID-19 patients, regardless of the patient receiving an aerosolized procedure. From my understanding, the reason they are currently recommending face masks is because there is a shortage of N95 respirators, not because face masks are adequate protection.
Below is additional information from the CDC (2/2020) and the New England Journal of Medicine (3/17/2020) noting the virus could be airborne and not droplet, which would make it essential to wear N95 respirators to protect ourselves and our non-infected patients, co-workers, and community members.
https://stacks.cdc.gov/view/cdc/85187?fbclid=IwAR2_t10yvQnUliy4xSGmrXneOm9uA2RA1vltEvTpxEBVydcQh6CONZFp3I8
https://www.nejm.org/doi/10.1056/NEJMc2004973?fbclid=IwAR2XddmG6ektE6cr3kRpoHzIywFOcViKil4jjanYhXEgxnZQyXfO6u05UZ0
I understand this situation is constantly evolving and it may be out of our hands due to the shortage of N95 respirators, but isn’t it better to try to obtain more N95 respirators, then to risk healthcare professionals and subsequently more patients becoming infected with COVID-19?
I will continue to follow your journey and I hope you get well soon.
Thank you,
Arielle
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Hi Arielle,
Thank you so much for the question. The reason is that it is not clear that the virus is effectively transmitted through aerosolization during routine interactions since it mostly inhabits large droplets. The data suggesting it can be aerosolized but was under artificial conditions that simulated close contact during an aerosolizing procedure.
The main concern is that, if every patient who has suspected or even confirmed COVID19 required staff to use an N95 mask they would run out rapidly and not be available for high risk aerosolizing procedures. Because of the above the risk to benefit ratio of using an N95 (since a surgical mask is most likely sufficient) does not favor using the masks. The CDC expresses this in the fact that they have different recommendations depending the levels of supplies.
The bottom line is that in confirmed positive patients a surgical mask, gown, and gloves is most likely sufficient as of now. More important than the mask is the fact that many healthcare workers are not putting on and taking off PPE correctly which is a greater risk to them. Pass this video around work to help decrease risk: https://youtu.be/bG6zISnenPg. Keep up the good work and stay safe!
Dan
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I hope that this reply finds your health improving. Your writings are very clear and understandable to us who are non-medical people. I have a number of questions. First, what constitutes “recovery”? Secondly, when someone recovers from Covid-19, does that person have immunity? How would that immunity be measured (I am thinking by a blood test similar to the titre for tetanus immunity?) Thirdly, if you had immunity, when you recovered, would you be able to treat patients without protective gear?
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Good Shabbos Neighbor!!! May next week offer you a FULL and COMPLETE recovery and reentry to the world of helping others!!!
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Feel better, Dr. Grove.
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Already back to 100%, thanks!
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100%? I am glad for your recovery. I have a couple of topics that are somewhat related, I think, about which I would like your comment. First, the importance of widespread general testing amongst the general public. Why do that and what do we learn from that? Secondly, it has been reported without any data that not everyone who is exposed to coronavirus gets the disease, even those who are within the 6 feet zone of someone who is later diagnosed. Why? Is there something that we can and should learn from people who are exposed but who not get the disease that is useful for us to prevent the spread of coronavirus? Thanks.
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Widespread testing would allow us to find asymptomatic individuals who were exposed but not sick. They spread the disease without knowing. If we could find them we could isolate them more strictly and slow the spread.
Why some people get the disease and other don’t is not known. It could be that there is a large quantity of asymptomatic people that are being missed. This would be found if exposures were tested more frequently.
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