Updated: Apr 5
The purpose of this post is to provide further instruction how as to how physicians can manage their own personal supply chains of Personal Protective Equipment (PPE). Unfortunately, this is necessary for several reasons including lack of understanding of how the virus can spread in the hospital setting, the slow response of health system authorities in recognizing and controlling risk to health care workers, and deficits in the health system supply chain that deny proper PPE that is often available at reasonable cost to those willing to take responsibility for themselves and ultimately their loved ones at home.
In spite of practical evidence from countries successful in controlling the COVID-19 challenge, where much higher levels of hospital worker PPE have been the rule (notably South Korea and Singapore), it has been only recently that authorities in the U.S. have acknowledged that the “droplet spread dogma” is deficient in recognizing that aerosolized MICRO droplets produced by talking or even by just breathing can spread the virus. This was recognized by Dr. Harvey Fineberg, former Dean of Harvard School of Public Health and chair of the National Academy of Sciences' Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats in remarks to the WHITE HOUSE this past Wednesday April 1, 2020, and is vividly documented in the video above from Japan. Other, published reports have pointed to this additional route of transmission (van Doremalin, NEJM, Ong et al, JAMA).
What the "air transmission" notice to the WH does is provide you with more support by regulators such as the Joint Commission primarily. Physicians, we believe you need to aggressively manage your own PPE personal supply chain on an advance 6 week rotation. Don't expect bureaucracies of any kind to be able to act fast enough, let alone understand how to assign the correct PPE components to risk levels accurately. This is a novel virus. Who can you trust to understand novel threats? It takes a risk management mindset.
According to OSHA, nurses, doctors, lab and morgue workers make up the highest risk groups out of all occupations for COVID-19 exposure. https://www.healthcaredive.com/news/healthcare-worker-safety-complaints-COVID19/575219/
To be super clear, I do not believe that bureaucracies on either the private or public side can act in time or accurately enough relative to accurate PPE requirements for real risk levels. This is especially in order to manage those of you who are either working in high risk "hot zones", doing high risk procedures, or are high risk yourselves, including being near or over 60 or have diabetes etc.
This is why we developed this guide for YOU to be able to assess and assign and manage your own risk according to well understood Biosafety levels I-III; including what to buy according to your risk level, and how to buy it.
Many of you reported items being sold out when shopping online. This is where individual planning, persistence, and personal supply chain maintenance become key.
It might be too late for more "official" supply chains; though it's not too late for MD’s to manage their own PPE "personal supply chains". We outlined exactly how to do that here & now the Joint Commission backs you up. I hope it helps you and some of your loved ones.
Dr. Art Douville used to oversee infection control governance at two hospitals. We worked together on a risk assessment & management plan at both the individual and proposed system level (please request if you need). We got some questions from many of you.
Question: What if the PPE item Is Sold Out?
Answer: Things always coming on and offline on Amazon. We advise that you make a wish list even if things are sold out. This is so that you have memory of what the items are called, the specs etc. You can continually do new online shopping Amazon searches for anything needed. We advise this to be done on a 3 month rolling basis for a 6 week shipping requirement; all who have followed this have what they want.
Question: If I can't nail the perfect PPE ensemble, does that ruin it and should I just forget it?
Answer: No: the impact of the disease is also dependent on exposure to total viral load. No one is "perfect at PPE". We all need to continue learning how to and become better over time, at managing different types of risk. Managing your own PPE logistics and supply chain, and skills will be an ongoing learning curve. It's best to manage what you can don and doff perfectly and keep practicing and incorporating PPE elements until you can flawlessly don and doff the level appropriate to your risk level.
Question: How do I know what PPE levels I should plan for?
Answer: MD’s can use guidance in this post to calculate what you need. Dates in the post for quoted ship dates are from days ago. Please also look in the comments of the post for understanding & assigning your specific Biosafety risk level I-III. Use this image for visualizing risk level PPE guidance.
Note: It is our view that all physicians where the following factors are present should START at BSL2 :
-have a pre-existing condition such as asthma or diabetes
-is at or near age 60
-lives with someone who has a pre-existing condition or is near or over 60 years old
-working in a "hot zone"
-does ANY work requiring close proximity to patients (because most carriers are asymptomatic)
Question: Can Only Medical Professionals Buy PPE?
Answer: There are appropriate limits online for hospital grade specific equipment such as PAPR (powered air purifier respirator) and 3M branded N95 masks. However, many common sense items are available to the public. For example, Asian countries manufacture and sell KN95 masks (differentiated by the K in front) which don't have the same regulatory approval as the U.S. N95 but have rough equivalence. There is also the ability to buy goggles, hair covers, and things that all high risk individuals (or those that live and care for them) can buy. We list what you should buy according to your risk level here.
By: Sherri Douville CEO & Board Member at Medigram, Inc. Prior to her current work in the mobile privacy, security, health IT and AI industry, Sherri worked in the medical device industry consulting on the areas of physician acceptance and economic feasibility of medical devices. Prior to that, Sherri worked in Field Marketing, Sales and as a National Sales Trainer for over a decade in over a dozen disease states; including with a variety of respiratory infections and treatment. During that time, she leveraged her multi-disciplinary STEM background to help physicians understand the microbiology behind the sensitivity and effectiveness of specific and different pathogens to a range of anti-infective agents
Dr. Art Douville, CMO at Medigram and Attending Neurologist. In addition to practicing Neurology, Dr. Art Douville has held several leadership and administrative positions in healthcare including helping physicians understand and leverage the data by which they're measured. He also has experience as a hospital Chief Medical Officer for two separate health systems. He oversaw both infection control and biohazard governance in hospital environments. Dr. Douville has expertise in clinical integration and was recently Regional Vice President/ Chief Medical Officer at Verity Health System. In this position, Dr. Douville oversaw physician relations, patient safety & quality, regulatory compliance, and the development of innovative clinical programs. He was part of the leadership team to spearhead bundled payment and Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiatives. Dr. Douville has over a decade of experience leading physician culture and developing leadership, performance improvement, regulatory compliance, clinical process design and implementation, as well as physician alignment.