In their pristine white coats and protective gear, they’re fighting on the front lines of a war, against an invisible enemy. Every day, they risk their lives to tirelessly perform their duties, in the service of the community. They are our modern-day heroes — our fearless front-liners — who wear their courage on their sleeves while saving people who are affected by the ongoing crisis that is the SARS-Cov-2/COVID-19 pandemic.

In this war that we are waging against COVID-19, it is regrettable to say that many of our health-care workers have fallen ill, due to inadequate protection, while being repeatedly exposed to the virus. To prevent them from this peril, the use of personal protective equipment (PPE) is imperative for their safety while they perform direct patient care with possible or confirmed COVID-19 patients, in various healthcare settings.

What is PPE and What Constitutes It?

Personal Protective Equipment (PPE) is specialized equipment used by our frontliners (doctors, nurses and all allied staff) to guard themselves, patients, and other persons within their perimeter, when providing care. PPE helps protect our frontliners from potentially contagious patients, materials, toxic substances, and other potentially dangerous medical exposures.

PPE includes but is not limited to facemasks, gloves, gowns, aprons, goggles, face shields, shoe covers and respirators. The use of PPE does not confer our frontliners total protection and must be used in combination with other precautionary measures such as hand sanitization, physical distance and negative pressure facilities. Additionally, even when available, improper usage of PPE (e.g. taking off PPE while still working or inconsistent usage while working with possibly infected areas or patients) may result in a false sense of protection and possibly lead to self-contamination.

The World Health Organization (WHO) published interim guidance for the rational use of personal protective equipment (PPE) for COVID-19. The interim document summarizes WHO’s recommendations for the use of PPE in both healthcare and community settings. 

Apart from preventive and mitigation measures imposed by WHO, additional precautions are highlighted for healthcare practitioners to protect themselves and prevent transmission in the healthcare setting. Healthcare practitioners who directly or indirectly care for patients with COVID-19 must properly select PPE. They must be trained on how to put on, remove, and properly dispose of said PPE, to evade risks.

COVID-19 is an infectious respiratory condition that is different from other diseases like influenza or Ebola. Because of the differences in transmission, the PPE requirements for COVID-19 are different from those required for other conditions.

According to the University of Nebraska Medical Center, the necessary PPE required for the appropriate care of patients with or under investigation of COVID 19 are non-disposable isolation gown, fit-tested N95 respirator, face shield, eye protection, and patient care gloves. 

The Centers for Disease Control and Prevention (CDC) requires strict adherence to the standard, contact precautions, and airborne plus eye protection for the care of patients with or under investigation for COVID-19.

The Scarcity of PPE

With the continued soaring numbers of COVID-19 cases, front-line medical workers are in distress as PPE shortages currently pose a huge challenge to the US healthcare system. Consequently, many healthcare workers have cried foul as they are forced to deploy creative yet desperate and often inadequate strategies to improvise alternatives for face masks, gowns, gloves, respirators, and eye protection, despite their unfounded efficacy.

Some of them have even had to wear homemade masks, like bandanas and scarves, as alternatives. While these measures may be better than using nothing, in a healthcare setting, these alternatives are no substitute for the protective equipment that frontliners need to stay safe and meet surging patient demand. Although these kinds of alternatives are recommended to keep up with an influx of patients, in an absence of the correct PPE and are outlined in the guidance issued by the US Centers for Disease Control and Prevention, caution should be applied when considering these options. Ideally, homemade masks should only be used with eye goggles and a face shield that covers the whole face, if no alternative (i.e. correct and proven PPE) is available.

Considering all of the new pushes, at the State and Federal level, to reopen the country, and the absence of clear and standardized guidelines and safeguards for the workplace, coupled with our continued poor understanding of the prevalence of this infection in our communities, it is clear that the COVID-19 surges around the country will not be stopping anytime soon. Despite all of our attempts to acquire PPE and support our frontliners, we are now faced with a heartbreaking reality: it still is not enough! 

The crisis in the healthcare system across the United States continues to mount and our doctors, nurses and allied health professionals are being pushed to their breaking points. Resources are still limited in more places than we would like to admit and there continues to be too many sick patients and too few frontliners with adequate PPE to treat these patients.

It is also important to understand that this PPE crisis highlights the probable risk of putting our front liners at risk for SARS-Cov-2 infection and COVID-19 infection; even as we all rely on them, now more than ever, to curb the outbreak. This situation does not only threaten our health care workers’ well-being but it also imperils our US health care capacity and communities, at large. In fact, now is the time that we need to scale up our medical manpower to effectively confront the rise of coronavirus cases before we incite the second wave of infections.