infection-control

I was talking to a nursing friend who works in a large suburban Melbourne hospital emergency department, triaging patients for a particular area. I will call her Angie.

Given the high through-put of patients in the area in this time when we are supposed to be trying to reduce the transmission of coronavirus, I was curious to know what measures her hospital was taking to protect their staff and patients.

ANGIE: "None, as far as I know," she said.

NEUTRINO: "You're not issued with masks for every new examination? You're not wiping down surfaces with alcohol or sodium hypochlorite, with every new patient? You are not even wearing gloves? You're not screening people in the waiting room for high temperatures?"

ANGIE: "That's right," she said, and laughed, as nurses do when they acknowledge helplessness at the behest of universally absurd hospital systems.

NEUTRINO: "Are they discussing policy with you, at least?"

ANGIE: "We get emails from them from time to time."

NEUTRINO: "Emails saying what?"

ANGIE: "Oh, just the number of infections in the state and the country."

NEUTRINO: "Do they tell you where they infections are and which hospitals are looking after them?"

ANGIE: "No."

NEUTRINO: "Then you're not getting any more information than the general public does from the news?"

ANGIE: "I guess so."

NEUTRINO: "Are you going to cancel your trip to Japan?"

ANGIE: "Probably, although it seems to me we may be in more danger here. At least the Japanese have cancelled most of their public festivals and tourism attractions."

NEUTRINO: "They have also closed all schools and universities."

ANGIE: "Yes."

NEUTRINO: "Ambivalence rules infection control in Australia. For instance, in Sydney, one school where there was an infected pupil reopened a few days later, and the day it reopened, another closed with two infected pupils."

ANGIE: "So, would you like to meet for coffee at the Italian restaurant on my days off?"

NEUTRINO: "Please don't take this personally, but I'd rather we keep it to telephone conversations for the time being."

ANGIE: "I don't take it personally at all. I don't blame you. Telephone is fine."

NEUTRINO: "Good.

ANGIE: "Although we could meet for coffee on the terrace of the Italian restaurant."

NEUTRINO: "How about we meet on a bench on the beach, and I'll bring a thermos."

ANGIE: "Okay, but I'll get my coffee from the restaurant."

Here is the case for wearing masks whether you are infected or not. In my opinion, people should proceed as if they are infected and wear a mask in order to protect others in the community. Waiting until you are infected is like closing the stable door after the horse has bolted. None of us know when or if we are infected until/if symptoms arise and are tested. We could be infected without ever knowing. If we all wear masks (and gloves) in public we can substantially reduce infection risk. Official support for this would help us to overide embarassment or the stigma involved in initiating a new public behaviour. Shop owners and other businesses with a public interface can reassure the public by offering masks and gloves at the entrance, and keeping alcohol wipes close to cash registers and electronic keypads, and wiping them with every use or making sure that customers wipe them with every use (and wait 10 minutes between uses).

In Australia and in many western countries, the public have been advised that they should not wear a mask unless they are infected. The explanation is that a mask helps to prevent droplets escaping from an infected person, and that it will not protect an uninfected person from other unmasked peoples' droplets. The problem is that people cannot know whether we have been infected and will only find out if they become ill or are linked to a known infected person and thence formally diagnosed. So if we behave as if we are infected, and wear masks, we will be increasing public safety by reducing droplet transmission through use of the mask as a barrier. We need to be careful when we remove the mask; we should avoid touching the exterior and abrupt movements that might dislodge droplets from the outside. See third video at the end of this article.

Most of us realise there is a logical dissonance in the advice we are receiving about masks. Some of us think this is because of the shortage of masks. The government should be ensuring local manufacture and distribution of quality masks. Unfortunately it is unlikely that really effective masks will become available to the general public - due to problems of supply as much as policy.

In the meantime, it is possible to make relatively effective masks to prevent the spread of infection, as in the first video. These are basically absorbent barriers and last 2-4 hours. The second video evaluates different kinds of mask, notably the N95 mask (which excludes up to 95% of particles). The third video explains how to use and remove a commercially manufactured N95 mask.