Allah (swt) grant you strength in the coming months as you fight this noble fight.
In Ireland, is there a contingency plan to draft doctors from different specialties to potentially retrain and work as support for intensivists? I understand in Italy, this has already happened as their ITUs are overwhelmed. I'm not sure but perhaps they did a bit of this in China too, though they also pre-empted the crisis by moving specialist assets from other provinces into Hubei. Italy was a total shock as I understand.
Sorry for late reply. Yes number of steps have been taken here to ensure adequate staffing, such as
1) All retired doctors, GPs, Nurses ( particularly ICU experienced) , health care assistants have been asked to standby and will be recruited by HSE if needed
2) Since Covid-19 is primarily a medical conditional/infectious disease doctors from specialties like general surgery, orthopedics have been temporarily moved to cover medical teams.
3) All hospital doctors have been divided into Corona (red team) lead by respiratory an infectious disease physicians and non corona (blue team) , the two teams work separately, in order to prevent cross over of infections.
4) Final year medical students would be promoted to interns in May ( rather than July) this will pump more junior doctors into the system. Normally we have 700 interns starting house job in July every year, this year we will recruit 1000 interns. So between April-July we ll have additional 1000 junior doctors at the front line.
5) The Health Service Executive has been "overwhelmed" by people wanting to help in the fight against Covid-19. Interms of volunteering as you can imagine from the news available,
50,000 in three days apply to be 'On Call for Ireland' in response to HSE plea
6) We are training defense forces to help us with a crisis as well. First by tracing a positive case
Coronavirus in Ireland – Irish Defence Forces cadets drafted in to help HSE with Covid-19 contact tracing
The defense forces are also being trained to screen patients.
AT the minute we are happy that we have enough staff and we are ready for future increase needs. Not to mention that Ireland is a small country with a population of only nearly 5 million. But we do have large elderly population that we are concerned about.
This is a needed thread.
I'm in the US in a smaller town in Texas.
This illness will undoubtedly have different effects on the community depending on demographics/location/infrastructure/population health literacy.
Over here its fairly rural but we do have a small airport linking with major TX cities with alot of travellers in this community who frequent Europe and Asia and in fact our positive cases are from these aforementioned travellers.
We attempt to triage these people in a tent outside the physical building with testing and then with either inpatient care or send them home for quarantine.
The issue now I see is perhaps sometimes these patients present with diarrhea or non respiratory symptoms and escape that initial triage screen.
So the question is at what point do you begin to suspect for COVID when now you have respiratory OR GI symptoms and potential community spread.
Thats like half the people coming into the ER?
Exactly we have created a separate ED or respiratory recovery unit RRU for suspected Corona patients. The purpose again is to prevent mixing of Covid-19 patients with the rest. This is what went wrong in Italy and China.
One of the major step we have taken is , if some one thinks he has Corona virus infection and has symptoms of disease, he is advised NOT to come hospital. He calls the helpline, a team is send to his house and swab is taken. While the results of the swab are pending he is kept in self isolation for two weeks. People need to know that if they have flu like symptoms DONT come to hospital.
According to the WHO and what I've seen first hand:
Surgical mask for non aspiration procedure
N95 where available
Face screen with goggles/ where face screen is nor available goggles
Sleeved apron or where unavailable they are using disposable Pinny aprons
Surgical gloves
Arm covers where available
Boot coveres where available
But in reality in Pakistan I have seen doctors with just facemasks and gloves, we have NO PPE, dont let pictures kid you. PAKISTAN is not prepared for this.
View attachment 616073
This is all the PPE one hospital had left in Pakistan.
PPE is important as Doctors , Nurses, Paramedics and hospital are the MAJOR reason for spread of disease. They may have mild symptoms like 90 percent of the people would have, but they transmit the disease to frail elderly people who have multiple co morbidities and are immune compromised.
There are two types of masks,
1) Surgical mask ( That is to be used all time and changed after every patient)
2) N95 masks only to be used if suspected patient is undergoing invasive procedure like intubation.
Centers for Disease Control and Prevention in America recommends,
Instead of recommending that health-care workers use specialized masks known as N95 respirators, which filter out about 95 percent of airborne particles, the Centers for Disease Control and Prevention posted
new guidelines Tuesday that said “the supply chain of respirators cannot meet demand” and that looser fitting surgical face masks “are an acceptable alternative."
Reduce, reuse ==> "Our hospital announced that we were going to have to be reusing our PPE, which the CDC has already released guidance on doing this and trying to do it safely," said the Boston anesthesiologist.
