World Health Organisation (WHO) announced that the COVID-19 outbreak as a Public Health Emergency of International Concern on 30 January 2020 after more than a month of the first case documented in Wuhan, China in November 2019. Initially, most cases were reported from China and among individuals with travel history to China. At this point, COVID-19 confirmed cases are reported from 198 countries and territories around the world and one international conveyance. It was declared a pandemic by WHO on March 11, 2020. As of 28 March, COVID-19 cases reached whooping 597,458 with 27,370 deaths. The number of cases in USA is 104,256 with 1,704 deaths, Italy 86,498 with 9,134 deaths and China 81,394 with 3,295 deaths (Worldometers.info, 2020). Spain has already the second-highest number of deaths after Italy with 57,786 cases registered and 4,365 deaths so far. Among Asian countries, Iran recorded 32,332 cases with 2,378 deaths. Nepal has registered only five cases and among them, one is already recovered and no fatality reported as yet (Worldometers.info, 2020). Spain has already the second-highest number of deaths after Italy with 57,786 cases registered and 4,365 deaths so far.
Scenario There are different levels of healthcare institutions. Depending on the level of the health centres, different levels of health manpower work. The need for personal protective equipment (PPE) varies depending on the type of service provided. Health workers in the Intensive Care Unit need different protection than people working in different wards, pharmacies or labs. Higher protection is needed in places where chances of acquiring infection are greater. In Nepal, the public sector comprises a total of 32,809 workers, with the health management and support staff group (cleaners, ward helpers, and other non-clinical support workers) the largest group (33 per cent) followed by co-medical practitioners (26 per cent). Whereas in the private sector, 21,368 health workers were documented with the largest group being nursing professionals. Sixty per cent of all doctors and 80 per cent of all pharmacists were employed in the private health sector (MoHP, 2013). Personal protective equipment (PPE) includes gowns, gloves and eye protection (goggles or face shields, not personal eyeglasses or contacts) besides the face mask. At this point, authorities do not suggest face masks for healthy individuals, who are not at risk. Health care workers caring for patients with the 2019-nCoV are at high risk of contracting the disease. Among the deaths, many were healthcare professionals and thousands of workers contracted COVID-19 resulting in a severe shortage of already scarce health manpower at this crucial juncture. It has been found that the use of a surgical mask provides minimum protection only and sometime it may even increase the risk of spread disease owing to a false sense of security. These masks protect pathogens from the surgeon’s mouth and nose entering into the surgical field. Therefore, appropriate use of the mask is important in containing the spread of this virus.
It is difficult if not impossible to find a face mask that fits perfectly around our mouth and nose and makes us safe for a long period of time. We lose the protection the minute we scratch our nose or touch our mouth behind the mask. The face mask, however, may protect us from droplets when an infected person coughs or sneezes. It is recommended that the people who already have the infection or are at high risk of being exposed should wear a surgical face mask. Authorities recommend a respiratory mask for anyone caring for someone infected in a medical setting as part of airborne precautions. The mask should best fit possible around our mouth and nose. Disposing of it is equally important and put on a new one anytime someone coughing or sneezing around us contaminates it. At this time, the Centre for Disease Control (CDC, 2020) recommends that the mask is important for the person caring for patients and also important is washing hands thoroughly and regularly throughout the day, avoiding touching eyes, nose, and mouth with unwashed hands. The best practice is to avoiding contact with people who are sick and surfaces that are contaminated but are not often possible for healthcare workers, so they contract the COVID-19 easily. Such precautions and practice not only protect us from coronavirus but also many other infectious diseases. COVID-19 is spread primarily via respiratory droplets. Health care personnel can use a face mask if an N95 respirator isn’t available while entering into the patient’s room, according to the CDC. However, during aerosol-generating procedures, such as sputum induction or open suctioning, N95 or higher-level respirators should be used. These types of equipment also should be worn when collecting respiratory specimens, although face masks are acceptable during this procedure if necessary. The CDC continues to recommend health care personnel wear gowns, gloves, and eye protection when caring for patients with suspected or confirmed cases of COVID-19. The CDC has updated guidance on airborne infection isolation rooms, more popularly known as negative pressure rooms, reserving those for patients undergoing aerosol-generating procedures. Hospitalised patients with suspected or confirmed COVID-19 should be placed in a single cabin room with the door closed and a dedicated bathroom.
Safety Health care personnel collecting diagnostic specimens while wearing an N95 or higher-level respirator (or a face mask if respirators are not available), eye protection, gloves, and a gown can do so in a normal examination room with the door closed, according to the CDC (Melissa, 2020). Therefore, keeping ourselves safe is the key until the vaccine or drug is available for COVID-19 infection. Nepali healthcare professionals are working without sufficient PPE at this very crucial period of the global pandemic. I urge the Nepal Government to make it mandatory and also provide essential PPE to all healthcare workers in both public and private hospitals as soon as possible. They are risking their and patients’ life needlessly, although, there is known protection equipment available while dealing with patient having coronavirus infection. Healthcare workers should use PPE compulsory and protect themselves from COVID-19.
(Prof. Dr Lohani is the academic director of Nobel College and can be reached at email@example.com)