key: cord-011808-ev7qv94b authors: Sfeir, Maroun M title: Frontline workers sound the alarm: be always sure you’re right, then go ahead date: 2020-06-16 journal: J Public Health (Oxf) DOI: 10.1093/pubmed/fdaa066 sha: doc_id: 11808 cord_uid: ev7qv94b Amid personal protective equipment shortage, clinicians, nurses, and other frontline workers across the world have faced threatening and/or firing for self-protection during this coronavirus disease 2019 (COVID-19) pandemic. This perspective describes the different challenges that the stressed and overworked frontline workers encounter when they raise concerns despite being right. It also highlights the importance of communication and appropriate execution upon hearing those concerns. On 30 December 2019, Dr Wenliang Li, a Chinese ophthalmologist at Wuhan Central Hospital, was the first medical professional who raised a concern in an online chatroom alarming the healthcare personnel of an outbreak related to a severe acute respiratory syndrome (SARS)-like infection in seven inpatients admitted with severe respiratory tract infections after they visited the Huanan Seafood Wholesale Market in Wuhan, China. 1 Thereupon, Dr Li was silenced by the Chinese authorities in Wuhan and required to sign a letter certifying he was spreading erroneous comments. 1 Subsequently, adoption of protection measures such as avoiding visits to the Wuhan wildlife market, social distancing, wearing masks, hand hygiene, etc. got undeservedly delayed. Unfortunately, Dr Li got infected by SARS coronavirus 2 (SARS-CoV-2) while treating patients and he died on 7 February 2020 at Wuhan Central Hospital in Wuhan, China. 1 Later on, the Chinese authorities mourned Dr Li's death and regretted the fact that he was reprimanded and prohibited from speaking up. 1 Dr Li has been widely regarded as China's hero physician. In lieu of confrontation and pushbacks, communication and constructive execution by mitigating efforts during this coronavirus disease 2019 (COVID-19) pandemic would save lives. In one way or another, frontline workers during the COVID-19 pandemic were subject to unfair disciplinary actions across the world including the USA. Social media outlets have been bursting with frustrations and fearful stories from healthcare workers and other frontline workers. 2 For instance, early during the pandemic and before the Centers for Disease Control and Prevention (CDC) recommended wearing face coverings in public settings on 3 April 2020, many clinicians and nurses in the USA confessed that they faced intimidation, threatening or termination for wearing self-supplied masks in the hospitals. 2,3 Some healthcare workers were told by their hospital administrative leadership that they cannot wear masks in hallways and/or that they cannot bring their own masks to the hospital. Hospitals administrators justified that protective gear needs to be conserved and used as minimally as possible to the notion that it scares patients. Many overwhelmed healthcare workers state that they feel they have been betrayed by their hospital administrators. In CA, nurses at an integrated delivery system were being told that they could be terminated for wearing their own N95 masks according to a memo by the California Nurses Association and the National Nurses United. 2 Another nurse in Oklahoma City claimed that he was fired on the spot after wearing a surgical mask while caring for patients. 4 Moreover, stressed and overworked healthcare workers shared critical concerns about lack of personal protective equipment (PPE) nationwide. 3 Alternatively, many healthcare professionals raised concerns anonymously and others reported fear of speaking up and declined to comment because they were worried about retaliation from hospital employers or citing the lawsuit. 2 Some healthcare employees were warned that they will be terminated if they speak out about inadequate PPE or if they talk on social media without authorization, in an attempt to limit reputational damage of the hospital. As the COVID-19 crisis continues to mount, critical shortage of PPE and critical supply chain disruptions have been widely reported by healthcare workers across the nation. 2, 3 Hospitals were running out of supplies such as ventilators, medications, toilet paper, etc. 3 Further, healthcare workers have been frustrated of reusing masks that they have never had to reuse before across the country. 4 Healthcare Workers' Duty of Care implies their duty to care for patients including public health emergencies and outbreak conditions. On the other hand, healthcare employers should assure safe and healthy working conditions for working employees. Nevertheless, the lack of preparedness and readiness during this COVID-19 pandemic has not secured that latter rule which lead to high potential exposure risk among healthcare workers across the nation and worldwide. 3 In fact, safety and security of the healthcare workers are paramount. All healthcare workers must have access to appropriate PPE. If hospitals understandably cannot furnish PPE, they should allow healthcare workers to wear their own PPE. The Joint Commission has genuinely issued a statement on 31 March 2020 that healthcare workers should be allowed to wear their own PPE. 5 As of 9 April 2020, at least 9282 US healthcare workers had tested positive for SARS-CoV-2 and at least 27 had died according to the CDC report. 6 The U.S. Department of Health and Human Services published a survey of 323 hospitals that found the shortages left the facilities unable to effectively test staff and patients who frequently waited >1 week for results because of delays at outside laboratories. 7 Note that many healthcare workers were denied testing. In New York City, a nurse treated patients in the intensive care unit in late March 2020 but could not get a SARS-CoV-2 real-time polymerase chain reaction (RT-PCR) test from her hospital after she started displaying nausea, abdominal pain and low-grade fever. 3 She continued to care for patients as well as colleagues and family members despite the serious risk of exposing them without knowing she is carrying the virus. Ultimately, she took it upon herself and tested positive for COVID-19 at a private clinic. 3 On 4 April 2020, the hospital employees were told that hospital would increase testing of healthcare personnel with symptoms of the SARS-CoV-2 virus. 3 Similarly, in GA, a nurse did not qualify for COVID-19 testing after treating an infected patient with SARS-CoV-2 who died. 3 Hospitals are elseways facing a public health dilemma of testing staff with mild symptoms despite the severe shortage in testing capacity and keeping them home for days as they await results while there is a dire demand for essential healthcare workers. Likewise, ignoring concerns and/or delayed appropriate and timely execution have been critical issues among other frontline workers, e.g. bus drivers. For example, a bus driver in Detroit, MI, complained on social media on 21 March 2020 of a female passenger who coughed in the bus without covering her mouth. 8 Grievously, the bus driver felt sick <2 weeks after expressing concern, and died of COVID-19 just a few days after. 8 Latterly, safety measures got extended to all bus drivers by providing gloves and sanitary wipes, and obliged passengers to board and exit the bus at the bus back door away from the bus driver. Such a preparedness and readiness plan implemented a little bit early would have had a better impact. In this challenging time, we should ramp up our efforts to slow the spread of COVID-19. We should also encourage communication with frontline workers, listen to their concerns and execute promptly and effectively. Furthermore, paying tribute to the healthcare workers and other frontline workers and protecting the most vulnerable from the effects of the disease are key strategies as the COVID-19 case numbers continue to explode. Ultimately, a main lesson this COVID-19 pandemic might teach frontline workers conforms well to David Crockett's attributed quote of 'Be Always Sure You're Right, Then Go Ahead'. Author has no conflict of interest to disclose. MMS designed the manuscript, contributed with acquisition of data and wrote and approved the final version of the manuscript. Author has no conflict of interest to disclose. China's hero doctor was punished for telling truth about coronavirus. CNN Opinion Global Nurses United Press Clips Especially in Areas of Significant Community-Based Transmission Nurse claims he was fired for wearing face mask to treat Okla. hospital patient The Joint Commission. Joint Commission issues statement on use of face masks brought from home Characteristics of health care personnel with COVID-19 -United States Hospital Experiences Responding to the COVID-19 Pandemic: Results of a National Pulse Survey The high price of keeping Detroit moving None.