key: cord-0781380-758cda1i
authors: Ferneini, Elie M.; Halepas, Steven
title: Protecting Ourselves during the COVID-19 Pandemic
date: 2020-05-11
journal: J Oral Maxillofac Surg
DOI: 10.1016/j.joms.2020.04.047
sha: 72f8a642461c8bbde6b630a70a924c3cf6cff98e
doc_id: 781380
cord_uid: 758cda1i

nan

The current pandemic has run rampant on our healthcare system. At the time of writing this, three resident physicians have died, one of whom was in our field 1 . These young doctors had their entire careers ahead of them; they were working long hours, relying on their hospitals, their government, and their healthcare system to protect them. These residents are by no means the only victims within the health care system; this virus has claimed the lives of attendings, nurses, and other essential healthcare providers.

When one of the authors was training to be an emergency medical technician, he would get tested on different scenarios, but each was an automatic failure if he did not ask the same first questions "BSI (body substance isolation) and is the scene safe?" It was drilled into our brains to worry about scene safety above all else. We were taught that the most important thing is to make sure you are safe, your partner is safe, and then worry about the patient. We do not let firefighters run into buildings without the proper equipment; it follows that we should not let doctors and nurses tend to the ill unprotected. When we took the Hippocratic Oath, we agreed to run into a burning building for the sick, but we did not agree to do it naked. Without protecting our healthcare workers, our healthcare system will fail.

Private practices across the country are remaining open to serve their community for emergency treatment to relieve stress on hospitals and emergency rooms. Throughout this pandemic, oral-maxillofacial surgeons (OMSs) provide treatment to life-threatening conditions such as head and neck infections and facial trauma. "As COVID-19 threatens to overwhelm our healthcare systems, oral-maxillofacial surgery practitioners are charged with reducing the burden placed on other emergency centers and, if necessary, lend our unique experience and training in anesthesia and intensive care unit care to other medical and surgical services 2 ". At hospitals across the country, oral-maxillofacial surgery residents and faculty have been redeployed to ICUs to take care of these COVID patients given. In the darkest days, residents were given one N95 mask to hold onto, carrying it around in Tupperware containers between shifts, to ensure they had one the next day.

Our scope of practice puts us in a high-risk category given our procedures generate viruscontaining aerosols. SARS-CoV-2 has been demonstrated to remain aerosolized for up to 3 hours 3,4 . Working intimately in the oropharynx means OMSs need to take all precautions very seriously. Viral shedding can occur in asymptomatic and pre-symptomatic patients and is greatest in the nasopharyngeal region. Many of these private practice offices do not have the proper personal protective equipment (PPE) to provide care to patients in today's environment. Surgeons are calling every distributor they can think of and ordering masks and gowns whenever possible with many of the major distributors on backorder.

We live in unprecedented times when Federal and State governments are fighting with hospitals for PPE. Andrew Artenstein, the Chief Physician Executive and Chief Academic Officer at Baystate Hospital, recently published a correspondence explaining how he attempted to buy PPE for his hospital. He went with trucks to try to execute the purchase. However, before he could wire the funds, two FBI agents arrived and started to question him. The Department of Homeland Security was trying to redirect the PPE that the hospital was trying to purchase. It took the intervention of their Congressional representative to allow the hospital to keep the PPE 5 .

It is the duty of OMSs to provide emergency coverage for our patients. It is essential for governments to classify OMSs as critical first responders to allow us access to the PPE we need to provide urgent care safely. We also need the ability to administer rapid COVID-19 testing in our facilities and clinics to expand testing within our communities. If a vaccine becomes available, we need to be allowed to administer that vaccine to provide immunity as efficiently as possible.

Our health care system is failing us and the days of being driven by profits and administration need to be behind us. United States health care system administration costs have increased exponentially. Our health care system let our providers down. OMSs are on the front lines of this battle, both in our private practices and in the hospital settings. Governors and other state officials have called on us to donate our PPE to hospitals, but still expect us to see emergency patients in the private setting to reduce the strain on the emergency system. We must not waste the lessons learned in this crisis. We should use it as an opportunity to become better integrated and recognized as a vital part of our health care system and help strengthen it.

COVID-19 claims member of Class of 2018 Chris Firlit

The UIC COVID Protocol: A Technical Note for Pandemic Oral and Maxillofacial Surgery Call Coverage

Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

Coronavirus Disease 19: Implications for Clinical Dental Care

Pursuit of PPE