The safety of our faculty, trainees, staff, and patients is UW Medicine’s top priority. Since beginning our COVID-19 preparedness and response efforts over 2 months ago, protecting our workforce has been one of UW Medicine’s guiding principles. We heard your Town Hall questions that focused on concerns about the safety of your patients, your families, your friends and yourselves. Over the last few weeks, we have seen more COVID-19 patients in our hospitals and clinics. There is also been a constant stream of COVID-19 discussion on TV, in social media and in the papers that may contribute to increased anxiety and stress.
Over the weekend, many of us were made aware of a new recommendation from the Partners Health System in Massachusetts to mask all healthcare workers. At the same time, a New Yorker article by Dr. Atul Gawande was published on the topic of protecting healthcare workers that was aligned with Partners’ recommendation. Unsurprisingly, this excellent article and the Partners’ recommendation was shared widely and has led to questions from our UW Medicine colleagues. In this piece Dr. Gawande makes several important points, most of which align with current UW COVID-19 Guidelines, including predominantly droplet spread and the utility of surgical masks and eye protection for safety. Unlike some of the locations that are now being affected in the United States, we have had early access to SARS-CoV-2 testing and appropriate personal protective equipment (PPE) since the outbreak was detected. So far, our hospitals have been able to accommodate patients without compromising patient or healthcare workers. The UW Medicine Incident Command is tracking the situation 24/7 and is prepared to adapt as the situation evolves.
We are seeking additional information from our colleagues at Partners as we want to learn from their experience and be as informed as possible. All hospitals in the US are facing challenges at this time and we need to come together to best manage limited supplies of personal protective equipment while keeping our workforce safe.
In response to the above and to reinforce our commitment to the safety of every person in UW Medicine, the UW Medicine Infection Prevention & Control leadership continues to affirm that our current COVID-19 related policies are safe and scientifically based. PPE shortage remains a concern and continues to be addressed daily and at the highest levels. For the moment, our ability to continue to use PPE in the safe care of our patients remains intact.
Specifically, we are united behind the following points:
1. SARS-CoV-2 is not airborne except in specific medical procedural circumstances
- Human epidemiologic data on how SARS-CoV-2 is predominantly transmitted across the world continues to support spread by droplets and close contact. This mechanism of transmission is agreed upon by WHO, CDC, and OSHA.
- All UW Medicine hospitals and clinics have adopted evidence-based PPE protocols that target droplet spread.
2. Safe care of patients with COVID-19 requires the following actions:
- Reliable screening to identify and mask symptomatic patients at entry points to reduce the burden of droplet dispersion.
- Droplet/contact PPE for the care of patients with acute respiratory illnesses.
- Use of respirators (e.g., N95s, PAPRs) for aerosol generating procedures for patients with viral respiratory infections.
- Ill healthcare workers must stay home.
- Self-monitoring for symptoms by employees, especially if there is close contact with people with COVID-19 in their home or community, or there is a gap in PPE during care of patients with COVID-19.
- Easy access to rapid testing for any employee exhibiting symptoms of a respiratory infection (appointments and testing turnaround are generally available by the following day).
3. Safe delivery of care does not require universal masking of healthcare workers
- Reports of asymptomatic cases are concerning for many healthcare workers. However, data continues to support that many of these “asymptomatic” cases are in fact mildly symptomatic and most can be identified through symptom screening. Additionally, truly asymptomatic cases are uncommon (see below from study of 72,000 patients in China, reference below).
The Novel Coronavirus Pneumonia Emergency Response Epidemiology Team. The Epidemiological Characteristics of an Outbreak of 2019 Novel Coronavirus Diseases (COVID-19) — China, 2020. CCDCW 2, 113–122 (2020)
- The evidence continues to support that proven cases of COVID-19 have had close contact with other symptomatic cases, supporting that symptomatic people are the dominant method of spread.
- Universal masking consumes an unnecessary amount of PPE and provides a false sense of security that can undermine hand and face hygiene, social distancing, and source control of symptomatic patients for the delivery of safe healthcare by staff.
- Uniform masking may also unintentionally decrease our ability to have the appropriate PPE available when caring for patients with COVID-19 during the coming weeks.
Rapid access to testing for SARS-CoV-2 continues to be of paramount need throughout the country and is not uniformly available in all locations. Within UW Medicine, we have access to quick and reliable testing in the UW Virology Laboratory that enables us to safely isolate and evaluate our patients. The ability to rapidly test patients allows us to put the appropriate patient into precautions and remove those precautions with a negative test result (~94% of UW Medicine SARS-CoV-2 tests are negative). This reduces unnecessary overuse of PPE that results when people must wait days for results. Additionally, we have easy and fast access for employee testing. The UW Virology lab is rapidly expanding their testing capabilities which will continue to help support patient care in UW Medicine and also help to support the safe response to this disease throughout our region.
We remain deeply committed to the safety of all members of our workforce. You are our colleagues, our friends, and, in many ways, our family. We want you to be safe and we are working collaboratively with leaders across the country and the world to do this in the most informed way possible.
