This ^^^ is how close I sit to covid patients in the ambulance... I'm only 5'2" in duty boots, and my knees still almost touch the stretcher. I'm basically a Subway footlong sandwich away from my patient. Starting an IV, the patient's hand/forearm rests on my left thigh so I can assess their AC. Yeah, close is an understatement.
Months upon months of sitting this close to symptomatic covid patients, in an unventilated tin can, and getting even closer to assess and provide treatments while they cough and sneeze and vomit and wheeze and sweat the virus at me.
Yet throughout this pandemic, we haven't had one single paramedic in our service get sick with covid
on duty here. NOT ONE. <--- that stat isn't luck or magic, it's active prevention by each and every paramedic, with every single patient interaction.
Now that we have omicron... things are more challenging, because this virus got waaaayy more efficient. I suspect this variant is more airborne than prior ones, based on what I'm seeing here
, and that still doesn't mean this thing isn't preventable. It just means the virus evolved, and so must the prevention strategies:
- *******what mask is worn?*******
exhalation? wearing cloth/surgical/home mask PROTECTS OTHERS FROM WHAT COMES OUT OF YOU, cannot stress this enough! These masks don't prevent you from breathing IN another's infected droplets, they are not in-filters they are out-catchers, meant to contain your yick as much as possible, to reduce your yick spread to as few feet as possible, and to reduce your viral output like catching fish in a net. Thus you ''protect'' others with your mask but you can
still be infected
***inhalation? 1:57*** wearing respirator/N95/N100 PROTECTS YOU WHILE BREATHING IN, this is an in-filter mask not a yick out-catcher, this mask is all about you and not about others
*I wear both masks during patient care. No exceptions. And I've found this to be effective at not fogging up my safety glasses so badly, too
- is 6' enough distance? not in all circumstances and physical locations, sometimes more distance is needed... 6' was a socially acceptable number, not specifically a scientific one. It's not a rule, the virus can and does go beyond 6' if propelled with enough force and/or in favorable environments. And droplets hang about in the air, I've seen various stats showing anywhere from 5-20 minutes. Larger droplets travel a shorter distance and fall out faster, smaller droplets go farther and stay up longer. Airborne is another animal altogether, a cloud that lingers and falls out very slowly.
- is the
hand hygiene done properly? because who honestly cleans their hands like this, every.single.time?
- is the
doffing (removing) of protective equipment being done properly? in the original SARS many many years ago, it was found that health care workers were being infected while they were doffing PPE, not as a direct exposure during patient care. The steps go in order of contamination, removed in the way that best protects you from infecting yourself
- is the vaccine effective? yes and no. All of the current vaccines are based on the original strain, not any of the variants from alpha to omicron, so how far removed are today's dominant strains (delta, omicron) from the original one (nearly 2.5 years ago)? Depending on your unique
risk factors, the vaccine may protect against death/ICU/serious illness/hospitalization, but not against infection; this is not a vaccine failure, any more than needing to refill your gas tank to keep your car running is; the virus evolved and vaccines will have to as well, but in the mean time the vaccines are still offering good protection; NO vaccine offers 100% protection, there is no such thing as the perfect vaccine
- eye protection? yup, this virus can infect you through your eyes. Protect your peepers
Our unventilated tin cans don't give us magical immunity, we don't have PPE that others don't have access to, we don't have superhuman immune systems, and omicron is omicron both on duty and off duty. We do have paramedics that were infected
off duty, but none on duty... why, when we are so exposed in our tin cans? The elephant in the room is the human factor. From transmission, to exposure, to infection... people are the reservoirs, people are the transmitters, and people are the portals/hosts via their unique health, lifestyle, personal, and other
risk factors. For transmission to be successful, something went sideways somewhere. Small sideways, big sideways, tried-your-best-sideways, no-effort sideways, oops sideways...
happens. The reservoir released the yick. For infection to be successful, the yick has to have a way in AND a susceptible host, and that's where those pesky risk factors come in. Transmission, exposure, and infection is an
unbroken chain. Prevention is about breaking ANY link in that chain. Possible? Absolutely, when you can target any or all of the 5 links.
I think we will all get this eventually
I've been hearing this a lot in the last few weeks... basically daily and from a lot of different sources. My partner and I discussed this earlier this week too. I think this is true, but not because prevention is impossible or because this is inevitable.
The statement itself is a symptom of attention span/loss of interest, length of the pandemic, pandemic fatigue, magic bullet thinking/disappointment, hopelessness, need for instant gratification, intolerence for challenge/hardship/sacrifice, misinformation, freedumb, etc. With this as the prevailing attitude, yes we will all get it, because we are manifesting this, we are creating it, we are willing it to be. Globally, this has become the intention, whether we intended that or not.
And while this was not really what was meant by 'endemic', I think this is what it's going to look like.
