16 ms·

Keeping the coronavirus from infecting healthcare workers

182 points by razin 7y ago

bamboozled 7y ago
“Health-care facilities don’t remotely have the supplies that would allow staff members to see every patient with all that gear on.“ As the article states, China had that ability. If that statement is true, It’s amazing to me that this is something China can do and not the U.S.A. The country that put man on the moon not even a century ago! Incredible. I feel like there are a lot of acquisitions lately that go on about how “draconian” China’s behaviour is etc, but they protected their medical staff by making sure they were adequately equipped. It read a bit like jealousy.
- watwut 7y ago
  > The country that put man on the moon not even a century ago! Aren't those two massively different tasks/skills? And both in massively different situations?
  - bamboozled 7y ago
    It seems though that the US couldn’t actually go back to the moon or maybe even put people into space without the Soyuz, so now so it’s lost those capabilities amongst others, that is my point. Even in a crisis, all that economic wealth and military dominance that the US claims to have can’t put masks and gowns on people that need them, so is there really much steam left in the tank ? I hope there is and I’m sure there is, it just needs to find the right channels. God Bless America!
    - leetcrew 7y ago
      no country has the ability to go to the moon tomorrow. if there were a pressing reason to do so, the US and probably china or russia could do it eventually, but it takes time to organize that sort of effort. it's probably true that the time between deciding to go to the moon and actually doing it would probably be longer today, but a large part of that might be increased expectations for the crew's safety. it's a similar story with the PPE. the US has moved a lot of manufacturing capacity overseas because it's economically efficient. the US is certainly wealthy enough to manufacture as much of this stuff as needed, but it isn't a switch that can be flipped overnight and the unit cost would be much higher due to regulatory burdens like worker protection.
- jtdev 7y ago
  U.S. leaders of industry along with our political establishment have undermined American security by outsourcing the production of critical resources to an authoritarian, communist nation (China). It’s high time we wake up and hold these people accountable.
  - makomk 7y ago
    This. Something ridiculous like 95% of surgical masks and 75% of N95 masks are normally imported from China, because theirs were slightly cheaper. Almost all of them have been diverted to domestic use. Now the US, with almost no manufacturing capabilities, has doctors and nurses who are forced to use dubious improvised masks whilst China increases its international influence by selling a small fraction of its output at inflated prices to desperate countries in Europe. I've seen a load of dumb takes on social media blaming this on a lack of "leadership and competent diplomacy", but having a leader who grasps the diplomatic advantage of doing this is no good if your country can't make the damn masks in the first place.
    - wbl 7y ago
      3M is in Minnesota. There was no effort to make more masks in the months we had. This is entirely a failure of government at all levels.
      - makomk 7y ago
        3M and the various US surgical mask manufacturers have been ramping up production since, if I remember rightly, January, but that's not enough to cope with even the normal demand for them let alone the extra supplies needed due to the coronavirus.
        wbl 7y ago
        With the Feds helping and mandating setup of new lines and paying for them so much more could have happened.
        jtdev 7y ago
- markbnj 7y ago
  > If that statement is true, It’s amazing to me that this is something China can do and not the U.S.A. The country that put man on the moon not even a century ago! My wife is an R.N. and is the clinical care coordinator on a cardiac critical care unit in northern NJ that has been converted to a negative pressure covid-19 unit. They currently have two positives and several suspected under treatment. They do not have enough PPE gear to see every suspected patient using full protection, i.e. gown, goggles, N95 mask, gloves, etc. This is a fact that bothered me much more than her. It's possible to prevent transmission to health care workers without full PPE on every case. See for reference this article currently linked on HN front page: https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers https://www.newyorker.com/news/news-desk/keeping-the-coronav.... Naturally I still wish she was wrapped head to toe in antiviral something every time she goes near the place, but my fears are those of a layperson and I have to trust her professional judgement.
- sjg007 7y ago
  The ICU videos out of Wuhan have the doctors wearing triple PPE. China has a lot of experience with SARs and other respiratory viruses. They are basically ground zero right.. so I would expect people to listen to China when they say you need masks.
zaroth 7y ago
There is a lot of conflicting data. China went full hazmat with the influx of new healthcare workers they sent into Hubei, but Singapore and Honk Kong took significantly more measured approaches which ultimately have also been successful in limiting exposure. The US policy of 14 day quarantine for healthcare workers who had even limited exposure to a COVID patient was never sustainable and threatened to shut entire ERs before the restrictions were loosened. A broad array of moderate measures (stringent hand washing, surgical masks all the time, 6 foot rule except during exams, etc.) combined with isolation of only identified “close” contacts has worked in a few different places now. The question of asymptomatic spread is still confounding experts. It seems they can’t fully explain the spread in some places without it, but they can’t explain lack of spread in some places with it. When left in a situation where data is conflicting and unreliable, I think the path forward has to always balance the conflicting interests. Just like you can’t send the entire ER department home in the middle of an epidemic, you also can’t exhaust your entire years supply of hazmat gear in a week, and you similarly can’t crater your entire economy to put on a show of strong action. Measured responses ultimately are what will save the most lives, because they can be sustained for the reasonable expected duration of the outbreak rather than shock and cripple the whole system in a matter of weeks.
- marcosdumay 7y ago
  > It seems they can’t fully explain the spread in some places without it, but they can’t explain lack of spread in some places with it. They surely can. They just have to assume there are way more asymptomatic cases than they have been assuming, and a relatively small susceptible population.
  - taeric 7y ago
    Wrong in what way? Small susceptible to getting severe? Or getting it at all?
    - marcosdumay 7y ago
      Well, you need both. If none would get it at all, it wouldn't spread, but if all got the virus it would show on exams. Every model around assumes that everybody contracts the virus. If you have part of a population that is immune to it, the population behavior changes.
jtdev 7y ago
Can we all agree that outsourcing the production of critical medical supplies to China over recent decades was a bad idea? I understand the “golden arches” theory, and the intent if globalism, but I feel that COVID19 has revealed what a short sighted, deeply flawed view the globalists have.
- kingaillas 7y ago
  Exactly! I too understand the theory of competitive advantage, but in light of this new information, current economic/business/free-market theory needs to be rebuilt from the ground up to take into account risks (global supply chain disruption, customer base vanishing, etc) seriously considered.
- phreeza 7y ago
  I would argue the opposite is the case. The disease affects basically all countries, so what matters is the global supply of these goods. So we are better off if countries can specialize on their respective competitive advantages. In the scenario you propose, every country would have their own very inefficient mask industry which would now be just as or even more overwhelmed.
  - nradov 7y ago
    We all understand Ricardo's law of comparative advantage. The problem is what happens in a supply chain disruption. In that case it's better to have at least some inefficient local capacity instead of nothing. As an extreme example, the US continues to manufacture it's own military aircraft instead of buying from China. Even though China might be willing to sell them cheaper than we can make them.
  - SpicyLemonZest 7y ago
    The problem is that each individual country will (reasonably!) not allow critical medical supplies to be exported during a crisis. It worked out mostly okay this time, because the countries with large domestic mask production all got their crisis under control before the rest of the world got it. If the next pandemic happens in China and the US simultaneously, we're not going to have any masks at all. And note that "mostly okay" here doesn't mean we have anywhere close to enough masks. Just that, with extreme rationing, we can ensure most but not all doctors have the absolute bare minimum of protective gear.
hprotagonist 7y ago
Atul Gawande is a voice i’m happy to listen to here, and this is a small ray of hope. He’s a practicing surgeon, public health researcher, educator, and he was one of the early champions of wide use of checklists in hospitals to reduce infection rates and complications. He is not prone to blowing sunshine and rainbows, either.
ZhuanXia 7y ago
The shameful lies about masks not working for civilians will kill thousands. Evidence based medicine (over the modern Bayesian Science-based medicine) has paralyzed our health officials from making common sense calls off priors. Homemade masks appear to be reasonably effective. The official response should be to make some form of improvised mask required when out of home, and ration regular mask for health care workers. Even a scarf made of a t-shirt over the nose and mouth will likely reduce RO when used at scale on the population. The best way to protect healthcare workers is to reduce the R0 below 1. Nothing else will help. Widespread use of homemade masks, though not tested in a double blind trial, is low risk enough and seemingly effective enough to encourage. Countries enforcing widespread mask use have lower ROs.
- brigandish 7y ago
  How widespread is widespread? Japan, South Korea, China, Hong Kong, Taiwan… these are countries in which people wear masks in large numbers on a normal day. They all still have an R0 above 1.
  - harikb 7y ago
    Those countries also have higher population densities and public transport usage than some of the western countries. How can you say the mask isn’t helping?
    - brigandish 7y ago
      > How can you say the mask isn’t helping? I didn't but I also didn't make the claim that they would help so I suggest we start by getting claimants to back up their claims before we get anyone checking claims to prove negatives.
      - fspeech 7y ago
        We need universal mask wearing AND unlimited testing. South Korea showed it works. In Japan, even without widespread testing the spreading is still slower than the west. It's true Singapore does not mandate mask use, but they have thorough contact tracing and draconian quarantine laws.
ZhuanXia 7y ago
China has half the world’s manufacturing ability, a civil service selected strongly for cognitive ability, a much more diligent and capable people, and a large population. Not to mention experience in pandemics of this type. China will become zeroth world shortly. We will have to get used to them surpassing us.
- quartzite 7y ago
  How can China become zeroth world shortly when half of the country is still living in third world conditions? I suppose if you only consider how the wealthiest in Shanghai and other Tier 1 cities live their lives then yes China is approaching parity with the West but that ignores that America's per capita income is almost 5 times higher than China's. China also has the nasty problem of many of its best and brightest wanting to come to America and the West where they will have political freedom and more broadly freedom of expression, something that cannot be bought in China no matter how wealthy one becomes.
  - ZhuanXia 7y ago
    I have seen the progress in China since the late 1990s. A rate of change impossible for a modern westerner to believe. China is not a photograph but a video on fast-forward.
    - leetcrew 7y ago
      people were saying this about the USSR in the 1930s (see beyond the urals by john scott). it's always faster to catch up than to break new ground. their rate of progress will slow dramatically as they approach the state of the art.
      - Der_Einzige 7y ago
        Not with over 1 billion people and the western world on its knees. If anything, their going to progress far faster than anyone else once this is over.
cryoshon 7y ago
it's more or less unforgiveable that our american healthcare workers don't have the PPE they need to protect themselves. attrition among our healthcare workers is going to be very high, especially because unlike singapore, we use the most inefficient quarantine guidelines when we suspect that they have been exposed. people are sewing masks to make up the difference between what is needed and what we can supply. the federal government can't seem to supply the states with much of anything. and purchasing domestically-produced masks is becoming rapaciously expensive, with some manufacturers charging $7 per mask. allegedly our domestic manufacturers are ramping up production. but let's face it, that takes time. and we don't have time, because once one of our healthcare workers gets sick, they're out of commission for weeks. i will not abide by this disaster for our heathcare workers. i am working with an established charity to raise money to purchase thousands of n95 respirator masks from chinese manufacturers so that those masks can be shipped and donated directly to hospitals in epicenters like new york. i'm calling it the million mask campaign because i hope that we can eventually donate at least a million masks to hospitals in need. in reality, we will need many millions of masks if we want to protect our healthcare workers, but everything we can bring to bear on their behalf will be beneficial. please consider contributing to our campaign: https://www.gofundme.com/f/the-million-mask-campaign?utm_source=customer&utm_medium=copy_link-tip&utm_campaign=p_cp+share-sheet https://www.gofundme.com/f/the-million-mask-campaign?utm_sou...
christkv 7y ago
A couple of weeks ago there was some news about salt treated masks deactivating virus. I just found this site that claims to make them https://vkmask.com/ https://vkmask.com/ anyone know anything about them? Are they real or a scam.
- kevin_thibedeau 7y ago
  "fermented sea salt" Might be effective in some way but there's a heavy dose of wackadoo there. US patent 88,819,662 doesn't seem to exist either.
  - christkv 7y ago
    I think they are trying to pretend they are doing this https://www.nature.com/articles/srep39956 https://www.nature.com/articles/srep39956
js2 7y ago
"Why Telling People They Don’t Need Masks Backfired. To help manage the shortage, the authorities sent a message that made them untrustworthy." https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...

182 points by razin 7y ago

“Health-care facilities don’t remotely have the supplies that would allow staff members to see every patient with all that gear on.“ As the article states, China had that ability. If that statement is true, It’s amazing to me that this is something China can do and not the U.S.A. The country that put man on the moon not even a century ago! Incredible. I feel like there are a lot of acquisitions lately that go on about how “draconian” China’s behaviour is etc, but they protected their medical staff by making sure they were adequately equipped. It read a bit like jealousy.

watwut 7y ago
> The country that put man on the moon not even a century ago! Aren't those two massively different tasks/skills? And both in massively different situations?
- bamboozled 7y ago
  It seems though that the US couldn’t actually go back to the moon or maybe even put people into space without the Soyuz, so now so it’s lost those capabilities amongst others, that is my point. Even in a crisis, all that economic wealth and military dominance that the US claims to have can’t put masks and gowns on people that need them, so is there really much steam left in the tank ? I hope there is and I’m sure there is, it just needs to find the right channels. God Bless America!
  - leetcrew 7y ago
    no country has the ability to go to the moon tomorrow. if there were a pressing reason to do so, the US and probably china or russia could do it eventually, but it takes time to organize that sort of effort. it's probably true that the time between deciding to go to the moon and actually doing it would probably be longer today, but a large part of that might be increased expectations for the crew's safety. it's a similar story with the PPE. the US has moved a lot of manufacturing capacity overseas because it's economically efficient. the US is certainly wealthy enough to manufacture as much of this stuff as needed, but it isn't a switch that can be flipped overnight and the unit cost would be much higher due to regulatory burdens like worker protection.
jtdev 7y ago
U.S. leaders of industry along with our political establishment have undermined American security by outsourcing the production of critical resources to an authoritarian, communist nation (China). It’s high time we wake up and hold these people accountable.
- makomk 7y ago
  This. Something ridiculous like 95% of surgical masks and 75% of N95 masks are normally imported from China, because theirs were slightly cheaper. Almost all of them have been diverted to domestic use. Now the US, with almost no manufacturing capabilities, has doctors and nurses who are forced to use dubious improvised masks whilst China increases its international influence by selling a small fraction of its output at inflated prices to desperate countries in Europe. I've seen a load of dumb takes on social media blaming this on a lack of "leadership and competent diplomacy", but having a leader who grasps the diplomatic advantage of doing this is no good if your country can't make the damn masks in the first place.
  - wbl 7y ago
    3M is in Minnesota. There was no effort to make more masks in the months we had. This is entirely a failure of government at all levels.
    - makomk 7y ago
      3M and the various US surgical mask manufacturers have been ramping up production since, if I remember rightly, January, but that's not enough to cope with even the normal demand for them let alone the extra supplies needed due to the coronavirus.
      - wbl 7y ago
        With the Feds helping and mandating setup of new lines and paying for them so much more could have happened.
      - jtdev 7y ago
markbnj 7y ago
> If that statement is true, It’s amazing to me that this is something China can do and not the U.S.A. The country that put man on the moon not even a century ago! My wife is an R.N. and is the clinical care coordinator on a cardiac critical care unit in northern NJ that has been converted to a negative pressure covid-19 unit. They currently have two positives and several suspected under treatment. They do not have enough PPE gear to see every suspected patient using full protection, i.e. gown, goggles, N95 mask, gloves, etc. This is a fact that bothered me much more than her. It's possible to prevent transmission to health care workers without full PPE on every case. See for reference this article currently linked on HN front page: https://www.newyorker.com/news/news-desk/keeping-the-coronavirus-from-infecting-health-care-workers https://www.newyorker.com/news/news-desk/keeping-the-coronav.... Naturally I still wish she was wrapped head to toe in antiviral something every time she goes near the place, but my fears are those of a layperson and I have to trust her professional judgement.
sjg007 7y ago
The ICU videos out of Wuhan have the doctors wearing triple PPE. China has a lot of experience with SARs and other respiratory viruses. They are basically ground zero right.. so I would expect people to listen to China when they say you need masks.

zaroth 7y ago

There is a lot of conflicting data. China went full hazmat with the influx of new healthcare workers they sent into Hubei, but Singapore and Honk Kong took significantly more measured approaches which ultimately have also been successful in limiting exposure. The US policy of 14 day quarantine for healthcare workers who had even limited exposure to a COVID patient was never sustainable and threatened to shut entire ERs before the restrictions were loosened. A broad array of moderate measures (stringent hand washing, surgical masks all the time, 6 foot rule except during exams, etc.) combined with isolation of only identified “close” contacts has worked in a few different places now. The question of asymptomatic spread is still confounding experts. It seems they can’t fully explain the spread in some places without it, but they can’t explain lack of spread in some places with it. When left in a situation where data is conflicting and unreliable, I think the path forward has to always balance the conflicting interests. Just like you can’t send the entire ER department home in the middle of an epidemic, you also can’t exhaust your entire years supply of hazmat gear in a week, and you similarly can’t crater your entire economy to put on a show of strong action. Measured responses ultimately are what will save the most lives, because they can be sustained for the reasonable expected duration of the outbreak rather than shock and cripple the whole system in a matter of weeks.

marcosdumay 7y ago
> It seems they can’t fully explain the spread in some places without it, but they can’t explain lack of spread in some places with it. They surely can. They just have to assume there are way more asymptomatic cases than they have been assuming, and a relatively small susceptible population.
- taeric 7y ago
  Wrong in what way? Small susceptible to getting severe? Or getting it at all?
  - marcosdumay 7y ago
    Well, you need both. If none would get it at all, it wouldn't spread, but if all got the virus it would show on exams. Every model around assumes that everybody contracts the virus. If you have part of a population that is immune to it, the population behavior changes.

jtdev 7y ago

Can we all agree that outsourcing the production of critical medical supplies to China over recent decades was a bad idea? I understand the “golden arches” theory, and the intent if globalism, but I feel that COVID19 has revealed what a short sighted, deeply flawed view the globalists have.

kingaillas 7y ago
Exactly! I too understand the theory of competitive advantage, but in light of this new information, current economic/business/free-market theory needs to be rebuilt from the ground up to take into account risks (global supply chain disruption, customer base vanishing, etc) seriously considered.
phreeza 7y ago
I would argue the opposite is the case. The disease affects basically all countries, so what matters is the global supply of these goods. So we are better off if countries can specialize on their respective competitive advantages. In the scenario you propose, every country would have their own very inefficient mask industry which would now be just as or even more overwhelmed.
- nradov 7y ago
  We all understand Ricardo's law of comparative advantage. The problem is what happens in a supply chain disruption. In that case it's better to have at least some inefficient local capacity instead of nothing. As an extreme example, the US continues to manufacture it's own military aircraft instead of buying from China. Even though China might be willing to sell them cheaper than we can make them.
- SpicyLemonZest 7y ago
  The problem is that each individual country will (reasonably!) not allow critical medical supplies to be exported during a crisis. It worked out mostly okay this time, because the countries with large domestic mask production all got their crisis under control before the rest of the world got it. If the next pandemic happens in China and the US simultaneously, we're not going to have any masks at all. And note that "mostly okay" here doesn't mean we have anywhere close to enough masks. Just that, with extreme rationing, we can ensure most but not all doctors have the absolute bare minimum of protective gear.

hprotagonist 7y ago

Atul Gawande is a voice i’m happy to listen to here, and this is a small ray of hope. He’s a practicing surgeon, public health researcher, educator, and he was one of the early champions of wide use of checklists in hospitals to reduce infection rates and complications. He is not prone to blowing sunshine and rainbows, either.

ZhuanXia 7y ago

The shameful lies about masks not working for civilians will kill thousands. Evidence based medicine (over the modern Bayesian Science-based medicine) has paralyzed our health officials from making common sense calls off priors. Homemade masks appear to be reasonably effective. The official response should be to make some form of improvised mask required when out of home, and ration regular mask for health care workers. Even a scarf made of a t-shirt over the nose and mouth will likely reduce RO when used at scale on the population. The best way to protect healthcare workers is to reduce the R0 below 1. Nothing else will help. Widespread use of homemade masks, though not tested in a double blind trial, is low risk enough and seemingly effective enough to encourage. Countries enforcing widespread mask use have lower ROs.

brigandish 7y ago
How widespread is widespread? Japan, South Korea, China, Hong Kong, Taiwan… these are countries in which people wear masks in large numbers on a normal day. They all still have an R0 above 1.
- harikb 7y ago
  Those countries also have higher population densities and public transport usage than some of the western countries. How can you say the mask isn’t helping?
  - brigandish 7y ago
    > How can you say the mask isn’t helping? I didn't but I also didn't make the claim that they would help so I suggest we start by getting claimants to back up their claims before we get anyone checking claims to prove negatives.
    - fspeech 7y ago
      We need universal mask wearing AND unlimited testing. South Korea showed it works. In Japan, even without widespread testing the spreading is still slower than the west. It's true Singapore does not mandate mask use, but they have thorough contact tracing and draconian quarantine laws.

ZhuanXia 7y ago

China has half the world’s manufacturing ability, a civil service selected strongly for cognitive ability, a much more diligent and capable people, and a large population. Not to mention experience in pandemics of this type. China will become zeroth world shortly. We will have to get used to them surpassing us.

quartzite 7y ago
How can China become zeroth world shortly when half of the country is still living in third world conditions? I suppose if you only consider how the wealthiest in Shanghai and other Tier 1 cities live their lives then yes China is approaching parity with the West but that ignores that America's per capita income is almost 5 times higher than China's. China also has the nasty problem of many of its best and brightest wanting to come to America and the West where they will have political freedom and more broadly freedom of expression, something that cannot be bought in China no matter how wealthy one becomes.
- ZhuanXia 7y ago
  I have seen the progress in China since the late 1990s. A rate of change impossible for a modern westerner to believe. China is not a photograph but a video on fast-forward.
  - leetcrew 7y ago
    people were saying this about the USSR in the 1930s (see beyond the urals by john scott). it's always faster to catch up than to break new ground. their rate of progress will slow dramatically as they approach the state of the art.
    - Der_Einzige 7y ago
      Not with over 1 billion people and the western world on its knees. If anything, their going to progress far faster than anyone else once this is over.

cryoshon 7y ago

it's more or less unforgiveable that our american healthcare workers don't have the PPE they need to protect themselves. attrition among our healthcare workers is going to be very high, especially because unlike singapore, we use the most inefficient quarantine guidelines when we suspect that they have been exposed. people are sewing masks to make up the difference between what is needed and what we can supply. the federal government can't seem to supply the states with much of anything. and purchasing domestically-produced masks is becoming rapaciously expensive, with some manufacturers charging $7 per mask. allegedly our domestic manufacturers are ramping up production. but let's face it, that takes time. and we don't have time, because once one of our healthcare workers gets sick, they're out of commission for weeks. i will not abide by this disaster for our heathcare workers. i am working with an established charity to raise money to purchase thousands of n95 respirator masks from chinese manufacturers so that those masks can be shipped and donated directly to hospitals in epicenters like new york. i'm calling it the million mask campaign because i hope that we can eventually donate at least a million masks to hospitals in need. in reality, we will need many millions of masks if we want to protect our healthcare workers, but everything we can bring to bear on their behalf will be beneficial. please consider contributing to our campaign: https://www.gofundme.com/f/the-million-mask-campaign?utm_source=customer&utm_medium=copy_link-tip&utm_campaign=p_cp+share-sheet https://www.gofundme.com/f/the-million-mask-campaign?utm_sou...

christkv 7y ago

A couple of weeks ago there was some news about salt treated masks deactivating virus. I just found this site that claims to make them https://vkmask.com/ https://vkmask.com/ anyone know anything about them? Are they real or a scam.

kevin_thibedeau 7y ago
"fermented sea salt" Might be effective in some way but there's a heavy dose of wackadoo there. US patent 88,819,662 doesn't seem to exist either.
- christkv 7y ago
  I think they are trying to pretend they are doing this https://www.nature.com/articles/srep39956 https://www.nature.com/articles/srep39956

js2 7y ago

"Why Telling People They Don’t Need Masks Backfired. To help manage the shortage, the authorities sent a message that made them untrustworthy." https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-masks.html https://www.nytimes.com/2020/03/17/opinion/coronavirus-face-...