7 ms·

It's not about the money. PPE like face shields are specifically used during procedures that involve significant bodily fluid, like intubation, which is the pro

by uxp 6y ago

It's not about the money. PPE like face shields are specifically used during procedures that involve significant bodily fluid, like intubation, which is the process of pulling or pushing a tube down a patient's esophagus. Going to to the grocery store does not require a shield. Secondly disposable medical equipment, when used properly within a healthcare environment, is extremely wasteful. For most consumable items used in a hospital, they are covered in packaging with specific serial numbers and lot numbers that allow reconciliation if it's found that the goods are not sterile or have deficiencies. There is also a provenance or chain-of-command aspect that allows attestation of safety throughout the entire supply chain. While we might be talking about how to sterilize n95 masks, reuse face shields, and asking for donations of PPE from the public right now during a pandemic, the fact remains that in normal circumstances there is massive liabilities that hospitals and clinics would be subjected to if they started sourcing protective equipment from the public that could have been tampered with, may be slightly used and broken, or otherwise could cause harm to the patient and they'd be unable to identify the source of those resources. Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply. This is one reason why we pay federal taxes.

zbrozek 6y ago
Stanford hospital, for example, throws away one N95 per patient doctor visit. They are not sterilizing and reusing. So my friend who works there is using many dozens of them per day. It seems like they could come up with material-preserving procedures like sterilization, but they're not.
- prostheticvamp 6y ago
  Because best data to date is that sterilization procedures damage the mask in ways that render it unsafe. When someone comes up with data finding a safe way to do so, the masks won’t go in the trash. In the meantime, I’d you have the masks to spare, you -should- be using them safely. Masks are pointless if you use them in a way that will get you sick.
  - klipt 6y ago
    Says something about our society, though, that doctors at Stanford can use a mask per chat "just in case", while just across the bay at Oakland Kaiser nurses are working with multiple confirmed coronavirus patients on a single mask...
    - gwright 6y ago
      What does it say? It seems to me that pretty much every society has struggled to deal with this. Perhaps because it isn't something that has many reasonable direct analogues in our collective experience? It is very easy to spot deficiencies after the fact. Much harder to spot them before.
      - jonplackett 6y ago
        It says that there's massive inequality?
        gwright 6y ago
        I don't think it says that at all. You can't cherry pick two particular institutions and draw some sort of conclusion about "society". In this particular case it seems like the entire conclusion is based on nothing other than preconceived notions of what reactions "Stanford" and "Oakland" trigger in the reader. There doesn't seem to be any particular details about the actual situation at either location and how those institutions are managed.
        brodie 6y ago
        If anything his comment reinforces negative stereotypes about the two regions. So many people in the Bay Area look down on Oakland like it’s a blighted disease-ridden wasteland and think the peninsula is some kind of haven for the rich and well off.
        munk-a 6y ago
        For reference, one of those institutions is in Palo Alto and the other is in Oakland. While Oakland has been massively gentrified it's still much more affordable to live in compared with Palo Alto.
- bolasanibk 6y ago
  Like this one: https://news.ycombinator.com/item?id=22680799 https://news.ycombinator.com/item?id=22680799
- icebraining 6y ago
  The problem is that there isn't a known safe procedure for sterilization. Universities are working on that: https://news.engin.umich.edu/2020/04/engineers-work-to-decontaminate-n95-masks-for-front-line-medical-personnel/ https://news.engin.umich.edu/2020/04/engineers-work-to-decon...
- favorited 6y ago
  They're setting up one of these[0] in Boston, allowing hospitals to sterilize and reuse 80k masks / day. There's an article[1] in the Boston Globe about it, but I'm not sure what the paywall situation is there. [0] https://www.battelle.org/inb/battelle-critical-care-decontamination-system-for-covid19 https://www.battelle.org/inb/battelle-critical-care-decontam... [1] https://www.bostonglobe.com/2020/04/02/metro/boston-hospitals-getting-game-changer-machine-that-sterilizes-80000-protective-masks-day/ https://www.bostonglobe.com/2020/04/02/metro/boston-hospital...
epicureanideal 6y ago
"Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply." No, but there's no harm in it either, and some potential benefit in case it takes a few days for the federal government to organize a response. We all assume the government is going to make sure the food supply is maintained, but everyone is also buying some extra food just in case there's a temporary gap. We don't need to choose just one way of preparing for the unknown. Also, I was just saying the general public might purchase a few of these masks for themselves for their own use, not that hospitals might rely on the public for supplies.
- uxp 6y ago
  For what, though? And I'm 100% being honest here, what is the specific situation you are envisioning that requires a face shield in your home? In a medical setting, shields are typically used in conjunction with eye goggles and respirators when performing procedures that have a tendency to cause or be around splashing body fluids. Outside of someone sneezing or spitting on you directly, I can't think of an analogous situation that I come into on even a rare circumstance that a face shield would protect me from.
  - marcus_holmes 6y ago
    It's the same mentality as people buying guns. What situation that could conceivably arise from a pandemic requires an automatic rifle? It's a generalised sense of "bad things are happening, I need to be prepared for bad things to happen to me".
    - staticautomatic 6y ago
      I don't think that's why people prep and buy guns.
    - ThrowawayR2 6y ago
      > "What situation that could conceivably arise from a pandemic requires an automatic rifle?" Good thing that automatic rifles aren't available for sale to the civilian market[1] then, I suppose. [1] Yes, the pedants will point out that it's theoretically possible with special licensing but it's very uncommon.
GoodOldNe 6y ago
Pedantic point: If you’re intubation the esophagus, you’re doing it wrong. :-)
- Angostura 6y ago
  Might this explain the poor survival rate?
  - brodie 6y ago
    I hope a doctor or nurse or respiratory therapist can correct me, but my layman’s impression is that intubation itself isn’t causing deaths as much as having to be intubated means you’re already in dire straits. I was recently intubated 3 times in the last month and had no ill effects. I know that’s just an anecdote but no doctor ever told me it would be super risky. The alternative to not getting it however usually meant death.
catblast 6y ago
> which is the process of pulling or pushing a tube down a patient's esophagus. In the context of intubation that is most definitely a bad outcome.
cayblood 6y ago
All it takes is one accidental sneeze in a grocery store for a face shield to become useful.
gwright 6y ago
There is a shortage right now and we are collectively trying to address that but it is strange to say that this particular product and the safety practices you describe is the "reason why we pay federal taxes". Your more general point that having a national stockpile of <insert-critical-item-here> for disasters of various kinds is of course valid, but that is true irrespective of the particular nature of the normal use of those particular items. And we've learned that the federal government isn't particularly good at stockpiling. I hope we can find a way to have some non-partisan after-action committees to figure out how to do better for the next disaster.
roenxi 6y ago
> It's not about the money. PPE like face shields are specifically used during procedures that involve... There is currently a global pandemic afoot that is spread by droplets expelled from people's mouth and nose. What a tool was being used for 2 months ago isn't relevant; the situation is different now. > Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply. If masks or face-shields could be cleaned fairly easily then it probably is a scalable supply. Particularly if medical professionals are allowed to supply their own work tools.
- mbreese 6y ago
  > What a tool was being used for 2 months ago isn't relevant It is very relevant. These face shields wouldn't protect anyone from airborne/aerosol pathogens or viruses. They have a very specific purpose and that isn't one of them. If you're talking about adapting construction grade shields (like used for painting, etc) for medical use -- sure. But you aren't going to use a face shield as a replacement for a face mask, which is what it seems like you're arguing for. If you're saying that you should wear a face shield in public to protect yourself from aerosolized virus -- that's not the point of a face shield. The particles can travel around the sides of the mask too easily. If you want to protect from small, airborne particles, you need a mask.
  - roenxi 6y ago
    If someone is facing me and a stream of airborne particles hits a plastic shield instead of streaming out to me, it seems pretty likely that I will be protected. I'm certainly open to the idea that fluid mechanics are complicated and somehow air currents are going to do unhelpful things, but until I find someone with a paper on the topic I'd much rather be talking to someone wearing a face shield than not. Plus obviously wearing a face shield will protect against self-inflicted infections from a contaminated finger.
    - mbreese 6y ago
      > it seems pretty likely that I will be protected And you'd be wrong. Sure, a face shield will protect you from liquid streaming out at you (partially). However, it isn't a liquid that you need to protect yourself from in this instance... it is aerosolized particles. And those travel in the air. So when you breathe in, that air can and will move around the face shield. The sibling comment about smoke moving is exactly right. Smoke is a great example of how small particles can move and travel in the air. If you think that a face shield will protect you from something in the air, you'd be wrong. Side note: this is how N95 masks are actually fit. (Well, not using smoke, but similar test). If you can smell the chemical used in the test, the fit is wrong. If you really want to protect yourself from other people sneezing -- stay away from other people. That's why social distancing is still the primary, and best, recommendation.
andrei_says_ 6y ago
> disposable This is reusable, easy to sterilize w alcohol.
dillonmckay 6y ago
I used a face-shield in October when I was using an HVLP paint sprayer indoors, so there are definite uses besides the current pandemic. It definitely cost more than a few dollars and is not disposable. Also, according to the documentation, these are re-usable and can be sanitized w/ alcohol or H2O2.
FireBeyond 6y ago
> intubation, which is the process of pulling or pushing a tube down a patient's esophagus Hope not. It's endotracheal intubation. Tubing the gut (accidentally) leads to gastric distention as we ventilate the patient, leads to aspiration, leads to aspiration pneumonia, leads to huge increase in morbidity.
RcouF1uZ4gsC 6y ago
> like intubation, which is the process of pulling or pushing a tube down a patient's esophagus. Hopefully you are intubating a patient’s trachea and not not the esophagus.
- brodie 6y ago
  Does esophageal intubation happen much? I was intubated a month ago due to non-COVID respiratory failure. I also ended up getting pneumonia but no one knows when I got it. If that happened to me would my medical team have told me? Speaking generally obviously since you don’t know my case of course.
  - DanBC 6y ago
    > If that happened to me would my medical team have told me? I don't know where you are. In England healthcare professionals and their organisations have a statutory "Duty of Candour". They have to tell you when something went wrong, why it went wrong, what they're going to try to do to fix it for you, and what they're doing to prevent it happening again in future. https://www.cqc.org.uk/sites/default/files/Duty-of-Candour-2016-CQC-joint-branded.pdf https://www.cqc.org.uk/sites/default/files/Duty-of-Candour-2...
  - RcouF1uZ4gsC 6y ago
    In general esophageal intubation results in death. The patient is not getting oxygen, and so they die. I believe esophageal intubation gets reported to the Board of Medicine and is a really big deal for the hospital and doctor involved.
jnbiche 6y ago
> pulling or pushing a tube down a patient's esophagus No, that's another procedure. Intubating respiratory patients involves targeting the trachea and avoiding the esophagus. An esophageal intubation can be Very Bad. That said, as an early advocate for face masks for the general public, I'm in 100% agreement that face shields are pointless for the general public. We don't need them.
- DanBC 6y ago
  What's the point of wearing a face mask if you're going to leave your eyes unprotected?
  - deleted 6y ago
    [deleted]
  - jnbiche 6y ago
    Mostly, to help prevent you the asymptomatic carrier, from spraying your respiratory droplets into the environment. https://www.theguardian.com/world/2020/apr/02/face-masks-coronavirus-covid-19-public https://www.theguardian.com/world/2020/apr/02/face-masks-cor... The CDC is recommending then now. Do you disagree with their expert opinion (nevermind their stand a week ago)? Finally, with respect to the mask wearer's protection, look into viral load.
    - jnbiche 6y ago
      To go into a little more depth (I assume you'll see this given that you appear to be monitoring my threads): You seem to have a mental model whereby any viral particle that bypasses your body's physical barriers has "won" - game over. But that's now how the immune system works. We want to minimize the viral load as much as possible, since with all known infectious organizations there's a dose-response relationship: the larger the dose, the worse the illness often is. Tiny loads are often effectively fought off my the immune system. We this is vividly in a bacterial illness like TB. In TB, there's little risk if you pass a coughing TB patient in the hall. But if you spend the day with them in a poorly-ventilated office, your risk increases. If you live with the patient, your risk is very high. The same principle applies with viral illnesses like Covid-19. And given that the only access route that is actively pulling viral particles into the body is the respiratory tract, it stands to reason that protecting that route has a higher payoff than protecting a lower risk route like the eyes. That's not to say that people in high risk situations like Covid-19 wards of hospitals shouldn't cover their eyes! Obviously, they should and do. However, for most of us, the best protection we can use without using BL4 protection gear (obviously, not practical or needed for the general public) is to wear a mask. Mostly, the mask is to protect others from you, but depending on what kind of mask it is, it can also protect you from the virus. Finally, most health authorities are now recommending that the general public wear masks. CDC changed their recommendations a week or two ago to recommend wearing masks. As usual, the WHO is moving slowly as large bureaucracies often do, but I don't doubt they'll also recommend them in the end as more evidence of their efficacy emerges.

by uxp 6y ago

zbrozek 6y ago

Stanford hospital, for example, throws away one N95 per patient doctor visit. They are not sterilizing and reusing. So my friend who works there is using many dozens of them per day. It seems like they could come up with material-preserving procedures like sterilization, but they're not.

prostheticvamp 6y ago
Because best data to date is that sterilization procedures damage the mask in ways that render it unsafe. When someone comes up with data finding a safe way to do so, the masks won’t go in the trash. In the meantime, I’d you have the masks to spare, you -should- be using them safely. Masks are pointless if you use them in a way that will get you sick.
- klipt 6y ago
  Says something about our society, though, that doctors at Stanford can use a mask per chat "just in case", while just across the bay at Oakland Kaiser nurses are working with multiple confirmed coronavirus patients on a single mask...
  - gwright 6y ago
    What does it say? It seems to me that pretty much every society has struggled to deal with this. Perhaps because it isn't something that has many reasonable direct analogues in our collective experience? It is very easy to spot deficiencies after the fact. Much harder to spot them before.
    - jonplackett 6y ago
      It says that there's massive inequality?
      - gwright 6y ago
        I don't think it says that at all. You can't cherry pick two particular institutions and draw some sort of conclusion about "society". In this particular case it seems like the entire conclusion is based on nothing other than preconceived notions of what reactions "Stanford" and "Oakland" trigger in the reader. There doesn't seem to be any particular details about the actual situation at either location and how those institutions are managed.
        brodie 6y ago
        If anything his comment reinforces negative stereotypes about the two regions. So many people in the Bay Area look down on Oakland like it’s a blighted disease-ridden wasteland and think the peninsula is some kind of haven for the rich and well off.
        munk-a 6y ago
        For reference, one of those institutions is in Palo Alto and the other is in Oakland. While Oakland has been massively gentrified it's still much more affordable to live in compared with Palo Alto.
bolasanibk 6y ago
Like this one: https://news.ycombinator.com/item?id=22680799 https://news.ycombinator.com/item?id=22680799
icebraining 6y ago
The problem is that there isn't a known safe procedure for sterilization. Universities are working on that: https://news.engin.umich.edu/2020/04/engineers-work-to-decontaminate-n95-masks-for-front-line-medical-personnel/ https://news.engin.umich.edu/2020/04/engineers-work-to-decon...
favorited 6y ago
They're setting up one of these[0] in Boston, allowing hospitals to sterilize and reuse 80k masks / day. There's an article[1] in the Boston Globe about it, but I'm not sure what the paywall situation is there. [0] https://www.battelle.org/inb/battelle-critical-care-decontamination-system-for-covid19 https://www.battelle.org/inb/battelle-critical-care-decontam... [1] https://www.bostonglobe.com/2020/04/02/metro/boston-hospitals-getting-game-changer-machine-that-sterilizes-80000-protective-masks-day/ https://www.bostonglobe.com/2020/04/02/metro/boston-hospital...

epicureanideal 6y ago

"Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply." No, but there's no harm in it either, and some potential benefit in case it takes a few days for the federal government to organize a response. We all assume the government is going to make sure the food supply is maintained, but everyone is also buying some extra food just in case there's a temporary gap. We don't need to choose just one way of preparing for the unknown. Also, I was just saying the general public might purchase a few of these masks for themselves for their own use, not that hospitals might rely on the public for supplies.

uxp 6y ago
For what, though? And I'm 100% being honest here, what is the specific situation you are envisioning that requires a face shield in your home? In a medical setting, shields are typically used in conjunction with eye goggles and respirators when performing procedures that have a tendency to cause or be around splashing body fluids. Outside of someone sneezing or spitting on you directly, I can't think of an analogous situation that I come into on even a rare circumstance that a face shield would protect me from.
- marcus_holmes 6y ago
  It's the same mentality as people buying guns. What situation that could conceivably arise from a pandemic requires an automatic rifle? It's a generalised sense of "bad things are happening, I need to be prepared for bad things to happen to me".
  - staticautomatic 6y ago
    I don't think that's why people prep and buy guns.
  - ThrowawayR2 6y ago
    > "What situation that could conceivably arise from a pandemic requires an automatic rifle?" Good thing that automatic rifles aren't available for sale to the civilian market[1] then, I suppose. [1] Yes, the pedants will point out that it's theoretically possible with special licensing but it's very uncommon.

GoodOldNe 6y ago

Pedantic point: If you’re intubation the esophagus, you’re doing it wrong. :-)

Angostura 6y ago
Might this explain the poor survival rate?
- brodie 6y ago
  I hope a doctor or nurse or respiratory therapist can correct me, but my layman’s impression is that intubation itself isn’t causing deaths as much as having to be intubated means you’re already in dire straits. I was recently intubated 3 times in the last month and had no ill effects. I know that’s just an anecdote but no doctor ever told me it would be super risky. The alternative to not getting it however usually meant death.

catblast 6y ago

> which is the process of pulling or pushing a tube down a patient's esophagus. In the context of intubation that is most definitely a bad outcome.

cayblood 6y ago

All it takes is one accidental sneeze in a grocery store for a face shield to become useful.

gwright 6y ago

There is a shortage right now and we are collectively trying to address that but it is strange to say that this particular product and the safety practices you describe is the "reason why we pay federal taxes". Your more general point that having a national stockpile of <insert-critical-item-here> for disasters of various kinds is of course valid, but that is true irrespective of the particular nature of the normal use of those particular items. And we've learned that the federal government isn't particularly good at stockpiling. I hope we can find a way to have some non-partisan after-action committees to figure out how to do better for the next disaster.

roenxi 6y ago

> It's not about the money. PPE like face shields are specifically used during procedures that involve... There is currently a global pandemic afoot that is spread by droplets expelled from people's mouth and nose. What a tool was being used for 2 months ago isn't relevant; the situation is different now. > Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply. If masks or face-shields could be cleaned fairly easily then it probably is a scalable supply. Particularly if medical professionals are allowed to supply their own work tools.

mbreese 6y ago
> What a tool was being used for 2 months ago isn't relevant It is very relevant. These face shields wouldn't protect anyone from airborne/aerosol pathogens or viruses. They have a very specific purpose and that isn't one of them. If you're talking about adapting construction grade shields (like used for painting, etc) for medical use -- sure. But you aren't going to use a face shield as a replacement for a face mask, which is what it seems like you're arguing for. If you're saying that you should wear a face shield in public to protect yourself from aerosolized virus -- that's not the point of a face shield. The particles can travel around the sides of the mask too easily. If you want to protect from small, airborne particles, you need a mask.
- roenxi 6y ago
  If someone is facing me and a stream of airborne particles hits a plastic shield instead of streaming out to me, it seems pretty likely that I will be protected. I'm certainly open to the idea that fluid mechanics are complicated and somehow air currents are going to do unhelpful things, but until I find someone with a paper on the topic I'd much rather be talking to someone wearing a face shield than not. Plus obviously wearing a face shield will protect against self-inflicted infections from a contaminated finger.
  - mbreese 6y ago
    > it seems pretty likely that I will be protected And you'd be wrong. Sure, a face shield will protect you from liquid streaming out at you (partially). However, it isn't a liquid that you need to protect yourself from in this instance... it is aerosolized particles. And those travel in the air. So when you breathe in, that air can and will move around the face shield. The sibling comment about smoke moving is exactly right. Smoke is a great example of how small particles can move and travel in the air. If you think that a face shield will protect you from something in the air, you'd be wrong. Side note: this is how N95 masks are actually fit. (Well, not using smoke, but similar test). If you can smell the chemical used in the test, the fit is wrong. If you really want to protect yourself from other people sneezing -- stay away from other people. That's why social distancing is still the primary, and best, recommendation.

andrei_says_ 6y ago

> disposable This is reusable, easy to sterilize w alcohol.

dillonmckay 6y ago

I used a face-shield in October when I was using an HVLP paint sprayer indoors, so there are definite uses besides the current pandemic. It definitely cost more than a few dollars and is not disposable. Also, according to the documentation, these are re-usable and can be sanitized w/ alcohol or H2O2.

FireBeyond 6y ago

> intubation, which is the process of pulling or pushing a tube down a patient's esophagus Hope not. It's endotracheal intubation. Tubing the gut (accidentally) leads to gastric distention as we ventilate the patient, leads to aspiration, leads to aspiration pneumonia, leads to huge increase in morbidity.

RcouF1uZ4gsC 6y ago

> like intubation, which is the process of pulling or pushing a tube down a patient's esophagus. Hopefully you are intubating a patient’s trachea and not not the esophagus.

brodie 6y ago
Does esophageal intubation happen much? I was intubated a month ago due to non-COVID respiratory failure. I also ended up getting pneumonia but no one knows when I got it. If that happened to me would my medical team have told me? Speaking generally obviously since you don’t know my case of course.
- DanBC 6y ago
  > If that happened to me would my medical team have told me? I don't know where you are. In England healthcare professionals and their organisations have a statutory "Duty of Candour". They have to tell you when something went wrong, why it went wrong, what they're going to try to do to fix it for you, and what they're doing to prevent it happening again in future. https://www.cqc.org.uk/sites/default/files/Duty-of-Candour-2016-CQC-joint-branded.pdf https://www.cqc.org.uk/sites/default/files/Duty-of-Candour-2...
- RcouF1uZ4gsC 6y ago
  In general esophageal intubation results in death. The patient is not getting oxygen, and so they die. I believe esophageal intubation gets reported to the Board of Medicine and is a really big deal for the hospital and doctor involved.

jnbiche 6y ago

> pulling or pushing a tube down a patient's esophagus No, that's another procedure. Intubating respiratory patients involves targeting the trachea and avoiding the esophagus. An esophageal intubation can be Very Bad. That said, as an early advocate for face masks for the general public, I'm in 100% agreement that face shields are pointless for the general public. We don't need them.

DanBC 6y ago
What's the point of wearing a face mask if you're going to leave your eyes unprotected?
- deleted 6y ago
  [deleted]
- jnbiche 6y ago
  Mostly, to help prevent you the asymptomatic carrier, from spraying your respiratory droplets into the environment. https://www.theguardian.com/world/2020/apr/02/face-masks-coronavirus-covid-19-public https://www.theguardian.com/world/2020/apr/02/face-masks-cor... The CDC is recommending then now. Do you disagree with their expert opinion (nevermind their stand a week ago)? Finally, with respect to the mask wearer's protection, look into viral load.
  - jnbiche 6y ago
    To go into a little more depth (I assume you'll see this given that you appear to be monitoring my threads): You seem to have a mental model whereby any viral particle that bypasses your body's physical barriers has "won" - game over. But that's now how the immune system works. We want to minimize the viral load as much as possible, since with all known infectious organizations there's a dose-response relationship: the larger the dose, the worse the illness often is. Tiny loads are often effectively fought off my the immune system. We this is vividly in a bacterial illness like TB. In TB, there's little risk if you pass a coughing TB patient in the hall. But if you spend the day with them in a poorly-ventilated office, your risk increases. If you live with the patient, your risk is very high. The same principle applies with viral illnesses like Covid-19. And given that the only access route that is actively pulling viral particles into the body is the respiratory tract, it stands to reason that protecting that route has a higher payoff than protecting a lower risk route like the eyes. That's not to say that people in high risk situations like Covid-19 wards of hospitals shouldn't cover their eyes! Obviously, they should and do. However, for most of us, the best protection we can use without using BL4 protection gear (obviously, not practical or needed for the general public) is to wear a mask. Mostly, the mask is to protect others from you, but depending on what kind of mask it is, it can also protect you from the virus. Finally, most health authorities are now recommending that the general public wear masks. CDC changed their recommendations a week or two ago to recommend wearing masks. As usual, the WHO is moving slowly as large bureaucracies often do, but I don't doubt they'll also recommend them in the end as more evidence of their efficacy emerges.