4. Or is the current PPE not adequate against this novel virus?

Guess, the reasons for infection among healthcare workers is a mix of all you have mentioned, breach in protocol, lack of PPE and through other contacts. In India, the official figures are 1073 confirmed cases (May 23rd). Due to overwork and long hours, breach in protocol is the most likely cause.

I agree

So, you are saying it is fixable for the future; more education?

July 26, 2020: After due consideration, to your question:

1. Face masks are not perfect.

2. The possibility of leakage and contamination increase with time (e.g. a 12 hour shift too long for one mask)

3. There are breeches in protocol

4. There are other modes of transmission than just airborne-respiratory

5. Some of the cases may be contracted outside of work, e.g. home and play.

Stay safe and thank you for allowing these thoughts. Gary Ordog, MD

Here is an interesting study. Showed that the healthcare workers contracted the virus at home, and not in the hospital. A must-read:

Webinar: SARS-CoV-2 Research: Implications of Viral Sequencing—The Children's Hospital Los Angeles Experience

In this webinar, Dr. Timothy J. Triche MD, PhD, Co-Director of Center for Personalized Medicine at Children’s Hospital Los Angeles​ (CHLA), shares how he and his team used sequencing data generated from the Ion AmpliSeq SARS-CoV-2 Research Panel to analyze phylogenetic relationships among a cluster of six SARS-CoV-2-positive samples. By identifying two distinct lineages between the two sets, the team was able to conclude that the source of transmission wasn’t shared. Comparative analysis showed that, not unexpectedly, the mother and son had nearly identical strains of the virus that originated in Utah, with links to Europe, while the four health care workers had strains only distantly related to each other and to the family. This confirmed that there was no transmission between the patient family and the health care workers. Further, the health care workers acquired the virus from community spread and not from the patient and family member. "The NGS sequence data permitted Children's Hospital Los Angeles to draw conclusions within 48 hours of sample procurement from the six individuals. This information gave leaders at our institution greater confidence in our ability to provide a safe environment for our patients and our team members."

Today in JAMA a report that sheds some light on this topic:

Research Letter August 6, 2020

Prevalence of SARS-CoV-2 Antibodies in Health Care Personnel in the New York City Area

Joseph Moscola, PA, MBA1; Grace Sembajwe, DSc, MSc, CIH2; Mark Jarrett, MD, MBA, MS1; et alBruce Farber, MD3; Tylis Chang, MD4; Thomas McGinn, MD, MPH2; Karina W. Davidson, PhD, MASc2; for the Northwell Health COVID-19 Research ConsortiumAuthor Affiliations Article InformationJAMA. Published online August 6, 2020. doi:10.1001/jama.2020.14765

COVID-19 Resource Center

Summary: A 13.7% prevalence of SARS-CoV-2 antibodies in this study of Health Care Providers in the greater New York City area was similar to that among adults randomly tested in New York State (14.0%) but higher than among adults in Los Angeles (4.1%). Health Care Providers in a single hospital in Belgium had lower sero-prevalence (6.4%), which was significantly associated only with household contact. High levels of Health Care Provider reported suspicion of virus exposure and prior positive PCR testing results were most strongly associated with sero-positivity. It has been reported previously, that Health Care Providers have three times the likelihood to be seropositive than the general population.

September 19, 2020: Here is a news update discussing the Canadian Healthcare Workers situation. The infection rate is over 20% in Canadian healthcare workers, which is probably much higher than the general population at the present time. More details here, again discussing Canada:

Nearly 20 per cent of COVID-19 infections among health-care workers by late July

10 hrs ago: Provided by The Canadian Press

VANCOUVER — Health care workers in Canada made up about 20 per cent of COVID-19 infections as of late July, a figure that was higher than the global average.

In a report released earlier this month, the Canadian Institute for Health Information said 19.4 per cent of those who tested positive for the virus as of July 23 were health-care workers. Twelve health care workers, nine from Ontario and three from Quebec, died from COVID-19, it said.

The World Health Organization said in July that health-care workers made up 10 per cent of global COVID-19 infections.

A national federation of nurses' unions blames the infection rate on a slow response to the pandemic, a shortage of labour and a lack of personal protective equipment. 

Mahi Etminan, a registered oncology nurse who was working at a hospital in Vancouver in mid-March, says she doesn't know how she was infected by COVID-19.

"It could have been anywhere in the hospital," she said.

"In March, we weren't required to really wear any masks or anything."

Etminan said she has tested negative for the virus twice but still feels the after-effects of her illness. She tires easily, has lost her sense of taste — even salt — and is losing chunks of her hair.

She agrees with the Canadian Federation of Nurses Unions that proper precautions weren't put in place to deal with COVID-19.

"I think we were behind in putting a proper protocol in place," Etminan said.

Linda Silas, president of the 200,000-member nurses' federation, said Canadian hospitals approached COVID-19 based on the findings of a 2003 Ontario government commission into SARS.

"I thought we were ready," Silas said in an interview.

"And then mid-March, early March, we realized how unready we were. And that's one of the reasons that we have one of the highest levels of health-care workers getting infected."

She said with the routes of transmission for the virus being uncertain — and later research showing it was possible the virus could be airborne — it was critical that health care workers get full protection.

The Ontario government convened the commission to investigate the origin, spread and response to SARS. One of the key recommendations of the report was improving the safety of health-care workers.

Ontario Health Ministry spokesman David Jensen said lessons learned from SARS have been implemented, including giving more powers to the chief medical officer of health to issue directives to workers and organizations.

The province recommends health-care workers use appropriate precautions when conducting clinical assessments, testing and caring for patients who are suspected or confirmed to have COVID-19, he said.

The approach to the novel coronavirus was taken on a precautionary basis because little information was available about its transmission and clinical severity, Jensen said in an email response to questions.

"The majority of cases are linked to person-to-person transmission through close direct contact with someone who has COVID-19. There is no evidence that COVID-19 is transmitted through the airborne route."

The World Health Organization acknowledged in July the possibility that COVID-19 might be spread in the air under certain conditions.

It said those most at risk from airborne spread are doctors and nurses who perform specialized procedures, such as inserting a breathing tube or putting patients on a ventilator.

Michael Brauer, a professor at the University of British Columbia's school of population and public health, said COVID-19 doesn't fit the traditional airborne model where viruses remain infectious over long distances and time periods.

"There's been a little bit of an evolution in our understanding of the transmission," he said, adding there was evidence as early as March that showed the virus can be transmitted via air.

While early on more attention was paid to surface transmission, it now seems as though the airborne route is more prominent, he said.

Health Canada spokeswoman Tammy Jarbeau said long-term care facilities and retirement homes were among the hardest hit during the peak of COVID-19 in the spring, likely affecting health-care workers.

The federal government is working with the Canadian Institute for Health Information to better understand the virus, including expanding case data for health-care workers.

The Quebec government said the high rate of community contamination in the province coupled with a labour shortage at the beginning of the pandemic affected health-care workers who were working in several long-term care homes to maintain essential services.

"In recent months, Quebec has gone through an unprecedented health crisis," said Robert Maranda, a spokesman for the ministry of health and social services.

The plan to deal with COVID-19 was based mainly on the experience gleaned from the 2009 swine flu pandemic, he said.

"However, H1N1 influenza is not the same virus that we are currently fighting against," Maranda said.

"A person with COVID-19 can transmit the virus without having any symptoms, which is not the case with the flu."

But as more is known about the new coronavirus, he said the province's response has changed, including no longer allowing health-care workers to work in different places.

Silas said the nurses' federation has started an investigation led by a former senior adviser to the SARS commission into why Canada didn't better protect health-care workers from COVID-19. The report is expected later this year.

The Public Health Agency has done a poor job of gathering data about health-care workers infected with COVID-19, she said, adding that the federation has relied on data collected by Statistics Canada.

"There's this lack of information flowing," Silas said.

Natalie Mohamed, a spokeswoman for the Public Health Agency, said 25 per cent of all reported cases were among people who describe themselves as working in health care and it has been collecting data from the provinces and territories since March.

Those who identify themselves as health-care workers include physicians, nurses, dentists, physiotherapists, residential home workers, cleaners, janitorial staff and volunteers.

Some health-care workers may also be getting infected outside work, Mohamed said, although exposure data is incomplete.

The associate executive director of the Canadian Medical Protective Association, which provides advice and assistance in medical-legal matters to doctors, said it began fielding concerns from members about a lack of protective equipment when the virus started spreading.

Dr. Todd Watkins said the questions have shifted to how things will be handled in the future.

"Will there be a second wave and how am I going to respond to that? Is my clinic prepared for that? Will there be appropriate protective gear?"

Christine Nielsen, chief executive officer of the Canadian Society for Medical Laboratory Science, said the flow of information is affected by the fact the provinces and territories deliver health care and they could collect data differently.

"There's room for improvement with how public health has responded," she said. "Just the scale of the pandemic has really caught everyone off guard."

Thank you, again a Canadian discussion (as evidenced by the labour as opposed to labor!) Stay safe, and unfortunately, if you are isolating, a good time to avoid medical establishments for routine visits, obviously must go in an emergency. The PPE, even in medical care workers, is not 100% effective. So far, everything points to the conclusion that we really need a good vaccine given as soon as possible. Stay tune. Gary Ordog, MD September 19, 2020.

I published this in JAMA Ophthalmology today, it might help with protection to protect the eyes with PPE:

Comment Journal of the American Medical Association Ophthalmology September 19, 2020 Eye Protection as an Essential Part of PPE. Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for the informative study. First, in response to a previous question, the methodology is stated to include direct questioning about eyeglasses, also in my experience, the direct questioning of patients upon hospital admission includes the use of eyeglasses, dentures, prostheses, pacemakers, etc. which would make this information readily available on admission documents. So this set of data seems plausible. The validity of matching of the experimental with the control group is more questionable. Nevertheless, the results show a very strong association in the protective action of eyeglasses against SARS-CoV-2, and in conclusion would support the use of eye protection in PPE use. The preferred PPE should have eye protection that prevents "touching" and direct air flow to the eyes. Also, there may be other confounding variables that are causing this strong association, for example: 'further investigation could show that eyeglass users frequently clean the glasses with sterilizing wipe, thus presenting a chemical shield to the virus.' Again, thank you for your work, and as usual, further study is required. Stay safe with eye protection. CONFLICT OF INTEREST: None Reported Brief Report September 16, 2020 Association of Daily Wear of Eyeglasses With Susceptibility to Coronavirus Disease 2019 Infection Weibiao Zeng, MS1; Xiaolin Wang, MS2; Junyu Li, MS3; et alYong Yang, MS2; Xingting Qiu, MS4; Pinhong Song, MS2; Jianjun Xu, MD, PhD1; Yiping Wei, MD, PhD1 Author Affiliations Article Information JAMA Ophthalmol. Published online September 16, 2020. doi:10.1001/jamaophthalmol.2020.3906 COVID-19 Resource Center editorial comment icon Editorial Comment Key Points Question What is the association between the daily wear of eyeglasses and susceptibility to coronavirus disease 2019 (COVID-19)? Findings In this cohort of 276 patients hospitalized with COVID-19 in Suizhou, China, the proportion of daily wearers of eyeglasses was lower than that of the local population (5.8% vs 31.5%). Meaning These findings suggest that daily wearers of eyeglasses may be less likely to be infected with COVID-19. Abstract Importance The proportion of daily wearers of eyeglasses among patients with coronavirus disease 2019 (COVID-19) is small, and the association between daily wear of eyeglasses and COVID-19 susceptibility has not been reported. Objective To study the association between the daily wearing of eyeglasses and the susceptibility to COVID-19. Design, Setting, and Participants This cohort study enrolled all inpatients with COVID-19 in Suizhou Zengdu Hospital, Suizhou, China, a designated hospital for COVID-19 treatment in the area, from January 27 to March 13, 2020. COVID-19 was diagnosed according to the fifth edition of Chinese COVID-19 diagnostic guidelines. The proportion of persons with myopia who wore eyeglasses in Hubei province was based on data from a previous study. Exposures Daily wearing of eyeglasses for more than 8 hours. Main Outcomes and Measures The main outcomes were the proportions of daily wearers of eyeglasses among patients admitted to the hospital with COVID-19 and among the local population. Data on exposure history, clinical symptoms, underlying diseases, duration of wearing glasses, and myopia status and the proportion of people with myopia who wore eyeglasses in Hubei province were collected. People who wore glasses for more than 8 hours a day were defined as long-term wearers. Results A total of 276 patients with COVID-19 were enrolled. Of these, 155 (56.2%) were male, and the median age was 51 (interquartile range, 41-58) years. All those who wore glasses for more than 8 hours a day had myopia and included 16 of 276 patients (5.8%; 95% CI, 3.04%-8.55%). The proportion of people with myopia in Hubei province, based on a previous study, was 31.5%, which was much higher than the proportion of patients with COVID-19 who had myopia in this sample. Conclusions and Relevance In this cohort study of patients hospitalized with COVID-19 in Suizhou, China, the proportion of inpatients with COVID-19 who wore glasses for extended daily periods (>8 h/d) was smaller than that in the general population, suggesting that daily wearers of eyeglasses may be less susceptible to COVID-19. Introduction Coronavirus disease 2019 (COVID-19), the pathogen of which is severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly infectious disease that broke out in Wuhan, China, in December 2019 and has spread to more than 200 countries.1 COVID-19 has been proven to be transmitted mainly through droplets and contact.2 The eye is also considered an important route of infection. According to reports published in recent years, the prevalence of myopia in China is now more than 80% of the population. Wearing of eyeglasses is common among Chinese individuals of all ages.3 However, since the outbreak of COVID-19 in Wuhan in December 2019, we observed that few patients with eyeglasses were admitted in the hospital ward. Therefore, we collected information on the wearing of eyeglasses from all inpatients with COVID-19 as part of their medical history and used the data to examine the association between wearing eyeglasses and COVID-19 infection. Methods This cohort study was approved by the ethics committee of Suizhou Zengdu Hospital, Suizhou, China, and followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) reporting guideline. Patients signed written informed consent and were not provided with any incentive or compensation to participate in the study. The study enrolled patients admitted to the hospital from January 27 to March 13, 2020, with the admission criteria of a diagnosis of COVID-19. The diagnostics and clinical classification of COVID-19 were based on the fifth edition of Chinese COVID-19 diagnostic guidelines.4 Throat swab samples were obtained from patients at admission and tested using real-time reverse transcriptase–polymerase chain reaction assays to identify COVID-19 infection. Patients were specifically asked about the reason they wore eyeglasses, the length of time that they wore eyeglasses during daily activities, and whether they wore contact lenses or had ever undergone refractive surgery. This information was recorded by the patients’ treating physicians while taking their medical history, starting February 4, 2020. Information on exposure history and clinical symptoms was extracted from the medical records. People who wore eyeglasses for more than 8 hours a day were defined as long-term wearers, and these people were considered to wear eyeglasses when socializing. To estimate the population myopia rate, we extracted data from the Research on Chinese Student Physique and Health Study,5 which recorded data from a survey about the physical and health status of Chinese students, organized by state educational institutions and the Ministry of Health of China in 1985. We used descriptive statistics to characterize the study sample. Results As shown in the Table, a total of 276 patients with COVID-19 were enrolled in the study. The median age was 51 (interquartile range, 41-58) years; 155 patients (56.2%) were male and 121 (43.8%) were female. Most patients with COVID-19 were moderately ill, with 14 (5.1%) severely ill. Common symptoms were fever (227 [82.2%]), cough (218 [79.0%]), and fatigue (141 [51.1%]). Underlying disease was present in 88 patients (31.9%), with hypertension the most common, accounting for 47 (17.0%) of all admitted patients. Thirty patients with COVID-19 wore eyeglasses (10.9%), including 16 cases of myopia and 14 cases of presbyopia. None of the patients in this study wore contact lenses or underwent refractive surgery. All 16 patients with COVID-19 who wore glasses for more than 8 hours per day had myopia, accounting for 5.8% (95% CI, 3.0%-8.6%), and the median age was 33 years. Their symptoms, underlying disease, and COVID-19 severity were not significantly different from those of other patients. The results from previous research5 showed that the mean rate of myopia among students aged 7 to 22 years in Hubei province was 31.5%. By 2020, these students were aged 42 to 57 years, which is close to the median age of our patients with COVID-19. The myopia rate of 31.5% is higher than the 5.8% among our patients with COVID-19. Discussion At the time of writing, this study was the only research, to our knowledge, to assess the association between wearing eyeglasses and COVID-19 infection. Our main finding was that patients with COVID-19 who wear eyeglasses for an extended period (>8 h/d) every day were relatively uncommon, which could be preliminary evidence that daily wearers of eyeglasses are less susceptible to COVID-19. Considering the prevalence of COVID-19, conducting a sample survey among the local population would have been difficult. Instead, we used data from a previous survey for approximate reference and comparison, although the age, region, and educational level of the students in that survey had some differences compared with our study population. We hypothesized that eyeglasses prevent or discourage wearers from touching their eyes, thus avoiding transferring the virus from the hands to the eyes.6 Studies have shown that normal people will involuntarily touch their eyes about 10 times per hour.7 Eyes usually lack protection, and an abundance of the SARS-CoV-2 receptor angiotensin-converting enzyme 2 has been found on the ocular surface,8 through which SARS-CoV-2 can enter the human body. SARS-CoV-2 may also be transported to the nasal and nasopharyngeal mucosa through continuous tear irrigation of the lacrimal duct, causing respiratory infection.9 According to available statistics, nearly 1% to 12% of patients with COVID-19 have ocular manifestations,10,11 SARS-CoV-2 was detected in tears or the conjunctival sacs of patients with COVID-19,12 and some ophthalmologists were reported to be infected during routine treatment.13 Therefore, the eyes are considered an important channel for SARS-CoV-2 to enter the human body.11 For daily wearers of eyeglasses, who usually wear eyeglasses on social occasions, wearing eyeglasses may become a protective factor, reducing the risk of virus transfer to the eyes and leading to long-term daily wearers of eyeglasses being rarely infected with COVID-19. Presently, many COVID-19 guidelines state the need to pay attention to preventing infections through the eyes,14 but most people only focus on wearing masks and home isolation, ignoring recommendations such as washing hands frequently and avoiding touching the eyes with the hands.15 The results of this study can be used as evidence of the importance of these 2 recommendations. Limitations Our study had some notable limitations. First, it was a single-center study with a small sample size. The numbers of patients who wear eyeglasses and long-term wearers were limited, which limits the extension of the results to a larger population, so our results need to be verified by large-sample multicenter studies. Second, the proportion of wearers of eyeglasses was based on data from previous literature and was not calculated from current local populations. Third, the myopia rate obtained in previous studies included a small number of people with myopia who did not wear eyeglasses. Information on these people was lacking and partly affected the integrity and validity of our data. Fourth, none of our research participants wore contact lenses, so the association between wearing contact lenses and susceptibility to COVID-19 remains to be studied. In addition, further studies are needed to clarify the reasons that wearing eyeglasses may decrease susceptibility to COVID-19. Conclusions Our study found that the proportion of inpatients with COVID-19 who wear eyeglasses for extended daily periods was lower than that of the general population, suggesting that daily wear of eyeglasses is associated with less susceptibility to COVID-19 infection. These findings suggest that the eye may be an important infection route for COVID-19, and more attention should be paid to preventive measures such as frequent hand washing and avoiding touching the eyes. Back to top Article Information Accepted for Publication: July 28, 2020. Corresponding Author: Yiping Wei, MD, PhD ([email protected]), and Jianjun Xu, MD, PhD ([email protected]), Department of Thoracic Surgery, The Second Affiliated Hospital of Nanchang University, 1 Min De Road, Nanchang 330006, China. Published Online: September 16, 2020. doi:10.1001/jamaophthalmol.2020.3906 Author Contributions: Drs Wei and Xu had full access to the study data and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Xu, Yiping. Acquisition, analysis, or interpretation of data: Zeng, Xiaolin, Junyu, Qiu, Yong, Song, Yiping. Drafting of the manuscript: Zeng, Xiaolin, Junyu, Qiu, Song, Yiping. Critical revision of the manuscript for important intellectual content: Zeng, Yong, Xu, Yiping. Statistical analysis: All authors. Obtained funding: Zeng, Xu, Yiping. Administrative, technical, or material support: Zeng, Junyu, Yong, Xu, Yiping. Supervision: Yong, Xu, Yiping. Conflict of Interest Disclosures: None reported. Additional Contributions: We thank the physicians who supported Suizhou Zengdu Hospital, Suizhou, China, in the fight against coronavirus disease 2019 for their contribution to patient management and data collection for this study. References 1. Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention.  JAMA. 2020. doi:10.1001/jama.2020.2648 ArticlePubMedGoogle Scholar 2. Pongpirul WA, Pongpirul K, Ratnarathon AC, Prasithsirikul W. Journey of a Thai taxi driver and novel coronavirus.  N Engl J Med. 2020;382(11):1067-1068. doi:10.1056/NEJMc2001621PubMedGoogle ScholarCrossref 3. Chen M, Wu A, Zhang L, et al. The increasing prevalence of myopia and high myopia among high school students in Fenghua City, eastern China: a 15-year population-based survey.  BMC Ophthalmol. 2018;18(1):159. doi:10.1186/s12886-018-0829-8PubMedGoogle ScholarCrossref 4. General Office of National Health Commission. Diagnosis and treatment protocols for novel coronavirus pneumonia (trial version 5, revised) [in Chinese]. Published February 4, 2020. Accessed March 15, 2020. http://www.gov.cn/zhengce/zhengceku/2020-02/09/content_5476407.htm 5. Chinese Student Physique and Health Research Group. Research on Chinese Students' Physique and Health [in Chinese]. People's Education Press; 1987. 6. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1.  N Engl J Med. 2020;382(16):1564-1567. doi:10.1056/NEJMc2004973PubMedGoogle ScholarCrossref 7. Kwok YL, Gralton J, McLaws ML. Face touching: a frequent habit that has implications for hand hygiene.  Am J Infect Control. 2015;43(2):112-114. doi:10.1016/j.ajic.2014.10.015PubMedGoogle ScholarCrossref 8. Holappa M, Vapaatalo H, Vaajanen A. Many faces of renin-angiotensin system—focus on eye.  Open Ophthalmol J. 2017;11:122-142. doi:10.2174/1874364101711010122PubMedGoogle ScholarCrossref 9. Xiao X, Chakraborti S, Dimitrov AS, Gramatikoff K, Dimitrov DS. The SARS-CoV S glycoprotein: expression and functional characterization.  Biochem Biophys Res Commun. 2003;312(4):1159-1164. doi:10.1016/j.bbrc.2003.11.054PubMedGoogle ScholarCrossref 10. Guan WJ, Ni ZY, Hu Y, et al; China Medical Treatment Expert Group for Covid-19. Clinical characteristics of coronavirus disease 2019 in China.  N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032PubMedGoogle ScholarCrossref 11. Wu P, Duan F, Luo C, et al. Characteristics of ocular findings of patients with coronavirus disease 2019 (COVID-19) in Hubei Province, China.  JAMA Ophthalmol. 2020;138(5):575-578. doi:10.1001/jamaophthalmol.2020.1291 ArticlePubMedGoogle ScholarCrossref 12. Seah IYJ, Anderson DE, Kang AEZ, et al. Assessing viral shedding and infectivity of tears in coronavirus disease 2019 (COVID-19) patients.  Ophthalmology. 2020;127(7):977-979. doi:10.1016/j.ophtha.2020.03.026PubMedGoogle ScholarCrossref 13. Lu CW, Liu XF, Jia ZF. 2019-nCoV transmission through the ocular surface must not be ignored.  Lancet. 2020;395(10224):e39. doi:10.1016/S0140-6736(20)30313-5PubMedGoogle Scholar 14. World Health Organization. Coronavirus disease (COVID-19) advice for the public. Updated June 4, 2020. Accessed April 1, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public 15. Machida M, Nakamura I, Saito R, et al. Adoption of personal protective measures by ordinary citizens during the COVID-19 outbreak in Japan.  Int J Infect Dis. 2020;94:139-144. doi:10.1016/j.ijid.2020.04.014PubMedGoogle ScholarCrossref Comment Journal of the American Medical Association Ophthalmology September 19, 2020 Eye Protection as an Essential Part of PPE. Gary Ordog, MD, DABEM, DABMT | County of Los Angeles, Department of Health Services, (retired) Thank you for the informative study. First, in response to a previous question, the methodology is stated to include direct questioning about eyeglasses, also in my experience, the direct questioning of patients upon hospital admission includes the use of eyeglasses, dentures, prostheses, pacemakers, etc. which would make this information readily available on admission documents. So this set of data seems plausible. The validity of matching of the experimental with the control group is more questionable. Nevertheless, the results show a very strong association in the protective action of eyeglasses against SARS-CoV-2, and in conclusion would support the use of eye protection in PPE use. The preferred PPE should have eye protection that prevents "touching" and direct air flow to the eyes. Also, there may be other confounding variables that are causing this strong association, for example: 'further investigation could show that eyeglass users frequently clean the glasses with sterilizing wipe, thus presenting a chemical shield to the virus.' Again, thank you for your work, and as usual, further study is required. Stay safe with eye protection. CONFLICT OF INTEREST: None Reported

Thank you for your support. Stay safe, protect your eyes as well! Gary Ordog, MD September 17, 2020

Resident Doctor Dies of Coronavirus at 28 After Treating COVID-19 Positive Patients in the ER

Resident Doctor Dies of Coronavirus at 28 After Treating COVID-19 Positive Patients in the ER

September 21, 2020, 4:20 p.m. PDT

Resident Doctor Dies of Coronavirus at 28 After Treating COVID-19 Positive Patients in the ER

Adeline Fagan, who was in her second year of residency, tested positive for COVID-19 in July

A young resident doctor has died from the novel coronavirus (COVID-19) after a two-month battle with the illness. She was 28.

Adeline Fagan was in her second year of residency at a hospital in Houston, Texas, where she worked in the OB/GYN unit, Syracuse.com reported.

Fagan, who was from Central New York, was taken to the emergency room on July 8 and tested positive for COVID-19. She was placed in quarantine, during which her condition worsened, the outlet reported.

Fagan's sister Maureen said in a campaign set up to help with medical bills that the resident became ill after working with COVID-19 patients in the hospital's emergency room. She was placed on a ventilator on August 3, a move that came after weeks of "several different respiratory therapies and put on dozens of drugs." "That night her vitals were unstable and the doctors said that she was not responding well to the ventilator," Maureen said, explaining that doctors then "took the last remaining step available": placing Fagan on an ECMO machine, which oxygenates the blood.

At the time, Maureen said that her sister was expected to be on the ventilator for six to eight weeks.

On September 19, Fagan's dad Brant shared an update to announce that she had died.

Fagan was found unresponsive by her nurse the night before, and was taken to get a CT scan, which showed that she had a "massive brain bleed."

"The neurosurgeon said it was a '1 in a million' chance she would even survive the procedure, but that Adeline would have several severe cognitive and sensory limitations if she did survive," Brant's update said. "Of that the doctor was sure."

"Everyone was crushed by the events, the nurses, the doctors, and, of course, us. The doctor said they have seen this type of event in COVID patients that spend time on ECMO. The vascular system is also compromised by the virus, resulting in bleeds. We spent the remaining minutes hugging, comforting, and talking to Adeline. And then the world stopped."

"If you can do one thing, be an 'Adeline' in the world. Be passionate about helping others less fortunate, have a smile on your face, a laugh in your heart, and a Disney tune on your lips," the mourning father wrote. "We love you, Adeline, with all our hearts."

There have been 123,817 confirmed cases of COVID-19 in Harris County, Texas, with 1,706 reported deaths, according to the county's department of public health.

Yes, anyone, even young healthy people can get COVID-19. We have no indication where the contamination breach occurred, other than as stated "in the Emergency Department." This would indicate a breach in PPE or protocol. One can see how in dealing with Emergency situations continuously, that this could occur. Also, medical staff must maintain full PPE to try to avoid this. We must stay safe until the good vaccine is given. Thank you. September 22, 2020. Gary Ordog, MD

For your consideration:

This partly answers the question. PPE in hospital works.

September 25, 2020

What Is the Incidence of Nosocomial COVID-19?

Carlos del Rio, MD reviewing Rhee C et al. JAMA Netw Open 2020 Sep 9

With rigorous infection control measures implemented, nosocomial COVID-19 is a rare event.

During the height of the pandemic in Boston, hundreds of patients were admitted to hospitals for COVID-19. Investigators studied patients at one Boston hospital who were diagnosed with COVID-19 on hospital day 3 or later or within 14 days after discharge to assess the risk for nosocomial acquisition of SARS-CoV-2. Measures implemented for infection control evolved over time but included screening for symptoms; testing for SARS-CoV-2; dedicated COVID-19 units with airborne isolation rooms; personal protective equipment; universal masking of staff and, later, patients; and visitor restriction.

Between March 7 and May 30, 2020, of the 9149 patients admitted, 697 (7.6%) were diagnosed with their first episode of COVID-19. Median length of stay was 7 days. Of the 697 patients, 12 (1.7%) were first diagnosed on hospital day 3 or later. The median time from admission to diagnosis was 4 days. After review of their records, the investigators classified these 12 patients as definitely community acquired (4), likely community acquired (7), or definitely hospital acquired (1). Among the 8370 patients discharged from the hospital during the study period for non-COVID conditions, 11 (0.1%) tested positive for SARS-CoV-2 within 14 days after discharge. Of these, only one case was thought to be hospital acquired.

COMMENT

Multiple studies have raised the alarm about nosocomial transmission of COVID-19. This study demonstrates that a well-implemented infection control program — one that includes routine testing of all admissions, serial testing of patients with clinical syndromes suspicious of COVID-19, universal masking of staff and patients, and limiting visitors — is effective in making hospital-acquired SARS-CoV-2 a rare event. For the foreseeable future, hospitals should continue to make these interventions part of their standard of care, much like universal precautions became standard of care after the emergence of HIV in the 1980s, and work with employees so that “battle-weary” staff don't let their guard down, as recently occurred at the exact same hospital where this study took place. Such incidents notwithstanding, patients need to be reassured that contracting COVID-19 is unlikely in a hospital or clinic where infection control measures are enforced.

EDITOR DISCLOSURES AT TIME OF PUBLICATION

Disclosures for Carlos del Rio, MD at time of publication

Consultant/Advisory BoardInfectious Diseases Society of AmericaGrant/Research SupportNIH/National Institute of Allergy and Infectious Diseases; NIH/National Institute on Drug AbuseEditorial BoardsClinical Infectious Diseases; JAIDS: Journal of Acquired Immune Deficiency SyndromesLeadership Positions in Professional SocietiesInternational Antiviral Society–USA (Board of Directors); American Conference for the Treatment of HIV (Board of Directors)

CITATION(S):

Rhee C et al. Incidence of nosocomial COVID-19 in patients hospitalized at a large US academic medical center. JAMA Netw Open 2020 Sep 9; 3:e2020498. (https://doi.org/10.1001/jamanetworkopen.2020.20498)

Carlos del Rio, MD

So this would imply that as there are very low nosocomial COVID-19 infections, that the staff are getting infected outside of the hospital. Again, speaking for better protection outside of the hospital, in the staffs' personal lives, to decrease the infection rate in hospital workers. Thank you and stay safe, Gary Ordog, MD

Excellent contributions Dr Gary, thanks.

Thank you, Jorge. Glad to be of service.

I found this old discussion again, and thought that it was still pertinent today.

If this was a contributing factor, please do not let it happen again!?!

October 16, 2020: Here is today's CDC report for California on COVID-19 in California's Healthcare workers.

" As of October 13, local health departments have reported 41,575 confirmed positive cases in health care workers and 193 deaths statewide. "

These are healthcare workers that I would have to assume to be working must have started out healthy and fit to work. So, in California alone, 193 have died needlessly in nature's process of natural herd immunity.

This is evidence against pursuing natural herd immunity, rather than giving a good vaccine against the virus.

Thank you for your support and please stay safe, we need a good vaccine as soon as possible. October 16, 2020; Gary Ordog, MD.

November 22, 2020; published in JAMA today:

"It’s a grim reality. Included among the 232,000 deaths in the US attributable to coronavirus disease 2019 (COVID-19) are more than 1336 physicians, nurses, environmental staff members, technicians, orderlies, emergency medical technicians, and other health care workers."

(The figures do not specify where the healthcare workers contracted the virus, as many could be non-work related. The other point to make is that these healthcare workers are then going home and exposing their families and others to the virus, presumably) Thank you and stay safe.

January 24, 2021: Gary Joseph Ordog, MD: Today in the news, and this related to the topic here, preventing of COVID-19 in healthcare workers. I don't want to embarrass him, having respected him for many years through meetings at the AFMR, etc. But it also shows that we all can make mistakes. Today he is in the news with a national network using a photograph of Dr. Anthony Fauci giving answers to COVID-19 vaccination questions, while he is sucking on the handle of his eyeglasses. Sorry Anthony, but other people noticed it too.

It is February 02, 2021. Front page news shows a photograph of two health care workers holding a patient. The patient is wearing a surgical mask, which is fine. The two healthcare workers are gowned and gloved with eye shielding in place, but look at the masks they are wearing. Each one has a one way valve, thus expelling directly to the patient all organisms from the healthcare workers. On top of this is the fact that the SARS-CoV-2 is higher in healthcare workers. This is a travesty. They are protecting themselves but exposing the patients. The appearance of the mask is deceptive in that it looks like they are trying to protect the patient, but the fact is the other way around, they are deliberately exposing others to their own organisms. I thought that after all my discussion of valved masks and articles, including in JAMA, that the word would be out. Not so apparently. This photo is a year after the pandemic started, February 02, 2021. Gary Ordog, MD.