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Correspondence
In Pursuit of PPE
April 17, 2020
DOI: 10.1056/NEJMc2010025
As a chief physician executive, I rarely get involved in my health system’s supply-chain activities. The Covid-19 pandemic has changed that. Protecting our caregivers is essential so that these talented professionals can safely provide compassionate care to our patients. Yet we continue to be stymied by a lack of personal protective equipment (PPE), and the cavalry does not appear to be coming.
Our supply-chain group has worked around the clock to secure gowns, gloves, face masks, goggles, face shields, and N95 respirators. These employees have adapted to a new normal, exploring every lead, no matter how unusual. Deals, some bizarre and convoluted, and many involving large sums of money, have dissolved at the last minute when we were outbid or outmuscled, sometimes by the federal government. Then we got lucky, but getting the supplies was not easy.
A lead came from an acquaintance of a friend of a team member. After several hours of vetting, we grew confident of the broker’s professional pedigree and the potential to secure a large shipment of three-ply face masks and N95 respirators. The latter were KN95 respirators, N95s that were made in China. We received samples to confirm that they could be successfully fit-tested. Despite having cleared this hurdle, we remained concerned that the samples might not be representative of the bulk of the products that we would be buying. Having acquired the requisite funds — more than five times the amount we would normally pay for a similar shipment, but still less than what was being requested by other brokers — we set the plan in motion. Three members of the supply-chain team and a fit tester were flown to a small airport near an industrial warehouse in the mid-Atlantic region. I arrived by car to make the final call on whether to execute the deal. Two semi-trailer trucks, cleverly marked as food-service vehicles, met us at the warehouse. When fully loaded, the trucks would take two distinct routes back to Massachusetts to minimize the chances that their contents would be detained or redirected.
Hours before our planned departure, we were told to expect only a quarter of our original order. We went anyway, since we desperately needed any supplies we could get. Upon arrival, we were jubilant to see pallets of KN95 respirators and face masks being unloaded. We opened several boxes, examined their contents, and hoped that this random sample would be representative of the entire shipment. Before we could send the funds by wire transfer, two Federal Bureau of Investigation agents arrived, showed their badges, and started questioning me. No, this shipment was not headed for resale or the black market. The agents checked my credentials, and I tried to convince them that the shipment of PPE was bound for hospitals. After receiving my assurances and hearing about our health system’s urgent needs, the agents let the boxes of equipment be released and loaded into the trucks. But I was soon shocked to learn that the Department of Homeland Security was still considering redirecting our PPE. Only some quick calls leading to intervention by our congressional representative prevented its seizure. I remained nervous and worried on the long drive back, feelings that did not abate until midnight, when I received the call that the PPE shipment was secured at our warehouse.
This experience might have made for an entertaining tale at a cocktail party, had the success of our mission not been so critical. Did I foresee, as a health-system leader working in a rich, highly developed country with state-of-the-art science and technology and incredible talent, that my organization would ever be faced with such a set of circumstances? Of course not. Yet when encountering the severe constraints that attend this pandemic, we must leave no stone unturned to give our health care teams and our patients a fighting chance. This is the unfortunate reality we face in the time of Covid-19.
Andrew W. Artenstein, M.D.
Baystate Health, Springfield, MA
Disclaimer:
The information contained herein is, to the best of our knowledge and belief, accurate and current as of the date of this SDS. However, since the conditions of handling and use are beyond our control, wemake no guarantee of results, and assume no liability for damages incurred by use of this material. All chemicals may present unknown health hazards and should be used with caution. Although certain hazards are described herein, we cannot guarantee that these are the only hazards which exist. Final determination of suitability of the chemical is the sole responsibility of the user. No representations or warranties, either expressed or implied, of merchantability, fitness for a particular purpose or any other nature are made hereunder with respect to the information contained herein or the chemical to which the information refers. It is the responsibility of the user to comply with all applicable federal, state and local laws and regulations.
Silane is a colorless, flammable and poisonous gas, with a strong repulsive odor. It is easily ignited in air, reacts with oxidizing agents, is very toxic by inhalation, and is a strong irritant to skin, eyes and mucous membranes. Silane is lighter than air. Under prolonged exposure to fire or heat the containers may rupture violently and rocket. It is used in the production of amorphous silicon.
Male ICR mice were exposed to silane 1000 ppm, a concentration 200 or 2000 times higher than the recommended occupational exposure limits by many countries and academic associations, for 1, 2, 4, and 8 h (phase I study) and for 6 h/day, 5 days/week, over 2 and 4 weeks (phase II study). Hematological and biochemical studies were performed, and the animals were examined for histopathological lesions of the cornea, nasal cavity, respiratory tract, lung, liver, kidney, spleen, pancreas, thymus, thyroid, bone marrow, salivary glands, esophagus, and testis. All mice in both studies survived until they were sacrificed. In the phase I study, no exposure-related changes were found as a result of the hematological, biochemical, or histopathological examinations. In the phase II study, hematological and biochemical examinations failed to reveal any exposure-related changes, but mild irritation, manifested in the form of a small amount of exudate (eight out of ten animals), and inflammatory cells and/or necrotic cells on the nasal mucosa (six out of ten animals) was observed in the mice exposed to silane for 4 weeks. These findings suggest that silane toxicity and irritation are not severe.
dada » Sat Apr 18, 2020 8:35 pm wrote:Big scene in Ulaanbataar. Big stars, big stadium shows. Although I'm guessing the Ulaanbattar venues are shut down at the moment. But there's a big scene. They have everything in Ulaanbataar. If I showed you a picture of a weekday morning in Ulaanbataar, you'd see the same thing you see anywhere else. Kids in suits heading to work at the bank, Fanta ads.
Agent Orange Cooper wrote:
Project Willow » Sun Apr 19, 2020 10:35 pm wrote:...herd immunity is the goal with all novel contagions and natural herd immunity is best when mortality rates are low as they are with this virus. There are studies published over the last couple of weeks suggesting in terms of mortality it is no worse than a bad flu season, even Nature had to admit that the numbers coming back from Santa Clara look promising. This isn't Ebola gone wild, it isn't the black plague.
The "second wave" comes when we all go outside again, we aren't getting rid of it by staying inside, we're just prolonging the infection rate.
Scientifically, the tide turned this week, but we're seeing even more draconian control measures being pushed and a shitload of propaganda this weekend as if things are worse. That is a hint that this pandemic, however it arose, is being used as an op to move towards more overt authoritarianism, (and a host of other projects and tests).
What no one who is panicked over the virus seems to be considering is the predictable, inevitable death toll of economic collapse, delayed medical treatment for cancer and other conditions, and long term isolation. The UN estimated the economic shutdown would cause the deaths of hundreds of thousands of children across the globe. Who's talking about them?
Gotta love how the media in the US can divide people ALWAYS on the basis of Trump supporters VS CNN viewers.
So if you think the lockdown is a bit much at this point and should be lifted, you’re automatically a right-wing, mouth-breathing, racist ignorant goon.
Got it.
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