The Boston area has been a covid-19 hotspot. Yet the staff members of my hospital system here, Mass General Brigham, have been at work throughout the pandemic. We have seventy-five thousand employees—more people than in seventy-five per cent of U.S. counties. In April, two-thirds of us were working on site. Yet we’ve had few workplace transmissions. Not zero: we’ve been on a learning curve, to be sure, and we have no way to stop our health-care workers from getting infected in the community. But, in the face of enormous risks, American hospitals have learned how to avoid becoming sites of spread. When the time is right to lighten up on the lockdown and bring people back to work, there are wider lessons to be learned from places that never locked down in the first place.
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This self-screening is obviously far from foolproof. Anyone could lie. Nonetheless, in the first week of rollout, more than five hundred colleagues indicated through the Web site that they had symptoms. Through the first week of May, symptoms, often mild, prompted more than eleven thousand staff members to stay home and receive testing. Fourteen hundred of them tested positive for sars-CoV-2 and avoided infecting patients and colleagues. Daily check-ins are equally important for less measurable reasons: they send the right message. Embarrassingly, people in health care have often seen calling in sick as a sign of weakness. Screening has changed that. Toughing it out is now a shameful act of disloyalty.
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Surgical masks are made of a melt-blown polypropylene fibre fabric, which, under magnification, looks like cotton candy. Most of the filtration this material provides isn’t from direct blockage but from an electrostatic charge applied to the fibre using a machine called, aptly enough, a corona charger. The static electricity captures viral particles the same way that a blanket in the dryer catches socks. This allows the material to breathe more freely. Cloth masks feel warm and smothering by comparison, and people tend to loosen them, wear them below their noses, or take them off more frequently. The fit of improvised masks is also more variable and typically much worse. A comparison study found that surgical masks did three times better than homemade masks at blocking outward transmission of respiratory viruses.
Don’t ditch your T-shirt mask, though. A recent, extensive review of the research from an international consortium of scientists suggests that if at least sixty per cent of the population wore masks that were just sixty-per-cent effective in blocking viral transmission—which a well-fitting, two-layer cotton mask is—the epidemic could be stopped. The more effective the mask, the bigger the impact.
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Culture is the fifth, and arguably the most difficult, pillar of a new combination therapy to stop the coronavirus. People tend to focus on two desires: safety and freedom; keep me safe and leave me alone. What Doyle says she needs her people—both staff and residents—to embrace is the desire to keep others safe, not just themselves. She needs them to say, “I’m worried about my sore throat, and I am going to stay home.” Or “I am O.K. with being reminded to pull my mask up.” That is the culture of the operating room. It’s about wanting, among other things, never to be the one to make someone else sick.
From the article:
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