Open Letter to American Medical Association regarding proper PPE for Physicians

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Dear American Medical Association:

As the main organization with a mission statement to “promote the art and science of medicine and the betterment of public health”, we are begging you to stand up for our protection. 

Our medical system is underscored as being one of the best in the world. Physicians come here from other countries to train in our hospitals. Medical professionals spend a non-trivial number of years learning to care and treat others in our teaching institutions, sacrificing time and energy for a larger purpose. We went into medicine to serve. Now we feel hospital administrators and our government institutions do not value our sacrifices….our lives aren’t valued….our efforts wasted. 

By numerous personal reports, various medical colleagues have demonstrated concern over lack of sufficient personal protective equipment (PPE) as they care and screen for potential COVID-19 patients especially in overloaded areas.  Reports are being shared all over the country, from Washington State to Boston, from New York City to rural Georgia, from California to Florida. Physicians on the frontline have been told to reuse masks for days or not to wear masks if COVID-19 is not confirmed.  Hospital administrators are prohibiting them from bringing in their own masks and protection, but not provided with sufficient PPE from the hospital. Staff is being told not to wear masks for fear of frightening patients, although the patients may be exhibiting symptoms of this novel coronavirus. Garbage bags have been substituted for gowns. Handsewn masks or bandanas have been substituted for masks.

Please note that the Guidance on Preparing Workplaces for COVID-19 by the U.S. Department of Labor’s Occupational Safety and Health Act of 1970 (OSHA) provides the following: 

“Employers are obligated to provide their workers with PPE needed to keep them safe while performing their jobs. The types of PPE required during a COVID-19 outbreak will be based on the risk of being infected with SARS-CoV-2 while working and job tasks that may lead to exposure. Workers, including those who work within 6 feet of patients known to be, or suspected of being, infected with SARS-CoV-2 and those performing aerosol-generating procedures, need to use respirators: 

“… N95 filtering facepiece respirators or better must be used in the context of a comprehensive, written respiratory protection program ...  

“… When disposable N95 filtering facepiece respirators are not available, consider using other respirators that provide greater protection and improve worker comfort. …

“Consider using PAPRs or SARs, which are more protective than filtering facepiece respirators, for any work operations or procedures likely to generate aerosols. ... 

“A respirator shall be provided to each employee when such equipment is necessary to protect the health of such employee. 

“An employer may provide respirators at the request of employees or permit employees to use their own respirators, if the employer determines that such respirator use will not in itself create a hazard.” 

(See, OSHA’s Guidance on Preparing Workplaces for COVID-19, pages 15-16; OSHA’s Respiratory Protection Standard in Code of Federal Regulations, Title 29, Section 1910.134.) 

The CDC condoned bandanas and scarves while 1.5 million expired N95 are in storage somewhere in Indiana, as Washington Post reported last week. Statistically speaking, there are probably many more warehouses like this. FEMA is in charge of disaster relief, and this is a disaster. We need their help and we need it now. Who will care for the country’s sick when physicians themselves contract the virus and get sick or die. We can not serve without the appropriate armor. Please protect all physicians on the front line by mandating proper PPE be provided and allow us to use our medical judgement to protect ourselves. 

Physicians throughout the country are talking about walking away without proper protection. This applies across multiple specialties. We understand the concept of a shortage of PPE, but the supplies are here. These supplies must be delivered. Production must be increased. Expired masks are better than bandanas, so those masks in warehouses must be delivered to hospitals.  N95 masks are being donated that are not FDA approved, so please advocate for a voluntary assumption of risk as legal protection for hospitals if physicians choose to wear non FDA-approved masks from the EU, China, or even construction grade N95 rather than a bandana. 

Please stand up for physicians who are trying to protect themselves whether they are requesting PPE or bringing their own PPE to treat COVID-19 patients, such that they are not retaliated against by their employer. We cannot serve our fellow citizens if we are dead. 

Sincerely,

Concerned Physicians Throughout our Great Country