Protect the Filipino by local production of Personal Protective Equipment

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There is a war going on, and we can’t just wait for people from other countries to supply us with weapons to fight.
 
As cases of COVID-19 escalate around the country, physicians and other healthcare workers (HCWs) are facing severe shortages of personal protective equipment (PPE).
This crisis puts a large strain on our already depleted health system as more and more people are admitted for assessment, and evaluation or treatment of complications due to COVID-19.
Due to this shortage, recommendations from various advisory groups such as the PCP, PSMID and the CDC have shifted to appropriating PPE’s to healthcare workers at the frontlines.
However, this shift is not in response to overwhelming scientific evidence, but in having to take a major supply chain issue into account.
 
As quoted directly from the CDC website: “PPE recommendations for the care of patients with known or suspected COVID-19: Based on local and regional situational analysis of PPE supplies, facemasks are an acceptable alternative when the supply chain of respirators (N95 Masks) cannot meet the demand."..."When the supply chain is restored, facilities with a respiratory protection program should return to use of respirators (N95 Masks) for patients with known or suspected COVID-19."
As a result of these recommendations, many hospitals have taken the CDC recommendations to mean that facemasks are the preferred PPE, rather than a less desired (and potentially less safe) alternative. They have thus rationed N95s to be made available only for procedures, such as intubation and bronchoscopy, during which the virus is more likely to become aerosolized. This may be putting our HCWs in tremendous danger of contracting and spreading COVID-19.
 
A Harvard Study in China that suggested HCWs were at a 20% increased risk of severe infection compared to the general public. This risk decreased once the Chinese implemented full gear: protective suit, medical goggle, face shield, N95 mask and gloves – following this change there were no further reports of infected HCWs.
 
As we speak, HCWs around the world continue to get infected, end up in critical condition, and die while using “appropriate PPE”. According to a New England Journal Article on aerosol and surface stability of COVID-19, the virus can be detected in the air up to 3 hours after aerosolization.
 
Considering the mortality risk and lack of data to support a step-down to surgical masks, N-95 masks should continue to be the standard PPE for care of COVID-19 patients.
 
In the making of every healthcare provider, whether they be a physician, a nurse or technician, years are needed. To make an N95 mask may take only days, or with the proper facilities, perhaps even  just minutes. The supply of HCWs must be protected.  Other countries have clearly described the impact of losing HCWs to COVID-19. Infected HCWs will be of no benefit to patients – in fact, they will pose a serious risk. If we do not protect our healthcare workers, we will see them transition from physicians to patients. They will not only endanger the health of their colleagues, families, and communities, they will also be placing the patients they care for at serious risk.
 
This letter serves to urge our government, industry, media and general population, to assist HCWs in obtaining immediate access to critical PPE, including N-95 masks. All efforts should be taken to produce PPE locally, and to increase production in areas with capability.
 
Our HCWs are on the front lines, taking care of patients without appropriate protection, and our COVID pandemic is nowhere near its peak. Hospitals are already running out of protective supplies. We urge the government to exert its authority and use all its available resources to ensure that both the public and private sector immediately develop and produce our own PPE supplies. In addition, we urge our hospital systems to maintain the highest level of PPE standard for our HCWs, and demand the supply of N-95 masks and other personal protective equipment.
 
There is a war going on, and we can’t just wait for people from other countries to supply us with weapons to fight.
 

Brian Michael I. Cabral, MD

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