Health-care providers have been asking — no, begging — people to stay home while we go to work. As a pediatric otolaryngologist (ear, nose and throat specialist), I primarily treat infants and children with ear infections, sleep and breathing issues due to tonsils and adenoids blocking the airway, and more urgent issues that take place in the hospital setting. These days, it’s the healthy kids coming in for minor surgery who worry me.
One minor surgery (ear tubes) has morphed from one of the safest, most satisfying procedures on the planet to potentially one of the deadliest. This procedure is performed under something called “general mask anesthesia,” in which an infant or child inhales two anesthetic gases while being supported via a mask and bag ventilation by an anesthesia specialist.
The mask always fits snugly, but it is never a perfect fit. There is often a little bit of a leak of the child’s exhaled respiration that wafts out to the room. Normally, that’s no big deal. But these days, the patient could be spreading respiratory droplets containing the deadly virus to a room full of people. Strike that. To millions of people.
In the case of this virus, each infected individual has the potential to infect three other people — and each of them can spread it to three more: 3 x 3 = 9. Those nine can each spread it to three more: 9 x 3 = 27. Those 27 can spread it to … well, you get the point. Do this 13 times and you will get to more than 1 million.
Last week, you could sense these virtual millions in my operating room, although there were just five of us caring for one patient. Ear infections had made this toddler miserable, and medicine hadn’t helped.
So even though this is ostensibly an “elective” procedure — the kind we’re now being advised to postpone — we decided to go ahead. We donned our protective gear, including N95 masks, surgical masks on top of those, eye protection, gowns and gloves. This is a major procedure in and of itself, even before the patient goes off to sleep.
After the procedure, we doffed our gear. There is a method and precise order to this. It takes time and practice. Most people, health-care workers included, get it wrong, and mistakes only act to spread the virus.
And what about that distinction between “elective” and “necessary”? The difference isn’t always as clear as you might think.
What about the child who’s up all night screaming, tormented by fevers caused by ear infections? An ear-tube operation, a five-minute procedure, could relieve that. Helping that child could also put millions of people at risk from covid-19.
And what about the child who has horrible sleep problems, with snoring, gasping, coughing and choking all night? A tonsillectomy and adenoidectomy could relieve the child’s distress but put millions of people in danger. Surgeries in the mouth, including dental work, oral surgery and throat surgery, are considered especially risky.
Cancer surgery is not elective, but even that is now up for debate. Here’s the current recommendation: If your cancer isn’t going to grow in the next 30 days, cancel your cancer surgery. These are indeed dark days.
Now, many of us are wearing full-on protective gear in settings where we’d normally wear traditional scrubs and maybe some cute clogs or a funky scrub hat or pin. Those of us who treat children rarely wear white coats, so as not to scare them. In fact, many of us wear bright clothes, silly ties or bright-colored shoes. Now we’re attending to children in our hazmat suits. They’re terrified. So are we.
Hospitals and clinics have limited supplies, so we are already rationing. We have been informed that when supplies run out, they won’t be replenished. So we’re cutting back on whom we see, who gets protection, who gets care and who has to wait. We look official in our gear. But don’t be fooled by the fancy goggles; we’re just as spooked as you are.
Many folks have offered to help us. We are grateful. For those offering support to health-care workers, we say this: We will go to work for you, but please stay at home for us. Think of the millions of people you can help by doing just that.