Protecting Ourselves During the COVID-19 Pandemic.

The current coronavirus disease of 2019 (COVID-19) pandemic has run rampant on our healthcare system. At the time of writing this, 3 resident physicians have died, 1 of whom was in our field. These young doctors had their entire careers ahead of them; they were working long hours, relying on their hospitals, their government, and their healthcare system to protect them. These residents are by no means the only victims within the healthcare system. This virus has claimed the lives of attendings, nurses, and other essential healthcare providers.

When 1 of us (E.M.F.) was training to be an emergency medical technician, he would be tested on different scenarios. However, each was an automatic failure if he did not ask the same first questions “BSI (body substance isolation) and is the scene safe?” It was drilled into our brains to worry about scene safety above all else. We were taught that the most important point was to ensure you were safe, your partner was safe, and then to worry about the patient. We do not let firefighters run into buildings without the proper equipment; it follows that we should not let doctors and nurses tend to the ill unprotected. When we took the Hippocratic Oath, we agreed to run into a burning building for the sick, but we did not agree to do it naked. Without protecting our healthcare workers, our healthcare system will fail.

Private practices across the United States are remaining open to serve their community for emergency treatment to relieve stress on hospitals and emergency rooms. Throughout this pandemic, oral-maxillofacial surgeons (OMSs) have been providing treatment to life-threatening conditions such as head and neck infections and facial trauma. “As COVID-19 threatens to overwhelm our healthcare systems, oral-maxillofacial surgery practitioners are charged with reducing the burden placed on other emergency centers and, if necessary, lend our unique experience and training in anesthesia and intensive care unit care to other medical and surgical services.” At hospitals across the United States, oral-maxillofacial surgery residents and faculty have been redeployed to intensive care units to care for patients with COVID-19. In the darkest days, residents were given a single N95 mask to hold onto, carrying it around in plastic containers between shifts, to ensure they had a mask the next day.

Our scope of practice places us in a high-risk category because our procedures generate virus-containing aerosols. SARS-CoV-2 has been demonstrated to remain aerosolized for up to 3 hours. , Working intimately in the oropharynx means that OMSs must take all precautions very seriously. Viral shedding can occur in asymptomatic and presymptomatic patients and is greatest in the nasopharyngeal region. Many of these private practice offices do not have the proper personal protective equipment (PPE) to provide care to patients in today's environment. Surgeons have been calling every distributor they can think of and ordering masks and gowns whenever possible, with many of the major distributors on backorder.

We live in unprecedented times when federal and state governments are fighting with hospitals for PPE. Andrew Artenstein, the chief physician executive and chief academic officer at Baystate Hospital, recently reported a correspondence explaining how he had attempted to buy PPE for his hospital. He went with trucks to try to execute the purchase. However, before he could wire the funds, 2 Federal Bureau of Investigation agents arrived and started to question him. The Department of Homeland Security was trying to redirect the PPE that the hospital was trying to purchase. It took the intervention of their Congressional representative to allow the hospital to keep the PPE.

It is the duty of OMSs to provide emergency coverage for our patients. It is essential for governments to classify OMSs as critical first responders to allow us access to the PPE we need to provide urgent care safely. We also need the ability to administer rapid COVID-19 testing in our facilities and clinics to expand testing within our communities. If a vaccine becomes available, we will need to be allowed to administer that vaccine to provide immunity as efficiently as possible.

Our healthcare system is failing us, and the days of being driven by profits and administration need to be behind us. The US healthcare system administration costs have increased exponentially. Our healthcare system has let our providers down. OMSs are on the front lines of this battle, both in our private practices and in the hospital settings. Governors and other state officials have called on us to donate our PPE to hospitals but still expect us to see emergency patients in the private setting to reduce the strain on the emergency system. We must not waste the lessons learned in this crisis. We should use it as an opportunity to become better integrated and recognized as a vital part of our healthcare system and help strengthen it.