關於 face cover plastic mask ，我們在網路上蒐集到這些相關的討論、資訊與評價

22 March 2020

*PPEs and the lives of front-liners*

Datuk Dr Zulkifli Ismail, Paediatrician
Dato’ Dr Musa Mohd Nordin, Paediatrician

Despite an unusually heavy and tiring Sunday schedule, it was simply impossible to hit the sack. We were inundated with multiple and repeated messages from doctor friends serving in Ministry of Health (MOH) hospitals across the country appealing for personal protective equipments (PPE). These are MOH doctors working in the frontline of the COVID outbreak.

While bigger hospitals like Sg Buloh Hospital may have sufficient supply of PPEs, the same cannot be said of the many other hospitals, including private hospitals. Even the earlier suggestion that Sg Buloh Hospital was immune from this PPE deficiency syndrome, was not entirely true, because in the midst of writing this piece, we received an SOS message for mask N95, face shield, PAPR power air purifying respirator, hood cover, boot cover, etc from a trustworthy colleague serving a COVID dedicated hospital

Videos of MOH staff making their own PPEs using plastic bags, dustbin liners and other paraphernalia does not augur well for the reputation of the ministry. There have also been offers from individuals who have volunteered to make face shields for our MOH healthcare providers (HCP).

A team of doctors who were doing needs assessment of our HCPs managing the COVID patients in MOH hospitals concluded that the lack of PPEs was paramount. 99% of GPs are having difficulty getting PPEs, even the surgical asks. The prices for face masks have soared from 80 sen to RM3.50 per piece.

And in their efforts to redress this deficiency, they discovered that there are at least three plants manufacturing PPEs in Selangor state alone. According to them, there were long queues of trucks of agents and distributors to buy PPE supplies from the three plants.

Why have we not heard from these companies? Are they expecting to increase their price at a time of national crisis or are they ‘stockpiling’ to force the demand and reap from a supply shortage? Presumably, the middlemen, the agents and distributors, are similarly cashing in on the COVID pandemic.

At the height of the SARS-CoV2 infection in China, apart from the disciplined mobilisation of their healthcare workers, the PPE factories ramped up production and provided these to the front-liners and the infectious disease specialists. Where are our PPE manufacturers when our MOH front-liners most needed them?

The gravest sin to be committed during this outbreak is for unscrupulous individuals, politicians and companies to profit from the sufferings of our HCP who are risking their own lives to care and nurse the critically sick COVID patients in the Intensive Care Units (ICU).

And if they are infected as have happened among our HCP, or worst still if they lose their lives to the infection because Majlis Keselamatan Negara (MKN), MOH and the companies cannot provide adequate PPEs, blood of our HCPs will be on their hands. The failure to produce and ramp up production by manufacturers and to provide by MKN and MOH, basic PPEs to HCP who care for a patient with a potentially fatal disease is undoubtedly irresponsible, negligent and criminal.

The government has appealed to the people for their cooperation, to the private hospitals to sacrifice for the nation and to the front-liners to nurse and care for the sickest amongst us ravaged by SARS-CoV2.

The MKN must take the initiative to immediately mitigate the PPE shortages. They must secure urgently the supply chain, eliminate the middlemen and undertake bulk purchasing, which would ensure fair pricing. And they must distribute equitably to all COVID designated hospitals and not just in the Klang Valley. They must also keep reserve supplies to secure surge capacity. It is high time for the government to demand the PPE manufacturers to step up without fanfare and ramp up production, accept reduced profit margins and supply the critically needed PPEs to our healthcare workers.

It is utterly shameful that our HCP have to appeal to the public to provide them with PPEs which should be the primary responsibility of the MOH and by extension the MKN which is orchestrating the war against COVID.

These are our young men and women who have young families and who need the protection. They do not need to make PPEs from old plastic bags and garbage bags, the videos of which are a shame to show to the world.

Our frontline HCPs must wear their PPEs before they care for the sick, nay any COVID patient. The manufacturers should be able to supply them. The government of the day must ensure and if need be enforce this as much as they are enforcing the movement control order (MCO). Have a heart for our young doctors, nurses and allied health professionals!

Step up and be counted.

Photo below from the internet

#PleaseShare #COVID19
#武漢肺炎防疫重點英文版

According to the WHO and Chinese officials, the incubation period of the novel corona virus between disease exposure to the onset of symptoms ranges from 2 to 12 days (7 days on average).

However,based on the general view,the incubation period of COVID-19could be up to 14 days.

Based on the current literature related toCOVID-19, the clinical expression ofCOVID-19caninclude fever, weakness, respiratory symptoms (mainly dry cough) and in some cases,breathing difficulties can follow.

About 1 to 2 percent of the patients might develop severe pneumonia, adult respiratory distress syndrome (ARDS), multiple organ failure or shock, leading to death.Most of the deceased patients had concurrent chronic disease such as diabetes, liver disease, kidney disease or cardiovascular disease.

*Prevension
There is no vaccine to prevent corona virus infections. Daily preventative steps to take include avoiding affected regions, avoiding local hospitals or clinics unless necessary, avoiding eating uncooked meat or eggs,avoiding being in contact with animals and dead animals,and maintain good health habits.

Steps to practice good health habits are as follows:

Please keep your hands clean and wash your hands with soap frequently. If soap and water are not available, use an alcohol-based hand sanitizers.

However, soap and water should be used preferentially if hands are visibly dirty. You should wash your hands immediately after coughing or sneezing; after using the toilet; and if your hands touch any secretions from your respiratory tract, stool or body fluids such as urine. In addition, please refrain from touching your eyes, nose and mouth with your hands.

Pay attention to respiratory tract hygiene and cough etiquette.

a. If you have respiratory symptoms, please wear a medical-grade face mask and keep at least 1 meter away from others while talking to them.

b. If your hands touch any secretions from your respiratory tract, please wash your hands with soap and water thoroughly.

c. If you develop a cough or other respiratory symptoms, you should wear a medical face mask. When your mask is contaminated by secretions of nose or mouth, please fold it, throw it into the trash immediately, and wear a new one.

d. You should cover your mouth and nose with a tissue or handkerchief when coughing or sneezing. If you don’t have a tissue or handkerchief, cough or sneeze into your upper sleeve.

*Use of masks
a. Medical-grade face masks are mainly used for preventing the spread of disease and protect people around you. People are advised to wear medical masks when you go to see a doctor or accompany a patient; when you have symptoms of respiratory infections; and if you go out with people with weak immune systems or chronic disease. You should wash your hands frequently to protect yourself from catching illness in other situations.

b. To wear a medical mask properly, you should ensure that the water-repellent side (usually green) faces outwards. You should not remove your mask when talking, coughing or sneezing to prevent the spread of disease. You should replace your face mask if it is visibly soiled.

c. Steps to put on a medical face mask:
i. Open the package and examine if the mask is damaged.

ii. Put the elastic bands around both ears, fit the metallic strip over the nose bridge and extend the mask to cover your chin.

iii. Press firmly down on the metallic strip so that it fits around your nose

iv. Ensure that there are no gaps

d. You don’t need a face mask in open spaces, including walking on the streets or doing outdoor exercises.

*What to do while sick
If you have flu-like symptoms, including fever, headache, runny nose, sore throat, cough, muscle aches, fatigue/tiredness, and sometimes diarrhea. After your symptoms develop, you should rest, take and record your temperature regularly, drink water and eating nourishing food, observe your condition and take symptom-relieving drugs such as pain relievers/fever reducers to observe if they work.

You should rest at home for at least 24 hours after the symptoms improve.

You should seek medical attention if your fever lasts longer than 24 hours or is accompanied by other symptoms, such as purulent nasal discharge and purulent sputum, severe vomiting or shortness of breath.

You should inform the doctor of any history of travel, occupation, contact, and cluster (TOCC) when seeking medical attention.

You should follow the triage arrangement at the hospital if you have a fever to ensure efficient medical care and the health of medical personnel.

You should avoid going to school or work, attending gatherings and visiting crowded or poorly-ventilated public spaces while sick. You should avoid using public transportation to prevent the spread of disease if you need to go outside.

While staying at home, you should stay in a specific room, keep good airflow in the house, and avoid close contact with other people in your home, such as eating at the same table, kissing, hugging or sexual contact.

People living with the sick person should also pay attention to personal hygiene, wash hands frequently and refrain from touching eyes, nose and mouth with hands. Babies, children and the elderly or people with compromised immune system in the same household must keep at least 1 meter away from the sick person.

If the living environment requires disinfection, you can apply 1:100 diluted bleach (500 ppm).

That is, household chlorine bleach (a 5-6% sodium hypochlorite solution, providing 50,000–60,000ppm available chlorine) is diluted in water at 1:100 to clean object surfaces, such as doorknobs, desks and switches.

You can use disposable teaspoons (one teaspoon is about 20 cc), small Yakult bottles (one bottle is about 100 cc) and large plastic bottles (one bottle is about 1,250 cc) and follow the instructions below to make diluted bleach: �

a. Large amount: mix 100 cc of bleach (5 teaspoons or 1 small Yakult bottle) in 10 liters of water (8 large plastic bottles) and fully stir the solution before using.

b. Small amount: pour 10 cc of bleach into 1 liter of water and fully stir the solution before using.

For more information:
https://www.cdc.gov.tw/File/Get/HAvRHGs_EjKeROHYmzWm5w