From: ILPI Support <info**At_Symbol_Here**ILPI.COM>
Subject: [DCHAS-L] Another report from the PPE front line
Date: Fri, 24 Apr 2020 20:04:23 -0400
Reply-To: ACS Division of Chemical Health and Safety <DCHAS-L**At_Symbol_Here**PRINCETON.EDU>
Message-ID: BA847C1F-4B6A-48D7-B0E8-FD31F028AC8A**At_Symbol_Here**
In-Reply-To <00dc01d61a81$8884db80$998e9280$**At_Symbol_Here**>

Tangentially related to the other discussions (see below), I just wanted to chime in with another small slice of front-line perspective. I've been talking extensively with county emergency officials, hospitals etc.the past two weeks and in the past 24 hours hundreds of front line nurses, anesthesia folks, dentists etc.  We have been deluged with calls and emails from health professionals when we opened up orders on the shipment of N99's we are expecting at the end of next week.

Let me start with dentists.  I talked to several in depth.  None of them have been given any guidance on what precautions to take or how to reopen.  Many of the older ones are terrified at the idea of running a 4,000 rpm dental drill which is sending up a 3 foot plume of biohazard right at you. N95 and N99's are a start, but they also need protective face shields (also in short supply). And how do you use a face shield while wearing a set of dental/surgical loupes?  The ultimate solution for dentists is a PAPR, but those are unlikely to find wide availability before the end of the year.

Our N99 stash was mentioned on a nurse anesthetist list last night and we got the single largest surge in orders I've ever seen - you never knew there were this many people in that profession. These are the people who do the front line intubations. You've heard the PPE rationing horror stories. Their stories by phone and email are unreal. As is their courage and inspiration. I'm humbled by these people telling *me* how grateful they are that we are making the N99's and N95's available at non-gouging prices.  We opened orders for our less expensive N95's which won't be coming until the end of June/July and folks like these are ordering them anyway.  Orders for tens of thousands of N95's and I don't even have a firm arrival date.

I talked to a county official who said he was interested in our N99 stash but that were waiting on a bunch of promised N95 from FEMA that had yet to materialize. He told me they paid over $6 per mask for N95's three weeks ago. I think those were KN95's, too - not NIOSH approved, but as the FDA/CDC have allowed, any port in a storm.  County health officials are already lining up planning for the anticipated "second wave" in the fall, which is going to keep supply pressure high as they begin amassing stockpiles.  Gowns?  Every person you speak to in the supply chain asks that followed by "yeah, I know, just thought I'd ask."  Budgets?  Who knows.  I am not being like the slime bag profiteers who are demanding 100% cash in advance, sight unseen, but I harbor some serious doubts about the wisdom of filling state/local government agency purchase orders when there is at least one senator who is suggesting we should let the states go bankrupt.  Not enough to stop me, but just something to keep you awake at night - that's some serious $$$.  Cash flow will also hit everyone in the supply chain, too.

I have to give a big shout out to our supplier (name withheld).  I will shrink down a fascinating and compelling story to state that they could have easily sold them to a large commercial supply firm but if the purchaser want to jack prices way over list, there's nothing to stop them and they have shareholders to satisfy. Our supplier really liked that a) we are vetting our orders and/or requiring proof of essential role before we sell,  b) we are beating the pavement to find those people and c) we aren't screwing those people on prices.  And they're working with us on cash flow.  In these unreal and dark times, it's amazing to be given this important role. Same goes for all those others whose disparate niches make life possible too, whether it's the supermarket employees, agricultural workers, PPE factory workers, or truck drivers. It really does take all of us.

Ending on an uplifting note, it's the "we=E2=80™ll get through this together" spirit that rings true virtually every call or online order comment There is so much good out there in the face of adversity - it's really reminiscent of the time after 9/11. 

Rob Toreki

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On Apr 24, 2020, at 5:44 PM, Bruce Van Scoy <bvanscoy**At_Symbol_Here**TWC.COM> wrote:

Personally, I would just like them to stop all of this priority emphasis on hand washing.  I think they're dancing around the priority training/communication issue.
This is predominantly AIRBORNE, probably >95% of the transmissions.  
Handwashing, along with basic sanitation practices are good to prevent INCIDENTAL transmission.
Cloth facemasks are EYE CANDY, they make you feel like your doing the right thing, but if your not keeping at least 6' apart - its irrelevant.
The only thing that is going to stop this virus is herd immunity, which can be obtained either by immunization or natural transmission.  
Yes more testing is needed, and more studies, but It appears from the few studies that have been conducted so far that natural immunity is occurring and if this continues, herd immunity will occur.
The questions that need to be asked - and answered - is how is herd immunity going to be obtained the fastest.  
A immunization is 12-18 months out and that is a very best guess estimate (normally >5 years, if obtainable at all).  
The priority should be to prioritize those receiving herd immunity to those showing the lowest rate of severe or any complications.
The initial goal of the lockdown was to prevent the overload of the healthcare system.  Done.  
What happened in Italy was truly tragic, but that is nothing that will be seen in 3rd world countries.  I read of one that had 1 ventilator/10,000 citizens.  That's truly sad.
We can make a difference, in the U.S. and world wide - if we speak up.  
My Father used to say lead, follow or get out of the way.  I have not heard the hierarchy of controls fully implemented yet.  We've proven they work and eliminated workplace costs/impacts.  
What can or should we be doing now?  
Bruce Van Scoy

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