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An Insider’s Look at Working in an Israeli Corona Ward

AHA Publisher — Mon, 27 Apr 2020 07:00:37 +0000

Naama Barak via Israel21c – Physiotherapist Dania Hofi talks to ISRAEL21c about donning protective gear, treating Covid-19 patients and the rehabilitation that awaits them. “Entering the isolation wards is putting yourself at risk. We feel on the front lines.” This is what treating people suffering from coronavirus is like for Dania Hofi, a physiotherapist who runs Sheba Medical Center’s school of physiotherapy. In regular times, she doesn’t work in the wards – but once the pandemic hit Israel, she volunteered to treat Covid-19 patients. “Everyone there is giving their heart and soul,” she says. “There’s a personal risk but it’s part of the dedication that characterizes us as professionals.” Usually associated with things like back pain or injured athletes, physiotherapy also deals with respiratory treatment and rehabilitation. While this less-than-glamorous field is usually relegated to the backbenches, Covid-19’s adverse effects on patients’ respiratory systems has brought it forward. “The respiratory field is not very popular, but if there’s a field in physiotherapy that really deals with matters of life or death – this is it,” Hofi says. “Unfortunately, it’s very much in demand nowadays.” This demand started when Sheba opened its first coronavirus ward. At first, physiotherapists communicated with patients via telerehabilitation, giving them exercises and instructions from afar. But as the number of patients grew and their condition worsened, it was time to step in. “We see all types – we see the people who have corona and don’t have any symptoms at all in their respiratory system,” Hofi explains. “There are those who experience it lightly – perhaps a little shortness of breath while under stress, a dry and persistent cough. “Then there are the patients listed in satisfactory condition who fail to oxygenate properly,” she says. “They work very hard to absorb the oxygen. It’s tiring to breathe like a chimney all the time, and the respiratory muscles grow weaker and then comes the moment that they require a ventilator. That’s a very difficult situation with a high mortality rate.” Patients on the Verge In their treatment of coronavirus patients, physiotherapists have several goals. One is to ease breathing and reduce shortness of breath – this is done with breathing exercises, relaxation methods, placing patients in various positions and using different accessories. Another goal is to improve patients’ oxygen saturation so that their condition doesn’t deteriorate. And when a patient does require being hooked up to a ventilator, the focus turns to trying to prevent complications and to help with the weaning process. Because coronavirus patients can deteriorate so quickly, physios need to make sure they don’t tire them out. “There are patients who really are on the verge, and all it takes is for you to do a few innocent exercises with them and it’s beyond their capabilities,” she explains. “We keep this danger in mind.” Meanwhile, therapists also treat patients for more general difficulties associated with long-term hospitalization. “The disease isn’t over in a day or two, and patients lie down for a long time,” Hofi says. “Even if their condition isn’t that severe, they feel really ill and are confined to bed for a long time. Even if you put a young man in bed for a long period, it will be difficult for him to get up and walk.” Treatment Without Touching While in regular times treatment is hands-on, this isn’t a possibility for patients in isolation wards. “It doesn’t look like regular treatments,” Hofi explains. “It’s all about touch, closeness. We spend a lot of time with the patients. And suddenly you either treat from afar or you wear a suit through which you can hardly see your eyes. It’s against our nature.” While medical staff are required to limit patient contact as much as possible, therapists find themselves torn between adhering to safety guidelines and helping patients reach for their food, for example, or connect their phones to chargers. “We’re also seeing a lot of sad things – the terrible loneliness of the patients.” “It’s work that you take home with you, big time,” Hofi says. “I’m an old hand, and I’m telling you it’s not easy at all. We really are trying to do our best.” “Happily, I can point to people who do recover and that raises my morale,” she adds. Sharing Insights Coronavirus’ long-term effects on patients remain unclear. “I can tell you that the people I’ve seen recovering have recovered well. They go back to themselves,” Hofi says. “Does it leave respiratory limitations? That’s a question I can’t answer, but we’re thinking about it.” A bright side to working on the global pandemic, Hofi says, has been the spirit of mobilization and cooperation. “I’ve been very touched by the cooperation between physiotherapists here in Israel and also across the world,” she says. “Information is being put out quickly to share insights. Everything is being done very quickly to meet the requirements.” A physiotherapist from China with more COVID-19 experience, for example, has been passing on his insights to Israeli colleagues, while on a local level people are putting forward their knowledge and expertise. “I think Israel really can serve as an example,” Hofi says. “There’s room for improvement, but overall we deserve a pat on the back.” And, she adds, “Thank God it’s not total chaos like what we’re seeing elsewhere. It’s under control. That also needs to be said.” To read the original article click here. For more articles from Israel21c click here.

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New Design Will Allow Manufacturers to Mass-Produce PPE for Healthcare Workers

AHA Publisher — Mon, 06 Apr 2020 07:00:52 +0000

University of Massachusetts Amherst via News-Medical Net – In just under two weeks, researchers at the University of Massachusetts Amherst, with engineers, nurses and other health care professionals, have developed a design informed by clinical feedback for protective plastic face shields as the nation combats the spread of the coronavirus. It will be made available to manufacturers to mass-produce personal protective equipment (PPE) for health care workers and others. A Southbridge, Mass., company, K+K Thermoforming, is now producing the first order of 80,000 shields placed by the Face Shield COVID-19 Response Team at UMass Amherst. Shields will be distributed to medical facilities and other front-line responders in the region before an expected virus peak in mid-April, says Institute for Applied Life Sciences (IALS) director Peter Reinhart, who helped to organize a number of UMass Amherst COVID-19 Response Teams. The company says it will continue production based on demand, he adds. UMass Amherst has contributed more than $30,000 for the initial order, as well as the hundreds of volunteer hours spent designing, testing, revising and manufacturing the shields, Reinhart said, noting, “The campus response to requests for help to address COVID-19-related shortages has been extraordinary.” More than a dozen COVID-19 response teams on campus are working to help healthcare workers and others with needs, from face shields to ventilator parts to viral transport medium for virus tests. Members of the face shield and IALS teams are approved to be in a lab for the COVID-19 response, but most work is done remotely, they say, and many team members have never met. Face shield team leaders Frank Sup and Meghan Huber of mechanical and industrial engineering at UMass Amherst say a variety of engineering, nursing and other researchers teamed up to meet the need. “Given the number of requests we receive on a daily basis, we know the need is dire. They’re in crisis mode, that’s why we’re working so quickly.” (Meghan Huber of mechanical and industrial engineering at UMass Amherst) Sup recalls, “We knew existing supply chains were not keeping up with demand and needed to turn to alternative manufacturing options for this emergency. We also knew that package manufacturing companies had the materials on hand that might be underutilized. We found these manufacturers could scale up the production of face shields in a matter of days to meet the vast and urgent need. All they needed was the design.” How Face Shields Mitigate Risk of Contamination A face shield protects the eyes and can be worn over an N95 mask to mitigate the risk of contamination, says Huber. It is made from a single, flexible sheet of 0.010-inch plastic film designed and tested in IALS’s Advanced Digital Design and Fabrication (ADDFab) Lab, says core facility director David Follette. It folds to wrap around the forehead and fastens securely at the back with no added materials needed. This is important, Follette adds, because 3D printing a strap, for example, is slow and inefficient. “You could use all the 3D printers in the world but it’s never going to be as fast as laser-cut or die-cut plastic sheets. We decided early that our product would have to be not only effective, but cheap and fast,” he says. To supply large quantities requires high-volume manufacturing, he adds. Their final design can be made in seconds. It’s flat for easy storage, Sup notes, and its light weight makes shipping more affordable. Important Input from Nurses Testing the shield’s clinical usefulness was assisted by nurses and technicians from the College of Nursing. Associate Professor and AAAS Invention Ambassador Rachel Walker and Ph.D. student Ellen Smithline say they are impressed that the IALS designers sought user perspectives. Walker, with emergency nursing experience from other large-scale humanitarian disasters, says, “Nurses are so close to what the challenges are, you avoid a lot of pain by working with them early. Your product may be beautiful, but it may not function for the people and providers who actually have to use it.” Smithline agrees. “Nationally, it’s unusual to include nurses at the beginning. The UMass project shows what you can accomplish if you have a good collaboration.” She and Walker asked area colleagues to use and provide feedback on a series of prototypes. Based on this, Smithline, with 26 years of ER experience including with SARS and Ebola, and her ER physician husband, Dr. Howard Smithline, suggested modifications – a longer strap to adjust to head size, pony tails, glasses and safety goggles. Smithline knew fogging can be a problem, so the team investigated pre-coating with anti-fog material. Not only should PPE be comfortable, Smithline suggested, she wanted a place for the care provider’s name “because eventually everyone looks the same if you’re wearing an N95, head covering, safety goggles and gown. You may not know who you are talking to. It’s also important to have good vision to provide safe care without fear of exposure.” Walker says it was important to get input from home care agencies, hospices and others. She says, “Delivering health care in a disaster is a very haunting and horrible thing. I have deep empathy for my colleagues who are going through this right now.” To find local manufacturers, IALS’ Reinhart turned to Jim Flynn, the new assistant dean of research business development at the College of Information and Computer Sciences. He says, “When I call a company and say I’m with a UMass Amherst COVID-19 Response Team and we need help making equipment for healthcare workers, they patch me through to the president. Being from UMass Amherst gives us instant credibility.” Among many others, Huber, Sup and Follette salute technical staff Colby Norwood in the mechanical engineering department’s machine shop and Asmit Jain in the IALS ADDFab Lab for their tireless contributions. Reinhart adds, “The COVID-19 crisis has forced us to rapidly explore new ways of collaborating against a backdrop of social distancing. The effectiveness of the ‘virtual team’ model has been spectacular.” To read the original article click here.

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