Protecting Them While They Protect Us

By Charles McKenzie, November 24, 2020

The importance of personal protective equipment.

Madeline Arena ’13, DPT ’15, works at New York-Presbyterian/Columbia as a physical therapist.

(Photo submitted)

PARENTHOOD is a child rushing to greet a parent coming home from work. As with so many other things, COVID-19 has changed that. More parents are staying home, for one, but for frontline medical personnel like Dr. Jay Sellers ’05, that formerly bright part of his day only happens after one last battle with the coronavirus beast.

With so much time spent on the front lines of the health care crisis, Sellers, an infectious disease specialist, and his wife, a pulmonary doctor, are both terrified of infecting their family with the disease they’ve been fighting for months. So their two daughters (both under four) must wait for warm welcomes until scrubs are carefully peeled off in the garage and thorough showers are taken as their parents perform their final defense of the day against disease transmission.

Dr. Jay Sellers '05 is an infectious disease specialist in North Carolina.

The primary barrier between COVID-19 and the Sellers family is thin and ephemeral, as throughout the day gowns, gloves, goggles, face shields, and masks — the personal protective equipment (PPE) so important to frontline workers — are donned and doffed, all in a very particular order. At the end of the day, and sometimes even at the end of each patient visit, Sellers methodically removes them.

Unfortunately, the rough workdays, especially now, may be even harder to shed, particularly in a two-doctor family. The couple withstands double the exposure, both to the virus itself and to the mental toll it takes. They debrief when there’s time. Sellers’s wife, Subhashini Sellers, is on the COVID-19 response team at the University of North Carolina Hospitals, treating the most critically ill patients who are often on ventilators in the intensive care unit.

“I remember thinking to myself, ‘I hope all of this PPE is on correctly and it will hold up because this is the real deal.’ I wasn’t sure how sick the patient was going to be, if they were going to be coughing a lot, or how much I was going to be exposed to the virus,” he said. “But then, as the weeks progressed, I got more comfortable with the personal protective equipment and got more confident.”

When Sellers removes his PPE, literally his every move is meticulously watched by a hospital staff member and compared to guidelines designed to prevent contaminating the wearer. As it is in surgery, one false move could cost a life — his own, others, or both.

“I remember thinking to myself, ‘I hope all of this PPE is on correctly and it will hold up because this is the real deal.’”

Dr. Jay Sellers ‘05, infectious disease specialist

“The sequential order is very helpful, and we also have, for lack of a better term, a ‘spotter’ who will help you don and doff the equipment. The person will tell you, ‘Okay, now take off your gown. Now take off your goggles. Now take your gloves off with this hand.’ The spotters do a great job. They’ve even said, ‘Wait. You just contaminated yourself right there with your left hand, so you need to wash again.’”

Back in early January at a regular committee meeting, Sellers’s team had taken about five minutes to discuss the novel coronavirus that had appeared in Wuhan, China. But within weeks, the virus essentially became the sole agenda item. It was in late March that he saw his first confirmed COVID-19 patient.

Nurse Katie Paccione ’12 in full PPE at work in New York-Presbyterian/Columbia University Medical Center.

Katie Paccione ’12 still remembers the first time she donned the full PPE gear and walked into a COVID-19 room in New York-Presbyterian/Columbia University Medical Center. “There was a moment of holding my breath, not because I thought that if I breathed in I would get infected. I was like, ‘Okay, here we go.’’’

She understood the weight of the moment better than she’d understood the weight of all the gear: “It still feels heavy, and especially by the end of the shift, everything hurts because of that weight. But it felt especially heavy that first time.”

PPE is hot and sweaty, too. More than once, Paccione’s face shield slipped off completely, and she also nearly passed out from the heat — all potentially serious incidents that she lightly files under “oh, snap!” moments.

She said the question has never been whether she would get sick but when: “Every time you walk into that room, you have to wonder if this is it.”

Fear of catching the virus is a strong motivator said Susan Salahshor, a physician assistant who is the founding director of a new physician assistant program being launched soon at IC*, but the pressure to take physical precautions takes a mental toll.

“There has to be a healthy level of fear for you to say, ‘I need to be careful what I do,’” she said. But when does that healthy fear become something counterproductive, obsessive, or scarring? “That’s a very gray line, and that gray line is very thin. Almost every health care worker knows someone who has died, and of course they remember that episode. They know it only takes one mistake.”

Victoria Rainaud ’13, DPT ’15, a physical therapist working in New Jersey, always has her guard — and appropriate PPE — up, even with patients who aren’t yet known to be COVID-19 positive. “You’re going to be safest if you assume everyone has it. And that’s what we did, and so far, so good.”

Stretching the Supply

The “everyone has it” philosophy has taken its toll on some of the supplies at the hospital in central New Jersey. “At one point, we had to reuse gowns, so we’d figure out who was definitely positive because you can use the same gown with them. For patients under investigation, you can’t.”

When they ran out of the bouffant caps that typically cover the head and hair, they noticed that the surgical gowns came wrapped in a sterilized cloth.

“So we’re recycling that sterilization wrap and using it as a bandana to cover our heads, and then you just throw that out at the end of the day,” she said. “Then I wear my N95 mask with a surgical mask, and I wear goggles, gloves, and gowns, and this is for the majority of the patients that we’re seeing. It’s a big setup to go into a room to work with a patient for a short amount of time and then come out and start all over again.”

Rainaud estimates that the changing process takes between 5 and 10 minutes. One day, she saw 14 patients, so that could be almost a quarter of a day spent just changing gear.

Madeline Arena ’13, DPT ’15, who also works at New York-Presbyterian/Columbia, saw the depletion of the PPE supply. But when donations of masks and 3D-printed face shields began to materialize, she and many of her coworkers at the hospital became better equipped.

IC Making PPE

At the local level, face shields were also being supplied to health care workers in Ithaca and the surrounding area thanks to some fast-acting Ithaca College professors and staff. In late March, when New York Governor Andrew Cuomo publicly asked any companies and individuals who were capable of producing personal protective equipment to do so, the IC community jumped into action on scales both large and small.

When Jeff Golden, director of general services at the college, heard Cuomo’s announcement, he said that a light bulb went off. “It occurred to me, print operations manager Glen Harris, and warehouse associate David Westgate that we were in a position to produce a lot of stuff pretty quickly,” he said. “So we talked with executive director of auxiliary services Dave Prunty about what we needed to do to get it up and running.”

Using college equipment and materials, such as the four-by-eight-foot sheets of plastic used for on-campus signage, the group printed a large number of face shields quickly to help meet local needs. They hope to print medical masks eventually as well.

With their initial printing, they sent 1,000 shields to the William George Agency, a nonprofit residential learning center for young men and women, and they donated 1,000 shields to the Cayuga Medical Center in Ithaca. Arnot Health, which covers parts of southern New York State and northern Pennsylvania, also placed a request for 1,000 shields.

The IC print shop worked with faculty and staff to produce face shields for community health care workers.

(Photo submitted)

“Our production capacity is based on supply, to some degree,” Golden said. “But we could probably print up to 10,000 face shields a week. We’re in a unique spot to help with this, and we’re glad to do it.”

Susan Allen, professor of environmental studies and sciences, donated a LulzBot TAZ and an Ultimaker printer. Those and other supplies were distributed to associate professor of physics and astronomy Matt Price, Dana Professor of Physics and Astronomy Luke Keller, assistant professor of physics and astronomy Jerome Fung, and instructor of computer science Roy Westwater.

Westwater, who is also the founder and lead mentor of the robotics team at Charles O. Dickerson High School in Trumansburg, New York, had access to two printers from the high school in addition to his personal one. He and his son, Max, who was a senior robotics engineering and computer science major at Worcester Polytechnic Institute, turned their home into a makeshift print shop.

“We’ve got printers running 10 to 12 hours and the capacity to produce hundreds of pieces of PPE a week,” Westwater said.

An employee of Airtex sews level 2 disposable gowns.

(Photo submitted)

Across the country, third-generation entrepreneur Mike Miller ’84 of Minneapolis-based textile manufacturer Airtex Group/Acme Made pivoted his manufacturing operation at his Minnesota facility. The company was founded during the 1918 flu epidemic as a bag manufacturer, and for decades, its sandbags defended the Midwest from countless mighty floods. In April, he redeployed his workforce, going from making home textile products such as window treatments, pillows, throws, and products such as cases and bags, to sewing gowns, nonsurgical face masks, and face shields. The company says the gowns are disposable level 2 isolation gowns and are made using recycled medical-grade materials.

The North Carolina infectious disease doctor, Sellers noted an outbreak in nearby Raleigh in mid-April, saying that he felt like he spent all day going from one set of PPE into the next. His group, Raleigh Infectious Diseases Associates, saw 10 new COVID-19 patients, and he personally saw five of them.

“I remember just putting all the PPE on in the emergency room and thinking, ‘Wow, this is a historic thing that we’re involved in, and it’s going to change the way that we practice medicine and how any of us interacts with each other.’ That was a crazy time, suiting up for five different patients in five hours.”

For health care workers using the PPE, every ounce of extra protection could literally be life or death. Each time Sellers, the infectious disease doctor, wears the PPE, he’s carefully saving patients. Each time he carefully takes it off, he’s saving those around him, including the two adorable little reminders of his day’s vigilance. When he gets home, their innocence and sweetness are just the right medicine.

“Sometimes, I just need to go home, decompress, and do Cosmic Kids Yoga with my daughter. That can really help a lot.”

For the two Sellers children growing up during a global pandemic, that’s what will have to count as a playdate for the time being. And when the shower door opens at the end of the day, what emerges isn’t a frontline hero so much as a mom or a dad — and sometimes a yoga partner.

*This proposed program has not yet been reviewed or registered by the New York State Education Department. This proposed program has not yet been revised or approved by ARC-PA, the accrediting body for physician assistant programs.

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