Covid, Vax, PPE and ‘how to think about risk’ Discussion (+ video)

This is an hour long discussion I had with a small group of nurses, doctors, managers, first aid officers and lifeguards about recent Covid changes, some recent evidence, some distilled ‘lessons learned’, and how all of this can impact lifeguards. But it’s relevant to anyone trying to figure out how to deal with Covid risk in a responsible, rational manner.

A big word of thanks to the surf lifesavers who continue, time after time, to put themselves forward under challenging circumstances to help other people in trouble–whether than challenge is 3 metre swell or a pandemic. I am quite honoured to work with and for you.

-Gary

At Gareth’s request, here is an update on the rapidly evolving state of play regarding Covid for SLSNZ members, from a medical perspective. It is a partial summary of an hour-long Covid discussion on Covid, PPE, vaccination, and other pandemic issues. Enjoy.

Risk:

Must understand that the greatest risk of Covid is not from patients, but from family and friends, and colleagues.

You are vastly more likely to get infected via an overnight stay in the bunkroom, a social dinner or drinks at the clubhouse, or your fellow guard sitting with you indoors.

Bluntly put, the outdoors risk is minimal. The indoor social/group risk is substantial.

The way we minimise this risk is to:

1) Avoid proximity. Don’t ever be indoors, if you can be outdoors (remember sun safety and ensure your club has sun shades and fixed shade, especially for children. Melanoma kills 400 people a year, and lifeguards are a high-risk group.) 

There may be times you need to treat a patient in a first aid room. This will be a minority of cases. Most patients can be assessed and treated in an open-air environment.

But remember, your greatest risk is your fellow lifeguards. There have been superspreader events from lifeguards in other countries — to their peers. How to avoid this? Vaccination and masks.

2) Get vaccinated. Everyone should get vaccinated against Covid, it decreases your chance of death and hospitalisation by more than 90%. There is only roughly 1 person out of every million that cannot get vaccinated due to a medical issue, anaphylaxis. Everyone else can and should get vaccinated, to protect themselves and those around them. If you are caring for patients, then you have an obligation not to increase their risk of preventable harm. SLSNZ is awaiting word on final details of the government mandates for health and education workers, which will be shared with the membership as soon as possible.

3) Use face masks. Surgical masks (the blue, plastic/papery ones) are roughly twice as effective as cloth masks. Use them whenever possible. Studies have shown they can be reused up to 10 times and still remain effective. Face masks should be used whenever you are indoors around people not in your personal bubble, and when you are outside and cannot maintain 2m physical distancing from others. They really work, are cheap and simple, and can prevent Covid and/or reduce the amount you inhale. Perhaps more importantly, they decrease the chance of spread to others.

4) Understand risk (detailed in Risk section above). Your friends are a greater risk than your patients. Up to perhaps 40% of young people will have no symptoms. They will think they are healthy, they will feel fine, no cough, no shortness of breath. Yet they will be infectious to you and those around them. Wear a mask so you are not an unwitting spreader of Covid. If you infect a colleague or a patient of yours, the outcome can be bad. Get vaccinated too, because unvaccinated people are contagious for much longer than vaccinated people. If we used masks well, and vaccinated thoroughly, and maintained ventilation whenever we could, Delta would be a non-issue. As it stands, we still have a significant minority of the adult population (38% or 2.6 million) , as well all the under-12 child population (about 1 million), that are not fully vaccinated and are thus a potential tinderbox of Covid risk.

Recommendations are evolving, as expectations from government become clarified regarding patrolling during Level 3.

It is reasonable and appropriate and required to use a surgical mask, eye protection, and gloves for every patient interaction. Gowns are of uncertain effectiveness in this aerosol-spread disease, but still recommended. We are actively discussing N95 or KN95 mask use for longer/closer patient contacts. There are issues with supply and fit testing. Regardless, strive to maintain ventilation (ie, outdoor or open air care) and distance, whenever practicable. Always wear a mask, not just to keep yourself safe, but perhaps more likely, to keep the patient safer.

Hope this was helpful. Watch the video for a longer discussion. Skip the first 3 or 4 minutes while we wait for people to log on.

Cheers

Gary 

Dr Gary Payinda

National Medical Director Surf Life Saving NZ

Emergency Medicine Specialist