[uxp]

It's not about the money. PPE like face shields are specifically used during procedures that involve significant bodily fluid, like intubation, which is the process of pulling or pushing a tube down a patient's esophagus. Going to to the grocery store does not require a shield.

Secondly disposable medical equipment, when used properly within a healthcare environment, is extremely wasteful. For most consumable items used in a hospital, they are covered in packaging with specific serial numbers and lot numbers that allow reconciliation if it's found that the goods are not sterile or have deficiencies. There is also a provenance or chain-of-command aspect that allows attestation of safety throughout the entire supply chain. While we might be talking about how to sterilize n95 masks, reuse face shields, and asking for donations of PPE from the public right now during a pandemic, the fact remains that in normal circumstances there is massive liabilities that hospitals and clinics would be subjected to if they started sourcing protective equipment from the public that could have been tampered with, may be slightly used and broken, or otherwise could cause harm to the patient and they'd be unable to identify the source of those resources. Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply.

This is one reason why we pay federal taxes.

[roenxi]

> It's not about the money. PPE like face shields are specifically used during procedures that involve...

There is currently a global pandemic afoot that is spread by droplets expelled from people's mouth and nose. What a tool was being used for 2 months ago isn't relevant; the situation is different now.

> Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply.

If masks or face-shields could be cleaned fairly easily then it probably is a scalable supply. Particularly if medical professionals are allowed to supply their own work tools.

[mbreese]

> What a tool was being used for 2 months ago isn't relevant

It is very relevant. These face shields wouldn't protect anyone from airborne/aerosol pathogens or viruses. They have a very specific purpose and that isn't one of them.

If you're talking about adapting construction grade shields (like used for painting, etc) for medical use -- sure. But you aren't going to use a face shield as a replacement for a face mask, which is what it seems like you're arguing for.

If you're saying that you should wear a face shield in public to protect yourself from aerosolized virus -- that's not the point of a face shield. The particles can travel around the sides of the mask too easily. If you want to protect from small, airborne particles, you need a mask.

[rumanator]

> There is currently a global pandemic afoot that is spread by droplets expelled from people's mouth and nose.

Do you have any source on how face shields are an effective tool against atomized covid19 viruses? The general guidance is that facial masks are effective at barring infected people from emitting contaminated particles, but not good at stopping healthy people from having contact with the virus. Therefore why would an open face shield, which filters zero, be a better solution?

[GoodOldNe]

Pedantic point: If you’re intubation the esophagus, you’re doing it wrong. :-)

[Angostura]

Might this explain the poor survival rate?

[jnbiche]

> pulling or pushing a tube down a patient's esophagus

No, that's another procedure. Intubating respiratory patients involves targeting the trachea and avoiding the esophagus. An esophageal intubation can be Very Bad.

That said, as an early advocate for face masks for the general public, I'm in 100% agreement that face shields are pointless for the general public. We don't need them.

[DanBC]

What's the point of wearing a face mask if you're going to leave your eyes unprotected?

[catblast]

> which is the process of pulling or pushing a tube down a patient's esophagus.

In the context of intubation that is most definitely a bad outcome.

[FireBeyond]

> intubation, which is the process of pulling or pushing a tube down a patient's esophagus

Hope not. It's endotracheal intubation. Tubing the gut (accidentally) leads to gastric distention as we ventilate the patient, leads to aspiration, leads to aspiration pneumonia, leads to huge increase in morbidity.

[gwright]

There is a shortage right now and we are collectively trying to address that but it is strange to say that this particular product and the safety practices you describe is the "reason why we pay federal taxes".

Your more general point that having a national stockpile of <insert-critical-item-here> for disasters of various kinds is of course valid, but that is true irrespective of the particular nature of the normal use of those particular items.

And we've learned that the federal government isn't particularly good at stockpiling. I hope we can find a way to have some non-partisan after-action committees to figure out how to do better for the next disaster.

[RcouF1uZ4gsC]

> like intubation, which is the process of pulling or pushing a tube down a patient's esophagus.

Hopefully you are intubating a patient’s trachea and not not the esophagus.

[brodie]

Does esophageal intubation happen much? I was intubated a month ago due to non-COVID respiratory failure. I also ended up getting pneumonia but no one knows when I got it. If that happened to me would my medical team have told me? Speaking generally obviously since you don’t know my case of course.

[dillonmckay]

I used a face-shield in October when I was using an HVLP paint sprayer indoors, so there are definite uses besides the current pandemic.

It definitely cost more than a few dollars and is not disposable.

Also, according to the documentation, these are re-usable and can be sanitized w/ alcohol or H2O2.

[epicureanideal]

"Everybody stocking a "handful" of PPE isn't a scalable solution to maintain a national supply."

No, but there's no harm in it either, and some potential benefit in case it takes a few days for the federal government to organize a response.

We all assume the government is going to make sure the food supply is maintained, but everyone is also buying some extra food just in case there's a temporary gap.

We don't need to choose just one way of preparing for the unknown.

Also, I was just saying the general public might purchase a few of these masks for themselves for their own use, not that hospitals might rely on the public for supplies.

[electricviolet]

The harm right now is that there's not even enough PPE for hospitals, so anyone buying a face shield for themselves, if that were possible, would keep a face shields from going to a health worker who needs it more.

A couple months from now, when pressure on the healthcare system is lower and manufacturing capacity is ramped up? Sure, I'm all for it.

[uxp]

For what, though? And I'm 100% being honest here, what is the specific situation you are envisioning that requires a face shield in your home?

In a medical setting, shields are typically used in conjunction with eye goggles and respirators when performing procedures that have a tendency to cause or be around splashing body fluids. Outside of someone sneezing or spitting on you directly, I can't think of an analogous situation that I come into on even a rare circumstance that a face shield would protect me from.

[frogpelt]

"We all assume the government is going to make sure the food supply is maintained"

Do you assume this? I assume that capitalism is keeping the food supply maintained. When that fails, I think we're up the creek.

[cayblood]

All it takes is one accidental sneeze in a grocery store for a face shield to become useful.

[zbrozek]

Stanford hospital, for example, throws away one N95 per patient doctor visit. They are not sterilizing and reusing. So my friend who works there is using many dozens of them per day. It seems like they could come up with material-preserving procedures like sterilization, but they're not.

[prostheticvamp]

Because best data to date is that sterilization procedures damage the mask in ways that render it unsafe.

When someone comes up with data finding a safe way to do so, the masks won’t go in the trash. In the meantime, I’d you have the masks to spare, you -should- be using them safely. Masks are pointless if you use them in a way that will get you sick.

[icebraining]

The problem is that there isn't a known safe procedure for sterilization. Universities are working on that: https://news.engin.umich.edu/2020/04/engineers-work-to-decon...

[bolasanibk]

Like this one: https://news.ycombinator.com/item?id=22680799

[favorited]

They're setting up one of these[0] in Boston, allowing hospitals to sterilize and reuse 80k masks / day. There's an article[1] in the Boston Globe about it, but I'm not sure what the paywall situation is there.

[0] https://www.battelle.org/inb/battelle-critical-care-decontam...

[1] https://www.bostonglobe.com/2020/04/02/metro/boston-hospital...

[andrei_says_]

> disposable

This is reusable, easy to sterilize w alcohol.