Today Fire Engineering held a ground-breaking online conference, talking with physicians and Fire Chiefs to discuss getting firefighters back to work after they have been infected with the coronavirus. Hosted by Rick Lasky and Terry McGrath, the physicians talked about the effects of the disease and how it affects firefighters. The Chiefs discussed ideas and procedures for getting them back to work, and how to determine if they are ready — or should they be put on light duty.
You can watch the recording of the video conference at Facebook.
One practice being used now is to administer various medical or physical tests before they test positive, and then if they later test positive, administer it again to compare the results.
If you are interested in the effects of the coronavirus and how fire departments are dealing with it, the 91-minute Zoom conference can be extremely worthwhile and valuable.
If you can’t spare 91 minutes, at least watch Dr. Tim Harris, Chief Medical Officer at Texas Health Presbyterian Hospital, Denton, Texas explain how the disease affects firefighters, from 9:40 to about 19:00. I transcribed some of the highlights from that section:
The difficulty with this disease is, with your young and vibrant workforce, you probably will have either mild or asymptomatic disease. Even within that mild or asymptomatic cohort, we’re seeing 30 to 50 percent of people with long term residual issues that when you stress them physiologically or mentally you’re going to see some degree of impairment.
The primary impairment is because the ace receptors on your lung and heart, we’re seeing people with lung fibrosis. You can’t breathe. The scarring is permanent, irreversible, and can only be treated with a lung transplant… But the cardiac impairment, 30 percent of athletes that develop COVID have long term cardiomyopathy — you develop heart muscle damage where the heart can’t pump as hard as it normally does so you develop systolic heart failure, or you have arrhythmia.
The other one that is also somewhat worrisome is the neurological impairment. And that goes to judgment. And judgment is very important in your job. You don’t want these people entering a structure fire with an impairment, whether it’s cardiac, pulmonary, or neurological… You want the brains, heart, and lung working so they can do their job.
Testing positive for the coronavirus could mean the end of a firefighter’s career. We don’t know what all of the long term effects are going to be, but irreversible lung damage is occurring now in some patients.
Much of the discussion was about, “How do we know what the path back to work is, are we looking at the right data,” said Russel Burnham a PA-C who treats firefighters at Front Line Mobile Health. “Asking ‘Are you OK’, is not the best method to determine if someone is fully recovered.”
Dr. Harris said the cardiopulmonary exercise test is a very valuable tool for determining the cardiac and pulmonary fitness of firefighters, before and after coronavirus.
Fire departments and federal and state agencies that employ wildland firefighters need to develop a post-COVID protocol to determine fitness to resume work.
The trouble with such a test is that individual performance varies, with or without disease. Actual testing is required for a diagnosis, and given that physical exertion will result in particles spreading farther. If the solution to pollution is dilution, it appears that such an idea might be behind the idea that being outside REDUCES the RISK. Does anyone know how many particles it takes for effective transmission? I’ve heard “a thousand” thrown out, but it sounds too much like a UWAG to me in the absence of peer-reviewed research. Not that I’m against getting ahead of the data with a SWAG, provided it’s driven by solid scientific principles and reasoning from what IS known.
The Big Question seems to be “How is transmission ACTUALLY occurring? On the job? Off the job? Management or individual carelessness? Tracing?
I don’t think the tools are available to answer your questions. They’re great questions though.
From everything I’ve read, being outside does reduce risk of spreading the virus significantly (like several orders of magnitude). Wearing a mask reduces it even further. The problem with fire crews is that they often have to spend time cooped up inside together (like in the crew transport) which dramatically increases the spread of the virus.
No one knows the number of virus particles required to bring on symptoms because it varies so widely with different individuals. The general thought is that the greater the number of particles, the more severe the onset of the symptoms are, all other things being equal.
As for your last question, that can only be answered (hopefully) through effective contact tracing. Which isn’t being done adequately in most areas. It could be but often is limited by human resources and reluctance to provide the relevant data.
I was watching Bryan Gumbel’s show that I had recorded, and they had a piece on the “long term Covid effects.”
The prognosis can be grim, in the sense that Drs. cannot tell a person if or when they will recover, nor can they tell them what their capabilities might be in the mean time. I’m sorry to even share this info.
Looks like Covid19 is a death sentence for the career of a middle aged or older hotshot or smokejumper….. sad to see but it will happen