**2. PPE and trauma**

PPE has been an integral part of the ATLS principles of a trauma resuscitation and has been taught globally [1]. With the advent of the Covid 19 pandemic, more focus

has been placed on PPE protocols for not only resuscitation but for all patient interaction due to the infectious nature of the virus and the unknown state of the patient at first interaction. These PPE protocols have evolved over the last 2 years with the ongoing research into the spread of COVID 19 and all its variants from full PPE and fomite transmission to no fomite transmission and basic PPE such as a plastic apron, visor and N95 for all patient interaction, whereas the vast public is encouraged with social distancing, hand sanitizing and either surgical or cloth face masks [2, 3]. These evolving protocols have no effect on the trauma resuscitation, as the basis here is healthcare professionals safety from all bodily fluids in a high risk, life threatening situation. **Could this be the reason for a low positivity rate among healthcare professionals in the trauma surgical discipline?** In an attempt to answer this question, I provide you with unpublished data from our facility due to a lack of appropriate literature available to answer this question.

Our facility was faced with a MCI due to civil unrest in the week of 9–16 July 2021. At the same time we were experiencing the 3rd COVID wave, with an adjusted level 4 lockdown, this entailed a curfew from 9 pm to 4 am, and no alcohol sales. Our neighboring hospital (18 km away) with the only other functional trauma unit in our Metropolitan was shut down due to a fire and with the civil unrest, all patients were seen in the only functional trauma facility. Although the numbers of patients and procedures done increased, patient positivity rate was 9% below the national average of 29.1% at the time [4]. Only two doctors of a total of forty tested positive during this time (5%). This was with the adherence to standard PPE protocols according to ATLS principles with the inclusion of a N95 masks (unpublished data).

Similarly In Nigeria full PPE was used when intubating patients, and when performing an emergency room thoracotomy while standard precautions were used for ICD insertions [5]. Globally we have seen many doctors and healthcare professionals testing positive for covid and in the infancy of the pandemic, many had succumbed to the virus. Most of which were involved in patient care of COVID positive patients with the adherence of PPE protocols [6]. **Again, one would question why this is the case? Is it due to the combination of the burden of COVID positive patients seen by the individual and the burn out experienced by many which ultimately weaken the immune system?** A meta-analysis done in 2021 has failed to answer this question [6]. However the changing PPE protocols and COVID infections of healthcare personnel, community acquired or nosocomial, did not change how we would resuscitate a trauma patient with an unknown covid status, we adhered to basic principles, which was guided by ATLS principles [1].
