COVID-19 kills approximately 1 in 30 to 1 in 100 of those infected. Health care workers and trainees, including residents and medical students, are especially vulnerable. The first patient diagnosed with COVID-19 in New York came to Mount Sinai Hospital before its workers and trainees received rigorous training in self-protection and preparedness against COVID-19. Routine online training modules are not enough.

By rigorous training, we mean:

(1) Creating risk-stratified, scenario-specific guidelines on what kinds of personal protective equipment (PPE) to don in specific scenarios of managing COVID-19 patients (e.g. interviewing and transporting patients vs doing throat swabs).

(2) Releasing all risk-stratified, scenario-specific COVID-19 treatment and containment protocols including diagnostic algorithms, PPE donning and doffing, environmental sanitation policies and behavioral modifications on the health system intranet to be accessible to hospital staff and trainees.

(3) In-person training for donning and doffing PPE because of the high risk of contamination in these procedures (Kwon et al. 2017 showed among a sample of 18 healthcare workers that 100% of deviated from protocol while doffing PPE against the Ebola virus). Online modules are not enough.

(4) Realtime notifications on institutional containment efforts, including the number of persons under investigation and confirmed cases to the extent that patient confidentiality is preserved.

(5) Timely access to PPE, including clear protocols about what is available where and strategies for conservation.

(6) Timely testing for healthcare workers and trainees who may have been exposed and paid leave for the duration of quarantine and/or convalescence.

We believe these are actionable demands. We make them not in order to incite panic but to quell it. Preparedness is the best antidote against panic.