My opinion

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Since the pandemic started, I as anesthesiologist have been missing whiffs of air when almost always wearing mask especially at workplace. Then one day, I inadvertently sniffed that whiff of air which opened my eyes to the fact that mask can't prevent every whiff of air from reaching me. That whiff of air contained gases and aerosols [1-2] exiting from colon during colonoscopy when I went inside endoscopy lab to medically direct [3] non-physician anesthesia provider providing anesthesia for the said colonoscopy. It dawned to me that when my mask didn't prevent exiting colonic gases and aerosols from reaching me while medically directing anesthesia delivery in endoscopy lab, non-physician anesthesia providers, circulating nurses, colonoscopists and endoscopy technicians must be unavoidably sniffing them all the time by being inside endoscopy lab for the entire duration of colonoscopy-like procedures especially when endoscopy labs may be neither negative pressure rooms nor positive pressure rooms. Moreover, endoscopy technicians and circulating nurses who are only working in gastrointestinal endoscopy labs throughout their workweeks may be cumulatively sniffing more colonic gases and aerosols than non-physician anesthesia providers and colonoscopists who sometimes may be having other rotations, outpatient clinics and inpatient rounds during their workweeks. Historically, these whiffs of air might have been way larger quantitatively and cumulatively when non-physician anesthesia providers, circulating nurses, colonoscopists and endoscopy technicians were not required to wear masks in gastrointestinal endoscopy labs before the advent of pandemic [4-6]. Thus, the interesting question arises whether those cumulative whiffs of air induce any changes due to unavoidably sniffing newer nasal biomes and thereafter inadvertently ingesting newer gastrointestinal biomes among non-physician anesthesia providers, circulating nurses, colonoscopists and endoscopy technicians who are working non-stop in gastrointestinal endoscopy labs. Once such changes can be quantified among those working non-stop in gastrointestinal endoscopy labs, it may be interesting to explore whether these changes if any in nasal and gastrointestinal biomes of non-physician anesthesia providers, circulating nurses, colonoscopists and endoscopy technicians have affected their morbidity and mortality induced by SARS-CoV-2 [7-9] during the ongoing pandemic unless patients utilizing bowel preparation solutions prior to their colonoscopies have been already changing their biomes [10] thus their colonic gases and aerosols wherein protective effect if any due to induced changes in nasal and gastrointestinal biomes of non-physician anesthesia providers, circulating nurses, colonoscopists and endoscopy technicians would have been lost already. Once healthcare providers quantify their own biomes [11-13], in due course of time, they may be able to convince their own patients to get tested for biomes for which third-party payers may have been already convinced to provide coverage in due course of time because knowing our everchanging biomes’ genomes may be more important for our existential healthcare than just knowing our own human genomes and/or ancestral human genomes. This may finally open our eyes by refocusing our attention from the old narrative [14-16] whether or not screening colonoscopy every decade prevents human colon cancer to the new narrative [17-21] that it may be biome enriching inhalation and ingestion by humans from their prebiotic and probiotic thus synbiotic environments day in day out which may affect the incidence of not only colon cancer among them but also many other diseases among them secondary to multi-millennium-old collaboration between human genomes and their constantly evolving symbiotic metagenomes and metabolomes.   

Reference(s)

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1. Intraluminal gas escape from biopsy valves and endoscopic devices during endoscopy: caution advised during the COVID-19 era. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895664/
2. Gastroenterology Procedures Generate Aerosols: An Air Quality Turnover Solution to Mitigate COVID-19’s Propagation Risk. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7731398/
3. Definition of ?Immediately Available? When Medically Directing. https://www.asahq.org/standards-and-guidelines/definition-of-immediately-available-when-medically-di recting
4. Unmasking the surgeons: the evidence base behind the use of facemasks in surgery. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480558/
5. Will PPE Practices in Endoscopy Change Permanently After COVID-19? https://www.gastroendonews.com/Priority-Report-Endoscope-Reprocessing-and-Infection-Control/Article/ 07-21/Will-PPE-Practices-in-Endoscopy-Change-Permanently-After-COVID-19-/64000
6. GI Endoscopists Increase Face Mask Use. https://singleuseendoscopy.com/gi-endoscopists-increase-face-mask-use
7. Infection and mortality of healthcare workers worldwide from COVID-19: a systematic review. https://gh.bmj.com/content/5/12/e003097
8. Physician deaths from corona virus (COVID-19) disease. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239175/
9. COVID-19 and mortality in doctors. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7470789/
10. Colon Reparation After Colonoscopy. https://www.webmedcentral.com/article_view/5771
11. The Microsetta Initiative. https://microsetta.ucsd.edu
12. Get Your Kit. https://microsetta.ucsd.edu/how-it-works/
13. Instructions. https//microsetta.ucsd.edu/participant-resources/instructions/
14. ACS issues comments on European study on colonoscopies published in New England Journal of Medicine. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/press-releases/20 22/acs-issues-comments-on-european-study-on-colonoscopies-published-in-new-england-journal-of-medici ne/
15. Colonoscopy lowers CRC risk and death, but not by much: NordICC. https://www.mdedge.com/internalmedicine/article/258546/gastroenterology/colonoscopy-lowers-crc-risk- and-death-not-much
16. Effect of Colonoscopy Screening on Risks of Colorectal Cancer and Related Death. https://www.nejm.org/doi/full/10.1056/NEJMoa2208375
17. Maybe Disease-Evolution Is All About Foods Which Are Either Biome-Enriching Or Biome-Depleting. https://www.webmedcentral.com/article_view/5795
18. Is Pandemic Teaching Gut Biome Maybe Holding The Key With Us Carrying Our Answers In Our Gut? https://www.webmedcentral.com/article_view/5789
19. Time For Gut Biome Metagenomics During Annual Physicals And Screening Colonoscopies. https://www.webmedcentral.com/article_view/5791
20. Antibiosis: "Dear Microbiome, Are You Dead Yet?" Probiosis: "Maybe Never, Must Be Never." https://www.webmedcentral.com/article_view/5739
21. The Good Gut: Taking Control of Your Weight, Your Mood, and Your Long-term Health Kindle Edition. https://www.amazon.com/Good-Gut-Taking-Control-Long-term-ebook/dp/B00OZ0TOV2

Source(s) of Funding

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NOT APPLICABLE

Competing Interests

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NOT APPLICABLE