- Healthcare workers are rationing their protective equipment, especially in hospitals where treating novel coronavirus patients has become a daily reality.
- N95 respirators are the gold-standard for blocking out airborne particles, but widespread demand has caused a global shortage prompting hospitals to conserve their limited supply.
- Doctors are describing their confusion and anxiety over reusing masks while hospital administrators come up with protocols to reduce transmission and find more supplies.
- At one West Coast health system, workers are making their own protective gear from office and craft supplies.
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Healthcare workers are taking unusual steps to cope with a shortage of protective gear, as they work to fight the novel coronavirus.
At Providence St. Joseph Health in the Seattle area, administrators are crafting face masks and shields from office materials. Healthcare workers and suppliers are driving protective gear, or PPE, from one of the system’s hospitals to the next — once in the middle of the night — based on which facility needs it most, according to Alison Santore, a vice president of government and public affairs.
“We need PPE. We need N95 respirators. We need face masks,” she said.
“We need face shields. We need gowns. We need all of the above. We are expecting with our models and what we’ve seen over the past two weeks, every three days our in-patient admissions are expected to double.”
Reusing masks to cope with a shortage
Other doctors are reporting new policies that require them to reuse N95 masks — the industry’s standard for filtering out airborne diseases. Some are wearing the same mask all day. Some are storing them for reuse on coat hooks or in paper bags. Bloomberg News previously reported on Providence’s efforts to manufacture masks.
Reusing masks isn’t typical and follows a change in guidance from the US Centers for Disease Control and Prevention and other regulators to cope with shortages in medical supplies prompted by the pandemic. The US is working to ramp up production and the federal government is providing some masks from an emergency stockpile.
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Physicians are concerned the change doesn’t reflect recent findings in The New England Journal of Medicine that indicate the novel coronavirus can survive on common surfaces for up to 72 hours.
“We’ve been trained for a long time that these are one-time disposable things. That’s obviously going to be the most sanitary,” an emergency physician at a major hospital network in Ohio said. There’s no official rationing policy for protective equipment at that hospital, but the Ohio doctor said that staff there are supposed to use the gear “judiciously.”
“If I were to have to keep reusing a mask, at some point I might accidentally touch it. It might get onto my workstation. That is going to impose an infectious risk for me,” added the doctor, who asked not to be identified because the hospital is instructing workers not to speak with the media. Business Insider verified the doctor’s identity.
Doctors are taking steps to conserve supplies of gear
At Kaiser Permanente, an organization that includes 39 hospitals and roughly 23,000 physicians, workers are refraining from using N95s except in situations like intubating a patient who has the coronavirus, or visiting them in quarantine, according to Dr. Stephen Parodi, an infectious disease physician leading the organization’s response to the outbreak.
After exiting the quarantined area, physicians and nurses can leave their masks on hooks labeled with their names, which are stored in a sanitary space, until the next time they need them, Parodi said.
“I want to be really clear. I am concerned about the current supply of both N95 respirators and surgical masks in the US. And looking at our own supply, I am concerned,” he said. “That’s why we moved to some mitigation strategies to try to extend the life of and use of our personal protective equipment.”
Parodi said that staff at Kaiser hospitals have been drilling for an epidemic like this since the Ebola outbreak of 2014, and have strict protocols for monitoring and cleaning protective equipment.
But providers elsewhere are reporting little guidance when it comes to the masks.
‘It’s a dilemma’
An emergency physician near major outbreaks in California said the hospital’s instructions are to wear one N95 mask per day for up to five uses, unless it becomes “soiled or damaged.” If they come into contact with a higher risk patient, they’re supposed to rely on their discretion and consider changing it.
“It’s a dilemma. If I keep the N95 mask on all day, I’m unlikely to get it through breathing in airborne particles,” the physician said, continuing: “I’m also going from one room to another with possible COVID patients. Does that increase the risk of transmission? The data isn’t out on that.”
The doctor asked not to be identified because they were not cleared to speak on the matter. Business Insider verified the physician’s identity.
While the virus remains stable for hours or even days in the air and on surfaces like plastic and stainless steel, it’s passed mainly from person to person, according to the CDC. Emergency physicians and hospital administrators told Business Insider that a sick patient would likely have to cough or sneeze in order to produce the respiratory droplets required for surface contamination.
Healthy patients would likely have to touch the dirty masks or surfaces, or something that came into contact with them, in order to ensure exposure. Hospitals are working to ensure that doesn’t happen.
At Providence, masks are being assigned to caregivers with their names on them, according to Santore. They’re being reused in compliance with recommendations and standards from the Washington state health department and World Health Organization.
Even so, these procedures are not their first choice, Santore said.
“The other option is not to have N95 masks or not to have PPE equipment at all. So this is not a first choice,” Santore said. “But it’s the only option we have right now.”
Across the country, Massachusetts General Hospital is prepared to convert operating rooms into much-needed critical care units, as the number of coronavirus patients is expected to increase exponentially, according to Anne Prestipino, the hospital’s incident commander for the pandemic.
“Many of us feel that things could have been better organized more quickly. The seriousness of this being downplayed in the early days was a huge mistake,” Prestipino said, referring to country-level preparation.
Mass General is in relatively good shape when it comes to its current and expected capacity, she added.
The Cleveland Clinic announced on Tuesday that coronavirus testing will be reserved for patients at the highest risk of contracting the disease.
‘We’re kind of bent as far as we can before we break’
“We hope to continue to receive additional supplies, which will be a key part of our decision-making,” a spokesperson for the Cleveland Clinic said in an emailed statement to Business Insider, citing a limited supply of testing swabs and a backlog of patients waiting to be tested.
A key worry for doctors is that the situation could deteriorate before it starts improving. While estimates vary, some projections say millions of people with the coronavirus could end up in hospitals. Cities and states are now closing restaurants, bars, and gyms, and actions like that to keep people apart could help curb the spread of the virus.
The Ohio doctor said physicians are concerned about a worst-case scenario.
“I think a good number of them are freaked out not because end times are here, but because they’re just scared that if things were to get worse, the capacity is stretched here,” the doctor said. “We’re kind of bent as far as we can before we break.”
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- Jacob Shamsian contributed reporting.