Health care workers across the country tell STAT they are grappling with new hospital restrictions on personal protective equipment like masks, which are in short supply at some hospitals at a time when the need for it is climbing. Those shortages are fueling fear and frustration among medical staffers who are worried about how they will protect themselves, their patients, and their own families.
“I don’t have any confidence [my hospital will be able to] protect me. Which is not necessarily their fault; they can’t get the gear,” said Megan Sims, a critical care nurse who works in the emergency room of a Minnesota hospital.
In the U.S. and across the world, concern about the coronavirus and the disease it causes, Covid-19, has triggered a run on global supplies of personal protective equipment, or PPE. Health care workers rely on that equipment — including gowns, gloves, and N-95 masks, which protect against the spread of respiratory pathogens — to protect themselves against infection. Data from other countries has shown that health care workers are particularly at risk of being infected with the coronavirus.
Hospitals and health systems have their own stockpiles of PPE. They can also call on what’s known as the Strategic National Stockpile, a federal store of masks, medicine, and medical equipment. But the outbreak has already strained stockpiles. Some hospitals have started locking away their supplies, fearful that patients or even staff might steal the gear for their own use.
Many are already launching protocols to conserve their limited supplies. At Brigham and Women’s Hospital in Boston, health workers are washing and reusing the face shields they would normally toss after each use.
“There is a lot of concern we are going to be short on PPE,” said Elizabeth Goldberg, an emergency room physician at Rhode Island Hospital, where staff are also being asked to clean and reuse face shields.
There, as is the case in many other hospitals, health workers have also been told to reuse N-95 masks, which are also typically thrown away after a single use. At some hospitals, staff are being restricted to one N-95 mask per shift. At others, it’s five uses per mask.
Staff that don’t normally need masks are now being asked to wear them, in case they are caring for patients that might be carrying the virus. An ICU nurse in Illinois told STAT she and others now have to spend time scouring for masks for ultrasound and CT technicians who come into contact with patients, but don’t have masks. Some health care workers also said they are being asked to no longer don gowns for certain situations they otherwise might use them.
“It would be negligent of us not to conserve at this point,” said Trish Powers, a trauma operating room nurse at the Brigham, in a press conference this week. The hospital has tested and treated many of the patients diagnosed with Covid-19 in Massachusetts. Two employees have been infected, and dozens are currently furloughed due to potential exposure.
Several health workers told STAT they don’t feel they have been properly trained in how to safely take off, store, and don gear again that they usually treat as disposable. Others said their hospitals have provided training in how to safely stick to the new restrictions.
“I know, of course, how to put on an N-95 and a PAPR,” said Sims, referring to a powered air purifying respirator, which protects health workers against contaminated air. “But do we know how to do that when we are being asked to be reuse it?”
For health workers, the situation as a whole is a deeply frightening experience.
Sims, the critical care nurse in Minnesota, said she understands why gear from the national stockpile is being sent to bigger hospitals and areas that are currently seeing the most cases. But that is cold comfort for her and colleagues who are watching their own supplies dwindle, unsure of whether they will, at some point soon, also face an influx of Covid-19 patients and a shortage of the gear needed to safely treat them.
“What’s going to happen to me?” she asked. She knows that if she cares for patients, she could become infected. She has three children at home, along with a husband who has a respiratory condition.
“I’m having to make the decision of, do I want to go to work? Do I risk losing my job?” she said.
Some health workers are taking the matter into their own hands. Late last week, Powers decided that the hospital’s nurses needed to start thinking about how to gather their own supplies.
She posted a call to action in a Facebook group for the hospital’s nurses, urging them to stock up on supplies or ask for donations. The nurses started sharing the request with their own Facebook friends, and the posts took off. In just a few days, the posts have fueled a surge in donated supplies from across the country.
“It took off like wildfire,” Powers, who is also the chairperson of the Brigham’s branch of the Massachusetts Nurses Association, told STAT in an interview. “We have 3,600 nurses just at the Brigham. Everyone has a family, and they spread the [request] out to their families,” she added.
Some also started scooping up PPE themselves for the makeshift stockpile, using money from the Brigham nurses’ union fund, a rainy-day account where a fraction of their union dues are funneled. Powers said the hospital has paid for or received thousands of N95 masks and pairs of goggles. They’ve bought bleach wipes at grocery stores and scooped up face masks for painting from supply shops. Dentists have donated spare gloves and surgical masks.
One nurse explained the situation to a New Hampshire hardware store manager, who donated the rest of the store’s N95s and goggles. Another connected with someone who was willing to sell a large number of N95 masks for $6 each. The nurse haggled the seller down to less than $5.
There’s a small team of nurses — several of whom who don’t work in clinical care and as such, have been asked to work from home — cataloguing all of the donations and purchases in a spreadsheet.
The group is sharing that information with the hospital and, in the event that supplies run short, will be ready to meet the demand. They have an on-call rotation of people who live within 30 minutes of the hospital who can field a call, hop in the car, and drop the supplies off where they’re needed, Powers said.
Powers encouraged health workers in communities that haven’t yet been hard hit by Covid-19 to start searching for alternate sources of PPE, in the event their hospitals run short.
“You need to protect yourself, and by protecting yourself, you’re also protecting your patients and your family,” she added.
Several health workers said it’s unfortunate that they are being left to hunt down their own supplies or worry about whether they’ll have the gear they need. It isn’t the ideal use of their already overburdened schedules.
“We need to be protected. We don’t really want to be involved in advocacy efforts right now,” Goldberg said. “We want to be on the ground helping our patients.”