Face Masks Run Short, Showing Snags in U.S. Medical Stockpile
CORONAVIRUS IS THE ULTIMATE CRISIS OF CAPITALISM
(Bloomberg) -- A week after Washington state requested a fresh shipment of protective medical gear from the federal government’s emergency stockpile, it hadn’t been approved.

The delay comes as medical workers nationwide scramble for masks, face-shields, and gowns to protect themselves while treating patients who may have Covid-19. Health authorities and hospitals have changed their guidelines for what level of protections are recommended as the supplies run short.

Some doctors are concerned that the delay increases the risk for themselves and their patients, several said in interviews. Most asked not to be identified by name because they were not permitted to speak publicly.

In many settings, medical workers are being advised to treat the new coronavirus as though it spreads only through droplets, though some doctors believe that stricter precautions used for airborne pathogens are more appropriate. Growing evidence that the virus is sometimes spread by people before they show symptoms increases the risk of inadequate protective gear. Doctors and nurses who might be exposed to Covid-19 patients and continue working could unwittingly infect other patients and clinicians.

President Trump said Friday that he has invoked the Defense Production Act, which could be used to increase the supply of protective gear. It remains unclear whether the administration has mandated new production.

The move came after widespread frustration from states and medical workers over shortages as the number of Americans with Covid-19 climbs. Lawmakers in Massachusetts have been pushing the federal government to release more of its Strategic National Stockpile. On March 5, the state had requested about 750,000 N95 masks, surgical masks, gloves, gowns and other PPE. But so far, it’s only received about 10 percent of that request, according to a Wednesday letter from the state’s congressional delegation.

“We’re seeing a major, major shortage of PPE and it’s expected to only get worse,” said Donna Kelly-Williams, president of the Massachusetts Nurses Association.

Nurses can’t exercise social-distancing like everyone else, said Kelly-Williams. They need to interact closely with patients, touch them, take their temperature. Since hospitals are saving N95 masks and other types of PPE for known Covid-19 patients, this puts nurses at risk. “The greatest worry is the number of people who are asymptomatic,” she said.

One New York hospital system warned staff that it was running low on needed protective equipment and sent out guidelines to conserve gowns, gloves, masks, and face shields. Staff were advised to discard masks only if they were visibly wet, contaminated or damaged. N95 respirators, which are used to protect against airborne pathogens, are in “critical shortage,” according to documents seen by Bloomberg News.

One of the nation’s largest physician staffing companies, Envision Healthcare, sent an email to doctors this week encouraging them to purchase their own protective equipment if they can. Envision provides thousands of doctors and other medical staff to hospitals nationwide. One doctor who works for the company said the suppliers the company suggested were all out. An Envision spokeswoman said physicians rely on hospitals to supply equipment and that the company was trying to keep its doctors safe.

One physician at a New York City hospital said doctors had to sign out N95 respirator masks from a central nurses’ station and were told they would be given one for the day. The physician was told to store it in a paper bag with the physician’s name on it.

Every hospital is dealing with shortages differently. “There’s just general sort of confusion,” said Deepak Bhatt, a cardiologist at Brigham & Women’s Hospital in Boston. He said the hospital has adequate supplies, but a “patchwork” approach to conserving protective equipment could exacerbate shortages. “Part of the challenge is lack of clarity and sort of unity on a national level in terms of exactly what we should be doing,” he said.

In Washington state, two previous requests for supplies from the strategic national stockpile were fulfilled, delivering 870,000 surgical and N95 masks to the state in the first two weeks of March. The state requested more on March 13, along with face shields and gowns, but as of Friday, the request hadn’t been approved, a state spokeswoman said. The Department of Health and Human Services didn’t immediately respond to questions about the delay in Washington state.

Medical systems have people working full-time to try to buttress their thinning reserves. “We’re literally looking all over the world,” said Yvonne Maldonado, an infectious disease specialist with Stanford Health Care. “It’s not going to be easy.”

Some health systems were improvising solutions. Providence St. Joseph Health, based in Washington state, began assembling home-spun masks and face shields with off-the-shelf supplies this week. By Friday it was recruiting volunteers with sewing machines on its website to pick up kits with materials at its headquarters in Renton, Washington, and sew 100 masks at home.

The project will expand to other areas from there, with the ultimate goal of making 100 million masks, according to the website.

In addition to Providence St. Joseph Health, other hospitals have begun to put together their own supplies. Phoebe Putney Health System, based in Albany, Georgia, has been making its own homemade masks to cover the scarce N95 masks. Now, they’ve developed a prototype for a homemade face shield and hope to ramp up production of it on Monday.

Deaconess Health System, based in Evansville, Indiana, has also been encouraging the public to help sew face masks. It put up instructions on its website, saying “while it’s less than ideal, we want to do our best to protect our staff and patients during this pandemic.”

The Centers for Disease Control has published guidance on how to conserve limited protective gear and what to do if it runs short. As a last resort, it says, homemade masks may be used. “However, caution should be exercised when considering this option,” the agency said.