Health care workers are making adjustments to conserve a limited supply of protective gear as they treat a growing number of COVID-19 patients. But without swift action from the government, they worry they won’t have enough to keep themselves or patients safe ― a situation that would be dire for all involved.
“We would not send the United States military to war without uniforms, equipment, or armor— that would be preposterous,” said Sylvia Owusu-Ansah, a pediatric emergency medicine physician at UPMC Children’s Hospital of Pittsburgh. “So why are we allowing this for our front-line pandemic providers?”
N95 respirators and other important personal protective equipment known as PPE are crucial to helping health care workers protect against spreading infection and staying safe themselves. The equipment is not something they would normally even consider entering certain care settings without, both to protect the patients and themselves.
But the coronavirus pandemic has created shortages in some regions for N95 face masks and other important supplies. And although the Trump administration has promised to provide more, the government hasn’t clarified when this will happen, and workers on the ground say they are still waiting. The low supply is creating widespread anxiety among health care workers who know that treating patients without the appropriate PPE can carry serious risks, not only to their health but to patients and the broader health care system.
“I think that all of us are concerned that we need to protect ourselves both to be there for our patients and to avoid becoming a vector for transmission of illness,” said Arvind Venkat, an emergency physician at Allegheny General Hospital in Pittsburgh and president of the Pennsylvania chapter of the American College of Emergency Physicians.
Appropriate equipment helps health care workers avoid getting sick and keeps them in the workforce, explained Mark Simon, an OB/GYN and chief medical officer at Ob Hospitalist Group. If a health care worker without protective equipment is exposed to a COVID-19 patient for a prolonged period, Centers for Disease Control and Prevention guidelines demand they be restricted from work for 14 days.
“There are a limited number of physicians or limited number of nurses and other health care workers, and to have a significant percentage of them out of work for a prolonged period of time would be crippling,” Simon said.
Many hospitals and health care systems already face PPE shortages, and others are preparing for low supplies as the number of COVID-19 cases continues to rise. In response, many are taking steps to conserve available supplies.
This is playing out in a number of ways. Many institutions are postponing elective surgeries and other nonessential procedures so that PPE can be saved for COVID-19 cases. In addition, many health care professionals are communicating with patients remotely, using telehealth services, instead of in-person appointments when appropriate.
Some workers are reusing N95 respirators or wearing them for extended periods while seeing multiple patients. President Donald Trump on Saturday accused health care workers of throwing masks away instead of sanitizing them for reuse.
Typically, health care workers wouldn’t use the same N95 respirator when caring for more than one patient. But due to shortages, many are now following CDC guidelines that encourage extended use and limited reuse of these N95 respirators.
The CDC suggests workers can wear “the same N95 respirator for repeated close contact encounters with several different patients, without removing the respirator between patient encounters.” It adds that “limited reuse has been recommended and widely used as an option for conserving respirators during previous respiratory pathogen outbreaks and pandemics.”
Still, better data is needed for health care workers to know whether repeated N95 mask use is actually safe, Venkat said.
One nurse recently quit because her health care setting didn’t have enough PPE, said Cheryl Peterson, vice president of nursing practice and work environment at the American Nurses Association, who added that nurses across the country are seeing shortages.
“I think our biggest concern that we’ve heard nurses raise is around access to the N95 respirator, and some have even said that there’s a shortage of surgical masks,” Peterson said, adding that this equipment is “absolutely necessary” for patient care.
The shortage has led some professionals to modify treatment methods. Normally it might be routine for a team of six or more care workers to meet with a patient at their bedside. Now, they’re reducing that number to conserve PPE.
Some organizations are arranging treatment teams so PPE can be prioritized for those who interact with COVID-19 patients, Venkat said. Often this means wearing the same PPE to see multiple patients.
“A lot of places are designating a single nurse who is in the most extensive personal protective equipment and that nurse does all of the nasal swabs and all of the initial assessments of patients,” Venkat said.
Should PPE supply run extremely low, PPE would need to be rationed for patients known or believed to be sick with COVID-19, “which means you’ll have to then decide how much and what protective gear is necessary for other health care encounters,” said Simon, the OB/GYN.
“We need a combination of rapid dissemination of personal protective equipment supplies now, as well as better science as to what is the personal protective equipment you need in particular circumstances,” Venkat said. “And then third, we need government action to backfill supplies.”
Until then, health care workers are struggling to deal with the shortage ― or the stress of knowing one is coming. Owusu-Ansah, the Pittsburgh pediatric emergency medicine physician, said she hasn’t experienced a PPE shortage yet, but her hospital is taking measures to save equipment.
“Mentally, it takes an additional toll on us providers thinking daily will this be the day we run out of PPE and really expose ourselves,” she said.