TRANSFORMING HEALTH — Hospitals across Pennsylvania are drastically limiting the use of key protective gear out of fears that a dramatic increase in coronavirus cases could diminish reserves and cause a dangerous shortage.
The rationing comes as the state Department of Health maintains that it has personal protective equipment available and is working with health systems to make sure they have what they need. Still, the head of an advocacy organization for the state’s emergency room physicians said there’s fear the situation could rapidly change.
The gear includes eye protection, gowns, and N95 respirators, which are essential in preventing a health care worker from breathing in infectious particles when in close contact with someone who has COVID-19. Nationwide, the public has rushed to buy these masks, although they need to be specially fitted to work, and health authorities say people who are not sick don’t benefit from wearing them or less protective surgical masks.
Hospitals are using “conservation techniques” based on guidance from the Centers for Disease Control and Prevention and the state health department, said Mark Ross, vice president of emergency management at the Hospital and Healthsystem Association of Pennsylvania.
That guidance includes using surgical face masks rather than N95 respirators in most situations.
“Doing those conservation techniques helps us expand our capacity to make those masks last if there is a slowdown in the supply chain,” Ross said.
As of Sunday, the majority of Pennsylvania’s confirmed COVID-19 cases were in Montgomery County and clustered in the southeast part of the state, though the total number of counties affected has grown in recent days.
In Philadelphia, two doctors who work at the Hospital of the University of Pennsylvania said it’s barring the use of N95 respirators “except in extraordinarily limited situations.” Penn Medicine declined to comment.
Another city doctor, Daphne Owen, said in a tweet Thursday her clinic “for uninsured and undocumented patients” was completely out of masks. Two days later, the clinic, Puentes de Salud, said it was closed due to the pandemic.
“Very similar” demands were put on the supply chain during the 2009 swine flu pandemic, Ross said, adding that hospitals and health systems have not reached a point where the state should be handing out masks.
“It is not a lack of concern for the safety of the health care workers,” Ross said. “This is truly making sure that we are following appropriate protocols and wearing them at the appropriate times.”
Most hospitals haven’t run out of N95 masks, but doctors fear that could soon change, with COVID-19 cases multiplying daily, said Dr. Arvind Venkat, president of the Pennsylvania College of Emergency Physicians.
“We’re in danger of reaching a critical point with personal protective equipment,” Venkat said.
He emphasized that people should not panic and should not hesitate to seek necessary care. He’s hoping to see help from state and federal agencies before too many health care workers get sick.
“If we don’t protect ourselves appropriately, and become infected and don’t realize it, then just like any other person, we can transmit the disease to others as well,” Venkat said.
Nurses and other health care workers have been training “their entire professional lives for a crisis of this scale,” said Maureen May, president of Pennsylvania Association of Staff Nurses and Allied Professionals. She called on Congress to take “immediate steps to ensure that hospitals have adequate access to crucial medical supplies, including test kits, N95s, powered air purifying respirators, and ventilators.”
In early March, the head of the federal Department of Health and Human Services said the U.S. had just 1% of the N95 masks it needs for a full-blown pandemic stockpiled. As hospitals brace for an expected surge of patients, Pennsylvania has not disclosed what supplies it has on-hand, and when it might step in to help.
On March 12, Health Secretary Rachel Levine said the state has a “significant” stockpile of equipment, including N95 respirators, and also has access to protective equipment from the CDC.
However, Levine declined to answer key questions. She would not say how many N95 masks are available, how long the state’s stockpile would last, or if it has given any equipment to hospitals that need supplies. The health department also declined to provide a tour of the “secure facility” where it says the personal protective equipment is stored.
In early March, the department sought approval to purchase $315,000 in protective equipment, according to two emergency procurement requests. The documents cite COVID-19 as a threat that warrants the emergency funding.
One request was for “reusable eye protection, respirators, and associated filters for protection of health care workers.” The other was for “full face respirators and disk filters for protection of health care workers.”
In the documents, the department explained the consequence of failing to acquire that equipment: “The commonwealth would not be able to provide personal protection equipment to assist in the defense of the virus.”
The department is working with a national industrial supply company to obtain the equipment, the documents state.
“[The company] is using resources to obtain [personal protective equipment] supplies ASAP since we are a government agency,” the department stated. “This equipment is on backorder at most locations at this time due to the emergency situation.”