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The biggest constraint on reopening hospitals hiding in plain sight: PPE

April 17, 2020

    With the surge in Covid-19 admissions ebbing in some states, health care providers are rightfully beginning to think through how to reopen services they halted to free up capacity for Covid-19 patients.

    How are hospitals handling a PPE shortage?

    A wave of non-Covid patients will soon begin to suffer serious health consequences if they can't access care more broadly, and indeed many chronic care patients already are. Additionally, the financial health of many providers is now at grave risk. The operating income of hospitals and health systems is often less than 2%, meaning a growing number of facilities may permanently close if they don't reopen to a broader range of patients very soon.

    In light of this new reality, I appreciate the white-hot spotlight national media, politicians, and health care leaders are placing on the need to dramatically ramp up Covid-19 testing and contact-tracing capabilities. Such capabilities are essential to preempt a second, overwhelming surge of Covid-19 patients as we reopen our health systems and larger economies.

    Dire need for more PPE persists

    What confounds me is why the spotlight on personal protective equipment, or PPE, production has seemed to dim a bit. Our need for more PPE is no less dire than it was at the height of the Covid-19 surge—if anything the need is even greater as hospitals, ambulatory care centers, and medical groups prepare to continue treating Covid-19 flare-ups plus shepherding in non-Covid-19 patients who have delayed care. I believe it is the biggest, or perhaps most immediate, constraint on reopening hospitals and other care sites hiding in plain sight.

    Right now hospitals and health systems are struggling to secure sufficient PPE to care safely for the limited number of patients currently in their beds and coming into their facilities. Most hospital executives with whom I have been talking report occupancy rates in the range of 50%. Nonetheless, they also describe how PPE conservation tactics like the re-use of single-use equipment until visible signs of wear and "MacGyvered" alternatives have become standard practice. How can we ask our clinical leaders to take on more patients when circumstances are already forcing troubling PPE compromises in caring for their current patients?

    While we should definitely celebrate the creative measures taken by clinicians, local businesses and volunteers to bolster PPE supplies, these were stop-gap measures. We cannot count on them to manufacture the type and amount of PPE needed to safely double current patient volumes.

    The 3 conversations health system stakeholders need to have

    To ensure PPE constraints do not halt the reopening of our health system, I implore health care leaders, industry partners, and government officials to pull forward three conversations:

    • First, clinical experts need to determine interim standards for PPE use, and masking in particular, that account for heightened supply constraints. Allowances for relaxed protocols amid emergencies are no longer sufficient as what's now needed is guidance on minimum PPE standards to reopen facilities amid an ongoing crisis.
    • Second, facility administrators, supply chain experts, and suppliers need to quantify, based on these interim standards, supply gaps most likely to constrain broader health system access and aggregate these projections up to regional and ideally national levels.
    • Third, health system leaders, major manufacturers, and government officials need to convene on how production can be expedited and expanded to fill these gaps, including the production of more medical-grade, reusable products.

    Looking back across the last month, stretching the use of products intended for one patient interaction has proven critical to just barely meeting PPE demand. We may need to recalibrate the balance between single-use and reusable PPE to move forward.  

    How are hospitals handling a PPE shortage?

    A national shortage of personal protective equipment (PPE) is forcing U.S. health systems to deploy creative strategies to conserve and improvise alternatives to face masks, respirators, eye protection, and gowns, though their efficacy is unproven.

    Here we’ve assembled a running list of strategies US health systems and hospitals are using to disinfect, reuse, and create their own PPE.

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