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April 29, 2020

PPE shortages are dire—and it's not just N95s in short supply

Daily Briefing

    Most health care organizations have less than a two-week supply of PPE remaining, according to a recent national survey. Twenty percent of respondents reported being out of N95 masks altogether. But respirators didn't stand out atop the list of PPE needs.

    How are hospitals handling a PPE shortage?

    What does the data say?

    GetUsPPE.org, a grassroots collection of physicians, programmers, and data scientists, surveyed 978 institutions from 47 states and D.C. about their PPE shortages across the first week of April. Respondents, ranging from acute care hospitals to hospice and assisted living facilities, estimated how long their cache of different types of PPE would last. The survey results, reported in TIME, provide some transparency into what PPE supplies are in highest need and where.

    When asked to estimate their PPE needs over the next week, organizations reported that their most pressing supply shortages include booties, disinfectant wipes, shields, and thermometers. 36% of survey respondents indicated they had no remaining face shields nor booties, and 34% reported having no thermometers left.

    Shortages varied considerably among the hardest-hit states like California, Florida, Illinois, Texas, Massachusetts, Pennsylvania, and the Tri-State area. However, facilities in all states have a critical need for thermometers and booties (over half of institutions surveyed in Florida and Illinois have none left).

    The PPE shortage persists for two reasons. First, while we're reaching a plateau of cases in many areas, the baseline number of infected patients remains high—and other areas are just hitting their peak. But the second factor is more tectonic and arguably more permanent. The norms around PPE protocols have changed dramatically. In a couple of months, PPE usage has skyrocketed from a relatively modest percentage of hospital staff to all employees plus patients and visitors.

    What does this mean for health systems?

    Most health system leaders must continue to tap every possible PPE source for the foreseeable future to withstand supply shortages, including local businesses that stock PPE supplies like masks and gloves and any entity who can advance strategies to create and reuse PPE, like producing "DIY" PPE alternatives or sanitizing medical-grade equipment with hydrogen peroxide or UV light.

    At the same time, leaders must rethink their supply chain to source PPE at the needed scale. This should include both partnering with commercial manufacturers to ramp up production of current products as well as re-invigorating the production of multiple-use, medical grade PPE. Recent experience suggests that we will need to re-calibrate the mix of single-use versus multiple-use PPE to maintain sufficient stores at the much higher PPE “burn” rates that appear to be our new normal.

    A necessary first step for most health systems is to track and project their supply needs in order to quantify their new PPE demands. Here are two resources to help:

    • HHS' PPE planning tool estimates the number of gowns, shoe covers, respirators, and masks your organization will need based on your surge staffing ratios. HHS developed the tool before the novel coronavirus outbreak, and you’ll likely need to adapt the inputs to match your system’s use and protocols.

    Advisory Board tip: We suggest using the "Pandemic ED" and "Pandemic Inpatient" tabs on the Excel document and adjusting the "Section 2-PPE Assumptions" based on your organization's PPE practices.

    • The CDC's burn rate calculator helps you track your organization’s average PPE consumption per day and per patient. In the absence of national data about average PPE use for Covid-19 patients, this is the best tool we've come across to plan your organization’s future PPE needs. To calculate your organization’s average usage, input the current number of confirmed and suspected Covid-19 patients at your facility and your starting stock of PPE at the beginning of the time period, and update your supply numbers each day. The tool will calculate your organization’s burn rate for each category of PPE, plus the estimated number of days of supply you have left for each category of PPE.

    Advisory Board tip: Based on the data results above, we suggest adding in categories track your organizations use of booties, thermometers, disinfecting wipes, and hand sanitizer to the "Other" categories in Box A.

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