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July 13, 2020

Health care workers are facing PPE shortages—again

Daily Briefing

    Organizations representing providers are once again reporting widespread shortages of protective gear—including respirator masks, gowns, and gloves—leading some health care workers to reuse or forgo equipment.

    Cheat sheet: Strategies to optimize PPE & equipment

    Provider groups report PPE shortages throughout the country

    When America's coronavirus epidemic first peaked in March and April, PPE shortages were most challenging for hospitals in big cities. But now, demand for the gear is cropping up in a range of facilities across the country, the New York Times reports.

    National Nurses United (NNU), a union and professional organization for registered nurses, in a survey executed late last month found that about 85% of RNs who responded to the survey reported having to reuse their disposable N95 masks while treating Covid-19 patients.

    In addition, the nonprofit group LeadingAge has reported that, while the Federal Emergency Management Agency distributed 14-day supplies of PPE to nursing homes, many said they went through those supplies quickly. The organization also reported that providers have complained about receiving defective equipment, such as loose-fitting masks and gowns without armholes.

    GetUsPPE, which describes itself as "a grassroots movement founded by physicians and medical researchers on the frontlines of the Covid-19 pandemic," works to link health care facilities and providers to PPE supplies. The group said the amount of PPE requested by providers increased by 440% in Iowa and by more than 200% in both Louisiana and Texas—two states where coronavirus cases have recently surged—in June when compared with April.

    Providers in surge states face new PPE shortages

    Already, providers in states with severe coronavirus outbreaks have reported reusing protective gear in anticipation of avoiding a more serious shortage.

    Physicians at Memorial City Medical Center in Houston, for instance, have been instructed to reuse N95 respirator masks for as long as 15 days, the Times reports.

    Other health care workers have had to use surgical masks in place of N95 respirators.

    Medical workers at St. Petersburg General Hospital in Florida said they receive one surgical mask each day to use during their rounds. Further, N95 masks are distributed only to providers working in the Covid-19 ward, the Times reports.

    Barbara Murray, a nurse at the hospital, said she and other medical staff have been anxious that their surgical masks do not provide full protection against the coronavirus. "We're nurses—we want to take care of our patients and we want them to be safe," she said. "But at the end of the day, we want to go home to our families and know that they are safe too."

    According to the Times, a spokesperson for St. Petersburg General declined to comment on the hospital's policies regarding masks, but said employees have access to adequate supplies if needed.

    Smaller hospitals and medical practices lacking a secure supply chain and the funding to purchase new equipment are particularly struggling to access PPE. Some physicians say they've paid inflated prices for the gear on websites such as Amazon.

    "Community physicians have it worse because we are at the bottom of the totem pole," said Inderpal Chhabra, an internal medicine specialist in New York.

    Chhabra said he sees only five patients per day due to limited PPE. "Everyone is running around like crazy trying to get N95s, but no one can get them. I'm afraid for my staff."

    PPE shortages also mean that non-Covid patients in some areas are facing delays in needed care, the Times reports. The American Medical Association (AMA) has said PPE shortages have further delayed some medical specialists from reopening their offices.

    “We have kids living with grapefruit-sized abscesses for over three months who can't eat or drink, and there's nothing we can do for them because we can't get PPE," Kay Kennel, chief officer of Lubbock Kids Dental in Texas, said.

    Could the latest PPE shortages have been prevented?

    Medical experts say the shortages are partly due to the fact that the United States is largely dependent on foreign medical manufacturers. And, according to the Times, the few American manufacturers that make PPE say they're already producing the supplies at maximum capacity.

    "It's incredibly frustrating because a lot of attention was paid to the need for ventilators early on in the pandemic, but now we're realizing that there's going to be a tremendous ongoing need for simple things like masks, gowns, and face shields," said AMA President Susan Bailey.

    AMA, other medical associations, and federal legislators have been urging the Trump administration to play a larger role in the distribution and production of medical supplies in the United States.

    However, according to the Washington Post, administration officials have said reports of PPE shortages are "overblown."

    "I'm not going to tell you we're able to meet all demand, but there's significantly less unfulfilled orders today than in April," Rear Adm. John Polowczyk, who is in charge of the administration's allocation coronavirus-related supplies, recently said, according to the Post. He added, "I have not found a hospital system that is in threat of running out. … I don't have the sense of there being severe shortages," the Post reports.

    But Washington Gov. Jay Inslee (D) said the nationwide PPE shortage shows that "the status quo is not working."

    "It is akin to fighting a war in which each state is responsible for procuring its own weapons and body armor," Inslee said (Jacobs, New York Times, 7/8; Wan, Washington Post, 7/8; Mulvihll/Fassett, Associated Press, 7/7; Robinson-Jacobs, Forbes, 7/7; Budryk, The Hill, 7/7; Janes et al., Washington Post, 7/8).

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