July 1, 2020

Covid-19 is surging again. Could mask shortages make a comeback?

Daily Briefing

    Hospitals in coronavirus hotspots could face another N95 mask shortage as Covid-19 hospitalizations continue to surge, Austen Hufford and Melanie Evans report for the Wall Street Journal.

    As Covid-19 hospitalizations increase, the demand for N95 masks outpaces supply

    Hospitals in states that are seeing a spike in cases of Covid-19 are using more personal protective equipment (PPE), including N95 masks, to treat the sudden influx of patients. At the same time, non-health-care workers who need N95 masks—such as people working at factories and construction sites—are returning to work as business restrictions begin to lift, further increasing demand.

    And while hospitals and health systems say they can more easily access masks than they could in the early days of the epidemic—thanks in part to ramp-ups in production by manufacturers such as 3M and Prestige Ameritech—overall demand still exceeds supply.

    In fact, according to the Journal, the increased demand for masks could exhaust stockpiles created by state officials and local hospitals after the virus first appeared in the United States early this year.

    In the last month, the demand for masks has almost doubled among hospitals, surgical centers, and even nursing homes, according to organizations such as Stanford Health Care and Resilinc, which launched medical-supply exchanges in April.

    Further, data from CMS revealed that about 15% of nursing homes had less than a week supply of N95 masks as of June 7.

    Overall, according to the Federal Emergency Management Agency, demand for N95s in the United States is expected to exceed production and imports though August.

    And according to the Journal, the supply strain is especially difficult for hospitals trying to resume scheduled surgeries. Premier, a purchasing group for hospitals, reports that about 50% of the more than 1,000 hospitals that participated in mid-June survey said they did not have enough N95 masks to resume postponed scheduled surgeries.

    However, the Journal reports, mask availability varies between states and hospitals.

    Virginia's emergency management department said it has about 500,000 N95 masks and 3.5 million additional masks, while North Carolina reports 3.8 million N95s and 2 million KN95s. At the same time, Michigan on Thursday said 6% of its hospitals had less than a 15-day supply of N95 masks, while 20% of its hospitals had less than a seven-day supply of other types of equipment.

    How hospitals are responding to increased demand for masks

    Health facilities facing mask shortages are finding other ways to "extend the lifespan" of their current supply, according to Hufford and Evans.

    For instance, many hospitals are still following federal guidance for some frontline providers to wear a single mask for a full day, rather than putting on a new mask for each patient. And Pioneer Health Group in Arizona, a nursing home system that has less than a seven-day supply of N95s, gives each of its almost 500 employees one new N95 mask each week, plus one surgical mask per day to wear over the N95 masks so they can be reused.

    "We would not have enough for one week if we were using it for how it was intended to be used," said Amy Malkin, COO of Pioneer Health.

    Other states are sending used N95 masks through decontamination systems so they can be reused, Hufford and Evans report.

    For example, according to the Texas Division of Emergency Management, the state decontaminated more than 5,000 N95 masks in the past week amid an increase in hospitalizations. The state was one of the first to resume some scheduled surgeries, but Gov. Greg Abbott (R) on Thursday halted the surgeries due to an increase in coronavirus hospitalizations.

    Seth Christensen, a spokesperson for the agency, said the N95 "conservation measures are great to ensure we are not wasteful at a time when the supply chain is not fully recovered."

    But even with the decontamination methods, Serena Bumpus, director of practice for the Texas Nurses Association, said some health care workers "are still having to use one mask for the entire day. The more Covid patients we have in the hospital means the more PPE we will be required to use."

    The state currently has more than 47 million masks in its stockpile and had ordered $1 billion in PPE as of June 7. However, the state had to cancel more than $500 million in orders after manufacturers failed to deliver the products or delivered products that didn't pass quality inspection.

    “We don't even take it off the truck, and sometimes we send it back," Christensen said. He added, however, the state is still prepared to fulfill hospitals' PPE requests.

    Meanwhile, hospitals such as Cedars-Sinai Medical Center in Los Angeles have turned to new manufacturers that can meet their demands for increased PPE. Jeff Smith, EVP of hospital operations for Cedars-Sinai, said that although the hospital has been using more N95 masks since resuming scheduled procedures, it has months' worth of PPE in inventory and is working with Los Angeles to establish a public stockpile.

    Smith said patients should not delay care out of fear that hospitals do not have enough PPE to treat them, adding that delaying care "could lead to a second public-health crisis" (Hufford/Evans, Wall Street Journal, 6/27).

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