In the passenger seat of her car, Rachael, a hospice nurse in South Carolina, carries a Ziploc bag with two surgical masks inside. Every day, she dons one of the masks and wears it into nursing homes, hospitals, and private homes across the area, caring for her elderly patients. Twelve hours later, she takes what is supposed to be a single-use mask off, sanitizes it, and puts it back in the bag. It is the only equipment her employer has provided to protect her and her patients from the coronavirus, she said. It is meant to last her “indefinitely.”
"I'm not worried about getting [the 2019 novel coronavirus.] I'm assuming that I will,” said Rachael, who asked not to be named for fear of losing her job. But, she added, “I would feel terrible if I found out I was the person who brought it into three different nursing homes.”
"It feels like a Third World country,” she said. “I never thought this would be the challenge we were up against."
As has been previously reported, the exponential growth of the novel coronavirus in the U.S. has exacerbated an existing shortage of personal protective equipment (PPE), leaving hospitals to ration gear at levels many providers said they had never seen. The situation has become so dire that the Journal of the American Medical Association recently put out a call for ideas on how to conserve the supply of PPE and identify new sources.
Around the country, providers are now reusing single-use gear and fashioning new equipment out of protective material. Interviews with an array of doctors and nurses on the frontline of a national crisis revealed widespread astonishment at just how ill-supplied they were in what was supposed to be the wealthiest country in the world.
Peter Chai, an emergency physician at Brigham and Women’s Hospital in Boston, where two providers have already tested positive for COVID-19, compared the measures to using dirty bath water for multiple baths.
“That’s totally unheard of in America. Why would you ever have to do that?" he said. "Why would we ever run out of something so simple?"
The Centers for Disease Control previously recommended using N95 masks—a respiratory protective device that filters disease-carrying particles from the air—when treating any patient suspected of having COVID-19. But the agency’s recommendations have loosened as supplies dwindled. In guidance released this week, the CDC said providers should wear N95s only when performing procedures that might cause a patient to “aerosolize” the virus.”
In the latest guidance, the agency also suggested mask-strapped providers use bandanas or scarves as a “last resort.”
In an advisory Friday, the commissioner of the New York City Department of Health warned of the “rapidly diminishing supply of PPE.” Providers were instructed to immediately stop testing most non-hospitalized patients for COVID-19 to preserve supplies.
To stave off a complete shortfall, medical workers have resorted to creative measures, stapling plastic bands onto expired procedure masks and making splash shields out of plastic dividers and mounting tape, according to Twitter posts.
Alli, an emergency nurse in Indiana who asked to be identified by her first name only, told The Daily Beast she used a single-use surgical mask so long it was wet from her breath when she took it off. When her mother heard about the shortage, she asked her quilting group to sew more masks for the hospital. While the masks likely don’t meet medical standards, Alli said, “I want to have these on standby for when worse comes to worse. And I fear we will get there.”
An emergency physician in Tennessee, who asked not to be named for fear of professional retaliation, told The Daily Beast she brought leftover N95 masks from a home construction project into work with her. A good friend, who works for an alcohol distilling company, donated a box from her distilling plant as well. Her sister’s neighbor donated more than a dozen masks he found in his garage.
In Boston, Chai said all the major hospitals have banded together to conserve supplies, borrowing masks and goggles from shuttered research labs and experimenting with other protective materials. "The large institutions that usually don't talk to each other, there's all of a sudden all of this coordination and cross talk,” she said. “It just took a virus to do it."
Along with ingenuity, the situation has also spawned protests. Nurses at Kaiser Permanente in San Francisco demonstrated outside the hospital Thursday, waving signs reading, “Protect nurse, patients, public health.” More than 760,000 people have signed onto a Change.org petition asking hospital administrators for more protective equipment. Another group of physicians wrote an open letter to President Trump and Vice President Pence asking them to boost the supply and develop clear guidelines around sanitizing and reusing protective gear.
“The only institution with the power to require adequate production of protective equipment, to distribute the equipment effectively, and to create universal guidelines on its use, is the federal government,” the physicians wrote. “The federal government needs to step up, right now.”
The federal government has taken some measure to increase the supply of protective gear. The Department of Health and Human Services tweeted Thursday they were deploying equipment from the Strategic National Stockpile—a repository of pharmaceuticals and medical products for use in a public health emergency. Trump this week invoked the Defense Production Act to accelerate production of supplies, and Pence noted that a coronavirus relief law would also protect manufacturers from lawsuits when selling protective gear to health care workers.
The New York National Guard was also preparing to deliver a mix of protective gear, medication, and ventilators from two large warehouses in the state, a source there told The Daily Beast. "The scale of the supplies ordered is massive,” the source said. “The quantities of PPE items are in the tens of millions per item.”
The National Guard did not immediately respond to a request for comment.
But the interventions came too late for some. One travel nurse told The Daily Beast that he and his wife chose to terminate their contracts when their hospital ordered them to repurpose single-use masks. The two moved home and have enough in savings to survive without income for a while, he said.
Others weren’t so lucky. His roommate, a 53-year-old nurse, could not afford to stop working at the hospital. “We all cried when we left,” he said. “She’s scared.”
The equipment shortages are also taking a toll on other, non-virus-related hospital procedures. The emergency physician in Tennessee said she recently treated a gunshot victim whose chest had to be cracked open in the ER. The disposable gowns usually used for such a procedure were nowhere to be found, she said—they had been locked up in a separate room, stockpiled with the other protective gear.
"There was blood everywhere,” the doctor said. “I don't think anyone got exposed, but it could have been a lot worse than it was."
The same doctor said she had recently tried to order her own protective gear, for fear that her hospital would run out. When she went to check out, she learned the items were back-ordered until mid-April. She recently checked Amazon to see if they had any in stock, she said, and saw the same mask she’d been eyeing for $25 was now selling for $70.
Ordering protective gear is even more difficult for small, rural clinics. Dr. Surinder Sra, the owner of a freestanding clinic in Cherokee Village, AR—population 4,600—said he had tried to order masks, goggles, and hand sanitizer to prepare for an outbreak in his town. The supplier cancelled his order, he said, telling him he did not order from them regularly enough to be prioritized.
Sra told The Daily Beast his clinic was still getting by on the supplies they saved from last year. “But if they’re not going to send us the new ones,” he said, “how am I going to continue to protect myself, my staff and my patients?"
Chai said the situation is causing many providers to have these kinds of life-altering questions. His wife is also a provider, and he said they have started thinking about the best way to change out of their clothes when they get home, to prevent spreading the virus to their child.
“It's stuff you never wanted to have to think about,” Chai said. “But as an emergency physician this is my job. This is what I signed up to do. We're not going to run away from this.”