When registered nurse Charnai Prefontaine arrived Thursday for her shift at the intensive care unit of an Illinois hospital that’s treating three confirmed COVID-19 cases, she was greeted with unwelcome news: They were completely out of N95 masks in her size, for the first time in her seven-year career. “I’ve never had anything like that happen before,” she says.
Along with the confirmed coronavirus patients, Prefontaine’s hospital has numerous suspected cases awaiting test results, and the hospital just this week changed its policy on suspected cases. Previously, nurses and doctors were required to use airborne protection, which would mandate the N95 masks. Now, the standard has been lowered to droplet protection — regular, non-filtering surgical masks, which put only a barrier of cloth between them and the virus. Nurses at Prefontaine’s hospital (she and other nurses who spoke for this story asked for their hospitals not to be named) were upset to hear about the change, suspecting it has a lot more to do with equipment availability than science. As it happens, Prefontaine is allergic to those standard surgical masks, so she has already been in close contact with potential COVID-19 patients while wearing an N95 mask in the wrong size.
Across the country, as doctors and nurses prepare for — or already face — a surge of COVID-19 patients, health care workers are seeing unprecedented shortages of personal protective equipment (PPE). They are begging the government, private companies, and hospital management for help. “My day starts out every morning with nurses describing to me how they are being refused the N95s and having to take care of [COVID-19] positive patients,” says Bonnie Castillo, a registered nurse and executive director of National Nurses United, the largest nurses’ union. “Nurses are being handed a surgical mask, even being asked to reuse a surgical mask. It’s outrageous. What I keep hearing nurses tell me is, ‘We feel like we are just a calculated risk. We’re expendable. We’re fodder. They expect us to go in there with nothing.’ But this is a calling for them, and they are compelled to go to work.”
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The concern goes well beyond the obvious and urgent moral obligation to protect the health of doctors and nurses, along with their families and friends. If significant numbers of healthcare workers get sick, as has happened in Italy and elsewhere, it could have catastrophic consequences, affecting hospitals’ ability to care for what is anticipated to be an already overwhelming flood of COVID-19 sufferers, not to mention patients who need help for other problems, from cancer to accidents. “It’s completely frightening and crazy,” says Marcia Santini, a registered nurse in the emergency department of a large hospital system in Los Angeles, where gowns and goggles have already run out and N95 masks are running low. “If we do not protect our healthcare workers on the front line, and anybody that has to take care of COVID-19 patients, we are going to have a major healthcare crisis. Your hospitals, they’re gonna crumble.” Doctors and nurses are already being exposed to the virus: In the two facilities in Santini’s health care system, she says, over 100 health care workers are already on medical leave due to possible COVID-19 infection.
Meanwhile, the Centers for Disease Control and Prevention (CDC) lowered its guidelines for health care workers, suggesting it’s acceptable to use surgical masks instead of N95s. “There’s a lot of distrust for the CDC right now on the part of registered nurses,” says Katy Roemer, a registered nurse and vice president for National Nurses United. “CDC downgraded the criteria because of a shortage of equipment, not based on the science of how this virus is transmitted or the precautionary principle.” This week, the CDC went further, in a new guidance posted on its web site: “In settings where face masks are not available, [health care provides] might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort,” while noting that those masks “are not considered PPE, since their capability to protect [health care providers] is unknown.”
There are many factors behind the shortage, though nurses point specifically to for-profit hospitals’ use of a “just-in-time” organizational system that’s not built for times of crisis, along with a lack of planning on the part of both some hospital administrators and federal and state governments. There are also significant supply-chain shortages after the pandemic ran through China, the main source of PPE manufacturing. Meanwhile, for all the claims from President Donald Trump and other officials of delivering masks from stockpiles to frontline workers, nurses say they have seen few results. “Where did they go?” Castillo says. “Because we’re not seeing them.” Meanwhile, the president’s recent plan for ramping up production of masks reportedly may not bear fruit for as long as 18 months. Trump had been reluctant to fully utilize the Defense Powers Act, which would allow the government to mandate that manufacturers ramp up production of necessary medical supplies such as ventilators and masks, though on Friday afternoon he said that his usage of the Act was in “high gear.”
Robyn Begley, senior vice president with the American Hospital Association, responded to nurses’ fears by saying that “Hospitals and health systems are working diligently to protect those who care for our patients. Our health care workers are the most valuable resource when it comes to treating and stopping the spread of the virus.” She added that the AHA along with the American Medical Association and American Nurses Association called on Congress yesterday to allocate $100 billion in funding for hospitals to fight the virus.
In some cases, Castillo says, nurses are bringing in their own privately obtained N95s — and facing threats of discipline from management for using them. “Health care workers, especially nurses are at really high risk,” says Roemer. “More than anybody else we are on the front lines of this thing. And we need to have the kind of protections that allow us to do it safely. We want to take care of our patients. We want to provide people with the care that they need, but it is not fair to send us into rooms when we are not protected. That is a terrible situation to put registered nurses in.”
The shortages appear to be nationwide. “Our hospital only has approximately 100 N95 masks, and all size small,” says a registered nurse in Pennsylvania. Frustrations are also widespread — multiple health care workers mentioned seeing images of Chinese doctors and nurses in head-to-toe protective gear that’s not widely available in U.S. hospitals. “Every single country is dressed head to toe in that impermeable suit where you could wipe them down with Clorox,” says Santini. Adds another nurse in the Bay Area, who asked for anonymity, “Why are all the nurses in other countries in bunny suits and hazmat gear — practically like Ebola protocols — and we’re not?”