As Covid-19 cases rise, healthcare workers say PPE is still a struggle

“Since the end of the summer, we have increased the capacities of our personal protective equipment by 10 to 15 compared to what they were before Covid, and we continue to develop our capacities to meet the peak needs that we can expect from the current workload, ”said Sanford.

“We are in a much better position than just a month ago, and certainly over four or five months, to meet our nation’s growing PPE demands.”

However, health workers across the country said hospitals and other facilities still use PPE in very different ways than before the pandemic. Doctors describe storing N95 respirators in paper bags between uses and incorporating storage of supplies into routine.

“My colleagues across the country are reusing N95s for as long as they can. A lot of hospitals still use hand sanitizer that they make on site instead of buying it from buyers, etc., ”said Dr. Megan Ranney, an emergency physician at Brown University. , who helped found the nonprofit Get Us PPE.

The group has also created a database to track requests for PPE donations, and a “shortage index” to identify places where PPE levels are getting dangerously low. It reported in October that it had received 16,900 requests for donated items from facilities in 40 states and Washington, DC.

Ranney expects more requests to come.

Who is better

Personal protective equipment includes basic medical grade necessities, such as face masks, N95 respirator masks, face shields, surgical gowns, gloves, and disinfectants, such as hand sanitizers – necessities that healthcare workers use to safely care for Covid-19 patients.

Certain types of facilities have performed better than others, according to Dr. Sunny Jha, assistant professor of anesthesiology at the University of Southern California and co-founder of Los Angeles Surge Hospital.

Large integrated health systems and academic medical centers are better supplied than smaller health systems, “mom and dad” clinics and doctor’s offices across the country, Jha said. Conditions did not improve much for rural and smaller independent settlements in the months that followed.

California hospitals fared better early in the pandemic and were able to stockpile PPE early on by observing what was going on in the northeast, Jha said.

“We were lucky in that regard, but I think the people who really had the worst were the small community hospitals – hospitals that aren’t necessarily part of a larger integrated health system that had to compete. larger healthcare systems, and their controls (for PPE) – those that didn’t necessarily have links to the big suppliers, ”Jha said.

Ranney agreed, but said even large healthcare systems were struggling.

“While most large hospitals have been successful in purchasing at least the bare minimum of PPE to equip their employees, they certainly don’t have important supplies they sit on,” said Ranney, also a medical analyst at CNN.

Dr Judith Guzman-Cottrill, a member of the U.S. Centers for Disease Control and Prevention’s Infection Control Advisory Committee, said in a recent meeting that the agency acknowledged that “supply chains continue to change quickly for hospitals ”.

“Some weeks the supply is good, then the next week it can be unreliable,” said Guzman-Cottrill, a pediatrician in the Division of Infectious Diseases at Oregon Health & Science University.

The most necessary PPE items

The US Department of Health and Human Services has been working to increase the supply of PPE in the United States since last spring, AHA’s Schiller said, but “demand continues to outpace production.”

Supply issues with nitrile gloves, isolation gowns, N95s and testing supplies “continue to pose a challenge for hospital leaders, he said.

It has been difficult for most healthcare facilities in the United States to maintain an adequate supply of N95 masks throughout the pandemic. During the first wave of Covid-19 cases in March and April, N95 respirator masks – which can filter at least 95% of all types of airborne particles, including bacteria and viruses, according to the CDC – were in high demand and in short supply.

In Oregon, Guzman-Cottrill said there was a need for all PPE items, but mostly masks.

“Many hospitals, including mine, continue to track ‘prolonged use’ and ‘reuse’ of N95 respirators and face masks,” she said.

The Wisconsin Department of Health told CNN that health facilities across the state, which have seen an increase in coronavirus cases in recent weeks, are seeing a shortage of gloves.

“Currently, examination gloves are scarce,” spokeswoman Elizabeth Goodsitt told CNN.

“However, we do have examination gloves … in our state cache to help facilities that have delays in their supply chain.”

Nursing homes and long-term care facilities

PPE limits can affect all types of healthcare facilities, not just hospitals. Nursing homes and long-term care facilities face a severe shortage of PPE.

In May, the American Health Care Association’s National Center for Assisted Living (AHCA-NCAL), which represents some 15,000 facilities across the United States, sent a letter to HHS asking for help.

“The lack of PPE has also seriously disadvantaged caregivers to protect themselves as they care for the vulnerable population residing in our facilities. More than 70% of our long-term care providers couldn’t find enough PPE, such as masks. , gowns and face shields, and are facing shortages, ”wrote the AHCA-NCAL.

Look forward to six months, and the situation with PPE is still precarious, the nonprofit said.

“Although the availability of PPE has improved, we still hear from suppliers talking about difficulties in purchasing supplies,” the group told CNN in an email. “There are supplies out there, but they’re just not reaching our area.”

The AHCA-NCAL said demand for PPE supplies is increasing across all healthcare settings and sectors, as hospitals fill up again and coronavirus infection rates soar to record highs almost daily.

“This not only makes it difficult for long-term care providers to get PPE, but also their ability to afford it – the cost has skyrocketed,” the nonprofit added.

“We need manufacturers to manufacture more PPE that can be used by long-term care, as well as suppliers and state agencies to prioritize our facilities for these supplies.