Bracing for a surge
State passes 1,000 cases; 2 city deaths bring the Md. toll to 10 Outbreak infects at least 66 in Carroll County nursing home Maryland’s doctors, nurses battling coronavirus increasingly desperate to find ways to extend life of protective equipment Marylan
Dr. Richard Bruno has been using his N95 respirator mask, meant for one-time use, for a week now, hoping to leave more for colleagues who come in more frequent contact with potential coronavirus patients.
But with supplies of masks diminishing to worrisome levels across the country, a recipe for sterilizing them recently caught the eye of the Chase Brexton physician: “Bake at 149 degrees for 30 minutes.”
Medical professionals are increasingly desperate to find ways to extend the life of masks, gowns and other personal protective equipment, or PPE, as demand exceeds supply amid a spike in COVID-19 cases.
They have turned to social media to plead for donations from the public, often using the hashtag #GetMePPE, and post photos of themselves disinfecting their worn masks or even wearing trash bags instead of hospital gowns.
One Baltimore anesthesiologist posted a picture on Facebook of the mask she was issued, “the one thing that protects me from covid-19. We have been told to write our names on it, protect it and, despite it normally being disposable, keep using it until it get soiled . ...
“Save us,” she said, asking for donations of masks, “so we can save you.”
She and others expressed concern that the Centers for Disease Control and
After the 2009 H1N1 flu pandemic, a group led by Johns Hopkins University convened meetings of residents in 15 hotel ballrooms across Maryland to answer a terrible question: If there were another pandemic and hospitals were overwhelmed, who would get saved?
The responses now serve as the backbone of discussions that could determine how the most crucial weapon in the arsenal against the coronavirus — ventilators — are allocated if demand exceeds supply.
Ethicists, doctors and state leaders are working on the final plan to present to Gov. Larry Hogan for approval. It will rely on that public input, which emphasized treating those who are likely to survive the disease caused by the pandemic and also likely to be healthy enough to survive longer term.
So far, such a plan hasn’t been needed in the United States, though doctors in New York are beginning to report shortages, and doctors and hospitals in Italy and Spain face such tough choices daily. And the coronavirus, which can cause severe respiratory problems, is quickly cutting a nasty swath here, with tens of thousands of Americans sickened, including hundreds of Marylanders.
Hogan said in a tweet Thursday that “this battle is going to be much harder, take much longer, and be much worse than almost anyone comprehends.”
Prevention has loosened standards for protective devices, even suggesting that should nothing else be available, they use bandannas or scarves.
Hospitals say they’re having trouble replenishing their PPE stock.
“It’s become a crisis in the last week,” said Leslie Simmons, executive vice president of LifeBridge Health, which operates Sinai Hospital and other medical centers in the area.
Suppliers say the equipment is on back order and can’t give her a date for when they’ll be able to ship, she said.
“We are in conservation mode as many hospitals are,” Simmons said. Though “not ideal,” hospitals have resorted to giving staff a single mask or face shield to use throughout a shift unless they become soiled, she said.
The demand for PPE is expected to rise even more critically in the coming days, with the World Health Organization warning this week of “a very large acceleration in cases in the U.S.” On Thursday, the number of reported cases in the U.S. surpassed that of any other country.
Because of the nature of their work, medical professionals are at greater risk of exposure to the virus; they reportedly constitute more than 8% of cases in Italy.
Bruno, a family physician at the health clinic in Baltimore’s Mount Vernon neighborhood, said he’s seen several patients possibly infected with the virus, while some co-workers likely have seen more. He said he generally wears a surgical mask, reserving the more protective N95 for when a patient complains of respiratory problems. Some of the tests for the coronavirus offered at Chase Brexton have come up positive.
The clinic has been able to keep adequate stock of masks on hand — for now, he said.
“The problem is these supply streams aren’t always steady, and if things get worse, we could find ourselves in a predicament,” Bruno said.
It’s been heartening to see how people have responded to the plight faced by health care providers, he said.
His wife, Mary, a fashion designer and seamstress, is among the many who have been making and donating masks — some with a Harry Potter design for staff at the clinic who are fans of the wizard.
“They wear them over their masks, more as a morale booster,” he said. Some studies have indicated that depending on the material, handmade masks might not offer sufficient protection.
Still, people with sewing machines have been making a variety of masks for grateful health care workers. Additionally, those with 3D printers are helping fabricate plastic face shields with groups such as Open Works, a maker space in Baltimore.
Dentists, veterinarians, nail salons and even high school labs have raided their own supply cabinets for unused equipment to donate to hospitals and doctors’ offices.
“I’m just sad that this is where we are at, relying on people with sewing machines and 3D printers to protect our front lines,” said Heather Harget, a middle school teacher who lives in Parkville and created a Facebook page for Marylanders who want to stitch up masks. “That’s a terrible position to be in.
“It’s people stepping up in this terrible time,” she said. “It’s like a modern-day victory garden.”
Harget’s masks have pockets in which the wearer can add filtering material for more protection.
Acknowledging the shortage, hospitals have issued new guidelines on how to extend the life of masks and other PPE.
A spokesman for the University of Maryland Medical System, for example, said that while it currently has “a baseline supply” of protective equipment, it “will need more in the coming weeks and months.
“There is a national shortage of PPE and we are impacted by this,” Michael Schwartzberg said. “Currently, our system has embraced assertive PPE conservation strategies, consistent with [CDC] protocols.”
Health professionals have scoured stores and made online pitches for masks and other gear.
Dr. Rona Stein, a pediatrician in Owings Mills, went to paint and home improvement stores last weekend, and scored some masks and Tyvek coveralls. A Facebook post by her Valley Pediatrics practice netted some donations as well, including from a dental practice.
“The generosity of people is so awesome,” she said.
Usually it takes months for the practice to go through a box of masks, Stein said, but the threat of coronavirus transmission began depleting the stash. Doctors have been able to limit the number of patients coming to the office by screening them via telemedicine.
Still, Stein said, some need to come to the office — preferable to “clogging up” hospital emergency rooms — so safety gear is necessary, especially if they’re showing coronavirus symptoms.
“I had a kid who was exposed, plus with ear pain,” she said. “I used one of our very few masks, and we met in the parking lot.”
She’s awaiting results of the coronavirus test she ordered — and bracing for the rise in infections that many are predicting.
There are multiple reasons for the shortage of protective gear, said Jennifer Nuzzo, senior scholar at the Johns Hopkins Center for Health Security. China, where much of the world’s supply of PPEs is manufactured, shut down some factories while dealing with its own outbreak, although it has ramped up production again, she said. But even as operations resumed, demand soared, Nuzzo said — not just among medical personnel around the world but regular people fearful of contracting the virus.
“There was a huge demand for this, not just from the health care industry but the general population,” Nuzzo said. “These products are made in only a few places and the demand is far outstripping the supply.
“This is a worldwide problem,” she said. “We need to fix it.”
The Trump administration has been under pressure to secure more masks, ventilators, testing kits and other necessities by invoking the Defense Production Act, which would allow the federal government to direct private companies to prioritize its orders over others.
But President Donald Trump has sent mixed signals, at one point saying states need to buy their own supplies because the federal government isn’t a “shipping clerk,” and, on Tuesday morning, tweeting that masks are on their way without using the act.
“The Defense Production Act is in full force, but haven’t had to use it because no one has said NO!” Trump tweeted. “Millions of masks coming as back up to States.”
States including Maryland already have or are expecting to receive shipments from the Strategic National Stockpile of medical supplies. The stockpile had about 12 million respirator masks — the kind commonly known as N95 — along with 30 million of the less protective surgical masks, officials said earlier this month. But that is a fraction of the 3.5 billion N95 masks that health officials estimate the country will need over the course of a year to deal with a full-blown pandemic.
As health professionals await more supplies, concerns are mounting.
One Hopkins nurse, who like many other medical professionals requested anonymity to avoid repercussions, said it’s “disconcerting” to be instructed to reuse masks and other protective gear, which goes against past training and protocols. After multiple uses, N95 masks can get creased and misshapen, loosening the tight, protective seal on the wearer’s face, health care workers say.
“Under any other circumstances, an employee would have been reprimanded or even let go for that,” he said.
Another nurse said that while she feels safe now, she and her colleagues are “nervous” about what the future holds as supplies diminish and more patients sickened with COVID-19 need care.
“We want to work with these patients,” she said, “but we want to work in safe conditions.”
While Johns Hopkins did not respond to a request for comment, it is among the institutions that have issued guidelines to its staff on how “to safely conserve and reuse” and “help safeguard our supply of PPE,” according to a document obtained by The Baltimore Sun.
The guidance is similar to what the CDC has provided to “optimize” equipment “when there is limited supply.”
The CDC guidelines even say that as a “last resort” should no masks be available, health care professionals “might use homemade masks (e.g., bandana, scarf ) for care of patients with COVID-19.”
However, the guidance continued, the protective properties of such a mask are unknown, so “caution should be exercised.”
Appeals for help have prompted grassroots responses.
Dr. Julius Ho, a resident in internal medicine at Johns Hopkins, is part of the Baltimore Health Professionals Mutual Aid Cooperative, which is trying to get donations of supplies from the public and assist in distributing them to hospitals and other health care facilities.
Ho said volunteers are reaching out to those who might have masks and other protective gear and have arranged drop-off sites at four area churches.
“The nail salons have been very, very cooperative,” he said. “We’ve also made inroads to the creative arts community — painting, woodworking, anyone who might require respirators or gloves.”
Ho said he hopes those who previously bought masks and other supplies in fear of contracting the virus might realize they could be put to better use by health care workers.
Information about the group is available on its Facebook page, facebook.com/ bmorehealthmac.
When she heard the news that some health professionals were desperate for supplies, Peg Prentice, who runs the biomedical program at The Catholic High School of Baltimore, realized she had protective gear that students didn’t need with schools closed.
“When she asked if we could give away our supplies to help reduce shortages of necessary medical equipment, I was embarrassed that I hadn’t thought of it,” said Barbara D. Nazelrod, the school’s president.
Catholic decided to donate its supplies to Mercy Medical Center, where parents of some of its students work and which collaborates with the school’s Nurses’ Club.
Harget, the middle school teacher, got interested after she grew alarmed hearing that health care workers didn’t have enough protective gear. She noticed on social media that people were making cloth masks and decided to harness “all this crazy energy” from her school being closed.
Now she administers the Facebook group, Million Masks Mayday MD, and said there is at least one other similar group in the state, Sew Masks Central Maryland — Annapolis and Surrounding Counties.
Researching patterns that have proliferated online, she decided to make covers that could be worn for additional protection over the N95 masks that medical staff were having to use more than once. It’s not a perfect solution, but the group is getting requests, and she hopes its work may tide health care workers over until supplies are replenished. When medical facilities or personnel contact the group seeking masks, members volunteer to fulfill the request and work out delivery arrangements, Harget said.
“I feel like I’m doing my part to protect them,” Harget said.
Online, doctors are suggesting ways to make what used to be single-use masks safer, including heating them at various temperatures, usually around 150 degrees, for 30 minutes to sterilize them. But don’t try this at home, advised researchers at a Stanford Medicine lab — contaminated masks shouldn’t be brought into a household.
That protective gear is in such short supply at a time when it’s needed more than ever is grating, said the doctor who posted on Facebook.
“This is what is difficult for all healthcare professionals to accept,” she said. “The CDC has loosened its guidelines and accepts use of possibly compromised personal protective equipment so that we can continue to work in the face of a national shortage.”
For now, she can only wait for masks that government officials say have been ordered or are on their way.