For health workers, concern over supplies turns to anger
The e-flyer drops into a Toronto dentist’s mailbox.
Face masks! Face masks! Get yer face masks!
But just about every dental office in Toronto has been closed except for emergencies (some, strategically located) and remote appointments. Still, not a day has gone by during this coronavirus epidemic that the e-flyer hasn’t been distributed to dental practitioners from various providers.
And the inventory seems vast: N95s, the most protective and precious of facial coverings for health-care workers in these frightening times: $139.40 — 20 to a box.
Walmart had been selling a box of 20 for $13.24 (U.S.) online, shipped from a third party, before they ran out. Some resellers online have jacked up prices almost 600 per cent, although platforms such as Facebook and Instagram have forbidden gouging.
Meanwhile, local hospitals are scrupulously rationing their stock of N95s, keeping them under lock and key.
At the Hospital for Sick Kids, emergency department doctors and nurses are now being given two masks, the less sophisticated surgical version, per shift.
When the Star called one distributor on Thursday, Canada Wide Dental Supplies, we were told that Level 2 masks (fabric, with ear-loop) could be purchased for $81.95 a box, each containing 50 masks.
Buy 10 and there’s a discount: $78.30. N95s available, too, although they were earmarked as out-of-stock on the company’s website by Thursday evening.
To be clear, the vast majority of dentists have already donated their masks and gloves to front-line health workers.
One dentist, who shuttered her practice on March 16, had 30 boxes of supplies — masks and gloves — in her Markham garage, recently delivered. She tried to return them to her supplier so they could be redistributed to where the need was most urgent. “The woman I spoke to was very frustrated. She said that, even though they have stock, hospitals are only dealing with their regular suppliers,” the dentist says. “They have to go through regulated channels, won’t go to other sources.”
That flies in the face of critical shortages in hospitals bracing to be flattened by the rolling pandemic, with many hospitals in Ontario making public appeals for donations: surgical masks, nitrite gloves, battery-operated thermometers, hand sanitizers, wipes and respirators.
The Star was unable to reach hospital administrators by deadline to confirm they’re still cleaving to contracted suppliers.
The aforementioned mentioned dentist paid $28 for a box of 20 N95s in January. Now, they’re priced at $150 a box.
Dr. Kashif Pirzada, an Toronto emergency physician who spoke with the Star earlier this week, said he’s received more than a dozen emails from medical suppliers and so have all his colleagues.
“I think the issue is that we’re being inundated by Chinese resellers, trying to sell them at a huge markup.”
Premier Doug Ford, his government scrambling to outbid equally desperate mask-scavengers, has put out an order for five million masks.
Which would not have been so dire a shortage if, as the Star has reported, authorities hadn’t destroyed a stockpile of 55 million masks and other personal protective in recent years because the items’ bestbefore date had expired.
In the U.S. — the country has 18 million health-care workers, and the number of COVID-19positive among the public is doubling every day in California and New York state — the National Institute for Occupational Safety and Health recently published a research article on its website. Tests, of 4,000 samples, conducted at 10 facilities across the country showed that 98 per cent of expired N95s passed filtration performance standards.
There was no reason, in retrospect, to trash all those post
SARS-cached supplies, and the government hasn’t revealed whether they were replenished.
This week, the Ontario Medical Association and the Registered Nurses Association of Canada, released a joint statement urging expired masks, however many still exist, be immediately released.
At Sick Kids, doctors and nurses — and only those providing direct patient care — will have to make do with two surgical masks per day in the ER, and one mask per patient in all other procedures, with a precise list of precautionary steps to be taken:
Staff will perform hand hygiene before donning the first mask upon entry to the clinical area and place the other mask in a secure location.
Staff will wear the same mask for ALL procedures, and going in and out of a patient’s room. The exception: When an N95 is required or if an antiseptic treatment is needed when the mask has become soiled.
When caring for a patient in a droplet/contact room, the staffer must remove all PPE (personal protective equipment) except the mask. “Separate face shield or goggles will be used instead of combined shields and masks.”
“When removing the mask to eat or drink, the staff member will perform hand hygiene, then carefully remove the mask by the ear straps, and place it inside up on a clean surface, such as a clean paper towel, to avoid contamination. Hand sanitization should be performed before and after donning and doffing the mask.”
A Sick Kids physician who spoke with the Star on Thursday (name withheld, at their request) exclaimed: “Can you believe that? Donning and doffing maybe 20 times per shift. That’s for doctors. For nurses who are constantly in and out of patients’ rooms, it would be more.” Needs must, of course. N95s are being reserved for patients with airborne illnesses such as tuberculosis and influenza. “We have enough for one more month, based on current usage.”
In his press conference last Friday, Prime Minister Justin Trudeau assured that medical stockpiles have thus far been sufficient. “In coming days, we will be receiving millions more items.”
This doctor, as are all Sick Kids colleagues, is committed to the job, though fearful of contracting COVID-19 and bringing it home to family. “I’ll jump in without a mask if I have to.”
But there’s immense frustration over unrealistic directives and the impact on both practitioners and patients, especially when/if the predicted wave hits in the next week. “At first there was anxiety. “Now we’re mad.”