ST. LOUIS — Hospitals in the St. Louis area are rationing protective equipment for health care workers to avoid running out of supplies as the coronavirus epidemic intensifies across the region.
Nurses and other front-line medical workers at BJC HealthCare, SSM Health, Mercy and a VA medical center say leaders are asking some staff to reuse masks, are putting limits on sanitation materials and are setting new policies on how protective gear can be used.
Officials with Mercy, for example, sent an email to some Mercy Hospital South employees this month advising them not to wear masks around the hospital because it is a depletion of resources, could increase risk of infection as workers touch their faces to adjust them, and “propagates a sense of hysteria, distrust and misinformation among co-workers.”
“It’s like you’re being told you can’t protect yourself so that people won’t be scared,” according to one Mercy nurse who did not want to be named for fear of repercussions. “We’re getting close to patients every day, and we’re so exposed.”
The hospitals say they’re doing the best they can in a national crisis, and the measures are a necessary way to conserve protective gear, as institutions across the world are scrambling to get more of the same personal protective equipment, known as PPE.
In Illinois, there are now more than 3,400 COVID-19 cases statewide and more than 40 deaths. The number of cases in Missouri has surpassed 800 with at least 10 deaths.
“With the unknown of what’s coming, and knowing that we’re seeing places across the country running into shortages, we have to examine what all our options are — to use our supplies and our PPE when necessary and appropriate, conserving it when that is also appropriate,” Mercy spokesman Joe Poelker said. “That’s a big task.”
Some health workers worry, though, that the limits put them at risk of contracting COVID-19.
“My whole team is terrified,” one nurse at Barnes-Jewish Hospital told the Post-Dispatch. The nurse also asked not to be identified because she did not have permission from BJC to speak with the media. “Our anxiety is so high right now.”
The fears are not unfounded. Stories of health care workers getting sick, and in some cases dying, have followed most places where the coronavirus has overwhelmed hospitals. In Spain, for example, nearly 14% of the country’s 40,000 confirmed COVID-19 cases are medical professionals, the country’s health ministry reported Tuesday.
And in the U.S., three Boston hospitals have reported more than 160 staff members who tested positive for the virus, the Boston Globe reported.
Reports of shortages of personal protective equipment are also already common in the U.S. At a New York City hospital this week, a photo of nurses wearing trash bags over their hospital scrubs rather than protective gowns was widely shared in the media. On Tuesday, a 36-year-old nurse at the same hospital died after contracting the virus, the Associated Press reported.
St. Louis nurses told the Post-Dispatch they hope similar stories never play out here.
Local hospitals hold back
At Mercy, efforts to conserve supplies have included moving away from staff using N95 respirator masks — masks that fit tightly to the face and are designed to prevent spread of airborne illness. Staff are told that when possible they should use looser-fitting surgical masks that protect against disease spread by droplets, like influenza.
“We don’t want to use those more protective N95 masks and go through those supplies when we don’t need to,” Poelker said.
One pamphlet obtained by the Post-Dispatch that Mercy gave to employees said that N95 masks should be reused “unless creased, torn, soiled/wet” and that staff can wear the looser surgical masks for at least four hours.
There are efforts to recycle masks so they can be disinfected between use, said one member of the Mercy staff who provided a photo of a bag designated for mask recycling on a floor at Mercy Hospital St. Louis in Creve Coeur.
At BJC HealthCare, employees are told to wear surgical masks when they care for a patient or perform a procedure that requires it. Respirators like the N95 should be used for high-risk procedures, said Hilary Babcock, infectious disease specialist with BJC.
“Everyone is not recommended to just wear masks all the time throughout every place in the hospital, all day every day,” Babcock said. “Both the surgical masks and the respirators are not in unlimited supply.”
BJC has also sent out memos telling Barnes-Jewish Hospital staff that the institution has activated its emergency supply policy setting new guidelines for use of PPE.
The policy advises managers to sequester half of the high-demand products, like purple sanitation wipes, and keep reserve stock in a “highly secure area.”
“We are not out of PPE,” said a memo sent to Barnes-Jewish Hospital staff that was obtained by the Post-Dispatch. “Rather in expectation of increased need for PPE we are approaching inventory in a holistic view.”
The memo said staff should recognize that if an item isn’t on hand, accessible to nurses and doctors, it doesn’t mean the hospital is out of stock.
In another effort to keep protective gear in stock, BJC, SSM and Mercy have all taken the unusual step of coordinating to accept donations of personal protective supplies, according to a release from North County Incorporated, a development group that represents the 45 municipalities and unincorporated areas in north St. Louis County.
The effort is seeking FDA-approved surgical masks and respirators, N95 masks, infrared and forehead thermometers, disposable isolation gowns, goggles, hand sanitizer, nasal swabs and other materials.
Volunteers across the region have also started sewing homemade masks.
Denise Murphy, BJC HealthCare vice president of patient care systems and chief nurse executive, said earlier in the week that BJC is working through a procedure to accept homemade masks but will not provide them to health care workers caring for COVID-19 patients. Murphy noted that visitors and others will not be discouraged from wearing homemade masks, and that they can help as a visual reminder to maintain physical distance and avoid touching one’s face.
Where to get more supplies?
Missouri is working to ease the supply shortage, according to Gov. Mike Parson.
He redirected $28.3 million in state funds toward buying more protective equipment for health care workers and first responders, according to the Missouri Department of Public Safety.
About $18 million of that amount will be used to purchase 4.2 million N95 respirators, 61,000 safety goggles, 95,000 surgical masks, more than 7,400 surgical gowns and 335,000 bottles of hand sanitizer, according to the Department of Public Safety.
The state has bought those supplies on the private market, including from one supplier that traditionally makes bedding but switched to manufacturing masks and gowns in response to the epidemic, state public safety director Sandy Karsten said Wednesday.
In addition to the protective supplies purchased by the state, Missouri is getting shipments from the federal Strategic National Stockpile.
Lisa Cox, a spokeswoman with the Department of Health and Senior Services, said the department is tracking how many supplies have been received from the stockpile but would not provide the totals sent to Missouri this past week.
Before the pandemic spread to the U.S., however, the federal stockpile fell short of meeting estimated demand, according to federal officials.
The stockpile had about 12 million N95 respirators and 30 million surgical masks, Health and Human Services Secretary Alex Azar told a U.S. House committee in February.
The country would need about 3.5 billion N95 respirator masks in a serious pandemic, according to an assessment provided at a Senate hearing this month.
Missouri is advising hospitals and other health care providers to purchase any protective supplies they can find on their own, and the institutions can seek reimbursement through the Federal Emergency Management Agency.
But making those purchases may not be easy, according to one supplier.
Demand is up 300% in the medical supply industry, said Jesse Greenberg, public affairs director for Northfield, Illinois-based Medline Industries Inc.
The company has 42 medical supply distribution centers and 22 manufacturing sites in North America — including a 150-employee distribution center in Sauget. The company is also constructing another in St. Peters that’s scheduled to open in 2021.
“Demand is really greater than the current production,” Greenberg said. “It’s going to take awhile for production to catch up.”
Medline is focused on supplying customers with the same amount of supplies they have traditionally ordered, and the company can’t yet meet requests for more products, Greenberg said.
He said the company is asking a manufacturing facility in Latin America to increase production of face masks and PPE, and it is retooling a facility in Wisconsin to make more hand sanitizer.
“I’m sure we’re going to be continuing to deal with different product shortages,” Greenberg said. “Today it may be masks, tomorrow it may be something else. ... And we’re just going to have to adjust to those realities.”
“I think health care will be changed as a result,” he said.
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