Los Angeles, California – A severe shortage of gear that can protect healthcare workers from COVID-19 prompted Los Angeles County officials to advise doctors and nurses to reuse face masks and wear gowns and masks that are expired, a desperate attempt to conserve supplies amid the pandemic.
In an urgent alert sent to providers on Wednesday, officials from the L.A. County public health department said COVID-19 infections are rapidly rising in the county and that staff needs to implement these measures now, before a massive wave of patients hits, Los Angles Time reported.
The county has ordered more protective gear, but its stockpile is currently completely depleted of masks — both surgical masks and the more protective N95 respirators — and is running low on everything else, according to the advisory. The news has heightened fears among providers.
“I feel like I’m just going to end up using the same N95 mask and eventually it’ll get so tattered I’ll get exposed,” said one doctor at a major L.A. hospital who, like others interviewed for this article, did not have permission from her institution to speak to the media.
The local guidance is the reflection of a global shortage of supplies that has pushed US policymakers to slowly weaken safety precautions for health care providers treating COVID-19 patients.
“We need to collectively prepare for a surge of newly infected patients including those who are critically ill … and to try to avert severe shortages of medical supplies,” said the advisory emailed to all health care providers in L.A. County by Dr. Sharon Balter, director of the county public health department’s division of communicable disease control and prevention.
Hospitals have also been tightening rules to mitigate low supply levels. At a large hospital in L.A. County, nurses now have to sign out masks whenever they take one and are then subject to questioning by their supervisor to make sure they are being used for a valid reason, a hospital nurse said.
“It almost feels like they think we’re going to steal these masks,” she said, “We don’t really know what to do — we just know we can’t protect ourselves while we’re taking care of the patient.”
The nurse said they are only allowed to wear masks once a patient has been tested for COVID-19, not in any other circumstance when a patient is coughing and they are worried about infection. The hospital has forbidden staff from bringing in and wearing their own cloth masks, she said.
“It’s just a really terrible time to be working,” she said, “It really is coming down to whether we want to go work and get a paycheck and support our families, or if we want to protect ourselves.”
In the alert sent Wednesday, officials recommended that providers switch from using disposable supplies to reusable goggles and cloth gowns that can be washed. They also said providers could consider wearing the same face mask for multiple patients, something that has not been previously recommended due to concerns about carrying infections from room to room.
Gabe Montoya, an emergency medical technician at Kaiser Permanente Downey Medical Center, said his hospital is rapidly running out of protective gear and what remains has been locked up. He said they are being asked to wear items “for hours on end, even beyond manufacturers’ recommendations”.
Montoya said that he and his coworkers feel unsafe and some have moved out of their homes to stay in hotels or had their loved ones move out to protect them from infection.
“In my case, I’ve gone three weeks already without seeing my husband and my elderly mother,” he said in a statement.
“The shortage of personal protective equipment is a national disgrace,” he added.
Healthcare workers tend to be more exposed to viruses than others because of the number of sick people they interact with and the close contact required to do their jobs. In New York, now the national epicenter of the outbreak, a number of healthcare workers have already fallen ill.
A study found that in Italy, about 20% of healthcare professionals working on the front lines of the outbreak have become infected with COVID-19. At St. Francis Medical Center in Lynwood, the masks are currently “under lock and key”, and providers there have also been told to wear a single one while moving between multiple patient rooms, said a nurse who works there.
“I never in my life have been told to keep using the same N95 mask … they just changed their whole ideology because of the shortage,” he said, “The nursing staff are afraid, the respiratory therapists are afraid, the housekeepers are afraid to clean the room.”
This week, local nurses union SEIU 721 filed a complaint with the California Division of Occupational Safety and Health because of the reuse of face masks and lack of N95 respirators. Union leaders demanded that hospitals not assign suspected COVID-19 patients to their members until they were provided the appropriate gear.
“It is utterly disappointing that L.A. County would put front-line healthcare workers like myself in this kind of danger when it’s precisely in times like these that we desperately need all medical staff in top condition,” Cynthia Mitchel, a supervising registered nurse at LAC+USC Medical Center, said in a statement.
“Instead of being proactive, the county is setting us up to become super spreaders,” she added.
Federal recommendations for protecting health care workers have dramatically changed since the beginning of the outbreak. Originally, officials said that medical staff should wear N95 masks, which are more protective than surgical masks, when interacting with suspected COVID-19 patients. Now those masks are recommended only during certain high-risk procedures.
The changes in guidance are intended to stretch supplies so that no one is ever completely without gear, as has happened in other countries, officials say. The national stockpile has only 1% of the masks needed to respond to the pandemic. But providers say that isn’t good reason to put them at risk.
“It concerns me that we’re changing our practice based on conservation of supplies,” said UCLA nurse Marcia Santini, adding, “If we get sick, and we have to be self-quarantined, we’re going to have a staffing crisis.
L.A. County officials this week also rescinded an order requiring all medical staff who aren’t vaccinated for the flu to wear masks at all times while at work. They also asked doctors’ offices to cancel all non-urgent appointments to conserve protective gear that may have been used.
Additionally, officials advised doctors not to test all patients who are suspected of having COVID-19, only those for whom the test result would change the treatment. Officials said the recommendation was driven by a shortage of tests and backlogs in processing results, problems that have plagued the nation’s response to the outbreak for weeks.
At many L.A. County hospitals, the testing delays are also exacerbating the shortages of protective gear. If a patient is suspected of having COVID-19, staff wear protective equipment when interacting with them while waiting for the test results, said a nurse at a Westside hospital. As of Wednesday, the results could take as long as six days to come back, he said.
“We’re burning through tons of masks and gowns,” he said, adding, “If things become really bad, then we’re just wasting equipment before things even peak.”