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Some Hospitals Are Close to Running Out of Crucial Masks for Coronavirus Some Hospitals Are Close to Running Out of Crucial Masks for Coronavirus
(3 days later)
As hospitals around the country prepare for an influx of highly infectious coronavirus cases, their supplies of a crucial type of respirator mask are dwindling fast.As hospitals around the country prepare for an influx of highly infectious coronavirus cases, their supplies of a crucial type of respirator mask are dwindling fast.
“We’re not willing to run out of N95 masks,” Dr. Susan Ray, an infectious disease specialist at Grady Memorial Hospital in Atlanta, said in a phone interview, referring to the masks by their technical name. “That’s not O.K. at my hospital.”“We’re not willing to run out of N95 masks,” Dr. Susan Ray, an infectious disease specialist at Grady Memorial Hospital in Atlanta, said in a phone interview, referring to the masks by their technical name. “That’s not O.K. at my hospital.”
At some point she may have no choice. Grady executives said on Monday that the hospital had a little more than a month’s supply of N95 masks; they did not immediately explain whether that estimate was based on normal levels of use or accounted for a possible spike in need. With global supplies already depleted from the outbreak in China and manufacturers facing an explosion of new orders as the virus spreads, some hospitals in the United States have been unable to get new shipments of N95 masks or even an estimate of when they might become available.At some point she may have no choice. Grady executives said on Monday that the hospital had a little more than a month’s supply of N95 masks; they did not immediately explain whether that estimate was based on normal levels of use or accounted for a possible spike in need. With global supplies already depleted from the outbreak in China and manufacturers facing an explosion of new orders as the virus spreads, some hospitals in the United States have been unable to get new shipments of N95 masks or even an estimate of when they might become available.
“I can tell you my other colleagues across our multiple hospitals are really rationing,” said Dr. Ray.“I can tell you my other colleagues across our multiple hospitals are really rationing,” said Dr. Ray.
N95 masks are tighter fitting and thicker than surgical masks. While surgical masks can block only large-particle droplets, N95 masks filter out 95 percent of all airborne particles when used correctly. The Centers for Disease Control and Prevention recommend that they be used only by people with infectious respiratory illness and health care workers who treat or otherwise come in contact with them.N95 masks are tighter fitting and thicker than surgical masks. While surgical masks can block only large-particle droplets, N95 masks filter out 95 percent of all airborne particles when used correctly. The Centers for Disease Control and Prevention recommend that they be used only by people with infectious respiratory illness and health care workers who treat or otherwise come in contact with them.
“It’s not just about the patients identified as having the virus,” said Dr. Wendy Armstrong, another infectious disease specialist at Grady, who is more accustomed to using N95 masks to evaluate patients who might have tuberculosis. “It’s also about the people you are evaluating to rule out the virus, and the testing is not instant.”“It’s not just about the patients identified as having the virus,” said Dr. Wendy Armstrong, another infectious disease specialist at Grady, who is more accustomed to using N95 masks to evaluate patients who might have tuberculosis. “It’s also about the people you are evaluating to rule out the virus, and the testing is not instant.”
Protecting health care workers from the virus is essential to managing the epidemic, to ensure hospitals, urgent care centers and other facilities can handle inevitable surges in sick patients. A number of doctors and nurses around the country have already been quarantined for two weeks after patients they interacted with tested positive for the virus; health care workers in China have gotten sick and even died amid extreme shortages of masks and other protective gear.Protecting health care workers from the virus is essential to managing the epidemic, to ensure hospitals, urgent care centers and other facilities can handle inevitable surges in sick patients. A number of doctors and nurses around the country have already been quarantined for two weeks after patients they interacted with tested positive for the virus; health care workers in China have gotten sick and even died amid extreme shortages of masks and other protective gear.
The federal government’s Strategic National Stockpile of medical supplies includes 12 million medical-grade N95 masks and 30 million surgical masks — only about one percent of the 3.5 billion that the Department of Health and Human Services estimates would be needed over the course of a year if the outbreak reaches pandemic levels. The department announced last week that the federal government had put in a guaranteed order for 500 million N95 masks over the next 18 months, a move it said would encourage manufacturers “to immediately increase production of N95s for use by health care professionals.”The federal government’s Strategic National Stockpile of medical supplies includes 12 million medical-grade N95 masks and 30 million surgical masks — only about one percent of the 3.5 billion that the Department of Health and Human Services estimates would be needed over the course of a year if the outbreak reaches pandemic levels. The department announced last week that the federal government had put in a guaranteed order for 500 million N95 masks over the next 18 months, a move it said would encourage manufacturers “to immediately increase production of N95s for use by health care professionals.”
A spokeswoman for the health and human services department said the first step for hospitals experiencing shortages was to ask their local or state public health department, many of which have their own emergency supplies.A spokeswoman for the health and human services department said the first step for hospitals experiencing shortages was to ask their local or state public health department, many of which have their own emergency supplies.
“If the state is unable to provide supplies, state health officials — through the governor or his or her representative — may request federal assistance from the Department of Health and Human Services,” the spokeswoman said. “We are working with industry partners and soliciting information about their capacity to produce masks and other protective equipment so we can rapidly arrange contracts to buy supplies to protect the American people.”“If the state is unable to provide supplies, state health officials — through the governor or his or her representative — may request federal assistance from the Department of Health and Human Services,” the spokeswoman said. “We are working with industry partners and soliciting information about their capacity to produce masks and other protective equipment so we can rapidly arrange contracts to buy supplies to protect the American people.”
The Washington State Department of Health told health care providers last week it would start following World Health Organization guidelines, which say that surgical masks, which protect against droplets but do not form a seal around the face, should be used except when performing ”aerosol-generating procedures” like intubation.The Washington State Department of Health told health care providers last week it would start following World Health Organization guidelines, which say that surgical masks, which protect against droplets but do not form a seal around the face, should be used except when performing ”aerosol-generating procedures” like intubation.
The hospital shortages stem not only from global supplies being depleted after the prolonged outbreak in China but also because of widespread panic-buying of masks by anxious citizens here and abroad. Most hospitals don’t keep a large supply on hand, because they are not in the practice of buying far more than they need at any given time.The hospital shortages stem not only from global supplies being depleted after the prolonged outbreak in China but also because of widespread panic-buying of masks by anxious citizens here and abroad. Most hospitals don’t keep a large supply on hand, because they are not in the practice of buying far more than they need at any given time.
Tony Morain, vice president of communications at Direct Relief, a humanitarian aid organization in Santa Barbara, Calif., said the group had become so frustrated by shortages even before the virus outbreak that it had contracted with a company in China to start manufacturing its own supply.Tony Morain, vice president of communications at Direct Relief, a humanitarian aid organization in Santa Barbara, Calif., said the group had become so frustrated by shortages even before the virus outbreak that it had contracted with a company in China to start manufacturing its own supply.
Direct Relief had two million N95 masks on hand in early January, Mr. Morain said, anticipating another busy wildfire season in the western states this summer. Then the Australian wildfires happened, and the group sent a few hundred thousand masks there. When the Chinese outbreak escalated, Direct Relief sent most of its remaining stock there.Direct Relief had two million N95 masks on hand in early January, Mr. Morain said, anticipating another busy wildfire season in the western states this summer. Then the Australian wildfires happened, and the group sent a few hundred thousand masks there. When the Chinese outbreak escalated, Direct Relief sent most of its remaining stock there.
“Now we are receiving quite a few requests from health centers around the country and our supply stands at about 500,000 N95 masks,” Mr. Morain said, adding, “In the coming days, we will start apportioning them out to areas where health workers are at extreme risk of exposure.”“Now we are receiving quite a few requests from health centers around the country and our supply stands at about 500,000 N95 masks,” Mr. Morain said, adding, “In the coming days, we will start apportioning them out to areas where health workers are at extreme risk of exposure.”
At Highland Hospital in Oakland, Calif., emergency room physicians said they had been dipping into reserves and hoping that the state of emergency that Gov. Gavin Newsom declared last week would allow them to access whatever supply the state had on hand.At Highland Hospital in Oakland, Calif., emergency room physicians said they had been dipping into reserves and hoping that the state of emergency that Gov. Gavin Newsom declared last week would allow them to access whatever supply the state had on hand.
Lindsay Caulfield, a senior vice president at Grady Health, said Monday morning that the system had “over a 35 day supply” of N95 masks, adding, “We buy the maximum amount allowed to us each week” from the manufacturer Grady contracts with.Lindsay Caulfield, a senior vice president at Grady Health, said Monday morning that the system had “over a 35 day supply” of N95 masks, adding, “We buy the maximum amount allowed to us each week” from the manufacturer Grady contracts with.
Spokespeople for several other large hospital systems contacted last week — including IU Health in Indianapolis, Jackson Health in Miami, the University of Vermont Medical Center and the New York City Health and Hospitals Corporation — said in carefully worded statements that they had a sufficient supply of N95 masks for now.Spokespeople for several other large hospital systems contacted last week — including IU Health in Indianapolis, Jackson Health in Miami, the University of Vermont Medical Center and the New York City Health and Hospitals Corporation — said in carefully worded statements that they had a sufficient supply of N95 masks for now.
“In anticipation of possible supply chain disruptions in the coming months, we are implementing steps to preserve personal protective equipment while maintaining all clinical guidelines and protocols,” said Alyscia Grant, a spokeswoman for Care New England, a nonprofit system with several hospitals in Rhode Island.“In anticipation of possible supply chain disruptions in the coming months, we are implementing steps to preserve personal protective equipment while maintaining all clinical guidelines and protocols,” said Alyscia Grant, a spokeswoman for Care New England, a nonprofit system with several hospitals in Rhode Island.
The Food and Drug Administration last week granted a request from the Centers for Disease Control and Prevention to allow health care workers to use similar respirator masks approved by the National Institute for Occupational Safety and Health — not currently regulated by the F.D.A., and typically used in construction and manufacturing — during the coronavirus outbreak.The Food and Drug Administration last week granted a request from the Centers for Disease Control and Prevention to allow health care workers to use similar respirator masks approved by the National Institute for Occupational Safety and Health — not currently regulated by the F.D.A., and typically used in construction and manufacturing — during the coronavirus outbreak.
Updated June 5, 2020 Updated June 12, 2020
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
The C.D.C. has also said that if shortages worsen during an outbreak, N95 masks can be used for “repeated close contact encounters with several patients” instead of being thrown away after one encounter, as well as beyond their manufacturer-designated shelf life.The C.D.C. has also said that if shortages worsen during an outbreak, N95 masks can be used for “repeated close contact encounters with several patients” instead of being thrown away after one encounter, as well as beyond their manufacturer-designated shelf life.
If no respirators are left, the newly updated C.D.C. guidance says, health care providers who are older, have chronic medical conditions or are pregnant should avoid treating patients with Covid-19. Providers who have already had the disease, “who may have some protective immunity,” should be the first to treat them if no masks are available.If no respirators are left, the newly updated C.D.C. guidance says, health care providers who are older, have chronic medical conditions or are pregnant should avoid treating patients with Covid-19. Providers who have already had the disease, “who may have some protective immunity,” should be the first to treat them if no masks are available.
Dr. Ray of Grady Hospital said doctors there and at a number of other hospitals she had been in contact with were also concerned about running low on regular medical masks, to the point where Grady, one of the nation’s largest and busiest public hospitals, had made them harder to access.Dr. Ray of Grady Hospital said doctors there and at a number of other hospitals she had been in contact with were also concerned about running low on regular medical masks, to the point where Grady, one of the nation’s largest and busiest public hospitals, had made them harder to access.
“Health care workers, visitors — if someone sees masks, they are grabbing and taking them,” she said. Under the new rules, she said, “If people need them, they’ll have to ask.”“Health care workers, visitors — if someone sees masks, they are grabbing and taking them,” she said. Under the new rules, she said, “If people need them, they’ll have to ask.”
Doctors who see a lot of sick patients in their offices, rather than a hospital, are increasingly anxious, too. One physician at an outpatient center that is part of the N.Y.U. Langone Health System, who requested anonymity in order to speak freely, said, “We don’t have N95 masks, and are being asked to see patients with surgical masks instead. We are considering refusing to see potential Covid patients unless we have proper protection.” (“Covid” refers to the name of the disease caused by the virus, Covid-19.)Doctors who see a lot of sick patients in their offices, rather than a hospital, are increasingly anxious, too. One physician at an outpatient center that is part of the N.Y.U. Langone Health System, who requested anonymity in order to speak freely, said, “We don’t have N95 masks, and are being asked to see patients with surgical masks instead. We are considering refusing to see potential Covid patients unless we have proper protection.” (“Covid” refers to the name of the disease caused by the virus, Covid-19.)
Dr. Marc Habert, a pediatrician in Fishkill, N.Y., said the group he works for, with eight offices in three counties, had virtually no N95 masks or other protective equipment on hand.Dr. Marc Habert, a pediatrician in Fishkill, N.Y., said the group he works for, with eight offices in three counties, had virtually no N95 masks or other protective equipment on hand.
“We can’t get any. Everything’s back-ordered,” he said. “I was on a phone call earlier with the local department of health and they basically said the state has supplies, but we need to show we tried to order from three separate places first.”“We can’t get any. Everything’s back-ordered,” he said. “I was on a phone call earlier with the local department of health and they basically said the state has supplies, but we need to show we tried to order from three separate places first.”
Georgia had six confirmed cases of coronavirus as of Monday afternoon, including a teacher in the Atlanta area, which led to a decision to close public schools in Fulton County on Tuesday for deep cleaning. Nobody with the virus has been treated at Grady so far, but Dr. Ray said the hospital recently saw one suspected case that proved negative for the virus after several days during which workers went through a lot of personal protective equipment.Georgia had six confirmed cases of coronavirus as of Monday afternoon, including a teacher in the Atlanta area, which led to a decision to close public schools in Fulton County on Tuesday for deep cleaning. Nobody with the virus has been treated at Grady so far, but Dr. Ray said the hospital recently saw one suspected case that proved negative for the virus after several days during which workers went through a lot of personal protective equipment.
“Right now we are just anticipating that we are going to have a lot of patients,” Dr. Ray said, “and we aren’t going to have enough supplies if we don’t figure out how to use less.”“Right now we are just anticipating that we are going to have a lot of patients,” Dr. Ray said, “and we aren’t going to have enough supplies if we don’t figure out how to use less.”