N95 masks are essential for protecting health care workers and controlling the epidemic, but some hospitals have been unable to get new shipments as supplies dwindle.

March 9, 2020

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.”

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.

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.”

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.”

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.”

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.

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.

“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.

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.

“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 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.

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.”

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.

“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.

“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.”

Source：https://www.nytimes.com