In Milton, doctors wear construction goggles and masks they bought themselves. In Brighton, clinicians have been forced to re-use dirty gowns. And in Milford, a hospital resorted to begging its Facebook followers to donate rain ponchos to use as gowns.
Even as the rate of new coronavirus cases has ebbed across Massachusetts, medical workers say they still face shortages of gear to protect themselves, their families, and their patients. Many are taking matters into their own hands, while worrying that a second wave of infections, which some experts consider likely, would again send them into crisis mode.
“There truly was a supply chain crisis in March. ... But that was March and this is June, and me and my co-workers are still working in substandard equipment that we’re using multiple times that were supposed to be used only once,” said Jillian Brelsford, a nurse at Cambridge Health Alliance, where she says colleagues must wear face masks designed for single use for five shifts before receiving a new one. “Our health and safety and lives have been made expendable.”
The problem seems worse at smaller community hospitals, doctors say, but even the most well-funded systems are struggling. Hospitals say supply chains remain unreliable amid unprecedented worldwide demand, with vendors often delivering late or sometimes just a small fraction of the order.
Materials managers at Mass. General Brigham have “literally scoured the world,” and “no penny has been spared,” said Ann Prestipino, a senior vice president who helps oversee the pandemic response for the 14-hospital system. But the supply lines are still “a little fragile, as they are for everybody.”
As the state continues to gradually reopen the economy, doctors and nurses worry that non-health-care industries will buy the coveted personal protective equipment, or PPE, for employees, or that it will be used up by medical personnel performing elective procedures, now that such surgeries have resumed. They fear, too, that leaders may not see the problem as urgent now that the state’s coronavirus case numbers have fallen.
Hospitals are in charge of procuring their own protective gear, but the state can provide an emergency supply to last a week, if they’re running out.
The Department of Public Health requires hospitals seeking to ramp up non-coronavirus care to attest that they have enough PPE to last at least 14 days and to try to keep a reliable supply chain. Hospitals must also adhere to state and federal guidelines on PPE use. But those guidelines, clinicians say, are part of the problem.
Before the pandemic, health care standards said each N95 mask, which provides the best medical-grade protection against airborne virus particles, should be used for just one bedside encounter with an infectious patient. After supply chains collapsed in March, hospitals adopted emergency standards issued by the US Centers for Disease Control and Prevention, saying unsoiled N95 masks can be used up to five times to conserve them.
But talking and sweating during a 12-hour shift often causes a mask to become misshapen so it doesn’t create the necessary seal around the nose and mouth, reducing effectiveness, said Brelsford, the Cambridge nurse. The reused straps sometimes break while a nurse is in a virus-filled room, leading to dangerous exposure, she said.
Cambridge Health Alliance said it is confident the reuse practice is safe. If the hospital switched to single-day use of masks, its current three-month supply would run out in weeks, said David Cecere, a spokesman.
“We are working on solutions to allow us to return to the standard practice as soon as we can” to make staff comfortable, Cecere said.
Medical workers say the state and federal government need to boost domestic production of N95 masks. They blame President Trump for not forcing manufacturers of products such as refrigerators or cars to make protective gear.
In Boston last week, US Health and Human Services secretary Alex Azar said Trump inherited an inadequate national stockpile of pandemic gear and that states and organizations needed to build their own inventories.
Governor Charlie Baker’s administration, which secured PPE from China and the national stockpile, has disbursed nearly 1 million items to hospitals in need. To boost in-state production, Baker’s office and the quasi-public agency Massachusetts Technology Collaborative launched the Manufacturing Emergency Response Team to help local companies make PPE.
So far, 21 companies have received $10 million in grants and made more than 4 million PPE pieces, including masks, gowns, and testing swabs.
“Sourcing and providing PPE for front-line health care providers has been — and will continue to be — a key element in the Commonwealth’s pandemic response,” said Ann Scales, a Department of Public Health spokeswoman.
The state program has prioritized the production of what hospitals say they need, including N95s, and will help better prepare the medical system in case a new wave of infections erupts, said Carolyn Kirk, MassTech’s executive director.
“We in Massachusetts can absolutely make a big dent in that need for our health care institutions,” Kirk said, but “it’s going to take time.”
But health care workers questioned whether the response was adequate, or moving quickly enough.
“It’s not, if we’re going to see our numbers go up again,” said Dr. Karen Leitner, cofounder of the COVID-19 Action Coalition, a local physicians group.
At Brockton Hospital, in one of the state’s hardest-hit cities, nurses must reuse their N95 masks for five shifts before being able to get a new one, said Nicole Tanner, an intensive-care unit nurse.
The masks are then sent to a massive machine in Somerville that uses hydrogen peroxide vapor to disinfect them. That process has raised concerns the chemicals could be dangerous. Some nurses have reported nausea or headaches.
Nurse supervisors track how many times each mask is cleaned and are reluctant to provide new ones, Tanner said.
“It’s like pulling teeth,” she said. “They ask, ‘How long have you been wearing the mask? Have you cleaned it yet?’ You almost get mask-shamed when you try to get a new mask.”
Kim Hollon, CEO of the hospital’s owner, Signature Healthcare, said the system faced shortages, but is now in good shape and would be well-prepared in case of a resurgence of infections. He has ordered 200 reusable air-purifying respirators, at $1,500 apiece, for front-line coronavirus staff so they won’t need N95s.
He said Signature recently ceased chemical treatments and reduced the number of shifts that N95s are worn from five to three.
“Now we’re beginning to get some supplies in, but we were challenged like every other hospital,” Hollon said.
Some facilities are still relying on donations.
In May, Milford Regional Medical Center posted on Facebook asking people to donate rain ponchos to be used as makeshift gowns. One commenter said he purchased 260 ponchos in a neighboring town to donate and questioned why the hospital couldn’t do the same.
“We have purchased thousands of ponchos from local businesses when the supply is there and they meet our standards,” the hospital replied on Facebook.
Milford Regional didn’t respond to a request for comment.
At Beth Israel Deaconess Hospital-Milton, unreliable supplies prompted many staffers to purchase their own reusable goggles and N95 masks marketed for construction work, said Dr. Cheri Weaver, an emergency physician.
“It’s a bit ridiculous that people on the front lines are buying their own PPE because they don’t have faith that the hospital system as a whole will be able to supply it for them when they come to work,” said Weaver, who spoke on her own behalf.
She spent $80 on a washable N95 mask with a replaceable filter purchased online from a construction supplier. The hospital’s N95s aren’t always available in the correct size and must be reused multiple times and then disinfected chemically, she said, which “was not my first choice.”
Beth Israel Lahey Health said it struggled with supply disruptions but has secured adequate PPE through “hard work, creativity, and support from generous donors.” It said it uses a hydrogen peroxide disinfection process approved by the US Food and Drug Administration, and the disinfected N95s are tested.
At St. Elizabeth’s Medical Center in Brighton, N95 masks must be disinfected and reworn as many as 10 times, causing degradation, said Ellen MacInnis, an emergency room nurse.
Around early May, supervisors said gowns were running low and nurses should reuse dirty ones, a risky practice, MacInnis said. Weeks later, the governor announced that the hospital’s owner, Steward Health Care, one of the nation’s largest for-profit hospital operators, had donated 50,000 gowns to the state.
“You put my health and my life at risk for some publicity stunt?” MacInnis said. “It is lunacy.”
Steward didn’t respond to a request for comment, but previously told Boston 25 it received a new shipment that allowed it to restock and donate the gowns.
Naomi Martin can be reached at firstname.lastname@example.org.