At first, it was mostly infected seniors from St. Therese Senior Services of New Hope and Catholic Eldercare in Northeast Minneapolis who arrived in the medical-surgical unit, oftentimes disoriented.
The confused seniors sometimes wandered from their rooms and played with the masks and gowns they found in the hallway carts on their floor, one of North Memorial Health Hospital’s three new med-surge COVID-19 units.
Then their former nurses and nursing assistants began showing up at the Robbinsdale hospital, coughing and feverish and short of breath. They, too, had become infected.
But even now, after weeks of arrivals, nurses in the COVID-19 med-surge unit say they have been ordered not to don the filtered, close-fitting N95 respirator masks unless they’re nebulizing or intubating a patient.
Less-sophisticated surgical masks, they’ve been told, should do.
PROTECTIVE EQUIPMENT GETS REUSED
Supplies also are limited across the river in St. Paul. Melanie Timpano remembers the time before COVID-19, when a nurse might be disciplined for reusing personal protective equipment such as a surgical face mask as she walked from one patient room to the next.
These days, respirators and cloth gowns, once considered single-use products, are now reused over an entire shift.
“Now we’re being asked to just do it, and not question it,” said Timpano, an intensive care nurse at St. Joseph’s Hospital in downtown St. Paul. “The people I talk to are scared and irritated.”
Weeks after shortages of personal protective equipment — PPE — and supply-chain snags began making national headlines, many front-line health care professionals say access to needed protective supplies remains uneven, if not dangerously limited.
And if nurses get sick, they run the risk of becoming inadvertent carriers to their families and vulnerable patients. Of the more than 8,000 Minnesota residents who have tested positive for the virus in Minnesota, as of last week roughly one-eighth have been health care workers.
Haven’t supply chains loosened up by now?
“They’re not better,” said Dr. Abe Jacob, a chief quality officer closely involved with procurement at M Health Fairview. “We’ve just adapted to the significant supply-chain issues every health system in the country is facing.”
“When we contact our typical distributors, we’re not getting clear information on when those supply chains are going to become more reliable,” Jacob said. “PPE in general is certainly a source of anxiety for all of us. We wake up every day and it’s the first question we ask. It’s the numbers we track all day long.”
SUPPLY EFFORTS RUN THE GAMUT
Widespread efforts to get badly needed PPE to front-line workers run the gamut. Both the general public and private industry have rallied to sew cloth masks, build visor-like face plates and scour basements and attics for supplies to donate.
Ecolab CEO Doug Baker has been co-chairing a Critical Care Supply Working Group with Alice Roberts-Davis, commissioner of the state Department of Administration, which has helped the state track down supplies and transport and vet vendors. They’re sometimes working international phone lines at 3 or 4 a.m. to reach out to Asian and European manufacturers.
Meanwhile, social distancing and the governor’s emergency stay-at-home orders appear to have provided at least a bit of breathing room, with the goal of giving supply chains, hospitals and the state’s new critical care supply warehouse a chance to catch up with demand.
The warehouse, which started out empty, was set up during the crisis as an emergency stop-gap when hospitals and care providers are within a few days of running out of inventory. It’s now making some 30 to 40 supply shipments to hospitals and other care providers daily.
Gowns and N95 masks have been especially difficult to acquire, but between hospital inventories and the state warehouse, Minnesota now has somewhere between one and three months of supplies stockpiled.
“The stay-at-home order bought us valuable time to get these supplies, and we’re appreciative for that,” Roberts-Davis said Wednesday.
‘YOU’RE GETTING IT ON YOUR FEET’
Nurses and health care workers have said those efforts are appreciated and essential, but they’re not out of the woods. At many hospitals, masks, respirators and even hospital scrubs are being watched closely by management, with the goal of conserving and reusing supplies where possible in advance of a likely patient surge.
On Monday, emergency room nurses and technicians protested outside United Hospital in St. Paul, calling attention to the fact they’re forced to bring their own scrubs home and clean them themselves, risking contamination of their loved ones.
“They’re saying they have to be visibly contaminated before we use the hospital-laundered scrubs,” said emergency room technician Michelle Visnovec.
Cliff Willmeng, a United E.R. nurse, said his concerns extend to the lack of footwear. “You’re walking through contaminated spaces,” he said. “You’re getting it on your feet.”
BURNING THROUGH SUPPLIES DAILY
While E.R. workers have been disciplined with verbal and written warnings for putting on fresh hospital-laundered scrubs, Allina Health said no workers have been disciplined simply for speaking out.
“Our policies prioritize the safety of our staff and patients, while enabling us to allocate the appropriate supplies for daily patient care and for a spike in COVID-19 cases,” Allina officials said in a written statement.
On a daily basis, according to state officials, hospitals this month have been burning through 877,000 gloves, 93,000 masks, 37,000 gowns, 11,000 N95 masks and 9,000 face shields.
That does not include usage by long-term care facilities and other care providers.
The supplies are taking a heavy toll on hospital finances.
“It’s a supply-and-demand issue,” Jacob said. “Normally, you would pay 4 to 6 cents for a face mask in normal time, and now those costs are up to 40 cents to a dollar.”
DEMAND FOR PPE EXPECTED TO GROW
The PPE issue is likely to intensify as the economy gradually nudges open and more grocers, retailers and shoppers reach for masks and gloves to protect themselves on the job or out in public. A patient surge at some uncertain time in the future would thrust demand into overdrive.
“As peak approaches, the burn rate for these supplies has increased,” said Roberts-Davis, noting price surges are common. “The situation today is still fluid. It’s still a very volatile marketplace … (though) we have started to see more stabilization in the marketplace for hospitals.”
On Tuesday, while acknowledging “dark days” ahead, Gov. Tim Walz announced that hospitals and medical centers may resume priority elective procedures if they have a formal plan for maintaining the reserve medical supplies needed for a likely patient surge.
“This is a quality-of-life issue,” Walz said, aimed at “not putting off things that need to be treated because we’re going to come out of this thing with worse outcomes that could have been prevented. … Our nurses and our front-line health care personnel are nervous about this decision. I want to recognize that.”
For some, the goal of reserve supply is still elusive. In Mankato, the Open Door Health Center — a community health center for low-income and uninsured patients — has decided it cannot safely offer on-site visits for elective procedures with the amount of personal protective equipment it has on hand.
Doug Jaeger, CEO of Open Door, said full dental services, widespread COVID-19 testing and elective procedures probably won’t resume until mid- to late June at the earliest, despite the sudden growth of newly jobless and uninsured patients who will likely soon need their services.
“That’s our projection, that we’ll secure enough by that time to reopen,” Jaeger said.
The governor’s decision to allow elective surgeries to resume by executive order was praised by the Minnesota Medical Association and individual hospital networks, but has drawn opposition from the Minnesota Nurses Association.
“We’re getting more supplies on the floor. (But) we’re still rationing,” said MNA President Mary Turner, an intensive care nurse at North Memorial. “I use one or two masks and I interchange them. I’ll go to work on Friday, and I’ll put one in a paper bag for 96 hours.”
Turner said the problem is whether there will be enough PPE once elective surgeries start.
“That is something hospitals are going to have to monitor closely. MNA sent a letter to the governor’s office with concerns, and that is a huge one,” Turner said.
HOSPITALS, HEALTH WORKERS DOING WHAT THEY CAN
Hospitals and health networks say they’re doing what they can.
On Wednesday, M Health Fairview debuted a dozen phone-booth-like testing areas with the University of Minnesota College of Science and Engineering. The booths save dozens of gowns and masks by providing a glass wall between the nurse and the patient being swabbed.
Both HealthPartners and M Health Fairview have begun experimenting with ultraviolet light to decontaminate dozens of masks at a time for reuse.
Meanwhile, to control virus spread at the source, “homemade masks donated by the community, those have been really helpful to give to our patients and visitors,” said Jacob, the M Health Fairview supply-chain officer.
At St. Joseph’s, nurses have been told to use their respirator mask for their entire shift when working with COVID-19 patients, and then place it in a paper bag for five days.
They use a different N95 mask the next day, and the next, returning to their original mask on the sixth day on the premise the virus won’t be able to survive on its surface that long if it’s there.
“It’s one mask, all day. And I work 12-hour shifts,” said an ICU nurse who recently became ill but has so far tested negative for the virus. “Ideally, you would use one mask every time you have a patient encounter. It’s a single-use product.”
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Despite statewide efforts, MN nurses say they’re still short equipment to protect themselves from coronavirus - TwinCities.com-Pioneer Press
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