Holding up face shields and masks fashioned from “nylon jersey fabric, elastic bands, Velcro, tongue depressors and air filter material,” Henry Ford Health System nurses Mariah Foster and Chantell Krage explain in a YouTube video how they’re “coming up with a product that would be safe for our patients and staff” in light of dire supply shortages due to the coronavirus pandemic.
Hospitals around Michigan and nationwide are facing shortages of personal protective equipment (PPE) such as N-95 respirators and surgical masks. As a response, health systems are rationing masks and other protective gear. Henry Ford Health System announced Friday that they will begin using homemade protective gear - a strategy the Centers for Disease Control described as "last resort:"
"In settings where facemasks are not available, HCP [health care professionals] might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE [Personal Protective Equipment,] since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face."
“Because we use thousands of masks everyday in a healthcare environment, we plan to ramp up to making 500-1,000 of these masks daily at hospitals throughout our system to bridge the brief gap between now and when we receive our regular masks,” said Henry Ford Innovation Institute CEO Scott Dulchavsky in a statement. (A spokesperson didn't know how long that "brief gap" would be.)
“This is very much an unprecedented situation for all of us,” Henry Ford spokesperson Jeff Adkins said Friday. Asked if this means the health system was completely out of the N95 masks that are considered critical to keeping healthcare workers safe while they’re caring for COVID-19 patients, Adkin’s wasn’t sure. “ I don’t know that we’re totally out of them, I just know it’s very, very low.”
The masks that are left are being sent to the ER. “That’s the one department I know has been prioritized to have what stock we do have, but I don’t have numbers.” He expects the homemade masks will be distributed to staff shortly.
Adkins said it was "possible" the homemade masks would need to be used by healthcare workers directly treating COVID-19 patients.
“Controlled chaos” about protective equipment, who to test
“Nurses making their own protective equipment is a sign of how desperate the situation is,” said Jamie Brown, RN, president of the Michigan Nurses Association. “This is not an arts and crafts project – this is an extreme method of dealing with a dangerous situation. If nurses don’t have the right protection, it’s like being sent into a war with no armor.”
Most health systems in Michigan are not yet at the point of making their own masks. Instead, the focus is still on what limited supplies of now-precious N95 masks are left, and who gets to wear them.
"For the general public, surgical masks are appropriate," says Brown, who worksin the critical care unit at Ascension Borgess Medical Center in Kalamazoo. But for health care workers caring for COVID-19 cases, "we really need that N95 masks, which are thicker and they filter out droplets, so we are better protected."
Unlike surgical “ear loop” masks, which are loose fitting, and “don’t provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection,” according to the CDC, N95 masks are fitted and, when worn correctly, can filter out “at least 95% of airborne particles including large and small particles.”
But even with preservation measures in place, large health systems can burn through more than a thousand N95s in a single day, thanks to growing screening lines and an increasing number of suspected or confirmed COVID-19 patients.
And there is no one-size-fits-all policy for how hospitals and clinics are supposed to protect workers on the front lines, while also rationing critical supplies. That leaves each individual health system scrambling to cobble together (and update) their own policies, and then get the word out quickly, sometimes to hundreds of staff across multiple departments and locations.
There are daily department conference calls, cascades of mass emails filling up inboxes, and unofficial group texts between staff swapping stories and speculation.
“The best way I can describe the last 24 hours is controlled chaos,” Brown said this week.
Brown gets it. Her hospital – like so many others – is sending out daily, sometimes hourly COVID-19 related updates to staff: Who gets the the N95s, and who doesn't?
Which staff are being reassigned, sometimes to entirely different departments – one day working in pre-op, the next, given a choice between screening possible COVID-19 cases, manning phone hotlines, or being reassigned to intensive care units?
What’s the latest criteria for which patients to test, and which to just send home with advice to monitor their symptoms and self-isolate?
Asked if they sometimes don’t know the most updated protocol about who to test, Brown says, “Absolutely. But it’s literally changing hour by hour, in some cases. Nurses are flexible and we’re good at dealing with crises. But we also like to know that we are protecting ourselves, so that we don’t get sick either.”
“Not protecting us now is only making it worse”
Health workers say once-readily available supplies are often now locked away or “hidden” from them, only accessible through a designated point person.
One nurse at Beaumont Health, whose name we’re not using to protect her job, said the supply carts in her department used to be well-stocked with gloves, gowns, and eye protection. They also had multiple kinds of masks just generally “all over the place,” she says.
But last week, she came in to work to find the carts emptied and the masks gone. “Apparently people were taking them, and they’re trying to preserve them,” she says. “That’s what the emails are saying.”
So when a patient came in with pneumonia and several symptoms associated with coronavirus last week, she couldn’t understand why the hospital wasn’t treating him as a possible COVID case - and she couldn’t find any masks.
“Every precaution should have been used, especially with his symptoms. He had the dry cough, he had the secondary infection of pneumonia. He had a low-grade fever. His lung function was going down,” she says. “But there were no masks readily available. And we didn’t [wear masks around him.]”
Instead, she “held her breath” while taking his temperature, she says. “I’m still concerned now. Every tickle in my throat.…” she trails off. “I think about it every day.”
She understands that protective equipment is limited, and with the coronavirus pandemic expected to worsen in Michigan, health systems are trying everything they can to make their limited supplies last.
“All around, we’d like to feel safer,” she says. “I think things are really bad right now. And not protecting us now is making it worse. I think it’s making it spread more. Don’t wait another week. Do what you can to help prevent it now.”
But when supplies do run out, she says, “I don’t know where they’re going to get more.”
Reusing masks and implementing “crisis strategies”
Most health systems are limiting N95s just to staff who are actually swabbing suspected coronavirus patients, or clinicians interacting with symptomatic patients whose test results have either confirmed the virus or are still pending.
And many doctors and nurses are being asked to reuse N95 masks with individual patients, so having one mask they use with Patient A, and another mask they use every time they see Patient B. Workers say they’re encouraged to “write our names” on the masks and “clean them off between uses.”
“It’s really important to have them in the hospital,” says Dr. Matthew Sims, director of infectious diseases research at Beaumont Health. “I know we don’t have enough. Nobody does.”
But right now, he says, healthcare workers who go into the rooms of suspected or confirmed coronavirus patients really should be wearing N95s.
“The people who are going in and out of the room … we have policies and procedures in place along the CDC guidance, to allow them to reuse masks for the day,” Sims says. “So they're going to use the same mask for that patient. So they're not using a different mask every time they go into the room.”
Meanwhile, they’re doing everything they can to reduce the number of people who have to actually interact with possible COVID-19 patients.
“So if you need to deal with something for that patient, but you can do it through the computer system, talk to them on the phone, things like that. We're encouraging that as much as possible. You can't always do that.”
The reality, though, is that everyone is “potentially getting exposed” in the broader community right now. And there’s no way to ensure that asymptomatic patients who come into the hospital for non-COVID reasons don’t actually have the virus.
“I would think that if everybody's following the rules, they are less likely to get it from the patient we know about, than from the patient we don't know about, right?” Sims says. “So if a person happens to come in for a belly pain, a very common reason for somebody who comes to the emergency room – you know, they're seen and they don't have a fever and nobody thinks they have a cough, et cetera. And … then later they turn out to have COVID. That's a bunch of people who are potentially exposed.
“We have policies and procedures in place to deal with that,” he adds.
Jamie Brown, the RN at Ascension Borgess and president of the MNA, is worried about what happens as more healthcare workers fall ill – especially as their protective equipment supplies run low.
“If we aren't protecting our nurses and they end up with COVID-19, we're not going to have enough nurses to take care of the patients,” she says.
Disclosure note: Henry Ford Health System is one of Michigan Radio's corporate sponsors.
Editor's note: Henry Ford Health System is one of Michigan Radio's corporate sponsors.