Putting on all sorts of protective gear is part of the standard procedure in a hospital when treating someone who is highly infectious. But without adequate testing, it’s hard to know when this gear is necessary.
“How do we know who we’re dealing with if we can’t prove that people are positive or negative?” said Christine Pontus, a nurse and the Associate Director Health and Safety at the Massachusetts Nurses Association.
Amidst the outbreak of coronavirus, hospitals have two options. They can assume someone doesn’t have the novel virus and, if that’s wrong, potentially expose medical personnel and other patients. Or, they can assume someone does have it and wear personal protective equipment, which is known within the medical profession as PPE.
Here’s the problem: That protective gear is already in short supply.
“Nurses are being asked to reuse N95, the mask that nurses are recommended to wear,” said Pontus.
In normal times, these masks are intended for one-time use but now hospitals are asking that their staff reuse the masks.
This is true at even the state’s top hospitals. For example, a spokesperson for Brigham and Women’s Hospital, which has confirmed that two of their health care workers contracted the novel coronavirus, told WGBH News that the hospital has a new policy for disposable surgical and procedural masks and protective eye wear.
This gear was previously discarded after each patient, but now “these can be reused for one shift only, and only if they are not soiled, contaminated, or physically damaged,” the hospital said in statement.
There have been reports that Massachusetts General Hospital has also asked that masks be reused, although their spokesperson could not confirm this. This type of reuse is happening elsewhere in the country, too.
The Centers for Disease Control and Prevention, or the CDC, has acknowledged this type of reuse is “not commensurate with current U.S. standards of care. However, individual measures or a combination of these measures may need to be considered during periods of expected or known N95 respirator shortages.”
A spokesperson for St. Elizabeth’s Medical Center wrote in an email, "we are following the CDC guidelines on the appropriate use of Personal Protective Equipment." However, given the CDC’s updated statements, she did not clarify whether this means the hospital is or is not reusing the equipment.
A representative at Tufts Medical Center said they are not currently reusing their personal protective equipment. “We have a stockpile of PPE at this time and for the foreseeable future,” the spokesperson said.
Pontus says a lot of the supply shortage goes back to a testing shortage.
From the beginning of the coronavirus outbreak in the U.S., testing hasn’t gone smoothly.
The federal government sent out faulty tests. Here in Massachusetts, the state initially wasn’t disclosing the number of people who’d been tested. And, when the state did start sharing the exact number over the weekend, it became clear a previous statement from Monica Bharel, commissioner of the Massachusetts Department of Public Health, or DPH, was inaccurate. On Tuesday, March 10, during the press conference announcing a State of Emergency, she said that roughly 400 tests had been completed. But when the official count came out on Saturday only 475 had been tested. Many experts said that number was very low.
“Right now, essentially, we’re kind of flying blind,” said Michael Mina, an epidemiologist at Harvard’s School of Public Health and a doctor at Brigham and Women’s Hospital.
“We don't know if the changes we're making are helping or hindering. We anticipate that they're helping, but until we actually have testing, it's hard to monitor and be able to anticipate what’s coming next,” he said.
However, Mina said things are moving in the right direction. The state is scaling up its testing capacity and sharing more information. From Saturday to Sunday, the state more than doubled the number of tests that had been conducted from 475 to 969.
DPH said this is because of certain changes in policy, including giving clinicians more flexibility in determining who needs a test. Previously, they had to get the state’s approval before getting a patient tested. And, in addition to the state lab, the federal government has let some hospitals and commercial labs — like Quest Diagnostics and LabCorp — start testing.
While it’s getting better, Mina said, “at the very moment in time that we are in, I think that things continue to be insufficient.”
A spokesperson for DPH said in an email that they didn’t know the exact capacity of testing in the state currently.
Mina said he is, at least, happy to see the public is taking the outbreak seriously. He largely credits detailed media coverage. “It has raised awareness to a level that has gotten the country's attention, and it's causing us to make the changes that are really required,” he said.
While he acknowledges hospitals are having to make really hard choices about who gets protective gear, from a public health perspective, he said, all the awareness takes some of the burden off of testing. Even without knowing the extent of the outbreak, some of the necessary control efforts are already happening, like closing schools and eliminating social gatherings.
“We need to ramp up to thousands, many thousands of tests a day in the short term,” said Robert Horsburgh, an epidemiologist at Boston University and an infectious disease doctor. “Eventually we'll end up testing pretty much everybody and then we'll know where things stand.”
Horsburgh pointed out that widespread testing is what let China get the outbreak under control. He doesn’t think the whole population in Massachusetts will be tested in the short term, but he is optimistic. He thinks the state will get to a much better level of testing quite soon.
“I hope we're not having the same conversation a week from now. I don't think we will be,” he said.
And that will hopefully mean the hospital’s short supplies of masks and other protective equipment will be used only when they are really needed.