Health care workers are taking steps to ensure they have enough protective gear to last them through a peak period of coronavirus infections projected to hit hospitals as soon as this week.
The measures include having doctors, nurses, and other front-line workers wear equipment for longer periods of time or reusing gear more quickly than they would under ideal circumstances. They also include moving patients through the medical system in a way that limits the exposure of health care workers and preserves resources.
"We've been following reports of our fellow health care providers — paramedics, nurses, physicians — becoming infected, dying," said Jamie Shandro, an emergency room doctor at Harborview Medical Center who teaches at the University of Washington School of Medicine. "This shakes all of us."
Shandro said health care workers and hospital leaders are trying to balance the concerns of frontline workers with the reality of a limited supply. If they use too much personal protective equipment, or PPE, they risk running out. If they don't use enough, they risk feeling unsafe at work and even catching the coronavirus.
Shandro, who leads a working group that's informing how protective equipment is used in the emergency room, said advice around gear has rapidly evolved over the past month.
"In the past week alone, I think it's been updated three times," she said. "This is an unprecedented rate of policy change, so it's a lot for us to adapt to."
Many concerns revolve around valuable N95 respirators, specialized face masks designed to prevent health care workers from breathing in the virus.
The N95 mask, which Shandro said "feels sort of like a thick felt," protects the wearer by filtering particles of virus and bacteria from the air. N95 masks must be carefully fitted to the wearer's face and cannot be worn with a beard.
That's opposed to a surgical mask, which she said "feels like a thin cloth" by comparison and is designed mainly to stop the person wearing it from breathing droplets onto other people.
One compromise some hospitals have made: Health care workers are wearing the same N95 mask for an entire shift in order to stretch out supplies, rather than putting a new one on for each confirmed or suspected COVID-19 patient, Shandro said.
Health care workers are wearing face shields over the respirators to make them last longer, she said.
"In an ideal situation, they are one-time masks," Shandro said. "If we were to go about having every staff member use a new N95 mask with every suspected COVID patient, we would probably run out in a few days."
Workers in some areas are reusing N95 masks for multiple shifts, Shandro said. She called that "concerning" because of the way the respirators must adhere to the wearer's face in order to work properly.
"You can imagine, if you're reusing an N95 mask day after day after day, that fit might not be right, which means it won't work as well as it needs to," she said. "So we're really working on that balance of maximizing safety with an eye towards using the supply that we have."
Before the coronavirus epidemic, N95 masks were rarely used, Shandro said. Typically, workers will don the respirators when they're concerned a patient may have tuberculosis. They were also used in the SARS and MERS outbreaks of past years.
Another concern is the supply of clean powered air-purifying respirators, systems that blow clean air into spacesuit-like helmets or hoods, which are used during risky procedures like inserting breathing tubes into patients.
"Many of those have not been designed to be reused as rapidly as we're able to reuse them," Shandro said. "But we have developed a mechanism whereby we can wipe them down safely and keep reusing those."
Hospitals have also redesigned the ways patients flow through their systems with an eye toward preventing infection and preserving gear.
At Harborview, patients are evaluated in an outdoor "triage tent." Patients who are "very ill" and need immediate care are taken into the emergency room, Shandro said. But she said many can be directed away from the hospital, reducing the risk of infecting other patients and workers.
"If they have a cough and a fever, but their vital signs look okay and they look stable, they can get COVID testing and they can get a chest X-ray if needed, and then they can go home," Shandro said.
Harborview has also set up "hot zones" to house patients at risk of infecting others with the coronavirus. Workers in hot zones continuously wear protective gear for hours, helping preserve it, Shandro said.
She said the precise amount of PPE isn't available to most staff, though reports from the UW medical system "sound like we are okay right now."
But Shandro said hospital policy is only one factor in whether PPE lasts. It's also up to actions the public takes to reduce infections, such staying home and avoiding human contact.
"The surge is really building right now," she said. "In the coming weeks, we're going to see how this PPE lasts. I think one of the big concerns among all health care workers is, are we going to have enough?"