Health care workers are on the front lines of the battle against COVID-19, but many say they are not being supplied with adequate armor. Nurses across the country have begun to protest against shortages of personal protective equipment, PPE — masks, gloves and gowns — which they say are putting their lives at risk.
Nurses, while following social distancing guidelines, staged protests in multiple states this week, according to National Nurses United President Deborah Burger. She said protests calling for more PPE took place in New York, Georgia, Illinois and several California cities throughout the week.
In New York, nurses say managers have been rationing PPE in anticipation of a peak in cases, expected to hit the city sometime in the next 21 days.
Kelley Cabrera, a registered nurse and president of the New York State Nurses Association's labor bargaining unit at New York's Jacobi Medical Center, said staff members at New York City hospitals have to reuse the same N95 mask — particle-filtering respirator masks — for five days. N95 masks are intended for one-time use, and are not to be used on multiple patients, according to Cabrera.
"These recommendations are based on CDC guidelines and are not based on science," Cabrera said. "But because our hospitals lack adequate supplies. This is a dangerous practice that puts healthcare workers and patients at risk."
The Centers for Disease Control and Prevention provides "strategies for optimizing the supply" of N95 respirators and face masks. During a crisis, when there are shortages, the agency says healthcare workers are allowed to reuse PPE when necessary. The CDC cautions, however, that since little is known about the coronavirus' transmission, "care should be taken to ensure that (workers) do not touch outer surfaces of the mask during care, and that mask removal and replacement be done in a careful and deliberate manner."
Burger said the CDC's guidance has been an "ever shifting position."
"It's a problem because nurses look to the CDC for protections, but we keep reminding them that the CDC guidelines are just that … employers can pick and choose," she said.
According to Burger, most nurses are being asked to reuse N95 masks for an entire shift, and to store them on a hook in a COVID-19 patient's room, rather than throw them away. This method is far from full-proof, she said, as severe patients are likely on ventilators, which can circulate the virus.
When face masks are not available, the CDC guidance says health care providers "might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort." According to Burger, hospitals "seized" on that guidance, and encouraged nurses to make their own masks, despite not having any evidence showing they protect from viruses. She called the direction the "height of irresponsibility," because it gives nurses a "false sense of security that they're being somehow protected."
The New York State Nurses Association has issued several position statements disagreeing with the CDC guidelines, and has drafted a protest of assignment form — a document notifying the employer that an assignment is unsafe — that is geared specifically towards COVID-19.
New York Governor Andrew Cuomo has stressed the state's continued need for ventilators — another key device in battling the coronavirus — but said Wednesday that any health care worker dealing with the outbreak should currently have access to PPE.
"Today, no hospital, no nurse, no doctor, can say legitimately 'I don't have protective equipment,'" Cuomo said. "Right now, and for the foreseeable future, we have a supply. We have not yet secured a supply for three weeks from now, four weeks from now, five weeks from now, but we are still shopping."
The head of New York City's hospital system, Dr. Mitchell Katz, told NPR on Friday that the city only has enough PPE "to get through the rest of March." Katz said that in order to get through the next several weeks, the city's public hospital system will "need massive infusions of protective equipment and ventilators from the federal government and other providers."
At a news conference Friday, Katz said that health care workers treating only coronavirus patients could conserve supplies of N95 masks by wearing one throughout their shifts.
As of Friday, 48 California health care workers have tested positive for the virus through person-to-person transmission, according to the California Department of Public Health. New York has not publicly provided data on how many health care workers make up the over 52,000 people sickened from the virus. At least one health care worker in the state, a 36-year-old nursing manager at Mount Sinai West, died earlier this week after helping treat patients with coronavirus. The death toll in New York is over 500, according to Johns Hopkins University.
"We need public support to help us demand further action from the federal government," Cabrera said. "We know there are several ways to ramp up production of PPE and ventilators, but the current administration refuses to use these powers, therefore leaving our frontline staff and patients at risk of infection and death."
Burger also called on the federal government to encourage private sector production of PPE. She said that, while she's trying not to make the issue political, "it's hard not to mention that the person in charge was not taking this seriously … when we could have done something serious."
"How is it that we can produce landfills worth of useless articles, yet we can't produce masks? Burger said. "That's a lie."
"People should be righteously angry that we don't have these stores in place."