How does PPE get to Minnesota health workers who need it?

N95 face masks in boxes.
Boxes of donated N95 masks sit inside the Minnesota Nurses Association office. Many hospitals and clinics are struggling to get the personal protective equipment, including N95 respirator masks, they need to protect health care workers on the front lines of the COVID-19 pandemic. 
Courtesy of Minnesota Nurses Association file

Many hospitals and clinics are struggling to get the personal protective equipment — or PPE — they need to protect health care workers on the front lines of the COVID-19 pandemic. 

MPR News reporters have been digging into the factors driving the shortage, what’s being done about it and the impact it’s having on health care workers. Here’s what they learned.

What is PPE, and why is it important?

Personal protective equipment is designed to protect health care workers and their patients from the spread of infectious agents like viruses or bacteria. It can include gowns, gloves, face masks, goggles and face shields.

This protection is crucial: While scientists are still learning about the highly infectious coronavirus, they believe it is mainly spread through respiratory droplets that travel through the air, or also land on surfaces.

Different types of PPE offer different levels of protection based on the risk of exposure. A loose-fitting surgical mask is mainly designed to block large-particle droplets that may contain germs. However, a respirator mask such as an N95 fits tightly around the mouth and nose and filters out 95 percent of tiny particles, including bacteria and viruses.

Almost all types of PPE are in short supply right now — not just in Minnesota, but around the United States and the world.

What impact is this shortage having on health care workers?

It’s a stressful time for many health care workers on the front lines of the pandemic, and the PPE shortage is adding to the strain.

Some health care workers have expressed frustration with the changing protocols issued by hospitals as they try to stretch their PPE supplies as far as possible. In some cases, staff are told to reuse surgical masks and gowns multiple times, instead of disposing of them and donning new ones between patients, as they typically would.

Some nurses have said they’ve faced disciplinary action for wearing hospital-issued scrubs usually reserved for sterile procedures instead of their own because bringing them home after work could possibly put their families and loved ones at risk.

“A lot of nurses have gotten into these crazy routines of stripping down in the garage, throwing on a robe and running into their homes ... to try to keep all of this potential contamination away from their families,” said Amanda Moriarty, a registered nurse who works in the emergency department at United Hospital in St. Paul.

Hannah Biesiada, another registered nurse at United Hospital, brought her own N95 mask from home to wear while caring for neurology patients. Biesiada, who has asthma, said she was told she can't wear it because it’s industrial-grade, not meant for medical use, and hasn’t been fit-tested for her.

"If it costs me my job, I've come to the point where I'm OK with that,” Biesiada said. “I won't like it, for certain. But I'd rather lose my job than lose the life of someone around me."

She said she is now allowed to wear a hospital-issued N95 after filing a job accommodation request under the Americans with Disabilities Act.

Sara Criger, president of Allina Health-owned United and Mercy hospitals, said staff are told not to reuse surgical masks that are damaged or soiled. Criger said the hospitals are following recommended safety practices for reusing N95 masks after leaving them in a bag for five days, which the Centers for Disease Control and Prevention says is long enough to kill the virus. 

“It's really a good practice from a conservation perspective, and just as safe as taking a new mask,” Criger said. “We think that's important right now to ensure that we have what we need when and if the surge hits us, that we're not putting people at risk either now or in the future.”

When the U.S. outbreak began, most hospitals and clinics canceled elective surgeries and procedures, so the PPE that normally would be used for those could be redirected to staff dealing with the coronavirus. 

And health care providers are trying to “optimize” their PPE supplies and prepare for a potential surge of COVID-19 cases by reserving the highest level of protection for those in contact with sick patients. Those actions also include physical changes in health care facilities, such as putting up barriers and rerouting traffic, to reduce contact between patients and staff.

Why didn't hospitals stockpile PPE before the coronavirus outbreak began?

They did — but not enough.

Hospitals and clinics do plan for disasters, but typically for something like a hurricane or tornado that would result in a brief surge of patients, not a global pandemic of this scale, said Karthik Natarajan, an assistant professor of supply and operations at the University of Minnesota’s Carlson School of Management and an expert in health care supply chains. 

Preparing for a massive disaster falls to federal, state and local governments, which all maintain stockpiles of PPE, but it’s nowhere near enough to meet the demand that’s occurring right now, Natarajan said.

The U.S. government maintains a strategic national stockpile of emergency medical supplies, but it’s seriously depleted. Minnesota has received some supplies from the federal government, but it’s been slow and not necessarily the items the state needs most.

Why can't hospitals or states just order more?

They're trying, but that’s difficult to do in a global pandemic, when nearly every country in the world is experiencing an outbreak of COVID-19.

Usually, countries send medical supplies to others that need it, such as during the Ebola outbreak in Africa. However, right now no one wants to share, Natarajan said.

“Everybody is running short on supplies and everybody wants to get their hands on products that are being manufactured,” he said. “So, that's why you see bidding wars between countries, but also between states.”

Sometimes the supplies are going to the highest bidder, not necessarily to the places where they're needed the most, Natarajan said.

Also, much of the U.S. supply of PPE has been manufactured in other countries like China. Once the coronavirus outbreak began, China began to halt exports of those products, adding to the global shortage. 

What is Minnesota doing to try to get more PPE?

Gov. Tim Walz appointed a critical care supply working group to focus on procuring more PPE, led by Alice Roberts-Davis, commissioner of the Department of Administration.

The group has been working through traditional procurement channels and with Minnesota companies, such as Ecolab and Medtronic, to help procure more PPE through their supply chains, Roberts-Davis said.

Some Minnesota companies that make N95 masks, such as 3M and Honeywell, have ramped up production. Other companies — like Duluth Pack and Frost River Trading Co. in Duluth — have switched from making their regular products to making PPE.

Those efforts are helping. But it can take time for a company to obtain the supplies it needs — and retool its plants — to start producing something completely different, Natarajan said. And those companies often make cloth or surgical masks or face shields, not the more complex N95 masks that are in high demand, he said.

Is there anything that the general public can do to help with this shortage?

Yes. If you have any N95 masks, you can donate them to health care facilities. The CDC does not recommend that the general public wear N95 respirator masks to protect themselves from COVID-19. 

However, the CDC does advise everyone to wear a cloth mask or face covering while in public to slow the spread of the virus.

If you’re handy with a sewing machine, you can make cloth masks and donate them. Many health care facilities are accepting homemade masks, mainly to be worn by patients or employees who don’t have face-to-face contact with patients.

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