A hospital nurse in Michigan says she and her colleagues have discussed bringing in bleach to make their own disinfectant wipes. A pregnant nurse in Ohio says she has no choice but to tend to critically ill patients without a specialized N95 mask. And a health care worker in Georgia has resorted to scouring local hardware stores in an effort to secure the protective masks.
These are just some of the stories told to NBC News by more than 250 health care providers on the front lines of the coronavirus pandemic, including many who work in major hospitals.
The accounts were solicited through an NBC News survey, pushed out on social media, about access to personal protective equipment (PPE), a broad term for the gear, such as masks, glasses, gowns and respirators, donned by health care workers to protect against the transmission of germs.
Nearly all who responded said there were shortages of PPE in the hospitals, outpatient clinics and offices where they worked.
Many reported being forced to ration or reuse supplies, including surgical and N95 masks, for fear of running out. Many also said they were facing shortages of basic sanitary supplies, including hand sanitizer and disinfectant wipes.
NBC News was not able to independently verify each account. But where possible, the facilities were contacted and given an opportunity to respond.
The nurse in Michigan, who is based in Flint and works primarily with immunocompromised patients, said that nurses at her hospital have been rationed one N95 mask each and are being required to store them in a bag and reuse them, against manufacturer guidelines. Nurses on her floor, she added, have also been unable to obtain enough disinfectant wipes.
“We ordered five containers the other day and we only got one,” she said. Like many medical professionals who spoke to NBC News, she asked to remain anonymous for fear of losing her job. “One container of bleach wipes for 42 beds.”
“I don’t feel like my hospital is failing us,” she said. “It’s the whole system that’s failing us.”
“We certainly would not ask a firefighter to fight a fire with a spray gun,” said Deborah Burger, president of National Nurses United, the nation’s largest nurses’ union. Burger, who has been a registered nurse for 45 years, said that neither the government nor the private sector are acting fast enough to get critical supplies to those who need them.
“It is a moral obligation of our government and our employer to provide safety equipment to those of us on the front line,” she said.
“We are unable to protect ourselves”
The overwhelming majority of the medical professionals across the country who responded to the NBC News survey expressed concerns about a lack of N95 masks, which offer more protection than surgical masks.
A health care worker at a hospital in Indiana described a Kafkaesque scenario: medical staffers can only get the masks when a patient has tested positive for the virus, but the facility has no way to confirm a case.
“There are many possible exposures in my hospital but are not equipped with the testing devices in order to confirm the cases,” the worker wrote. “We are then not allowed to wear proper PPE because they are not ‘positive’ and because our hospital is short on the PPE. We are also told that we are expected to keep the N-95 masks for several days and several patients and that they can be disinfected with Sanicloth wipes.”
“We do not have N95 masks, so we are being asked to intubate patients (which exposes us to entire airway) with normal masks,” wrote the pregnant nurse from Ohio. “It is unacceptable. We are supposed to treat every patient as suspected positive but we are unable to protect ourselves.”
The N95 mask filters out airborne particulates and aerosols, and the Food and Drug Administration advises that neither N95 masks nor surgical masks should be used more than once.
But in response to growing shortages of PPE, the Centers for Disease Control and Prevention has loosened its guidelines on proper use and reuse of masks. On Thursday, the agency advised that bandanas and scarves could be used by health care workers in place of a mask as a last resort.
“The fact that a recommendation like that came out from the Centers for Disease Control is mind boggling to me,” said Dr. Adam Friedlander, an emergency physician working in Atlanta.
“There was a time when a recommendation came from the CDC, we knew that it was evidence-based guidelines for how we could protect ourselves from becoming sick with a potentially fatal illness. Now we know the recommendations are coming from a place of desperation, acknowledging that these supplies are unavailable.”
A nurse who works at a major hospital in Massachusetts and spoke to NBC News on the condition of anonymity, said that medical staff have been told they must reuse their N95 masks five times before they are able to get a new one.
“It’s scary to have to reuse the mask,” she said. “At the same time it’s like, what are you supposed to do if there’s none to be had?”
“A nationwide problem”
The U.S. Department of Health and Human Services said in a statement this week that the agency has been steadily deploying PPE to areas in need from the Strategic National Stockpile, the nation’s supply of pharmaceutical and medical supplies, intended for use during a severe public health emergency.
“We have been transparent that more supplies are needed – hence the request to Congress for additional funding so we could procure more and scale up production,” the statement said. “The role of the SNS is to fill the gap temporarily until states and localities working with the private sector can respond to the state and local needs.”
The survey responses reveal the scope of the shortages, as many medical professionals pleaded for the government to step up delivery of supplies.
“We have no proper PPE,” wrote one survey respondent, who works in a hospital in New York City. “We are being told to come to work even if you had a COVID exposure...This system is doomed for failure without immediate help from the military. We need PPE, vents, staffing, more hospital beds, more tests.”
In the meantime, health care systems and staff are being forced to improvise.
One doctor, who works at a rural health clinic in Virginia, said that clinics are increasingly being asked to fill the gap and send their PPE supplies to hospitals, where the need is greater.
But that, of course, leaves clinics — and the patients they serve — exposed.
“There simply isn’t enough stock,” said the doctor, who spoke on the condition of anonymity. “We have no N-95s or gowns. We have limited surgical masks.”
“This is a nationwide problem, even on the private side,” he added. “No clinic in this country, or hospital for that matter, is going to have enough equipment.”
The limited supply of PPE has forced some hospitals to take the extraordinary step of asking the community for help. Seattle Children’s Hospital in Washington has received thousands of donated protective equipment and is currently accepting curbside dropoff of additional masks, gowns and gloves.
“Thanks to members of the local and international community, to date we have received 15,100 isolation masks, 1,200 N95 respirator masks and 400 surgical masks from donations,” a hospital spokesperson said.
“I am so scared”
Three survey respondents reported that they were asked to work with patients who tested positive for the virus without adequate protective gear. Others reported that they faced disciplinary action for using PPE outside of specified circumstances.
A memo distributed this week to Monmouth Medical Center Southern Campus in New Jersey, part of RWJBarnabas Health Facilities, informed staff that PPE must be worn in all rooms containing individuals with suspected or confirmed cases, but that staff could be disciplined for wearing masks, gloves and gowns outside patient rooms.
“RWJBarnabas Health facilities, including Monmouth Medical Center Southern Campus, are concerned about the possibility of a potential shortage of PPE including masks, eye shields and gowns,” a spokesperson said. “We are carefully managing current inventory of items to ensure adequate supply of materials to protect our staff and the community."
Dr. Robert Morin, a plastic surgeon who works in emergency rooms in major hospitals in New York City and New Jersey, said that such policies, put into place in response to shortages, put health care workers at risk. “We don’t need hospital administrators going out of the way to make us sick,” he said.
Morin said that he has been exposed to patients with positive cases while working in an operating room without proper PPE. “I don’t feel like we’re getting the support we need,” he said.
“The chaos, the lack of supplies, the lack of equipment,” he added. “The numbers are just going to keep going up.”
Some survey respondents and others who spoke to NBC News reported searching for PPE at local stores or on websites, like Ebay.
A doctor in Philadelphia, who is married to a doctor who works in a major hospital in the city, said that her husband searched for an N95 mask at four hardware stores before his shift yesterday but could find none.
“He says, “It’s my duty,’” she said. “He is proud of doing all that he is able to do right now, which I am also proud of, but I am so scared. I can’t even begin to tell you.”
Dr. Nivedita Lakhera, a doctor in San Jose, California, said her hospital is working hard to get N95 masks for all doctors but they are in short supply. She shared messages with NBC News from doctors she knows who are worried about their own mortality.
“The doctors are talking about making living wills and what will happen when we are faced with this,” she said. “All of us are wondering which one of us will die.”