On outbreak's front lines, medical workers fear mask rationing will heighten risks

Wednesday, March 25, 2020

Doctors and nurses on the front lines of the battle against coronavirus are increasingly anguished over the hospital-imposed rationing of masks, gowns and other protective gear, restrictions they say are exposing them to unnecessary risks at the worst possible time.

At Anne Arundel Medical Center in Annapolis, nurses said they were being handed a single mask in a brown paper bag at the start of each shift and told to make it last. At Medstar Georgetown University Hospital in Washington, D.C., the more protective masks, known as N95s, are being kept in a locked room, according to one neurologist who agreed to speak anonymously about his growing unease.

And at Mercy Hospital & Medical Center in Chicago, the situation is apparently so dire that the administration is hiding masks from its own staff, even as it prohibits the use of "outside [personal protective equipment]."

"There is a limited supply of N95 masks on the floor - Their location will be disclosed to you when you start your shift," reads an internal memo obtained by ABC News, a copy of which can be read below. "PLEASE keep this on a need-to-know basis as masks are disappearing and we do not have many left in the hospital."

They understand the shortages, several of medical workers said, but if they get sick, the coming surge will be that much harder to manage.

"I'm not trying to point fingers," the neurologist said. "Friends all over the country are asking me the same thing. Why are we not protecting the physicians?"

On Tuesday, National Nurses United, the country's largest union and professional association of registered nurses, issued a statement decrying the shortages that have led to nurses working with "vastly inferior protective equipment such as bandanas and craft store items that offer little, if any, effective protection."

"Instead of putting U.S. nurses and other health care workers in greater danger," said executive director Bonnie Castillo in a statement, "we should be stepping up protective standards for our most at-risk caregivers who are already selflessly saving patients here, not putting them in danger."

The careful rationing of protective gear has become widespread policy around the country, following guidelines from the Centers for Disease Control that urged hospitals to marshal their resources ahead of an expected surge in infected patients.

Mercy Hospital & Medical Center in Chicago, for example, is limiting the use of N95 masks to certain procedures that create a particularly acute risk of exposure to the virus.

"These are ONLY to be used IF you are performing an aerosol-producing procedure (AKA: CPR, Intubation, Sputum collection, or bronchoscopy)," the internal memo reads. "Normal labor/vomiting/coughing is NOT an aerosol-producing procedure."

When reached for comment by ABC News, a spokesperson for Mercy Hospital issued a brief statement.

"We are aware of the global shortage of supplies, and we continue to urge local, state, and federal governments to continue to make related stockpiles available," the spokesperson said. "Mercy also continues to work closely with suppliers globally to meet this challenge. Our leadership team recognizes it is important to protect our colleagues and our patients, and safekeeping our equipment is part of that effort."

Because many hospitals operate under strict rules that bar them from speaking out, nurses and doctors have been reluctant to talk publicly about their growing concerns. But in online forums and private social media groups, the discussions are revealing more and more anxiety.

"We are definitely feeling vulnerable and this week will be much worse," wrote an anesthesiologist in Maine in a private Facebook group of doctors from around the country shared with ABC News.

"We are now creating our own [masks] with plastic bags rubber band and nasal cannula taped to the top of face shields," wrote a Long Beach, California doctor in that same group.

Some hospital officials have questioned whether widespread use of protective masks is beneficial. UCI Health in Orange County, California even sent out guidelines calling constant mask usage by staff "harmful."

"Constant masking creates and stokes a culture of fear," reads the UCI Health guidance from March 18. "In China almost everyone wore masks and yet the virus raged on with worsening spread."

UCI Health did not respond to a request for comment from ABC News.

At New York's Presbyterian Hospital, an internal memo from the chief surgeon, pointed to an acute supply shortage. Dr. Craig Smith wrote that the hospital normally uses 4,000 regular surgical masks per day. But right now, they are consuming 40,000 masks each day, with the demand is expected to grow to 70,000 per day.

"We're told manufacturing is beginning to accelerate, but that relief is weeks away at best," he wrote.

Providing medical staff even one mask to use each day is probably too much, Smith wrote, but "is an important concession to their emotional needs. In theory the mask is to be used only if the person becomes symptomatic."

New York-Presbyterian Hospital also did not respond to a request for comment from ABC News.

That reasoning is not providing comfort, though, to many frontline medical workers, who now believe they are being exposed to the virus every day they come to work.

"We are not prepared," warned a caregiver in Fairfax, Virginia, who has treated coronavirus patients. "There has been panic and uneasiness among the critical care staff. We are used to panic mode. But when it comes to protecting ourselves, we are uneasy."

At least one hospital chain, the nonprofit Partners Healthcare in Massachusetts, is opting for a different approach. In a recent coronavirus update tweeted out by doctors there, the hospital chain announced a "new surgical mask policy" that would require its medical staff to wear masks at all times.

"Given what we have learned about COVID-19, this universal mask approach will serve to protect our patients and other staff members should the healthcare worker have asymptomatic infection," the memo says.

National Nurses United, meanwhile, has launched a campaign pressing public officials to step up the mass production of high-standard protective equipment,.

"The failure to assure all staff have secure and effective personal protective equipment," Castillo said in a statement, "will prolong this crisis."

ABC News' Pete Madden and Soorin Kim contributed to this report.

What to know about coronavirus:

Tune into ABC at 1 p.m. ET and ABC News Live at 4 p.m. ET every weekday for special coverage of the novel coronavirus with the full ABC News team, including the latest news, context and analysis.

Related Topics