‘They’re scared’: Doctors lack safety gear in fight against coronavirus in KC region
Expecting a surge of patients from the new coronavirus pandemic, doctors and nurses across the Kansas City area are being forced to do things they haven’t done before.
They are sterilizing disposable face masks and bleaching gowns, items they used to throw away immediately. They’re trying to reuse as many as they can and stretch the critical gear that protects them from the virus as they care for patients.
Some hospitals say they have enough personal protective equipment, or PPE, for now. But about half of Missouri’s hospitals report they have shortages and many in Kansas are scrambling to find supplies.
Already, nurses and their families have turned to scouring the shelves of Home Depot and Sherwin-Williams to find gloves, masks and respirators. They often find empty shelves. Some hospitals are accepting handmade masks, while others are not because of concerns about their effectiveness.
Kelly Sommers, director of the Kansas State Nurses Association, polled nurses earlier this week about the issues they face.
“Number one is PPE shortages,” she said, noting some are “having to be judicious on how they use those supplies.”
Nurses have shared their concerns with each other on the 13,000-member Nurses KC private Facebook group, said the moderator, Holly Gunter.
“They’re all out there taking care of patients and they don’t feel protected,” Gunter said. “They’re scared.”
In Kansas, more than 260 people had tested positive for the coronavirus as of Saturday. At least 50 have been hospitalized and five people have died.
More than 830 people in Missouri have been found to be infected, with officials noting a spike of more than 40% from Wednesday to Thursday. Ten Missourians have died from the disease.
Across the country, more than 112,000 people have tested positive for the virus, according to a database maintained by Johns Hopkins University. More than 1,800 across the country have died. The disease has spread to more than 640,000 people worldwide.
Meanwhile, experts say the worst is yet to come. Numbers in Kansas and Missouri are expected to grow as more people are tested.
“The question is how high will the curve go, how fast, because the curve could easily outstrip the supply chain in this country,” said Steve Stites, chief medical officer at the University of Kansas Health System. “And that’s really what we wrestle with every day.”
The United States Conference of Mayors on Friday released survey results that found more than 90% of cities lack the face masks needed for first responders and medical staff. The organization said it had become “abundantly clear” that the shortage of protective gear and medical equipment had “reached crisis proportions in cities across the country. “
Like other hospitals in the region, the KU Health System has delayed non-emergency surgeries and curtailed outpatient visits to conserve supplies. A key issue facing the nation, Stites said, is how to get equipment to areas that need it the most as “this wave moves from the coasts … into the center part of the country.”
While members of the public are advised to practice social distancing or stay home, many health care workers must get up close and personal with contagious patients every day.
Dozens have fallen ill across the country, taking health care workers out of action when they are needed most.
On Friday, the American Academy of Family Physicians released a statement saying adequate protection is imperative during pandemics to keep providers from being harmed or spreading the disease.
“If the primary care workforce becomes ill with pandemic COVID-19, the health care system will become overwhelmed, or even collapse, resulting in significant harm to the population.”
‘We don’t have enough’
Northeast Missouri’s Scotland County Hospital last week had a 10-day supply of facial masks with splash guards and N95 respirators. Gowns were down to a five-day stock and the hospital only had one day’s worth of other basics like sanitary cloth wipes and foaming hand sanitizer on Friday.
“No one feels safe,” said Randy Tobler, chief executive of the 25-bed facility. “You’ve seen pictures in the busy hospitals in New York City. These guys are in hazmat suits, Ebola suits. We are happy to just have enough N95s and plastic see-through shields for the eyes and these flimsy yellow gowns.”
To aid those on the front line, Missouri Gov. Mike Parson on Tuesday said he reallocated $18 million from the state’s budget to “meet the critical need of PPE.”
That funding would mostly be redirected to three departments: Social services, health and senior services and public safety, especially the emergency management agency.
The Missouri Department of Public Safety has been working to acquire more protective gear from sources that include major commercial suppliers and vendors online, said the department’s director, Sandy Karsten. By Tuesday, emergency management placed orders totaling $17.3 million.
“In every disaster, there is a commodity that’s in high demand: Sandbags in response to flooding, generators in response to an ice storm, roof tarps after a windstorm,” Karsten said. “With the corona pandemic, the precious commodity for everyone we work with is PPE.”
It was already clear, she said, that COVID-19 will have a more sweeping effect on Missourians “than any other previous disaster.”
The single most requested item for health care workers and law enforcement was N95 respirators, which are used to help filter airborne particles and limit the risk of infection. Missouri purchased more than 4.2 million respirators for $10 million.
State officials have also ordered more than 60,000 safety goggles, 95,000 three-layer surgical masks, 7,400 surgical gowns and 335,000 bottles of hand sanitizer.
More protective gear would be needed, Karsten said Tuesday, and officials were working to get it by other means, including a request with the Federal Emergency Management Agency.
But she encouraged local agencies to buy their own when possible.
Then on Wednesday, Parson said an additional $11 million would be reallocated to purchase more PPE. Parson said responding to the virus was “straining hospitals, health care facilities and nursing homes.”
Hospitals with no N95 masks will likely receive equipment from the state first, said Dave Dillon, spokesman for the state’s hospital association. It was “impossible to know” if the number of masks ordered by state officials would be enough, he said.
That will depend on the future patient population.
“What will determine that is how effective we are at bending the curve and flattening it,” he said. “The most important thing the public can be doing right now is not acquiring the virus.”
It makes sense for hospitals to be in “conservation mode” with protective gear as long as it does not put employees or patients at risk, Dillon said.
“Every hospital would prefer to have more than we currently have,” he said.
On Thursday, the health care workers’ union SEIU Healthcare Missouri said its members were reusing masks and facing shortages of gloves and gowns. The union called on Parson to secure adequate PPE.
“Those of us on the front lines need Gov. Parson to step up at this crucial moment and make sure we are equipped to deal with this deadly virus,” said member Caprice Nevils, who works at Saint Louis University Hospital.
The Missouri State Medical Association has called on Parson to issue a statewide “shelter-in-place” order, saying if the virus spread more, patients would deplete available hospital beds, ventilators and the “precious” protective gear.
Jeff Howell, the association’s general counsel and director of government relations, said earlier this week his wife, a nurse, asked him to go to Menards to see if he could find some painter coveralls.
“It’s to the point where they’re starting to take things into their own hands,” Howell said. “If you go to the Home Depot, you won’t find any respirators or the N95 masks on the shelves.
“Clearly we don’t have enough of these things,” he said.
High demand in Kansas
In Kansas, doctors have turned to places like Amazon to order supplies and started drive-thru services to reduce their use.
Dr. Jennifer Bacani McKenney, a physician in Fredonia, has given shots to patients in cars and received urine samples through a drive-thru line.
“It’s different than anything I would have thought I would ever be doing in my life,” said McKenney, who is also vice president of the Kansas Academy of Family Physicians.
“We don’t have a lot of everything,” McKenney said.
Although Wilson County, in southeastern Kansas, had not seen any confirmed coronavirus cases as of Thursday, physicians there were trying to be resourceful. Rural providers are at risk for shortages.
“It’s really a struggle between how much can we protect ourselves now when we don’t have any cases here, and still have resources available for when we know the cases are bad,” McKenney said. “It’s a constant discussion of how are we supposed to do this and what’s the right answer.”
As of Wednesday, the Kansas Department of Health and Environment had 25 pages of requests for personal protective equipment from health agencies across the state.
Dr. Lee Norman, secretary of the department, said the agency is typically not able to replenish all of what is requested. Two semi-trucks of supplies from FEMA arrived Tuesday, prompting “moments of encouragement,” he said.
KDHE is also in talks with providers and the Occupational Safety and Health Administration to acquire ultraviolet light sterilization devices. The technology would allow face masks to be reused by the same person up to five times.
The rate of infection in Kansas had grown this week to 4.4 per thousand, about the same as California’s rate, Norman said. The virus, he said, is forecast to “double in about every three to four days.”
As the coronavirus spreads, Gov. Laura Kelly told the Kansas Hospital Association her administration was “begging and pleading with the feds” to increase the number of personal protective gear shipments to the state and the speed with which they are delivered. Kelly said the state was also seeking supplies at universities and colleges.
Last week, faculty at Johnson County Community College collected hundreds of boxes of face masks, gloves, sanitizer and other items from its science labs and classrooms to donate to local hospitals.
Reusing protective gear
Overland Park Regional Medical Center recently notified nurses that it would stop stocking gowns, masks and face shields on individual hospital units.
Instead, that gear was moved to conference rooms last week for staff to pick up at the beginning of each shift. Nurses were instructed to return goggles, face shields and masks to those rooms at the end of their shifts so those items could be sterilized and reused.
“We will no longer dispose of any masks or goggles/face shields,” the hospital wrote in a memo obtained by The Star.
Officials with that hospital, owned by HCA Midwest Health, did not respond to a request for comment.
To help conserve equipment, the hospital is also designating specific nurses to care for groups of infected patients. For patients that require staff to wear masks and eye coverings, only one of each can be used “for the entirety of your shift while caring for those isolated patients,” the memo said.
At the Kansas City VA Medical Center, emergency room staff have begun bleaching and reusing N95 masks multiple times, according to Lisa Lanai, who said her brother is a physician there.
Lanai’s mosquito control business, Mosquito Joe of Southwest Nashville, shipped more than 200 of their N95 masks to her brother to distribute to hospital staff. He told her it “may literally be a lifesaver,” she said.
“Without the masks, they’re setting themselves up for exposure,” Lanai said, noting medical workers can’t treat patients when they themselves fall ill. “We got to protect them. They are the heroes, for sure.”
In an email, a VA medical center spokesman said its PPE usage followed “manufacturer guidelines and available scientific evidence.”
The first Missouri lawmaker to test positive for the coronavirus, Rep. Joe Runions, a Democrat from Grandview, sounded the alarm this week, saying his doctors at St. Joseph Medical Center in Kansas City were “deeply concerned” they could run out of essential supplies. That included the protective gear they wore each time they checked on him.
“I have witnessed first-hand how much of these supplies are being used up treating COVID-19, and I am just one patient,” said Runions, 79, who called on Parson to “do all in his power” to send supplies faster.
A St. Joseph spokesperson said the hospital currently has sufficient supplies but supported Runions’ efforts to ensure providers have enough to “face this unprecedented pandemic.” A Lee’s Summit company recently donated 1,500 N95 masks to the hospital.
A nurse working a 12-hour shift may, under normal conditions, use two or three masks per patient, one expert said.
As fears of depleting stocks mount, a few Kansas City-area health facilities have put out calls for handmade masks. Armies of volunteers have sewn their own cloth masks, but some officials have questioned their effectiveness.
The Centers for Disease Control and Prevention recently issued new guidance to say that “as a last resort, it may be necessary” for health care workers to use masks not approved by federal officials.
Doctors at the University of Kansas Health System rebuffed attempts to help through such donations.
“If people want to know what they can do to help, perhaps the best thing is — and it’s so frustrating and it’s so boring — it is to stay home,” Stites said. “You want to help us? Stay home.”
Children’s Mercy also said it is not taking homemade masks.
Others, like North Kansas City Hospital and Cass Regional Medical Center, said they are accepting donations.
Cass Regional spokeswoman Sonya McClelland said cloth masks may be worn over N95 masks to prolong their use.
The hospital has attempted to keep a 30-day supply of essential items such as masks, isolation gowns and disposable lab coats. Some items, like sanitizing wipes, have fallen below that threshold.
“We haven’t seen a patient surge here yet,” McClelland said, “but we are certainly preparing for it.”
The Kansas State Nurses Association said it does not support using cloth masks instead of N95s.
“If we’re in a situation where we have to, we will,” said Sommers, the association’s director. ”But we shouldn’t be in a position where those guidelines are so lax.”
‘A lot of game left’
Speaking to Democrat colleagues this week, U.S. Sen. Roy Blunt of Missouri said PPE was a term he may not have recognized six weeks ago. Now it was a large part of the conversation.
The lack of protective gear was one reason hospitals were halting elective surgery, Blunt noted. But if health care workers had more equipment, he said, “there would be no reason that those surgeries weren’t happening.”
Calling the COVID-19 circumstances ones that “no one has ever seen before in our country,” Blunt said expanding telehealth and encouraging people to not get tested if they don’t need to could cut down on the use of safety supplies.
“Because every one of those tests requires a pair of gloves, a unique mask, maybe, with some frequency, different protective equipment,” he said.
Blunt, along with the rest of Missouri’s congressional delegation, sent President Donald Trump a letter Wednesday in support of Parson’s request for a disaster declaration.
“In many Missouri communities, efforts to prevent and mitigate the spread of the virus are constrained by inadequate access to resources, including personal protective equipment,” the delegation wrote.
Trump approved the disaster declaration Thursday.
Nurses have reported vast differences in supplies across Kansas City’s various hospital systems. Some seem to have plenty of protective equipment and are even issuing surgical masks to patients. At others, nurses are wearing the same mask for an entire shift.
“Typically, that’s not what you would do any other time,” said Gunter, who has worked as a nurse in hospital, school and surgery center settings. “You would wear a new mask with every new patient, every new contact.”
A petition calling on the Trump administration to deliver more protective equipment garnered more than 130,000 signatures nationwide. Health care workers have also begun using the hashtag #GetMePPE.
As of Thursday, the Kansas City region had not seen an overwhelming number of COVID-19 cases, but health experts warned within weeks, the local outbreak could be as severe as in Seattle. There, King County officials reported more than 1,800 cases as of Saturday and 125 deaths.
Stites, the top medical officer at KU’s health system, hoped some factors, including the Kansas City region’s stay-home orders and its lower population density, would play in local doctors’ favor.
Bed availability, for example, has so far not been an issue in Kansas City. But in New York City, where the virus is doubling every three days, thousands of intensive-care beds will be needed.
New York Gov. Andrew Cuomo this week pleaded for more help from the federal government, which recently sent the city 400 ventilators though it reported needing 30,000.
Stites compared combating the virus to a football game. The Kansas City region was still in the first quarter, he said.
“There’s a lot of game left.”
The Star’s Steve Vockrodt contributed to this story.
This story was originally published March 29, 2020 at 5:00 AM.
