Scared of being sent into battle without a shield, Candice Cordero has been clamouring for better personal protective equipment since coronavirus hit the US months ago.
She and fellow nurses have protested on the kerb in front of their hospital, Blake Medical Center, just outside Tampa, Florida. Standing six feet apart in their scrubs and masks, some held homemade signs that read: “Safe nurses = safe patients”.
Now, the virus is spreading rapidly in Florida, with more than 300,000 cases and over 4,500 deaths — and it has taken Ms Cordero down with it.
She is at home sick with Covid-19, after she had only a surgical mask when taking care of patients — who she was told did not have the disease — not a more protective N95 mask.
“I just hope that there are no nurses that die at my hospital. There are no nurses who should have to die for their jobs,” Ms Cordero said.
Surges in Covid-19 cases in swaths of the US have left many healthcare professionals once again hunting for PPE, and asking why hospitals, state and federal government did not secure supplies in the months since the virus emerged in the country.
At least 300 healthcare workers have died from Covid-19, according to the official figures, but many believe it is undercounted.
Demand for PPE soared 176 per cent in Arizona in June, 224 per cent in California, 237 per cent in Texas, and 240 per cent in Florida from the month before, according to volunteer organisation GetUsPPE, which is helping healthcare providers source masks, respirators and gowns.
Ali Raja, a co-founder of the group and a leader in the emergency medicine department of Massachusetts General Hospital, said people were “desperate” for PPE because of the wave of cases sweeping states in the south and west. The group has more than 13,000 active requests and has only been able to fill about 10 per cent of the demand, as overseas suppliers are more reluctant to export during the global crisis.
“I’ve heard from my friends in hospitals in Houston, where they’re wearing raincoats and ponchos instead of hospital gowns, any plastic barrier to separate them,” he said. “We’re hearing a lot from folks who are telling us that they’re just making do without because they have patients who are ill and need to be cared for.”
Ms Cordero reports nurses are leaving their jobs because they do not feel safe and patient care is suffering because staff are focused on preserving supplies. But Blake Medical Center said its use of PPE exceeded the guidelines from the Centers for Disease Control and Prevention and the Florida Health Department.
“We are extremely disappointed in any efforts to discredit the hard work and excellent patient care being provided in our hospital during this pandemic,” the hospital said. “Our mission here at the hospital applies to our caregivers as well as patients: Above all else, we are committed to the care and improvement of human life.”
Major medical associations and unions representing healthcare workers are calling on the federal government to use the Defense Production Act, which requires private companies to prioritise its orders, to force the manufacture of more supplies. So far, the act has only been deployed to increase production of ventilators. They are also calling for a national system to allocate PPE, rather than individual healthcare providers competing against each other for supplies.
Kim Smith is a nurse at Corpus Christi Medical Center in Texas, between Houston and the border with Mexico. She has enough masks but they do not fit well and she worries about whether they are still effective after being cleaned and recycled. Ms Smith said she first lobbied management to come up with a plan for PPE on February 17 but felt like it was treated as a “joke”.
Eric Deppert, chief medical officer at Corpus Christi Medical Center, said it was meeting government guidelines, including extended use of masks and decontaminating respirators. “We have the supplies necessary to continue to protect our colleagues and patients as this crisis evolves,” he said.
Ms Smith also blames the federal government for putting politics ahead of preparedness. “We should have instituted the Defense Production Act . . . They should have just stocked us up,” she said. “The virus doesn’t care how you feel, or if we’re Democrat or Republican . . . we have to be prepared for this.”
The battle for PPE has also shown up inequality in the US healthcare industry, where it has been easier for large hospitals with purchasing power to obtain supplies, than for small, poorer or rural hospitals, said Dr Raja. Other healthcare providers — including long-term care providers that have suffered from explosive superspreader events — also need PPE.
Mark Labella is an administrator at Fair Oaks Manor, which provides care for adults with disabilities across several sites in and around Los Angeles. He has been spending his own money buying masks for staff and residents, even as their price has soared sixfold.
The navy veteran, who did pandemic drills during H1N1, believes the president is neglecting his responsibility to act as the “incident commander”. Pointing to President Trump’s reluctance to wear a mask, he said: “First and foremost, you have a president that does not care for PPE himself.”
Carri Chan, associate professor of business at Columbia University, who researches healthcare operations, said there should have been enough time since March to secure more PPE. She warned that a lack of PPE is a “long term problem”, as healthcare professionals will need extra supplies at least until a vaccine is widely available.
“We lost a lot of precious time by not acting when we saw the problems four months ago. We lost time when we didn’t act seven months ago and start to prepare,” she said. “The question is: what needs to happen to start to realise that more action is needed?”
Reaching for remdesivir
Patients hit by the most recent wave of the Covid-19 pandemic have a reason for hope that earlier victims did not: access to remdesivir, the Gilead drug that received emergency approval for treating those seriously ill.
But in some places, remdesivir is also in short supply. The Florida Hospital Association estimates the most recent shipment of 427 cases of the drug would only cater for 30 per cent of the patients who meet the criteria, as patient numbers soar.
The association said the health department was not expected to send more before July 27. New York sent some of its supplies to Florida but it has not been enough. “Hospitals are grateful for the allocations but remain very concerned about adequate access to the drug in the days ahead,” it said this week.