During normal times on a typical day at the small hospital where she works outside Dallas, licensed vocational nurse Meredith Daniels might use and dispose of multiple N95 respirator masks during her 12-hour shift. However, these aren’t normal times, and one day last week, Daniels helped care for as many as eight patients with COVID-19. Because the special, close-fitting N95s are effective for protecting against airborne droplets – the particles can fly off COVID-19 patients when they’re coughing or undergoing procedures like intubation – hospitals are conserving the respirators, and healthcare workers like Daniels are being allocated only one mask per shift.
“Ordinarily, you’d never reuse an N95 mask. But because we know there’s a shortage out there, we are reusing them,” Daniels says. “When you’re not using it, you go put it in a brown paper bag with your name on it. And that’s scary, because what if somebody that had it coughed on the outside of the mask and then you put that in the bag, and it gets on the bag? That’s not good, but I guess it’s better than running out. We just never realized we’d have to have this many.”
No doubt, conserving supplies of personal protective equipment (PPE) for healthcare workers has become a priority for hospitals nationwide during the coronavirus pandemic. On April 13, the Centers for Disease Control and Prevention (CDC) reported a shortage of PPE like N95 respirators, eye protection, gowns and gloves for U.S. healthcare personnel. On April 14, the CDC announced that more than 9,000 U.S. healthcare workers had contracted COVID-19 between February 12 and April 9, and at least 27 of them had died.
Protecting their workers aren’t the only concerns hospitals are facing these days. They’re also worried about their bottom lines. As priorities have shifted to focus on COVID-19 patients, elective surgeries and procedures have been suspended, choking off major sources of hospital revenue. Aside from her Texas hospital’s COVID-19 unit, Daniels says, “The hospital otherwise is really kind of dead, because we’re not admitting anybody unless it’s a COVID patient or someone with a real urgent need, like to get their gall bladder or appendix out, or they’re in labor.”
As a result, some hospitals – including ones in Chicago, Philadelphia and Duluth, Minnesota – have announced furloughs and layoffs. Others have grown cautious with their hiring, mainly seeking specialists like respiratory therapists to treat COVID-19 patients. Daniels’ hospital is no exception. She says it is actively seeking to hire respiratory therapists and registered nurses. Meantime, a measure of relief for cash-strapped hospitals has begun flowing from the federal CARES Act, which is providing them with $100 billion in bailout money.
Waiting for The Bottom to Fall Out
For nurses like Daniels on the frontlines of the pandemic, bits of good news are rare but especially welcome. “We had one patient come off the ventilator who’d been on it for over two weeks,” Daniels says. “He was a pretty healthy guy, middle-aged. But that’s what’s so scary about this virus; it’s just so unpredictable. There’s some sort of genetic component that the researchers haven’t figured out that causes it to react differently in different people.
“Someone who’s older and might have pre-existing lung disease or COPD, you expect to see it hit them hard,” Daniels goes on. “They might already be oxygen-dependent before this happens. You expect to see them gasping for air. But when you see somebody come in who’s in their late 40s, early 50s, who’s otherwise healthy, and they’re on six liters of oxygen or even have to go on a ventilator, that’s just mind-blowing.”
When we spoke on April 8, Daniels said her hospital was expecting its peak surge of patients to come later in April. “We’re adequately staffed at the moment. But in the next 10 days or two weeks, I think that’ll probably change,” she said. “Right now, all our staff is healthy, and we have enough supplies. But who’s to say that’s going to be the case when we’re really in the throes of it? We’re just bracing and waiting for the bottom to fall out.”
On April 8, the county where Daniels works had reported 15 cases of COVID-19. At the time of this story’s publication, the number of reported cases had risen to 41.
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