SOUTH BEND — Caramia Hummer felt loved recently when her husband, Bob, who works in drywall and painting, laid his extra face masks on the kitchen table for her, alongside cloth bags that his mother sewed to help keep her masks clean as she reuses them.
“This is what (heart emoji) looked like to me today,” the Granger mother of four posted on her Facebook page, with a photo of the items. “Who knew that PPE would soon be a commodity worth more than gold?”
PPE is shorthand for personal protective equipment, something Bob and his mother know Caramia will need in coming weeks as a respiratory therapist at Saint Joseph Health Center in Mishawaka.
She’s one of the many men and women on the front lines of the battle against the coronavirus amid a national equipment shortage that began as a supply problem in January after the outbreak halted manufacturing in China, where the virus started.
Those factories are ramping back up, but global demand for the products is surging as more people contract the virus.
Leaders at all three area health systems say they have enough gowns, masks, respirators, face shields and gloves for now, but they’re in “conservation” mode as they worry about an uncertain future.
“We’re keeping an eye on it basically 20 hours a day right now,” said Greg Piper, supply chain leader at Beacon Health System.
Dr. Brian Huber, medical director at South Bend Clinic’s Immediate Care Center in Mishawaka, said it’s “not gloom and doom,” but health care providers are looking for creative ways to make due with less.
“We’re in that innovative stage,” Huber said. “We know there’s not going to be enough in the long run and so what can we do between now and then to make up that difference? We’re getting more supplies in, but the more we get infections, the more we’re going to utilize. Today we’re fine. Five days from now we’re fine. What does it look like in two weeks? What does it look like in three weeks?”
The shortage factored into Saint Joseph Health System’s recent decision to eliminate visitors and elective surgeries and procedures for the near future, said Genevieve Lankowicz, chief medical officer at the system.
“That’s really hard for some patients, and it was a hard decision for us, but we had to conserve the equipment that we might need if we do have a surge of patients,” Lankowicz said.
At hospitals and clinics, conserving means reusing the respirators known as “N95s,” considered the gold standard for protection. The Centers for Disease Control doesn’t typically advise reusing protective equipment but has issued guidelines allowing the practice in light of the shortage.
Beacon hopes to make its supply of N95s last longer by having staff cover them with 22,000 cloth masks that a South Bend-based nonprofit, Sew Loved Women’s Center, is making and donating. The cloth masks are too loose-fitting to be worn by themselves when coming into contact with high-risk patients, but they can keep the N95s clean for longer. They can also be worn alone around patients who seem to be at lower risk of having the virus.
Piper said he’s also been approached by several Elkhart area manufacturers that are considering retooling their operations to make the masks.
“It’s been really very interesting to see all of the volunteers across our community here … that are pitching in to make simple face masks so that we can cover these N95s and conserve this precious resource,” he said. “Everybody has been wonderful and their generosity is coming out, and it’s great to see.”
Sew Loved, which teaches women to sew, is asking people to volunteer to sew or donate money for supplies on its website, www.sew-loved.org. Sewing kits will be sent out soon, according to the group’s Facebook page. A later phase will involve sewing masks that everyone who enters the hospital will be given to wear.
Dr. W. Graham Carlos, a professor at Indiana University School of Medicine, said he’s seen hospital personnel using homemade masks in situations that don’t involve direct patient care. IU Health Systems and Eskenazi Health, where he is chief of medicine, are requiring all staff to wear masks to decrease the spread of droplets “now that we know that the virus is endemic in our communities.”
Carlos said covering the N95s with the masks sewn by volunteers sounds safe.
“It sounds like they’ve taken the proper steps by doing this in a way that gives credibility to the material and ergonomics of the mask,” Graham said. “So it sounds like a good idea for hospitals that reach a desperate situation and need to protect their N95s as much as possible.”
Last week the St. Joseph County Health Department asked businesses that have closed or reduced hours because of the virus to donate any protective equipment they can to the department, which will then distribute it to area care providers.
Hospitals and clinics are required to send daily counts of their PPE to area emergency management agencies, which forward the figures to the Indiana State Department of Health, which is distributing protective gear from the Strategic National Stockpile. The three local systems were heartened to receive a range of supplies on Friday and to learn that another delivery was expected Tuesday.
Those shipments were for hospitals and clinics only. Dr. Mark Fox, the county’s deputy health officer, said he’s concerned that nursing homes won’t have enough N95s if the virus starts spreading among their patients, so he has asked area businesses to donate them. For now, the state Department of Health is asking all nursing home staff to wear the looser masks, like the ones volunteer groups are sewing, even before any cases are diagnosed.
“That’s one of the initiatives that will be very helpful,” Fox said. “We like to encourage people in that effort as we go forward.”
How to reuse
Lankowicz, of Saint Joseph Health System, said hospitals hope the National Stockpile shipments keep coming, “but we all know the concern is that we may not have enough. Folks are looking to conserve and when we say it that way, I don’t want the message given to the community that it’s dangerous and that we’re reusing things we’re not supposed to use, because there is a safe way to do it that has the approval of infection prevention experts in the CDC.”
Lankowicz described a process the CDC says allows an N95 to be worn up to five times, using a plastic face shield rather than the cloth mask.
“You can imagine if you’re wearing a big plastic face shield over your head to cover the front of your head, then if you’re wearing a mask underneath that big plastic shield, nothing is getting on that mask,” she said. “That’s why it’s safe to take off your gown and gloves, wash your hands, put new gloves on, take off your plastic shield on your head and clean that off with disinfectant wipes. Wash your hands again. Take off your clean face mask that was underneath that helmet and put it in a bag to be used again next time.”
Emergency medics also have had to get creative. In addition to reusing and sterilizing, the Mishawaka Fire Department is trying to make its roughly 200 N95s last longer by changing some operational standards, said Brian Thomas, EMS chief.
“If we had six people on scene, all six would go in full PPE and enter the scene,” Thomas said. “What we’re doing now is we’re having one person put on the appropriate PPE, go in and do a triage of sorts and then only request the exact number of people to enter that’s required for the scene.”
Thomas said the department thinks it has enough N95s to last a week or two.
“If someone a month or two months ago would have asked me, ‘Hey, how long would it take you to go through a couple hundred N95 masks?’, I might say the rest of my career. I wouldn’t be telling you one to two weeks.”
The delays in getting COVID-19 test results back — processing is taking a week or longer as private labs struggle with a national backlog — are making it harder to conserve equipment, said Hummer, the respiratory therapist.
“In the interim you are treating every patient who’s symptomatic like that, as if they’re a COVID patient, and you’re using all of these PPEs multiple times throughout the day for patients that may be negative that we don’t have to use as many precautions for,” she said.
Hummer wants people to understand that it’s frustrating for health care workers to see people wearing N95s while shopping in stores.
“I’m not saying those people shouldn’t be safe,” she said, “but it’s hard knowing that people are hoarding this and buying up this equipment, and making it more difficult for us to access that.”
Tribune reporter Christian Sheckler contributed to this story.