Emergency room physicians, nurses and hospital administrators never expected to have to become experts in the supply chain for rubber gloves, surgical masks or cotton swabs, but over the last three months they have become just that.
Now that hospitals like CHA Everett begin the phased approach of fully opening back up as COVID-19 cases continue to decline at the facility, those medical professionals once again feel the need to plunge most of their free time into finding PPE and other medical supplies – which are still hard to get.
Dr. Melisa Lai-Becker, chief of the Emergency Department at CHA Everett, said there have been great gains at the hospital over the past two weeks, but in some ways they find themselves back where they started – especially with PPE.
“Last Monday was the official Phase 1 of re-opening,” she said. “We are looking forward to the last week of the month if they progress appropriately, we should be able to begin Phase 2, which gets us able to get our ambulatory clinics back up and the in-person visits,” she said.
“The biggest part of the planning right now continues to be where we first started,” she continued. “That’s all about the PPE.”
As the hospital re-opens clinics and inpatient services, as well as isolates patients from the Emergency Department who need to be admitted – there is a requirement to test everyone for COVID-19 so that the virus isn’t spread to healthy people seeking routine non-COVID treatments. That, combined with the return of surgeries and other procedures requiring PPE and expanded testing, has put a strain on the ability to have all the supplies necessary for those on the front lines.
“It goes to the supply chain – the details of the supply chain,” she said. “It’s amazing how much everyone has learned about supply chains through all of this. We’re looking at a long-term N95 respirator solution. We would like to as soon as possible not have to re-use single-use N95 masks. We’re looking at our options. It is quite a feat on the supply side as each hospital has to individually – with the help of the state – look at the bottlenecks. I keep thinking over and over how lucky we are to be in Massachusetts.
“We really need to see if there will be enough N95 masks for the Emergency Department, the ICU and those who are on a regular medical floor,” she continued. “When we return to surgery, it will be important everyone in the operating room isn’t just outfitted in surgical masks. There are a lot of people to outfit.”
That said, as the hospital becomes busier with non-COVID responses, one of the areas of workers that are of great concern to the hospital are those in Environmental Services who have to clean and sanitize the rooms. They are, she said, right now at the greatest risk of contracting the virus in the hospital, and it is important she said to make sure they have enough PPE.
“They don’t even have the luxury of even being able to not go into some patients’ rooms,” she said. “For them, it’s a full court press the entire shift with practically every room and area they are cleaning. They will aerosolize every surface…That is our big challenge now.”
Another major concern along the supply lines is testing.
She said they offer three kinds of tests, but testing equipment and swabs for testing are still in short supply. Some of the tests, like the rapid test that gives results in 20 minutes, has at least 40 percent rates of false negatives. That means a negative test requires another costly, though more accurate, test that gives results in one or two hours. The third test gives results in about one day.
“The issue is the one to two hour test is very popular and there isn’t enough supply to test everyone,” she said. “You have to ration it. You have to use it only on patients going into the hospital. Even with rationing, a supply will last about two days. We just went through a 10-day period of not having that test. We had to rely on using the six to eight hour test. It becomes too much.”
That’s because anyone being admitted to the hospital, whether for medical reasons or behavioral health reasons, has to be tested and has to have a result before moving forward with anything. That is a safety precaution meant to prevent the spread of the virus to “well” parts of the hospital. For example, if someone breaks their ankle and needs surgery, they have to be tested for COVID-19 and get a negative result before they can get that surgery. If there isn’t enough testing available, such routine things become a waiting game.
It can become even worse at a place like CHA Everett where the testing supplies are short, and the six to eight hour test is only available at the Cambridge campus. That requires a courier to run tests back and forth – a courier that isn’t always as fast on Monday as he or she is on Sunday.
“We have to collect all the samples from Everett and get a courier,” she said. “On a Monday, that courier will make six to eight runs a day, which is good. On a weekend, they might only come by four times. You just try to time everything.”
The PPE situation is also a persistent problem that goes back to April, when things were on the upswing.
She said they ran out of disinfectant wipes eight weeks ago and could never get any more. They made due by soaking regular paper towels in disinfectant and using them instead. They’ve also been out of hand sanitizer for many weeks.
“We’re doing what many facilities do and that is we’re making our own sanitizer,” she said. “We’re also getting hand sanitizer the craft breweries are making. That is such a great pivot on their part.”
She said they hear that many of the supplies that were being made at places like Honeywell, and other industries that were compelled to begin making medical supplies, are not going to hospitals. Instead, they are going to the federal strategic stockpile. She said many hospitals would rather see these supplies continue to come to them. Once they are fully stocked with a 60-day supply, then maybe it can be put to the stockpile.
For now, she said she wonders how they’re going to continue on for the next year or more with on and off supply issues.
“We’re between Phase 1 and Phase 2,” she said. “The energy is going into how we are going to do this for another 18 months. Where do we stand with the supply chain? We don’t want to take it all for granted – all the extra time gained by everyone staying at home. We’re over the hump and getting ready for the next surge and we know it will come. Every hospital is looking at these issues that we have no control over. We’ve bought two months of time and it was all intended to be for making more supplies, testing agent, N95 masks and disinfectant wipes.”
Yet, at the same time, even with that bought time, hospitals like CHA Everett are coming up broke when they seek out critical supplies.
Large Gathering Surge
There is some concern that the large gatherings at protests – and in restaurants and other areas that are opening – might trigger a surge in cases.
While experience tells hospital officials that the large protests around the country – including in Boston – should trigger an uptick in virus cases, there is hope that it may not happen.
“Being outdoors and wearing masks – that could be a big help,” she said. “That’s much better than being inside with the same density of people.”
Only time will tell on that, and hospitals are watching and preparing in case there is a surge related to protests and warm-weather gatherings.