Oregon Is Burning Through PPE, Putting Health Workers Treating COVID-19 At Risk
Bryan White leaned in to greet his wife with a kiss on the forehead when she arrived home from a 12-hour shift at Salem Health, a hospital that's had 19 confirmed cases of the coronavirus.
“Nope, you don’t want that,” his wife told him as she rebuffed his kiss.
White’s wife, a registered nurse who is 22 weeks pregnant with their first child, has been reusing one disposable surgical mask for each shift, stashing it in a paper bag after every patient visit. She takes her scrubs with her each night to wash at home, where she also lives with her 95-year-old grandmother.
“Some days she comes home feeling on top of the world. Then some days she comes home in tears. Yesterday was one of those days,” White, 27, said.
His wife declined to speak and requested she not be named for fear of being fired.
On Friday, after weeks of watching his wife struggle to get basic protection from the hospital to keep her safe, White decided to make her a surgical mask. He left work to buy cloth and elastic at Walmart and began sewing for the first time since his seventh grade home economics class.
When he was done, hours later, she had a gray and white, polka dot mask to take to work.
“She's like a superhero,” White said. “And here, I mean, I work in retail.”
From Oregon to New York, many health care workers are fending for themselves without access to protective gear as they treat the rapid spread of the new coronavirus that had infected more than 83,000 Americans as of Thursday, more than any country in the world. In Portland, nurses are using swim goggles instead of face shields. Hospital nurses in Colorado set up an on-site sewing station. And in New York City, hospital workers turned trash bags into surgical gowns.
Oregon is one of many states that was relying on the federal government for its response. Leaders in the state waited more than a month after the first case surfaced in neighboring Washington to request more protective equipment from the federal government. They waited weeks longer to call for public donations and restrict non-emergency medical procedures to bolster their supply of masks, gloves and other equipment.
The result is a pregnant nurse in the world’s richest country without basic equipment to protect her from infectious disease.
"She is incredibly vulnerable to an unnecessary infection. That's because of the failure of the federal government to lead,” said Dennis Carroll, former director of the Emerging Threats Division of the U.S. Agency for International Development. Carroll, now a fellow at Texas A&M University, spent decades researching infectious diseases for the federal government.
“Public health workers should never have been put in the position they're in. It's a direct consequence of neglect,” Carroll said. Then he compared the U.S. to the nation that leads the world in coronavirus deaths. “Italy will look good by the time we're finished.”
'No one is coming to save us'
During a press conference Wednesday, Oregon Gov. Kate Brown said she found it “extremely alarming” that doctors and nurses were so low on supplies that they were making their own protective equipment.
The problem, Brown said, is that the federal government is forcing states to scour the open market for masks, gloves and other basic safety supplies.
“I'm not exaggerating when I say this outrageous lack of action will result in lost lives, including those of our health care workers,” Brown said of the federal response. “And it's completely unacceptable.”
Health experts say the problems can be traced back to actions by the Trump administration. Since 2017, the administration has cut programs across multiple agencies designed to detect threats to public health and communicate information about infectious diseases, including a position in Beijing monitoring Chinese outbreaks for the U.S. Centers for Disease Control and Prevention.
The federal government also was slow to roll out testing to monitor the spread of the virus after the CDC designed a flawed test for COVID-19 instead of adopting one used by the World Health Organization.
Portland-area doctor Smitha Chadaga said hospitals rely on state and federal health authorities to tell them when and how to prepare for outbreaks. She said the federal government’s flat-footed response and the lack of central coordination blindsided hospitals.
“We keep just sort of chasing our tails and trying to figure this out, and it adds a level of exhaustion that we really don’t need in our health care workers right now,” Chadaga said.
Chadaga, who worked through the 2009 H1N1 swine flu epidemic and 2014 Ebola outbreak, said she has never seen such a poor response at the highest levels to a public health crisis. And in her 20 years practicing medicine, she’s never faced the prospect of fighting a virus without enough masks, gowns and gloves to keep her safe.
“Everyone assumed that someone else was going to take care of it until it was on top of us and we realized we have to take care of this,” Chadaga said. “No one is coming to save us.”
The country’s Strategic National Stockpile, a cache of medical supplies and pharmaceuticals established in 1999 to respond to sudden crises like COVID-19, has been diminishing since President Barack Obama’s first term when states tapped the stockpile during the H1N1 influenza pandemic.
Carroll, the infectious disease researcher, said the national stockpile should contain between 500 million and 1 billion protective face masks for a situation like COVID-19.
But by the time state requests started flooding in this month, the stockpile had only 30 million protective face masks, many of which were expired. Last week, NewYork-Presbyterian Hospital estimated it would soon be using 70,000 masks per day. If every hospital in the country burned through masks at even 10% of that rate, they’d use up the stockpile in less than a day.
“That's appalling,” Carroll said of the depleted national stockpile. “It was bad planning, bad preparedness. The states shouldn't be stockpiling this at large scale. That's the purpose of a federal government.”
In White House press briefings, Trump has placed the blame for the shortage of medical equipment on previous administrations, saying they did “very little” on the matter.
The administration praised what it called an extraordinary outpouring from the private sector, and it said it was coordinating with governors to solve the equipment shortage.
“I just received a report — we’re going to be detailing it before the end of the week — where we’ve literally identified significant resources — not just around the country, but around the world — of the masks that can be used by health care workers,” Vice President Mike Pence told reporters Wednesday.
The administration announced the intention to buy 500 million masks in late February, but with exports limited because of a global shortage and few manufactured domestically, the order could take more than a year.
Lawmakers, including Oregon Democratic Sen. Jeff Merkley, and governors, including Andrew Cuomo of New York, have called on Trump to nationalize the medical supply chain using the Defense Production Act. The president has resisted the calls, saying companies would voluntarily meet the need.
In a pandemic, the stockpile should be the bridge between hospitals’ current supply and reinforcements from nationalized production, said Oregon State University professor Christopher McKnight Nichols.
“If it had been used more fully earlier and then combined with the Defense Production Act to ramp up businesses making ventilators and personal protective equipment, we wouldn't be in the situation that we are now in,” Nichols said. “You don't want mayors going down the street asking who's got an N95 mask.”
Competition for protective medical supplies has left many smaller states without critical gear.
Oregon had 317 known cases as of Thursday afternoon, with new ones every day. But it’s sandwiched between two of the most affected states in the country — California, with more than 3,000 cases, and Washington, which had the first documented COVID-19 case in the U.S. and had more than 3,200 people infected as of Thursday.
“The harsh reality is that the feds have told us that we need to go on the open market, but every state in the U.S. is competing to secure these scarce products. And we're also competing against the federal government,” Brown said. “What is available is being prioritized for hot spots like New York, California and Washington, leaving a state like Oregon with few options.”
Oregon asked the federal government for 400,000 masks, gloves, Tyvek suits and surgical gowns. The state got only a quarter of what it requested.
And when the trucks arrived from the federal government’s stockpile, they were carrying expired gear. Brown’s staff says they’ll use it anyway.
First cases challenge claims of readiness
Oregon Health Authority Director Patrick Allen on Feb. 28 said that officials would be ready if the coronavirus arrived in the state.
But when the state’s first case was announced hours later, officials weren’t ready.
Oregon has fewer hospital beds for its population than any state in the country. It has tested less than 0.1% of its population for COVID-19, a rate worse than at least 22 other states, according to an OPB analysis of data from The COVID Tracking Project.
By March 25, well before the expected surge in COVID-19 patients, the state had burned through all of its emergency stockpile of surgical masks, 80% of its respirators and 90% of its hospital gowns.
As China, later Italy and eventually neighboring Washington state fell into crisis, Oregon’s governor and lawmakers were locked in a political standoff over carbon emissions policy. Not a single bill passed dealing with the new coronavirus or the state’s health care system when the session adjourned March 8.
The governor plans to call lawmakers back as early as next week for a special session on the coronavirus.
On March 3, days after Oregon had its first coronavirus case, Brown requested additional supplies from the federal government. She followed up with another request one week later.
Her counterpart, Washington Gov. Jay Inslee, first requested supplies from the federal government on Feb. 29, the day of the first coronavirus death in Washington. The request came more than a month after the first confirmed case of the virus in his state.
On March 18, Brown ordered medical providers to stop all non-emergency procedures in the hopes of preserving equipment. Oregon began collecting equipment donations a day later, but workers at some hospitals said they were already days away from running out.
Major hospital systems in Oregon have not disclosed how many days of protective equipment they have left. Administrators acknowledge a national shortage but say that their current supplies are adequate and that they are taking steps to conserve what they have and secure more.
But several employees at Oregon hospitals said their organizations are trying to save face, caught off-guard by a global pandemic that is suddenly hyperlocal.
Lynda Pond, president of the Oregon Nurses Association, said hospital administrators keep their supply stocks to a minimum to avoid eating the cost of expired equipment. She said they should have learned from past outbreaks.
“To just continue to go about business as usual of just ordering the stock to maintain the safety of your employees for what's happening today, without thinking about tomorrow is a huge mistake,” Pond said.
Pond, who lives in Eugene, is part of a community effort to sew masks for nurses in the area.
“I didn't become a nurse to have to sit at home and make my own masks,” said Pond, speaking on behalf of her union’s members. “The hospital that has employed me has an obligation to me to make sure that I have the PPE necessary to protect myself and therefore my family.”
Leaping at the chance to help
Amber McPherson, an emergency physician in McMinnville, has resigned herself to the likelihood that she will get the coronavirus.
She knows that soon she and fellow doctors will be overwhelmed and unprotected during a wave of infected patients.
Because of that, she said, they found themselves wondering if they’d be better off just getting the virus sooner rather than later and hoping they recover in time.
Her hospital, the Willamette Valley Medical Center, is relatively well-prepared but still rationing masks.
When McPherson posted online asking neighbors to donate masks, quilters, crafters and other volunteers responded in such force that she’s now desperately looking for someone to coordinate donations as she splits her time between the emergency room and raising four kids.
“I'm a little bit in over my head, actually,” she said. “I wasn't prepared for quite how many people were ready to dive in, but it's great.”
Even as flocks of volunteers craft and donate masks for hospital workers, it’s unclear if they’ll be at all effective, or even used.
A hand-sewn mask, while perhaps better than nothing, is less effective against infection than a surgical mask or a certified particle-filtering respirator.
Some hospitals in Oregon are grappling with whether to accept protective gear sewn by the public. Others have policies against employees bringing their own equipment.
Oregon Health & Science University is not accepting handmade donations, but officials said they’re researching effective materials and patterns people could use to sew masks for the hospital.
The Salem hospital where White’s wife works prohibited employees from bringing their own equipment from home. So, White didn’t make any additional masks.
On Wednesday night, the hospital announced it was creating its own kits for volunteers to sew up to 10,000 surgical masks, enough to last them about three weeks.
White was happy to have a chance to help his wife.
“It’s hard to feel helpless,” he said.
This article was produced in partnership with the ProPublica Local Reporting Network. ProPublica is a nonprofit newsroom that investigates abuses of power.
This article was originally published March 26, 2020. The audio was added April 2, 2020 when it aired.
Copyright 2020 Oregon Public Broadcasting