A rash of panic-buying and worldwide demand has led to a shortage of masks to protect medical workers treating coronavirus patients in the US.
- Doctors treating coronavirus patients in at least two New York hospitals are reusing their masks to conserve their supply of medical gear.
- Generally, face masks are designed to be used once. It's not clear if N95 masks, which protect from airborne diseases, are safe to use repeatedly or for extended periods of time.
- Doctors at both hospitals described a paper bag system, where medical workers receive a paper bag to hold a single mask they can use repeatedly before swapping it out for a different one.
- The US is experiencing a severe shortage of N95 masks.
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Doctors treating coronavirus patients in two hospitals in the New York City area are taking steps to conserve their supplies of protective gear, amid a nationwide shortage.
In both hospitals, doctors using N95 respirators are being told to reuse them by keeping them in a bag and putting them on again later. N95 masks filter particles out of the air, and are commonly used when doctors are caring for patients with infectious diseases that spread through the air. Normally, doctors use a new mask for each patient or procedure.
In one of the hospitals, in New York City, administrators told doctors to continue using their surgical face masks until they're damaged or "soiled," according to a memo viewed by Business Insider.
Normally, doctors can obtain N95 masks, which provide a higher degree of protection than surgical masks, freely, according to the doctor. But the supply of N95 respirators has been severely limited.
Business Insider is not identifying the doctors at their request so that they can speak freely about the mask shortages at their hospitals without professional repercussions.
Northwell Health, a major New York City-area health system, confirmed that it's advising staff to use a single N95 mask for their full shift and store it in a paper bag when not using it. The health system said it's following CDC guidelines.
"We continue to seek an additional supply of N-95 masks, but because the supply chain is tight right now, we need to do what we can to protect our stock," a spokesman for the health system said.
N95 masks are a tight-fitting type of mask that's highly effective at filtering out airborne particles, such as the type that carry the coronavirus. Surgical face masks are less effective and are generally not recommended by the US Centers for Disease Control and Prevention to protect people from airborne diseases. According to the US Food and Drug Administration, neither should be used more than once.
The CDC recently changed its guidelines for mask use to respond to the shortage of N95 respirators. In places with shortages, it now says that N95 masks can be reserved for coronavirus cases involving "procedures that are likely to generate respiratory aerosols" — meaning that airborne particles carrying the virus would be flying about. In other cases, medical staff can wear surgical masks.
One of the doctors said that at their hospital, physicians are only permitted to use N95 masks when dealing with a situation that poses a high risk of catching an airborne disease — such as treating COVID-19 patients, or people tested for the coronavirus but who have not yet received their results — and must continue using the same mask until it's unusable.
"It's impossible to get the N95 unless you have real, direct patient contact," a doctor in one hospital said. "And even for those, they're giving you one a day and telling you to reuse it for half a day."
"It's happening because of the shortage," the doctor at the New York City hospital said. "It's strange seeing people walking around the streets with N95s knowing that the people on the front line don't have them."
The paper bag system
Cases of coronavirus have been increasing quickly.
And the virus has led to unprecedented nationwide measures to isolate people from one another and flatten the curve of likely deaths and illnesses. New York has 1,500 confirmed cases, more than any other state.
As the number of cases is expected to increase, doctors in the two New York hospitals are using a paper bag system to ration masks. Supervisors provide a paper bag with a surgical mask in it to each doctor, who has to put their name on it. The supervisors keep a list of all the doctors who received a mask, as if in a library. Doctors can get another mask only if their mask gets dirty or damaged.
While not using the masks, doctors are supposed to keep the masks in their bags to keep them secure.
But it's not clear if this system is safe for medical workers.
"Who says, like if you put it in a paper bag, the virus that's on the outer part of it can't go to the inner part of it?" a doctor at one of the hospitals told Insider.
The CDC has said its recommendation that doctors can use surgical masks instead of N95 masks is based on "local and regional situational analysis of [protective equipment] supplies."
Elsewhere on its website, the CDC lists the risks to reusing N95 masks and of using them for extended periods. Doctors need to be very careful handling an N95 mask that's going to be reused to avoid contaminating it.
The lack of personal protective equipment has been blamed for the large number of medical worker coronavirus infections in China. The CDC didn't immediately respond to Business Insider's request for comment.
Both doctors said that their hospitals have enough N95 masks in the short-term to be available in high-risk situations. But doctors are worried they won't last long.
We don't know when more supplies will come
Still, at the Memorial Sloan Kettering Cancer Center in New York City, an administrator told employees Friday that shipments from China may not come for another "four to eight weeks," according to BuzzFeed News.
"We're prepared to go forward, but at some point, we will run low on and perhaps run out of a critical care implement — the N95 respirator," Carl Ginsberg, a spokesperson for the New York State Nurses Association, told BuzzFeed News. "You really can't care for patients without proper equipment."
The delays in supplies — as well as testing — is causing logistical nightmares. A doctor at one of the hospitals said that it takes three days to receive the results of a coronavirus test. In the interim, patients need to be isolated until those results come back, leading to a shortage of places to put them.
"We have to rule out everyone with symptoms and isolate them," the doctor said. "That takes up space, room-wise, until they get the results back."
The federal government has a stockpile of 2 million medical-grade N95 masks and 30 million surgical masks, according to the New York Times, but that's only about 1% of the 3.5 billion masks that the Department of Health and Human Services estimates may be needed over the course of a year. The department said it ordered another 500 million N95 masks to arrive over the next 18 months.
On Tuesday, Vice President Mike Pence — who leads the White House's coronavirus task force — called on construction companies to send their N95 respirators to hospitals.
"Those industrial masks that they use on construction sites are perfectly acceptable for health care workers to be protected from a respiratory disease," Pence said at a White House briefing.