San Diego County asks hospitals to 'follow crisis strategies' to conserve medical gear .

Hospitals of the University of Pennsylvania

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A new San Diego County’s health advisory depicts the most dire scene yet of the region’s shortage of protective gear for medical workers treating patients during the COVID-19 pandemic.

The alert, sent to healthcare facilities on Wednesday, asked medical providers to consider following “crisis strategies” to further restrict the use of personal protective equipment, or PPE, even though it could increase the chance of spreading or contracting COVID-19, the disease caused by the novel coronavirus.

Roughly 1 million people have contracted the novel coronavirus around the world, including 280,000 in the U.S. and 1,200 in San Diego County.

As the virus continues to spread, shortages of protective masks can lead to an increased risk of transmission and endanger healthcare workers.

The advisory comes with rules and recommendations to help healthcare centers prepare for shortages. Facilities are supposed to close elective outpatient clinics, limit COVID-19 testing and remove face masks from public spaces. The county also said medical workers who haven’t received the influenza vaccine no longer have to wear face masks during flu season, which can last until May.

Under the new rules, facilities with low supplies of gowns should conserve them for aerosolizing procedures, including intubation and bronchoscopies, which can cause the virus to become airborne. A similar policy change the county implemented three weeks ago restricting the use of N95 respirator masks prompted fierce backlash from healthcare workers, who felt they weren’t receiving enough protection.

“I think that the biggest challenge is that this is the only defense we have for people taking care of patients,” said Philip Greiner, director of the nursing school at San Diego State University, after reviewing the new advisory.

“The personal protective equipment is the only thing that we have. We don’t have an immunization that we can give to providers. We don’t have a cure at this point,” Greiner said. “Taking care of a person who potentially has the coronavirus places each healthcare worker at high risk and then that risk is higher if you don’t have PPE.”

A healthcare worker wears a mask, gown and gloves in this undated photo. (Courtesy of Neighborhood Healthcare)

inewsource contacted seven San Diego County hospital systems to see how their policies could change because of the new health advisory. Only UC San Diego Health and Scripps Health responded to questions, but neither explained how the advisory could affect their hospitals.

UCSD said it has “carefully managed its supply lines since there was early awarenesses of COVID-19,” and its staff are not using bandanas or expired medical gear.

Scripps Health said since the pandemic began the hospital has moved most appointments to telehealth, freeing up protective gear for more pressing needs. The facility has a three-week supply of N95 respirators, a two-week supply of surgical masks and a one-week supply of gloves and gowns.

San Diego County officials have repeatedly said there are currently enough surgical masks and N95 respirator masks to meet demand and so far has provided more than 1.3 million pieces of protective equipment to the region’s healthcare providers. But the new alert suggests hospitals and clinics might not be able to receive all of the medical gear they need in the future.

The advisory said the county’s diminishing supplies might not be replenished quickly enough through state and federal stockpiles or through major distributors to meet growing demand as the number of people infected with the virus continues to rise. The county warned that medical gear “will be distributed on a priority basis” to facilities treating positive coronavirus patients, potentially leaving other local providers without the resources they need.

About this report

As the coronavirus spreads across the U.S. and in San Diego County, so does uncertainty. To provide you with accurate in-depth reporting on the pandemic, KPBS and inewsource are collaborating in their news coverage.

“The community needs to collectively prepare for a surge of newly infected patients including those who are critically ill,” the advisory said. “Lessons learned from the experiences of other countries and states affected by COVID-19 indicate a need to prepare for surges of ill patients and to try to avert severe shortages of medical supplies, staffing, hospital beds, ICU level beds, and ventilators.”

Most local hospitals, if not all, should now implement crisis strategies, the advisory said. The phrase describes policies from the Centers for Disease Control and Prevention that can conserve protective gear but “may pose a risk for transmission” between healthcare workers and patients.

The strategies include wearing expired equipment, reusing protective gear normally worn once, prioritizing resources for procedures that are more likely to spread disease and canceling unnecessary medical appointments.

Each facility will have to make decisions about which strategies to pursue based on how much equipment it has available, the advisory said. Providers should calculate their burn rates of different kinds of protective gear — such as masks, gloves, goggles, gowns and face shields — to help decide the best way to conserve resources.

The rapidly changing guidelines from local, state and federal agencies have caused stress and panic among healthcare workers.

While the county’s advisory tells hospitals not to test asymptomatic people for COVID-19 even if they have been exposed to the virus, UC San Diego’s most recent coronavirus policy expanded testing access to include people without symptoms who seek care at its hospitals.

The UC San Diego Jacobs Medical Center is shown on Feb. 1, 2020. (Zoë Meyers/inewsource)

“I’ll be honest, it is confusing, anxiety producing and can be detrimental to care and safety,” a UCSD nurse told inewsource about the frequent policy changes. The nurse did not want her name published out of fear of retaliation.

“The reality is that if you don’t know the latest updates and data it could be hazardous to your health and life,” she said.

Negotiations between frustrated staff and management over access to protective gear have resulted in quickly changing rules and guidelines at local hospitals.

A UCSD nurse told inewsource on March 21 that staff could be disciplined for wearing masks in the halls. Following complaints from the university’s staff and nursing union about mask restrictions, the university changed its policy on March 29 so staff can wear face masks in the hallways. Staff can now wear one face mask per day that they can leave on at all times, so long as the mask doesn’t get soiled or need to be changed to a different kind of protective gear for certain procedures.

UCSD spokeswoman Jackie Carr told inewsource the university’s hospitals have a sufficient amount of protective gear to last through the surge in COVID-19 cases.

At Kaiser Permanente, workers are being asked not to wear masks in the halls. But conversations between the nursing union and the healthcare provider led to Kaiser agreeing that its hospital staff could bring their own masks from home and wear them without being disciplined, said Rob Jones, a member of the United Nurses Association of California board of directors.

Jones, who is also a Kaiser emergency room nurse in San Diego, said staff currently has enough protective gear, but the scenes from New York and other coronavirus hotspots have caused him and his colleagues to fear what could happen in the future.

“We’re looking at other areas that are being inundated where the curve is going up exponentially, and that’s kind of a scary thing to look forward to,” Jones said. “So we’re hoping that everybody will hunker down, stay home and we can have that curve flatten out in our area here.”

KPBS health reporter Tarryn Mento contributed to this story.