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Letter from health care providers to Mass. residents underscores PPE shortage and concerns

"Healthy, asymptomatic people should be prohibited from wearing N-95s while strolling around their neighborhood."

By Arianna MacNeill

March 27, 2020

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Below is a letter from health care workers to Massachusetts residents.

From Your Doctors and Nurses: Help Us Help you

We want to continue serving you during this pandemic but we need your help.

There is a shortage of personal protective equipment (PPE) which is typically used to protect us from being infected with life-threatening infections while we care for you. Due to a range of constraints, from patents to online profiteering to excessive use, the shortage of masks, gowns, gloves, and eye gear may become dire.

This means that we will face an enormous risk every time that we help a patient who is infected with COVID-19. We have elders in our families who could become infected through us, or young children who could be orphaned if we do not survive a COIVD-19 infection. We face this choice: either help save a patient’s life today or preserve our own life so that we can live to care for our own families and our own children in the future. 

The shortage of PPE not only places your doctors and nurses at risk. Other patients in the hospital are at higher risk of infection as well. When another patient needs emergency surgery for a broken hip or a C-section to deliver a baby in distress, the doctors and nurses will not have the masks and gloves that they need to protect the patient from both COVID-19 and other more typical hospital-acquired infections. 

This PPE shortage is affecting our colleagues both in the U.S. and elsewhere around the globe. New York City is in crisis and other cities are on a similarly dire trajectory. Desperate, many of us are reaching out on social media and other channels in between hospital shifts to plead for help with the hashtag #GetMePPE. Some of our colleagues have already fallen sick.

Massachusetts has been a leader throughout this pandemic. Our governor passed a range of critical executive orders to rapidly expand telehealth so that our patients could be safely treated in their own homes and health care workers could minimize potential exposures. Our universities led the country with their bold moves to evacuate their campuses very early in the pandemic. Massachusetts has modeled a coordinated and conscientious response to this pandemic for our country in a moment of chaos and confusion. 

Now, Massachusetts must come together to provide the masks, gowns and gloves needed for those serving on the front line—not just us, but also clinical aides and assistants, respiratory therapists, first responders, ambulance personnel, and staff who clean spaces where sick people have gathered for testing or care—who risk their own health to care for you. 

Think of it this way: if you are not currently sick, you might become sick. The front line during this pandemic will be the paramedics in our ambulances, the staff in our emergency departments, the pulmonologists treating lung disease and critical care specialists in our Intensive Care Units (ICUs). They save us from asthma attacks and sepsis, overdoses and pneumonias. They are experts in treating our lungs, and they are ready now. They will put your neighbor on a ventilator to supply his body with oxygen when his breathing cannot otherwise continue. Since they work most closely with the infected lungs that disseminate virus particles, they will be the most vulnerable among us to falling ill.

Other physicians and nurses are well-trained, but we are all not experts in breathing. We need to keep pulmonology, respiratory and critical care teams healthy so they can keep serving the sickest patients. If a critical care team cares for your neighbor without adequate protection, they may not be available when you need their help. When we run out of PPE, we will run out of experts. This has already happened in other countries. When you get sick, who will you want to be there to help? 

We are enormously grateful for the generosity of the dentists, construction workers and neighbors who have donated masks. We are deeply moved by community members who are sewing masks by hand or printing them on their own 3-D printer. 

However, we need a large-scale, coordinated and sustainable effort to protect our entire workforce during the coming weeks to months.

First, we must aggressively eliminate all unnecessary use of PPE. Healthy, asymptomatic people should be prohibited from wearing N-95s while strolling around their neighborhood. If they are sick, then they should stay home; if they are healthy, then they are wasting a scarce resource. Similarly, when healthcare workers are treating asymptomatic patients for routine concerns unrelated to COVID-19, you will find that they are not wearing PPE above what is indicated by evidence-based guidelines and the CDC. All patient encounters that can possibly be conducted by either telephone or telehealth must be. We are grateful for the Executive Order from Governor Charles Baker that non-essential elective procedures should be cancelled and hope that other states will follow. 

Second, we must research which PPE is critical to prevent transmission of COVID-19 from patients to healthcare workers and to determine if decontamination and re-use of PPE is safe. Many healthcare workers are already routinely washing and reusing PPE although this is currently not recommended. UV germicidal irradiation exposure might allow us to decontaminate PPE for re-use, and Taiwan reportedly widely used sleeves over their masks to conserve the mask while replacing the protective outer layer. However, we lack research on whether any of these approaches are safe or effective to protect our healthcare workers from infection. 

Third, we must find new sources of PPE. It is time to distribute our country’s Strategic National Stockpile while we ramp up other sources. We must increase purchasing from China as they scaled up production during their pandemic and now have surplus PPE as their own demands have waned. 

The reality is undeniable: the situation is dire and we cannot afford delays in decision-making. Our health care workers, and subsequently, our families, neighbors, and communities are at risk. The time to act is now. We want you to know and to help.

Rachel Conrad, MD, is a fellow at the Harvard Medical School Center for Bioethics
Christine Mitchell, RN, is Executive Director of the Harvard Medical School Center for Bioethics
Sharine Wittkopp, MD, PHD, is a fellow at NYU School of Medicine
Katherine Calaway, MD, is a physician at Yale New Haven Health
Harika Rayala is a medical student at University of Michigan Medical School

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<h2>Baker: Federal delays in delivering medical gear ‘enormously frustrating'</h2>

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