Every day now, Linden Hills resident Parissa Delavari, an ER doctor at North Memorial Medical Center, is treating patients whose respiratory symptoms are consistent with COVID-19. Due to limited testing, she must use full-barrier precautions, including a mask, face shield and gown, each time she sees these patients.
But she said supply-chain shortages of personal protective equipment — particularly the N95 masks essential in procedures like intubations — have forced her and her colleagues to reuse equipment designed for one-time use, jeopardizing their own health and potentially spreading the coronavirus to uninfected patients.
“During one shift, I used a single N95 mask six times,” Delavari said. “At the end of our shift, we try to wipe down our personal protective equipment and put it [in a] big paper bag. … They don’t know how long the virus can live and be pathogenic on a surface and when you think you’re throwing all that protective gear in one paper bag overnight until your next shift, it’s a huge risk.”
On March 23, Delavari put a blue cooler in the front yard of her home near Southwest High School and posted on Nextdoor, asking her neighbors to donate any spare N95 masks they have left over from construction projects or other household uses. She ended up receiving about 40.
Delavari donated some masks to a pregnant colleague in California, who she worried would otherwise need to use fabric masks or bandanas. Others she delivered via bicycle to a friend at Hennepin County Medical Center — a doctor with severe asthma who’s been using bleach to clean his N95 mask and is concerned the chlorine will upset his lungs. The rest of the masks, she brought to her own hospital.
“I get asked if I’ll take used masks, and I’m happy to take those,” she said. “If we get desperate, we’ll dust off some dusty masks and use those too.”
A systemic failure
The current scarcity of personal protective equipment (PPE) for Minnesota health care workers points to a failure of communication and planning by government bodies and by the health care industry to prepare for the type of global pandemic that public health experts have been warning about for decades.
While private companies like 3M are ramping up PPE production, shortages could worsen dramatically as the virus spreads; President Donald Trump has invoked the Defense Production Act to help meet the need for ventilators but so far has resisted pressure to do so for masks and gloves. “Minnesota is in competition with 49 other states and many different countries [to obtain PPE],” Department of Administration Commissioner Alice Roberts-Davis has said.
Across the state, 629 patients have tested positive for COVID-19 as of March 31, but officials expect the number of cases to continue growing until the late spring or summer, with thousands — or tens of thousands — needing hospitalization during the epidemic’s peak. Health workers are sure to be disproportionately endangered; during the 2003 SARS coronavirus outbreak, they made up 20% of those infected globally.
Jane Ross, the co-president of National Nurses United, said this crisis should have been foreseen years ago.
“Here we are with our worst nightmare, a pandemic, and it shows you how being ill-prepared can bite you in the butt,” she said. “With hospitals, it’s not the shortage; it’s that they didn’t want to pay for this stuff [before the pandemic].”
Hospitals respond that they couldn’t have prepared for a pandemic of this scale, which has wreaked havoc on the global PPE supply chain.
Emily Lowther of the Minnesota Hospital Association said that while hospitals adjust their supply levels when they expect a severe flu season or other emergency event, “there is a balance in preparing for an epidemic and not spending significant resources that drive up the cost of health care.”
Helen Strike, the incident commander for Allina Health’s COVID-19 response, said the hospital relies on a system of “just-in-time” manufacturing and that Allina had hoped there would be more protective equipment in the Strategic National Stockpile.
In March, Alex Azar, the country’s Health and Human Service secretary, testified that there are about 40 million N95 masks in the stockpile; his department has estimated 3.5 billion will be needed nationwide. During the 2009 H1N1 swine flu epidemic, about 100 million N95 masks were drawn down from the national stockpile and never replenished.
“We’re learning the numbers as everyone else is about how much PPE was placed in the stockpile,” said Strike, who was not aware of any official guidance or requirements for minimum levels of protective equipment that hospitals should hold.
In recent weeks, thousands of people and businesses across the Twin Cities have donated their spare protective equipment directly to doctors and through drives organized by concerned citizens, local hospitals and the county.
Hennepin County is collecting N95 and surgical masks, eye protection, nitrile gloves and Tyvek coveralls and foot covers; more than 640 people have already taken materials to county drop-off sites.
Meredith Schwarz, the co-owner of Rustica Bakery in Cedar-Isles-Dean, is among the local residents mobilizing around protective equipment.
Schwarz has a brother and sister-in-law living in Hong Kong, and in late January, as the coronavirus spread there from Wuhan, they asked Schwarz to mail them some N95 face masks. She spent days driving to hardware and drug stores across the region, astonished to find that they were out of stock everywhere. “In Woodbury, Minnesota, and Shoreview, Minnesota, and Inver Grove Heights — I was going to all these stores, and there was nothing,” she said.
She finally found a two-mask package at a Hudson, Wisconsin, Home Depot and spent $180 to ship it express to Hong Kong.
A couple of months later, when COVID-19 arrived in Minnesota, Schwarz and her business partner, Greg Hoyt, were forced to close Rustica and lay off their 70 employees, just as they were planning to open a second location in Edina.
Schwarz and Hoyt tried to help their employees stabilize — paying them a week’s severance, plus 50% of the proceeds from a gift card drive — but Schwarz’ frustrating experience looking for face masks led her to wonder if there was more they could do for the community.
“I have a number of folks in my family who are doctors and nurses getting geared up for this crisis,” she said. “When I heard there was going to be a shortage, I realized we have in our kitchen gloves and other equipment that may be needed.”
On Friday, March 20, Schwarz began dialing around to area restaurants and food distributors, asking if they could donate nitrile gloves. Reinhart Foodservice, Hot Indian Foods and Jester Concepts — the company behind P.S. Steak and Monello — were among those that stepped up.
Schwarz and Hoyt put out the word on Rustica’s Instagram and on Nextdoor and, over a two-day span, Schwarz worked the phones as Hoyt drove around filling his Jeep Wrangler with gloves from businesses and N95 masks from individuals. By the end of the second day, Hoyt’s Jeep was fully loaded and he delivered the supplies to Hennepin County Medical Center.
“I’d actually like to ask some of these people what they were doing with all these masks,” Hoyt joked. “These were people in the city; they weren’t preppers out in hither and yon.”
Since March 22, Schwarz and Hoyt have been directing people interested in donating supplies to Allina’s drop-off program. They’re hoping to reopen Rustica in a few months.
While HealthPartners and Allina’s primary need right now is for items like N95 masks, surgical masks and air-purifying hoods, the hospitals are also collecting hand-sewn ear loop masks. The Centers for Disease Control (CDC) advises that handmade masks can be used as a last resort, though their “capacity to protect health care providers is unknown.”
“We haven’t had a lot of evidence yet saying exactly how we should wear them,” Strike said. “At Allina Health, we hope we never get there.”
The CDC could soon recommend that all Americans wear do-it-yourself cloth coverings while out in public, the Washington Post has reported.
In Southwest Minneapolis, religious institutions like Zion Lutheran Church in Lyndale and neighborhoods like Cedar-Isles-Dean have been sharing instructions for sewing masks, directing people eager to help toward CDC-approved mask templates. Boomerang Bags, a Linden Hills-based group that normally makes reusable grocery bags, has redirected all its efforts toward masks.
After she was laid off from her job as a bartender on March 17, East Harriet resident Emily Lemanczykafka starting sewing masks with her mother, Victoria.
Her bank account under strain, Lemanczykafka has courted donations of fabric and now has enough material, she estimates, to make more than 200 masks. The popularity of these projects nationwide has led to a shortage of elastic, and she’s had to adapt in making ear loops.
“I’m using bias tape and twill tape, which is a lot more labor intensive,” she said. “To make them fun, I’ve been mismatching prints and being resourceful with the weird materials I have.”
Lemanczykafka said she realizes the masks’ utility is limited but she wants to do something constructive and helpful before the state’s health system is overwhelmed.
“We have been very reactive and not proactive as a country, and I feel horrible for all the health workers thrown into this without basic healthy practices and equipment,” she said.
Peter Kumasaka of Linden Hills, an ER doctor at Regions Hospital, said homemade masks could benefit the general population, but he has doubts that doctors who wear them over their N95 masks are effectively protected during risky procedures.
“While the homemades might prevent gross droplets from hitting the N95, they allow way too much through them to assume the N95 is not contaminated, especially when used in an aerosolizing procedure, such as putting someone on a ventilator,” he wrote on Nextdoor.
Delavari said she’s also skeptical of homemade masks but “beggars can’t be choosers.”
“If it was between that and me wrapping a bandanna around my mouth and nose, I’d go with the homemade mask,” she said.