'It's like walking into traffic blindfolded': Kitsap health care workers face protective gear shortage

On Tuesday morning, Dr. Niran Al-Agba woke up to find two boxes of respiratory masks left on her doorstep. The masks, donated by an anonymous community member, were a godsend for the Silverdale pediatrician, who has struggled to get essential protective equipment in the battle against the coronavirus pandemic.

Weeks earlier, Al-Agba had tried to order N95 masks, the crucial respirators used by many medical professionals to protect themselves against infection. They were all sold out. She tried going through a health care network but was told gear was prioritized for hospital and emergency workers.

And Al-Agba is far from alone. 

Dr. Niran Al-Agba wipes down her stethoscope before putting it back into the wardrobe where she keeps her personal protective equipment to be used when examining patients with respiratory systems at Silverdale Pediatrics on Friday. Al-Agba has issued a plea to the community to donate masks and other equipment as her regular suppliers have run out.

As the number of COVID-19 cases climbs day after day, health care workers have faced a shortage of masks, goggles and other personal protective equipment (PPE) needed to shield themselves against the highly contagious virus.

Across the country, doctors, nurses and other health care workers have repeatedly raised concerns as hospitals and clinics try to preserve a dwindling supply of gear. Many, including Al-Agba, have turned to social media using the hashtag #GetMePPE in a plea for more equipment. All they and emergency first responders can do is conserve what they have and hope for fresh supplies to arrive.

Still, Al-Agba has continued to see patients with respiratory symptoms, while taking extra care to sustain her small supply for as long as possible.  

Donning a mask, gloves, goggles and a zipped-up paper suit, Al-Agba now conducts car visits for patients with a fever and cough in the parking lot of her Silverdale office. As patients pull up, Al-Agba conducts the check-up while a medical assistant stands several feet away, ready to hand off a pre-signed prescription. 

Dr. Niran Al-Agba puts on a second pair of gloves as she dons her personal protective equipment at Silverdale Pediatrics. Al-Agba modified the wardrobe at right with UV lights, and she stores all of her personal protective equipment in it, and from there she suits up and conducts car visits for patients with a fever and cough in the parking lot of her Silverdale office.

She has resorted to spraying the masks with alcohol solutions after every patient, using each mask repeatedly until it breaks down. “It's about as good as I can get. It’s not perfect,” she said. “I’m doing the best I can.” 

Her efforts have been bolstered by community donations, including the masks left on her doorstep, as well as extra surgical masks and paper suits dropped off by others. But as the virus continues to spread, Al-Agba's current supply is far from enough to handle an onslaught of new cases.

Like others in the field, Al-Agba is gravely concerned about the need for more protective equipment. She says it's not only about protecting herself, but ensuring she can continue caring for patients. That won't happen if she and other health care workers fall ill. 

“As long as we are healthy and not showing signs of illness, we are trying to keep seeing patients and not turning them away," she said. However, “if we are sick as your health care workers, we can’t provide care for people who need it.”

'It's like walking into traffic blindfolded'

At Harrison Medical Center, personal protective equipment is being conserved as respirator masks are already rationed among staff, according to an ER nurse who asked to remain anonymous out of concern for speaking without authorization from the hospital.

Nurses in the emergency department have been issued only one N95 respirator mask, according to a message sent to ER staff on Wednesday, which was shared with the Kitsap Sun.

"That is your one N95 for the duration unless it gets soiled or breaks," the message states.  

To swab patients who are tested for COVID-19, the ER nurse said she and other staff typically wear eye protection, gloves, a plastic gown and a respirator mask to protect themselves against contracting the virus. They may also wear a powered air-purifying respirator (PAPR), but the ER nurse says the equipment is no longer readily available.

A tent at the entrance of The Doctors Clinic in Silverdale on Wednesday, March 11, 2020.

But with limits on protective equipment, nurses are now struggling to find eye protection and respirator masks, even when dealing with suspected COVID-19 patients, the ER nurse told the Kitsap Sun. The ER nurse said she and others are wiping down their N95s after every patient, but in normal settings, the masks are usually disposed after each use. She said the hospital is stashing personal protective equipment under lock-and-key.

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Without the proper gear readily available, the ER nurse is concerned not only about contracting the virus and risking her own safety, but also spreading the virus to others and endangering the patients she's caring for.

"It's like walking into traffic blindfolded,” she said. “It's infuriating. It's frustrating. It's angering. It's demoralizing.”

Even away from the hospital, some health care workers are choosing to self-isolate themselves from their loved ones. The ER nurses said several colleagues have sent their children away to live with others, including her. 

Dr. Niran Al-Agba is reflected in the mirror of a wardrobe as she dons her personal protective equipment at Silverdale Pediatrics on Friday. Al-Agba modified the wardrobe with UV lights and stores all of her personal protective equipment in it.

“We are the frontlines for the community. There is no one else doing this job,” the nurse said. “We feel a massive sense of responsibility and commitment that we are putting our lives on the line because we care about our neighbors and community.”

While the Centers for Disease Control and Prevention provides guidance for health care providers to reuse N95 masks to preserve supplies during the pandemic, it also indicates there are risks to using the masks for an extended period, including transmitting the virus through contact with the mask. 

In a letter to health care providers last week, the Food and Drug Administration acknowledged that the need for protective equipment may outpace the supply during the outbreak, recommending strategies like not changing gowns in between patients with the same diagnosis or who are in the same area and reusing surgical masks for multiple patients if supplies are low.

CHI Franciscan, Harrison’s parent company, says the hospital system is taking “precautions to carefully monitor our supplies, including masks." In a statement Wednesday, the hospital system said it's following CDC and health department guidelines for masking, which outlines one per health care worker.

This week, the hospital system announced it is postponing elective surgeries, non-urgent procedures and routine visits. The effort aims to ensure there’s enough staff to serve COVID-19 patients and others needing immediate medical care. 

Dr. Niran Al-Agba dons her personal protective equipment at Silverdale Pediatrics on Friday. Healthcare workers on the frontlines of the COVID-19 outbreak are dealing with mask shortages in Kitsap County, often washing and reusing equipment that is meant for one-time use.

Cary Evans, CHI Franciscan's vice president for communications and government affairs, says the hospital system currently has "an adequate supply of mask and personal protective equipment."

“The safety and health of our staff and patients is our highest priority, and we have prepared for this pandemic since January," he said in a statement Thursday. "Our nurses, doctors, and staff are working long hours during a trying time."

However, concerns about lacking PPE have also been reported to UFCW 21, the union representing about 1,600 nurses, technicians and other health care workers at Harrison Medical Center.

“Really we’ve been hearing about those shortcomings (of PPE) for weeks,” said Tom Geiger, a union spokesperson. 

Protective equipment is not just important for nurses, Geiger said, but also other hospital workers, including those who clean rooms, bring food to patients or process intake. 

The union has also conducted its own “mask drive” to find places that don’t have a high need for masks right now, like dental offices, and redirect them to health care workers. In less than a week, the union has already collected about 200 masks, but they’ve yet to hear back from CHI Franciscan about where they should be distributed to. 

“I think that CHI (Franciscan) needs to be able to put more pedal to the metal on this and really address this shortcoming in the PPE in a more effective and quick fashion,” Geiger said. “It’s an urgent problem that needs to be addressed as soon as possible.”

First responders also preserving supplies

Emergency responders, often the first to come in contact with sick patients and take them to medical care, are also running low on protective gear.

Rick LaGrandeur, assistant chief of operations at North Kitsap Fire & Rescue, said his department's crews have shifted to trying to limit the number of people that treat a patient to conserve gear. Initially, only one person will be sent into a situation to respond, he said. If a patient needs additional aid, more crew members will go in to help, he said.

A Central Kitsap Fire & Rescue crew member is dressed in protective gear. Fire crews in other parts of the county say they are reusing protective equipment, including N95 masks and gowns, to conserve supplies.

"Right now we're OK," he said of remaining supplies. "We can sustain for probably another few days as far as how much we use, depending on call volume as well."

South Kitsap Fire & Rescue crews have been reusing personal protective equipment, including N95 masks and gowns to conserve supplies, Assistant Fire Chief Jeff Faucett said Thursday. Crews are given discretion about when to use the protective equipment and how many times they can re-use it. Equipment that is contaminated or damaged is disposed of. 

"They're wearing them as many times as they can throughout the day," Faucett said.

Faucett said SKFR, like other local fire districts, has put in a request to the Kitsap County Department of Emergency Management, which is coordinating procurement and distribution during the COVID-19 public emergency. Faucett said fire officials from all departments in the county are checking with each other daily and will share supplies as needed.

More supplies needed

Loren Bast is the executive director of Bainbridge Prepares, an emergency preparedness organization helping to direct the response to the outbreak on Bainbridge Island. The organization is making an appeal to the community: Get supplies like gloves and masks out of storage in garages, sheds, church basements and closets at schools and to fire departments and clinics where they’re actively needed.

“I don’t want someone to be cleaning out their garage four years from now and come across a box of 30 N95 masks and say, ‘Boy, I bet someone could’ve used these a few years ago,” he said. “We need to get all the supplies into the hands of our healthcare providers as soon as possible.”

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As he’s pitched the idea, he hears responses like, “What if there is an emergency? We’re going to need that stuff.”

“I have to try politely to say, ‘That emergency is now,’” he said. “The materials that you thought might be useful after that earthquake are sometimes even more critical right now.”

For now, an effort organized by Bainbridge Prepares has mobilized volunteers on the island to create masks. A volunteer team with the Bainbridge Artisan Resource Network has been sewing batches of masks out of towel fabric, pipe cleaners and elastic, all while members are scattered around the community in their homes. Once the kits are assembled, they’re picked up, sanitized and sent off to clinics where they’re needed, Bast said.

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As the N95 masks disappear, providers might switch to using surgical masks, which offer less protection. And while the homemade masks they’re making don’t offer the same protection, they’re better than nothing, he said.

In checking their plan to assemble masks with medical professionals, Bast said, the response was, “Everyone said, ‘Go for it, do it,’ and 'How many can I order?'”

“We’re trying to fill one of the gaps in the supply pipeline, and we’re doing what we can with the materials we have,” he said.

The Associated Press contributed to this story.

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