Doctors reusing masks between patients. Nurses going to work, even if they’ve been exposed to the novel coronavirus, to meet demand.
And if their supplies run out — staff having to replace face masks with bandanas or scarves.
That is what hospitals in the United States, facing a surge of coronavirus patients, could look like as the pandemic worsens, according to contingency plans released by US health officials.
These kinds of measures, designed to keep up with an influx of patients, are outlined in guidance issued by the US Centers for Disease Control and Prevention. They reflect a growing crisis in hospitals across the United States: There are too many patients, doctors say, and not enough resources to treat them.
“It hasn’t even really hit us yet, and we’re already facing crisis proportions in the hospital,” said one anesthesiologist in Boston, who spoke on the condition of anonymity out of concern for his job.
“I foresee a day very soon when we’re not going to have what we need to take care of ourselves,” he added. “I mean, in a way we already don’t.”
Health care facilities facing a “crisis” may need to consider steps to ration face masks during the pandemic, even if those strategies “are not commensurate with U.S. standards of care,” according to the CDC.
During shortages, the agency says health care providers should consider using masks beyond their designated shelf life and reusing them between multiple patients.
“Our hospital announced that we were going to have to be reusing our PPE, which the CDC has already released guidance on doing this and trying to do it safely,” said the Boston anesthesiologist. “I’m not convinced it can be done safely. I think that this is unnecessarily exposing providers to risk.”
Still, he admitted it’s better than the alternative of running out completely — a not-too-distant reality, especially for smaller hospitals.
“We have gone through five months, now six months’ worth of supplies in less than a week,” Scott Steiner, president and CEO of Phoebe Putney Health Systems in southwest Georgia, told CNN this week. With only a few days of supplies on hand, “we are scrambling.”
As a last resort, the agency said that health care providers could consider using “homemade masks” — such as bandanas or scarves — to care for coronavirus patients, ideally in combination with a face shield.
But while those measures may be better than nothing, they are also no substitute for the protective equipment doctors need to stay safe, and their ability to protect health care workers is “unknown,” according to the CDC.
If the virus takes out health care workers, “it’s game over. It’s lights out,” Dr. Peter Hotez, professor and dean of the National School of Tropical Medicine at Baylor College of Medicine, previously told CNN.
“If we have multiple front line health care workers, ER physicians, nurses go down in this epidemic — a situation where you have colleagues taking care of colleagues in the intensive care unit — there’s nothing more destabilizing for the United States.
“We have to make this our highest priority.”
‘We all signed up for this career’
CNN heard from multiple health care workers, speaking on the condition of anonymity, who felt that becoming infected was inevitable.
“I don’t think the hospital is really going to keep us safe at all,” said one OB-GYN in New York City. “We all signed up for this career.”
Hospital leadership is “telling us to come in even if we have confirmed exposure, as long as we’re asymptomatic,” said a radiation oncology resident at a different hospital in New York. She described a warlike mentality in the hospital.
“My coresidents and I are feeling like we’re being drafted, and terrified that we’ll have to intubate or manage vents,” she said, referring to medical interventions for patients who cannot breathe on their own, which are not typically performed by doctors in her field.
According to CDC recommendations, health care providers exposed to coronavirus — even those who show mild symptoms — may also be advised to wear a face mask and continue treating patients.
In New York City, local health officials have yet to go that far, telling health care workers in a Tuesday letter: “If you are sick, please stay home.” But even those with a “high-risk exposure” to a confirmed coronavirus patient can continue to work, according to the letter, despite the fact that people may spread the virus without feeling ill.
‘Somebody’s got to do it’
Health care workers told CNN they’re worried that shortages of protective equipment — and a lack of tests needed to identify infected patients — may mean they’re putting their families and vulnerable patients at risk.
And some are frustrated that, despite recommendations from state and federal officials to postpone elective procedures, some hospitals continue to perform them, adding to the strain on resources and creating additional risks for exposure.
“I’m intubating patients all day,” said the Boston anesthesiologist. “Some of them are febrile. Very few have been tested ’cause we just don’t have enough tests. And it’s very scary to think that I’m going to bring this home to my pregnant wife.”
The OB-GYN in New York, also a new mother, told CNN that she’s not pumping at work out of fear that she might contaminate her equipment and pass the coronavirus to her son and the rest of her family. While she breastfeeds at home, the stress of the virus “has diminished my supply,” she said.
“As emergency physicians, we know the risks of our calling,” said Dr. William Jaquis, president of the American College of Emergency Physicians, in a statement last week after the virus left two of the organization’s members in critical condition.
“I am deeply saddened by this news, but not surprised,” he said.
For doctors, nurses, and other health care workers, continuing to treat patients is the only option — no matter the risk.
“I keep showing up for work every day,” the anesthesiologist said, “because somebody’s got to do it.”