This anesthesiologist was told to not wear a face mask amid COVID-19 crisis
When the Swedish Cherry Hill anesthesiologist recently entered rooms with coronavirus patients, he wore an N95 mask. Everywhere else, he wore a surgical mask -- sometimes using the same one for days.
The mask was an added protection, in case he was an asymptomatic carrier of the coronavirus, he said.
But his decision to don the surgical mask sparked heated talks with Swedish leadership.
“(My husband) got REPRIMANDED today for wearing a surgical mask during his shift,” Jessica Green wrote on Facebook on March 25. “He got called into meetings with administration of Swedish because they don't want to panic employees into thinking they need to wear masks for protection.”
The anesthesiologist, who KUOW is not naming because of job loss fears, was told he could either not come to work the next day, or come in with no mask.
Green, his wife, wrote that one of the nurses in his unit tested positive for coronavirus. She was wearing a mask.
By the next day, on March 26, the anesthesiologist was allowed to wear the surgical mask without dispute, his wife said. The hospital had changed their policy to allow for universal mask wearing, she wrote on Facebook.
Swedish officials told KUOW they were running low on supplies. Because of this, Swedish has started allowing the reuse, and extended use, of N95 masks and face shields and have temporarily closed some of their clinics to shift equipment, supplies and caregivers to other care sites with greater needs.
“We recognize that many of these critical supplies are not infinite, which is why we have continuously enacted conservation efforts to help sustain existing resources,” Swedish spokesperson Tiffany Moss wrote in an email.
Varied mask policies
Policies related to personal protective equipment, referred to as PPE, vary across the United States.
California nurses at Kaiser Permanente hospitals and clinics were told that N95 respirators would no longer be used to care for patients both confirmed and suspected of having coronavirus, according to National Nurses United.
If the California Kaiser Permanente nurses were seen wearing their personal N95 masks, they could be fired for insubordination, National Nurses United said.
The decision was based on information from the Centers for Disease Control which state that coronavirus spreads via droplets and contact transmission, and is not aerosolized. Although the nurses union notes that these claims are new and not widely agreed upon.
The CDC has continually loosened their guidelines on mask use. They recently advised that in the most dire cases -- where protective gear cannot be found for health care providers treating COVID-19 patients -- bandannas might be used in conjunction with a face shield. However, these are not considered PPE, and should only be used as a last resort.
Across the country, Massachusetts General Hospital now requires staff to constantly wear face masks while inside any building that provides care. The universal mask policy was based on data that suggested asymptomatic carriers of the coronavirus contributed to the spread, according to media reports.
CDC has found that about 30% of residents tested at a King County long term care facility were positive for coronavirus. Half of those who tested positive for coronavirus were either asymptomatic or presymptomatic on the day of testing.
But when it comes to N95 masks, locally, there's not enough for universal use.
An email sent out this week to Swedish departments advised that health workers not wear an N95 mask, unless they are caring for COVID-19 positive patients or those suspected to have the coronavirus. They were following the guidelines of the CDC, Swedish wrote in the email.
Employees --- even those who might fear for their own health --- are not allowed to bring their own N95 masks from home to wear for general patient care. The email stressed that doing so would give the impression that there was an "isolation patient in that area."
Medical supplies remain scarce
The struggle to collect personal protective equipment for health care workers continues in King County. While the county is receiving periodic shipments of PPE -- from the federal pipeline, through the state -- it is far less than local providers are requesting.
It isn’t enough to meet the needs of the county's top priority group, said spokesperson Keith Seinfield, with Public Health - Seattle & King County.
The Washington Department of Health has organized who gets first dibs on incoming PPE into four tiers. In the top tier are: long term care facilities with confirmed coronavirus cases; hospitals with the highest number of confirmed cases; emergency responders asked to transport people with coronavirus; and health care workers at long term care facilities with confirmed cases.
On the bottom of the list are homeless shelters, jails, dorms and families with confirmed cases staying at home.
When asked about the highest priority facilities in the county on Thursday, Seinfield said “it can vary with each shipment and when it happens to arrive, what supplies are contained in it, what the specific shortages and needs are at each Tier 1 facility at that moment. So it’s somewhat dynamic, given there is not enough.”
Gov. Jay Inslee addressed the federal shipments of PPE in a March 26 news briefing. He said Washington state had received significant shipments of PPE from the federal government.
“However, we do have profound long term concerns about being able to procure these necessities,” Inslee said.
Additional equipment has been secured from private vendors and other donations have come in, but requests for the gear from around the state are not being met.
And while care givers wait for the needed supplies to arrive, they're asked to follow the direction of hospital administration, with rationing in mind.
“(We’re) not following pie-in-the-sky best practices,” the anesthesiologist said. “We are following a rationing system based on the fact that we don’t have enough PPE to last us through our projected peak surge, projected to happen in a few weeks.”