Medical staff at MaineGeneral Medical Center, which has campuses in Augusta and Waterville, have enough basic surgical masks to last about one to two weeks at their current rate of usage, according to an email sent by the top hospital administrator to staff on Wednesday.
The memo from Chuck Hays, president and CEO, illuminates the situation for health care providers who are going without now to preserve the protective gear that remains for when the peak of the new coronavirus outbreak hits. It has just begun at MaineGeneral, which was treating two of Maine’s 30 hospitalized patients for COVID-19 as of Friday.
In another message this week, Hays asked staff to treat the supplies “like gold.” His memo is the first detailed look at inventory of personal protective equipment at a Maine hospital amid an outbreak that has ballooned in just over two weeks to 168 confirmed cases as of Friday, when the state announced its first death from the virus — a man in his 80s from Cumberland County.
Nirav Shah, director of the Maine Center for the Disease Control and Prevention, has not used hard figures when discussing supplies in hospitals so far, but he described a statewide lack of protective equipment this way on Friday: “We’ve got an umbrella, and we’re in a hurricane.”
Hays did not say in his emails to staff, obtained by the Bangor Daily News, how long the hospital has until it runs out of N95 respirators, a different kind of mask that is close fitting and highly sought after because it blocks 95 percent of tiny airborne particles.
But in an email to staff on Friday, a nurse manager told staff to “make every effort” to wear their N95 masks for five days, unless they are soiled or damaged. The hospital has not removed any protective equipment from closets or shelves, or told staff they cannot use it.
An emergency room nurse for MaineGeneral Medical Center, who spoke on condition of anonymity, said staff had still been stockpiling some masks at home.
“I don’t want to come in one day and have nothing,” the nurse said. “It’s like a toilet paper scare on a health care level.”
Medical professionals may reuse the N95 masks to extend their life, according to the U.S. Centers for Disease Control and Prevention, but the greatest risk comes from staff touching the surface of a contaminated mask and then transferring pathogens to themselves or others.
It’s not ideal, but the situation calls for limiting and extending the use of masks, Hays said in an interview Friday. “We’re trying to follow the guidelines, so we don’t overutilize, so we have the masks when the pandemic continues to grow,” he said.
The nurse said staff understand there is a shortage of supplies, but they are concerned that they will become infected and inadvertently infect other patients or their families. At the same time, if the hospital runs out of masks, multiple nurses have talked about quitting.
“There are a lot of people I work with whose family members have serious pre-existing health conditions, and this could kill them,” the nurse said. “So I understand that.”
The hospital calculates how long its protective gear will last based on current usage, but, in an interview, Hays declined to say how long the hospital’s N95 masks would last. The projection changes daily.
“We are concerned about the supply of the surgical masks as well as the face shields and N95s,” he said. “The demand is getting higher.”
MaineGeneral Medical Center also has 52 powered air purifying respirators, which have a clear hood and are reusable. “Is that amount enough?” spokesperson Joy McKenna said. “It depends” — such as on how much social distancing reduces the number of cases.
For hospitalized patients who are known or presumed to have COVID-19 but are not critically ill, MaineGeneral medical staff should wear N95 masks or the powered air purifying respirators, but only if they will be in the room with patients for a long period of time, Hays wrote in an email to staff. Staff with less exposure should wear a more loosely fitting surgical mask.
Staff who are screening people before it’s known whether they have signs of a respiratory infection can also wear masks. But staff should not wear masks during their routine care of patients who do not have symptoms such as a fever, sore throat or cough, he said.
“Have there been reports of asymptomatic spread? Yes. But we believe that viral shedding through aerosol is very low in patients without respiratory symptoms, so transmission may be just as or more likely from contact with surfaces,” Hays wrote in the March 25 memo. “Does anyone know for certain? No.”
However, “[e]very mask we use for low risk cases now is one we can’t use for high risk scenarios later.”
The situation calls for reducing N95 mask usage, especially since the most likely source of transmission of COVID-19 comes from droplets, not through the air, which is what happens with an infectious disease such as tuberculosis, said Keith Siegel, the former director of respiratory care at Pen Bay Medical Center in Rockport.
“These are extraordinary times, so I think they’re trying to make do with what they’ve got,” Siegel said.