Supply shortages force health systems to devise own workarounds



In ambulance bays, physician offices, nursing homes and hospital facilities, Georgia medical professionals are struggling to maintain or devise enough equipment and supplies to treat their patients while staying protected from the coronavirus themselves.

Doctors and nurses say supplies of disposable gowns that can help protect them from infection are in short supply. Medics are being asked to re-use N-95 masks. Some clinics reportedly are running low on specialized swabs used to check for coronavirus. Hospitals say they will not have enough life-saving devices, such as ventilators, as more severely ill people with respiratory failure fill beds.

» COMPLETE COVERAGE: Coronavirus in Georgia

"We have less than two days of isolation gowns, less than four days of N-95 masks and less than a week of every other item, including eye protection and gloves," said Scott Steiner, president of Phoebe Putney Health System in Albany, which has been hit hard by coronavirus cases.

Earlier this week, Georgia public health authorities delivered a small number of masks and isolation gowns from the Strategic National Stockpile. And on Wednesday, President Trump announced that he has activated the U.S. Defense Production Act, a Korean War-era law, to ramp up production of medical supplies. U.S. Secretary of Defense Mark Esper also said one million N-95 masks will be immediately released from strategic reserves to the federal health department to distribute, as will 2,000 ventilators. President Trump said the federal government has millions of other medical supplies on order.

But healthcare providers say they are being forced to devise make-do solutions because those numbers fall far short of needs.

The U.S. typically consumes about 22 million N-95 masks a year. This year, consumption is expected to exceed 120 million, industry officials told the AJC.

A North Carolina-based supply chain company that secures contracts for 40 percent of all ventilators sold in the U.S. said it typically handles orders for 2,000 ventilators a year. But in the last 72 hours, one of its customers received an order for 600 ventilators, and it cannot keep up with demand.

“That’s a heck of a number in a 72-hour period,’’ said Michael J. Alkire, president of Premier Inc., which also secures contracts for other medical devices and supplies, many from plants overseas.

Top Georgia public health officials say they are trying to identify more resources. On Tuesday, Public Health Commissioner Kathleen Toomey said that the governor's coronavirus task force was in the process of identifying supply sources from both the federal government and the private sector.

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In the meantime, the Food and Drug Administration has given hospitals a list of ways to stretch resources. As a crisis strategy, it said hospitals may extend the use of disposable gowns for healthcare providers by having them not change the gown between patients with the same infectious disease diagnosis. Surgical masks can be re-used during care for multiple patients for activities with a low transmission risk, such as dispensing medications. If no surgical masks or gowns are available, it tells hospitals to refer CDC guidance for selecting clothing based on fluid barrier properties.

That isn’t assuaging concerns by health care workers on the front line.

One paramedic in Atlanta said protective gowns are not to be found, and he had been told to wipe off his mask with cleaning wipes, which he said is against the manufacturer’s recommendation. An Atlanta physician said he spent his own money on “dubious” masks because his hospital isn’t providing enough protective gear. Each asked not to be identified, for fear of jeopardizing their jobs.

No quick fixes

With no quick solutions to the shortages, health care providers say they know they must rely on their own resourcefulness to make up for the lack of essentials.

Employees at Phoebe Putney in Albany got together to sew masks to in case the shortage worsens, while the health system’s supply management team is working around the clock. The system is already sourcing protective gowns from connections in the restaurant industry and bleach from chicken plants.



“I never thought I would see anything like this in my healthcare career, but that’s where we are today. The normal supply chain for medical supplies in the United States is overwhelmed with demand because of COVID-19 right now, and we’re having to find innovative ways to ensure our staff has the equipment they need to care for our patients,” Steiner said.

In spots throughout Atlanta, paramedics and EMTs are running to paint stores, Lowe’s and Home Depot to try to stock up on masks.

Larry Richardson, chief executive officer at AmeriPro EMS in Stockbridge, says he’s asking his medics to keep a record of how long they wear their masks because they can be used for up to eight hours. EMS providers say they expect the shortages to get worse before things get better and aren’t waiting for a shipment of N-95 masks to be dropped at their doorstep anytime soon.

“Everyone in the world is looking for these things,” Richardson said.

» RELATED: As hospitals fight to keep up, they tell mild cases not to seek tests

» MORE: Coronavirus to test Georgia's chronic health gaps

Medics at Grady Emergency Medical Services told the AJC that they are trying to safeguard their disposable gowns so they can last until they can be replaced with new ones. They’ve been told the gowns are on national back order, and they should use the gowns only for confirmed COVID-19 patients.

Hospitals are reaching out to local health departments for help securing supplies, and the health departments are coordinating with the state to try to get supplies to the places that need them most, said Anna Adams, vice president of government relations at the Georgia Hospital Association.

Healthcare providers are waiting on government agencies to devise other workarounds. For one, they are waiting to see if the FDA will allow use of regular nasal swabs for coronavirus testing, to avoid a bottleneck in running tests until production can be ramped up.

“There are more viruses and health issues that are occurring in our communities … it just means that we’re going to have to get a lot more sophisticated at building more resiliency in the supply chain,’’ said Alkire, the supply-chain company president.

Few U.S. suppliers

The shortages are about to get worse, as more cases are identified, hospitals fill up and supply chain pressures mount for products that mostly come from manufacturing facilities in India, Russia, China, Taiwan and other overseas countries. Many essential supplies are not made anywhere in the U.S.

About 80 percent of N-95 masks, for example, are made in India and Asia, industry officials say.

Steiner said Phoebe Putney is seeking new supply sources in China and Mexico, but they are competing with other states and other hospital groups doing the same.

Some foreign factories have announced that they are no longer exporting personal protective equipment to the U.S. However, some factories in China closed because of the virus are re-opening and expected to be fully operational this week.

The scramble for ventilator manufacturers is even more intense.

While there are some small manufacturers in the U.S., such as Ventec Life Systems in the state of Washington, most ventilators are made overseas.

The Center for Health Security at Johns Hopkins estimated in February that there are about 160,000 ventilators available in the U.S. There are others in the Strategic National Stockpile, though the White House wouldn’t specify at a Wednesday news conference how many were there. With 2,000 released from the stockpile, Trump said that many more are on order.

“We got to build more resiliency into the supply chain,’’ Alkire said. “We cannot be dependent on countries for really, really critical products.”