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Despite promises of more masks, doctors and nurses have to reuse N95s

Nurses
Nurses hold a rally at UCLA Medical Center and Orthopaedic Hospital on Monday in Santa Monica to draw attention to their need for more personal protective equipment and other issues.
(Myung J. Chun / Los Angeles Times)

The nurse keeps her mask in a Tupperware container. In an unwelcome daily ritual, she dips her face in the plastic tub to put on and take off her N95 respirator, careful not to touch the front in case it is contaminated with the coronavirus.

“If you had told me I would be reusing N95 masks before the coronavirus, I would’ve laughed and not believed you,” said Jill Tobin, an emergency room nurse in the Bay Area. “The methods we’re using are not scientific.”

Despite assurances from government leaders about adequate personal protective equipment supplies, as well as COVID-19 numbers flattening, tensions between front-line health workers and hospital leaders are higher than ever. Nurses and doctors say hospitals are conserving gear by forcing staff to re-wear masks to stretch the existing supply — and endanger their own health.

These are some of the unusual new scenes across the Southland during the coronavirus outbreak.

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Statewide, more than 2,500 healthcare workers have fallen ill with COVID-19, a statistic that has raised the level of alarm among providers.

Seven nurses at a Santa Monica hospital were placed on administrative leave last week because they refused to enter COVID-19 patient rooms without an N95 mask, considered superior because it blocks small particles a surgical mask may not, according to the nurses’ union.

Last week. Gov. Gavin Newsom announced a major purchase of masks for healthcare workers that would begin flowing in the next few weeks. Tens of millions have already been distributed statewide.

But there is no sign that these unprecedented policies to conserve gear will be lifted.

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State health officials advised healthcare facilities on Monday to reuse gear as providers across California “continue to report severe shortages of PPE, including respirators, face masks, gowns, and face shields,” according to a letter sent by officials.

Tobin and others say supply remains too far behind demand, and politicians’ promises ring hollow.

“It’s still not enough, and it’s still a vastly different bar than what would’ve been acceptable two months ago,” she said. “We never would’ve used a mask on two different patients two months ago, and we’re just expected to accept that that’s normal and OK, but it’s not normal and OK.”

The frustration among healthcare workers traces back to the federal government.

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In January, scientists, public health officials and journalists were warning that the coronavirus was set to explode out of China. Few listened.

Early in the outbreak, the national Centers for Disease Control and Prevention recommended that providers wear N95 masks whenever interacting with patients suspected of having COVID-19. The guidelines were then loosened to recommend that only healthcare providers doing high-risk procedures wear N95 masks, a policy that has upset nurses who fear they are not being adequately protected from the virus.

On Friday, Jack Cline refused to enter the room of a suspected COVID-19 patient at Providence St. John’s Health Center, where he works. The hospital placed him on administrative leave, he said.

“I’ve been a nurse for 25 years; I don’t need the CDC to tell me when I need an N95,” Cline said. “When I have a patient coughing directly in my face ... I’m not going into that room unless they provide me with one.”

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St. John’s said in a statement that it could not comment on personnel matters but is taking precautions sanctioned by government health agencies to protect its nurses and has adopted the same protocols as major academic medical centers.

N95 masks are considered superior because they provide a custom fit and and block the virus when it is aerosolized, though it is unclear what effect the switch to surgical masks will have. A 2019 clinical trial found that health workers who wore surgical masks on the job were no more likely to catch the flu than those who wore N95s.

“We are so grateful for the heroic work our nurses perform each day and will not let the actions of a few diminish the appreciation we have for all our nurses and their commitment to our community,” St. John’s said in a statement.

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Angela Gatdula, also a nurse at St. John’s, said she believes she contracted COVID-19 while treating patients with the virus. Her symptoms earlier this month began with body aches and a cough, and she tested positive last week, she said.

She said she felt angry the hospital administration did not give her an N95, though it knew she was treating COVID-19 patients. She was told she would be protected by a surgical mask, she said.

“They could’ve done more,” she said, her voice breaking. “I don’t want it to be one of our nurses who ends up needing hospitalization, needing ICU admission, possibly even dying.”

Hospitals are stuck in a tough position as they try to navigate a nationwide shortage of gear. The three Los Angeles hospitals run by PIH Health — Downey, Good Samaritan and Whittier — are running low on hand sanitizer and wipes, and nurses on COVID wards have been asked to wear a single N95 a day, said Dr. Jaime Diaz, an emergency physician who serves as the chief medical officer at the Downey hospital.

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Diaz said the change extended the duration of the hospital’s N95 stockpile from a four-week supply to an eight-week supply.

“It’s dramatically decreased the amount of masks we are using on a daily basis,” he said.

In thousands of care facilities, where the coronavirus’ deadly toll has been acutely felt, staffers are growing scared, sick and overwhelmed as cases and deaths mount.

In an attempt to conserve masks, the UCLA health system has become one of the first in the nation to treat N95 masks with ultraviolet germicidal irradiation, “a validated process to kill viruses,” officials said in a statement.

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But on Monday afternoon, nurses at UCLA Medical Center in Santa Monica protested what they view as an unsafe practice, one that makes them feel like guinea pigs for this new technology.

“Bottom line is no method of sterilization has proven to be safe and effectively kill the coronavirus,” said UCLA nurse Kristan Delmarty.

Sydnie Boylan, a registered nurse at Hollywood Presbyterian Medical Center, said that shortages at her facility are persisting, despite reassurances from the state that more supplies are coming. A charge nurse who oversees a COVID-19 ward, Boylan said she is scrambling to keep her staff protected on a daily basis, cutting back on in-person visits to rooms to preserve PPE.

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“I have zero masks, I have zero face shields, I have zero goggles,” Boylan said Sunday. “It’s an ongoing battle.”

Dr. Jamie Chang, chief of clinical operations at Hollywood Presbyterian, denied in a statement that workers didn’t have access to protective gear, writing that “all staff at HPMC are provided with the appropriate level of PPE that is required per existing guidelines.”

But Boylan said she had been wearing the same N95 mask for four days. Though she received another one, it was the wrong size, and she didn’t want to waste it by trying to make it fit. She’s hoping to exchange it, but in the meantime, she’s trying to keep the one she has clean. She has soaked it in hydrogen peroxide and is considering baking it in the oven.

Times staff writer Ben Poston contributed to this report.


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