When Edward Hines Jr. VA Hospital needed more nurses to care for COVID-19 patients amid a surge in infections in April, Beverly Miles jumped at the opportunity.
Her first night on the job, the nurse and Army veteran who normally worked an administrative job in the suburban veterans hospital, looked for N95 respirators that add extra safeguards for health care workers exposed to the virus. Whatever masks were available, they were locked up, she said.
“There were no N95 masks at all,” she said.
A week later, she had a cough. Shortly after working with coronavirus patients, Miles became infected with COVID-19 and was off work for four months. Now she’s back on the job part time and suffers from chronic pain, she said.
Her experience may have been different, she believes, had she been provided an N95 mask, a highly effective, low-cost piece of protection that is still hard to obtain due to a national supply shortage. These respirators have been at the center of tensions between health care providers and their hospital employers who say they’re doing the best they can to obtain and build ample supplies.
Matthis Gutierrez, a Veterans Affairs nurse who provides home health care in an area that stretches from Chicago’s South Side to Kankakee, said he’s worn an N95 mask — intended for disposal after a single use — for a month straight because of short supply.
“I wore the same mask literally for 30 days,” he said.
In a statement, the VA said that Hines follows federal guidelines for providing protective gear to its staff and said its “current COVID employee infection rate” is well under 1 percent. The hospital now has a 30-day supply of N95 masks stockpiled, the VA said. “The pandemic tested America’s health care infrastructure like few events have,” the statement said.
Some Chicago hospital executives interviewed said they aren’t settling for one-month stockpiles of N95 masks — they’re aiming to reserve up to 90 days worth and hope that’s enough as 3M, the leading U.S. maker of the respirators, and other manufacturers can’t keep up with unprecedented demand. A recent Washington Post investigation noted that President Donald Trump declined to fully use the Defense Production Act to ramp up production, one reason a shortage exists.
National Nurses United, which represents Hines VA providers, has been critical of Trump’s “failure” to order the production of more N95 masks and other protective equipment. The nurses’ union says the country is estimated to need 3.5 billion N95 respirators throughout the pandemic.
Meanwhile, production of N95 respirators by 3M in the U.S. will jump to 95 million in October from 20 million a month early this year, a company spokeswoman said. But company officials have acknowledged that won’t be enough to meet demand.
Locally, addressing N95 respirator shortages were among demands made by striking nurses and health care workers at University of Illinois Hospital before two unions came to tentative agreements with the health system last week. Unions that represented the staffers said they won concessions to ramp up supplies of protective gear, including N95 respirators.
To help stretch the supply of N95s, which pre-pandemic could be obtained for just $1 each, U. of I. and other hospitals have experimented with sterilizing respirators so they don’t have to be disposed after every use. The strategy is endorsed by federal officials as a last resort but isn’t recommended by manufacturers like 3M.
Is there enough in reserve?
Even with respirators in reserve, the question remains as to whether there will be enough if a predicted next wave of hospitalizations occurs.
Hospitals scrambled for months to find sufficient numbers of the respirators and hit plenty of snags in the process.
At the University of Chicago, for instance, thousands of masks from China didn’t meet the hospital’s standards. But scouring the globe for N95s, U. of C. officials were able to stockpile 90 days worth of respirators.
“We’re in a pretty good position for another surge,” said Eric Tritch, vice president of supply chain at the hospital. “The question becomes how big a surge and for how long?”
Other hospitals expressed cautious optimism but noted the challenge of the supply chain issues.
“We have and continue to prepare for a significant and sustained surge of patients in our hospital,” Dr. Susan Bleasdale, acting chief quality officer at University of Illinois Hospital, said in a statement. But she added that the hospital is “inhibited” from significantly stockpiling “until there is significant improvement in the national supply chain.”
In May, Advocate Aurora Health, the dominant health system in Illinois and Wisconsin, bought a stake in a Texas company, Prestige Ameritech, that makes N95 and other protective masks to help manage its own supply. Still, the hospital system continues to search the world for additional respirators.
For hospitals who run into critical shortages, federal, state and some local governments have their own stockpiles. The state of Illinois has 2.6 million N95 respirators on hold for the neediest care providers, a spokeswoman said. As of late August, the city of Chicago provided more than 870,000 N95 respirators to health care providers and first responders.
Challenges to expand mask use
Another challenge for hospitals is that the N95 respirators need to be tested to fit very tightly on an individual’s face, said Dr. Emily Landon, an infectious diseases expert at the University of Chicago.
Without that tight fit, the masks likely don’t protect against the virus, she said. So when U. of C. or other hospitals order from multiple manufacturers across the globe, they have to go through the fit testing process for each new product.
For that reason, it’s unlikely — putting the supply issue aside — that the masks will be used more broadly outside health care settings, even if some hope the masks could help more workers in public facing industries get back to work.
“Once you’re fit tested in a mask, it’s really tight,” Landon said. “Could we get everyone to wear them? That’s not a realistic expectation.”
Brett Chase’s reporting on the environment and public health is made possible by a grant from The Chicago Community Trust.