Where Are the Masks?

“It’s like going to war with a butter knife.” That’s the description one physician in New York City offered for how he and his colleagues are trying to suppress the coronavirus, even as they deal with dwindling stocks of health-care supplies and personal protective equipment.

Over the past two days, I’ve talked with 22 health-care professionals, almost all of whom used metaphors and analogies usually reserved for combat movies. They are “soldiers” on the “front lines” and in the “trenches” fighting a “war” against a terrifying new “enemy” that is growing exponentially. But we’re failing these soldiers, sending them into battle without the weapons and armor they need to win.

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“This is a disaster. [Our health-care workers] are risking their lives,” the physician told me. “We need to advocate for our frontline workers.”

Most of the health-care professionals I interviewed, including the physician in New York, asked to remain anonymous. “I’ve got small kids to support. I can’t afford backlash from my institution [for speaking out],” said a physician from Baltimore, echoing the fears of many colleagues. Regardless, he reached out because he finds the current situation “maddening and exhausting” and believes it must be fixed.

A New York City emergency-room physician echoed that sentiment. “We are flying blind right now.” She pointed to the lack of testing kits available in the United States. South Korea, a country of 51 million, has aggressively tested more than 270,000 people. By contrast, the United States, which often boasts about being the most powerful country in the world, has tested only about 82,000. She said the turnaround time to obtain results for the very few tests she has on hand is about three days.

Health-care workers often don’t have access to the testing kits that magically appear for celebrities and politicians. They are running out of the life-saving medical supplies they need to do their jobs.

The shortage of personal protective equipment is particularly acute. Medical workers are supposed to be using N95 masks, which reduce their exposure by filtering out at least 95 percent of particles in the air. But on Wednesday, President Trump said his administration had ordered 500 million of these masks after receiving complaints about widespread shortages. To cope with the burgeoning coronavirus crisis, the Centers for Disease Control and Prevention told nurses to use bandanas and scarves as last-resort masks. Immigration and Customs Enforcement officers, meanwhile, have access to N95 masks as they apprehend immigrants during a national pandemic.

The escalating crisis led Margaux Snider to go public. She is the medical director of emergency medicine at Arroyo Grande Community Hospital, in California. “As of today, I have had it,” she said. “I am willing to be on the record. We need supplies, and we need the public to take this seriously. I’m willing to lose my job before my life.” She wanted to put her name to that call, whatever the personal cost. “I am deeply disillusioned with a country that is unwilling to protect the people that stand between them and death, risking our lives seemingly without concern,” she said. She cited the recent news about two emergency-room doctors, in New Jersey and Washington State, who contracted COVID-19 and are now in critical condition.

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Nearly every person I interviewed pointed to Italy as a preview of what’s about to happen to the U.S. health-care system unless drastic action is taken immediately. In Italy, 2,629 health workers have been infected by the coronavirus. On March 11, Roberto Stella, the leader of the Medical Guild of Varese, died from COVID-19 after he continued treating patients despite lacking proper protective gear.

Snider warned that this deadly trend will accelerate all across America, especially in small communities that are struggling to receive necessary supplies.

She said community hospitals are struggling to hold on to N95 masks and powered-air purifying respirator hoods, the white suits that look like they came out of 2001: A Space Odyssey. One community hospital in central California, Snider said, has only a single box of masks for the entire emergency department. That’s 30 masks, for a department that usually sees more than 30,000 patients a year.

“PPE matters the most,” she stressed. Emergency-room doctors and nurses are exposed to higher viral loads of the coronavirus, Snider explained, which means that, if infected, they may get sicker, faster, than the average citizen. When health-care professionals fall ill, no one else will be left, especially in small communities, to take care of patients as the coronavirus exponentially spreads.

I spoke with another physician who works at an outpatient clinic in the Washington, D.C., area. Most hospitals, she said, realized by last week that they don’t have enough equipment to deal with this outbreak. Medical workers are “totally vulnerable and exposed in an outpatient setting,” she said.  She’s seeing people with complaints ranging from respiratory infection to coughs to runny noses to fevers. All of those could be symptoms of the common flu—or of COVID-19. People who are infected with the coronavirus can be asymptomatic, meaning they don’t feel sick, but can still pass the virus to family members, friends, and their community—and, if they’re health-care workers, to patients.

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This physician worked all last week without a mask. She now worries every day that she could be infected but asymptomatic, and spreading the virus to her loved ones, including her four children. And she’s worried about what’s coming in the weeks ahead. “There will be so many people in the hospital,” she told me. “It’s going to be overwhelming. Doctors are going to be infected. They’re going to be sick. I don’t know if we have the infrastructure to take care of this.”

At a White House press conference on Thursday, Vice President Mike Pence said the administration’s recent measures have made 35 million N95 masks available, up from 3 million.

One government study from 2015, though, estimated that 1.7 billion to 3.5 billion such masks would be needed in a pandemic—and that was in its most optimistic scenario.

“People aren’t realizing the gravity of the situation,” a health-care worker in a Queens hospital told me. “We are going to run out of PPE.”

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“Private companies that make these materials can make a huge difference in terms of the outcome, but they need to be supported by the government,” he said. The CEO of General Motors recently offered to manufacture hospital ventilators in her auto plants, and other offers followed. On Wednesday, Trump said he would invoke the Defense Production Act, a wartime measure, to accelerate production of PPE and health-care supplies, but later tweeted that he would only “invoke it in a worst case scenario in the future.”

Almost every health-care professional I interviewed criticized the government’s lack of preparedness. “The biggest mistake we’ve made is that we awakened to this problem too late,” said the New York emergency-room doctor. “We had three months of warning from China and then Europe, and we didn’t take it seriously.”

“We have known for six weeks, and there was literally zero response and preparedness,” echoed another physician from New York City. “The entire health-care system is a massive failure on a federal level.”

They also voiced frustration toward the CDC and its changing guidelines on personal protective equipment. A few weeks ago the CDC said physicians needed N95 masks. Later, it said surgical masks would suffice. This week, it said bandanas and scarves can be used as a last resort. The physicians said they believe these shifting guidelines are driven by equipment shortages, and not the actual safety of health-care workers.

Some health-care professionals have decided to be proactive. Esther Choo started the hashtag #GetMePPE, urging health-care workers to share pictures of their equipment and stories of their struggles so Congress will take action.

Susan Puckett, a physician assistant from Boulder, Colorado, emailed me to say she has been hiding one N95 mask in her desk because of a shortage. She told me she is going to borrow her husband’s woodworking gear and goggles from the garage, because her office doesn’t have any eye protection, either.

Furkan Shinaishin, an attending emergency-medicine physician at Inova Loudoun Hospital, is more desperate. “Because of our shortage of masks, we keep one N95 mask per shift. After we’re done seeing the patient, we put it in a paper bag with our name on it. When it’s time to see the next patient, we put the same mask back on. It’s frightening.” She said because there’s no way to sterilize the mask, she and her colleagues were told to put a surgical mask on top of the N95 mask.

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She has been on immunosuppressants because she has lupus, and she has two small girls at home. “I’m hoping I’m lucky enough that I’m not going to get it,” she said. “I literally couldn’t sleep last night after my shift because I was in such a panic.”

Like soldiers in the trenches, many of the health-care workers I talked with believe they simply have to take care of one another. “A lot of us on the front lines are just thinking about tomorrow. The next 12 hours. The next four hours,” Jason Sample told me. He is the chief of acute, trauma, and critical care at New York–Presbyterian Queens.

“I don’t want people to forget that everybody who works in the hospital is part of the health-care team—from the janitors to the people in the laundry room to the people in the lab. We’re just doing our best to protect each other.”

He said New Yorkers need to pull together, as they have in previous crises. “Everyone right now needs to focus on being kind to each other,” he said, his voice breaking. “People were just walking the streets [after the 9/11 attacks] and people who would never talk to you were like, ‘What can I do to help?’ People were just kind to each other. I just hope if anything good comes out of this at all, that’s what comes out of it.”

Despite the shortages, many medical workers are undeterred from pursuing their mission. “We have to get back on the front lines, because this is going to get worse,” a nurse practitioner in Oregon told me. She works in a free mobile clinic that provides services primarily for vulnerable clients, including undocumented immigrants, transgender individuals, and the homeless. She has no N95 masks and no gowns in the van. All she has are surgical masks with eye protection, which do not offer adequate protection from the coronavirus, and she has only four left. But she refuses to abandon her patients. “If I get infected, hopefully it doesn’t kill me,” she said.

Don’t we owe her more?