The prognosis is grim. “We're all anticipating that the situation is going to get worse,” says Elissa Schechter-Perkins, an emergency room physician at Boston Medical Center. As the coronavirus spreads across the United States, health care workers are reckoning with how to protect themselves while helping Covid-19 patients in increasingly harrowing circumstances. Access to personal protective equipment (PPE) is severely limited in many parts of the country, testing remains inadequate, and the likelihood of shortages of everything from masks to ventilators to hospital beds has left many workers stressed out, angry, and, in some cases, resigned to endure bedlam.
“Ideally, we would be wearing full PPE for all patients that we're seeing in the emergency department,” Schechter-Perkins says. Yet, in many cases, they are not. She has witnessed patients come in for unrelated reasons only to later show signs of infection, after they’d already been looked after by hospital staff. “Some of them have gone on to become confirmed cases of Covid-19.” Because the nurses and doctors attending to these patients didn’t immediately categorize them as coronavirus cases, she says colleagues wound up “completely unprotected.”
“We have known, kind of from the beginning, that there is not a sufficient supply of PPE and there's not a confirmed supply chain for getting more anytime soon,” Schechter-Perkins says. “So right from the beginning, we have been placed in really difficult circumstances in which we need to ration our PPE in ways that are potentially quite unsafe.”
Across the country in Los Angeles, an emergency room physician is aghast at the equipment limitations he and his fellow health care workers face. (The doctor asked that his name not be used.) When asked what’s on short supply, he rattles off a list: masks, goggles, face shields, copper equipment, gloves—and disinfectant wipes. “We’re using diluted bleach and a spray can instead,” he says. “Not as effective.” All of this adds up to a hospital staff that is especially vulnerable amid a pandemic. Increasingly, this is the norm at hospitals in cities with surging Covid-19 outbreaks. In California, most ER physicians are classified as independent contractors. This can impact what kind of equipment they have ready access to. The ER doctor says one of the companies contracting him offered a stipend of $250 for personal protective equipment rather than obtaining it for the medical staff. “I went out and bought my own goggles on eBay.”
Even when the correct protective gear is provided, it is often in short supply. Schechter-Perkins is one of several doctors and nurses who told WIRED they’re reusing N95 masks, which are thick, particle-filtering face coverings designed for single use. “We are storing them in paper bags in between patients,” she says. “Then, at the end of the shift, we are storing them in paper bags so that we can use them the next day.”
In parts of the country where the coronavirus has yet to turn into a full-fledged outbreak, doctors are faring significantly better. “Everybody is working on their own timeline through this,” James Beckerman, a cardiologist in Portland, Oregon, says. “When I was on call last weekend, we had what we needed, but it’s a moving target right now.” Infection prevention epidemiologist Saskia Popescu, who is currently working in Arizona, hopes hospitals currently outside of hotspots can see what is going wrong in other regions to avoid their own catastrophes. “So many of us are looking at New York and seeing what they are going through, which is devastating, and trying to use that as a teaching moment,” she says. “New York is a warning for a lot of us.”
New York City is now the frantic heart of the coronavirus outbreak in the United States, with more than 790 confirmed deaths, and so it’s the part of the nation where health care workers are in the most jeopardy. After Kious Kelly, a 48-year-old assistant nurse manager at Mount Sinai West, died this week in what appears to be the first coronavirus death among New York nurses, his coworkers emphasized their lack of protection on social media. One nurse captioned a photograph of Kelly on Facebook with a hashtag: #GetUsPPEs. Another nurse decried the official response in her own Facebook post: “We do not have enough PPE, we do not have the correct PPE, and we do not have the appropriate staffing to handle this pandemic. And I do not appreciate representatives of this health system saying otherwise on the news. The public needs to know that we are not prepared, that this is serious, that they need to stay home to flatten the curve. How many more of my friends have to get sick, have to die, for the world to take this seriously?!”
The hospitals are trying to catch up. Nurse practitioner Peggy Desiderio, who works at Mount Sinai’s Morningside location, says the protective gear situation there isn’t sufficient, but that access has improved as frontline medical workers have asked for additional supplies. “I’m not saying that it’s great, or that it’s going to last forever, or that we won’t get shortages,” she says. “But they’re listening.” (Mount Sinai did not respond to a request for comment.)
However, many New York hospital workers continue to eye their limited equipment with worry. Recently, doctors and nurses at Queens’ Elmhurst Hospital Center began speaking out about the conditions they are facing as a surge of critically ill patients arrive. Benjamin Laitman, an ENT resident at Elmhurst, has seen the strict budgeting of protective gear firsthand. “It’s a crisis mode,” he says. The hospital isn’t out of anything yet, but the scarcity is an enormous preoccupation. “We have it because we’ve been rationing it.”
There is a sense of doom among many of the frontline workers in New York. “I sent my husband and child away,” says a nurse at a large New York hospital, who asked not to be identified. She walks to work and stays inside when she’s off the clock to avoid infecting others, getting meals dropped off, but cannot help feeling distressed over the likelihood of widespread, devastating illness among her peers. “Who do they think are going to come to take care of the patients if we get sick?” she asks.
This is a question obsessing large swathes of the country. As WIRED reported in February, some parts of the American health care system were already experiencing backorders for personal protective gear before the outbreak began in the United States. Since the supply chains for masks and respirators, in particular, are centered in China—according to data compiled by the US Department of Health and Human Services, 95 percent of the surgical masks and 70 percent of the ventilators used in the US are made there—the equipment supply was disrupted by the coronavirus even before it spread globally.
Domestic companies like Prestige Ameritech, the country’s largest mask maker, have scrambled to pump up production. The Minnesota-based manufacturing giant 3M intends to make a billion masks by the end of the year. For now, though, the demand outstrips current supplies.
Meanwhile, grassroots efforts from concerned citizens have also sprung up around the country. In Los Angeles, film director Lulu Wang leveraged her popularity to help a friend organize a PPE drive. The effort found supplies in unexpected places. “One of our first donations was a special effects company,” Wang says. Melanie Ensign, who helps coordinate the new nonprofit MasksForDocs, says that the masks they’ve sourced have come from a variety of donors, including art studios. Medical students Mericien Mendoza and Gaby Mayer, who helped coordinate PPEtoNYC, a New York–based campaign, say volunteers cold-called businesses they suspected might have gear in storage, like nail salons.
And some physicians, nurses, and other hospital and urgent care workers are receiving individual donations from friends and family. “I personally have a number of kind friends who have mailed me things from around the country,” Schechter-Perkins says. She has received masks, including ten N95 respirators. “I'm planning to bring those into my hospital and share them with my emergency department group.”
Stockpiles of all sizes are popping up and getting redistributed. Disaster preparedness company Judy, which includes N95 masks in its kits, donated 25,000 masks to New York State, for instance, while the Service Employees International Union located a whopping 39 million N95 masks from a distributor who will sell them to hospitals around the country.
Even with the outpouring of resources, though, health care workers are yearning to be prioritized by the government. As they ration and plead for help on the frontlines, the Trump Administration has shown a lack of understanding about the immediacy of the problem. After New York governor Andrew Cuomo said around 30,000 ventilators were required for proper care in the state’s outbreak, for example, the president scoffed. “I don’t believe you really need 40,000 or 30,000 ventilators,” Trump told Fox News’ Sean Hannity on Thursday, the same day his administration faltered on moving forward with a $1 billion partnership to produce tens of thousands of units. “You go into major hospitals sometimes, and they’ll have two ventilators. And now all of a sudden they’re saying, ‘Can we order 30,000 ventilators?’” Trump seemed to reverse course on Friday, tweeting that GM and Ford should "start making ventilators now!"
This is not the kind of behavior frontline health care workers are calling for. “Ideally there would be some direction from a federal level,” Schechter-Perkins says. “That lack of top-down attention makes it seem as though this is not a national priority. It leads health care workers, frontline health care workers, to feel really exposed, really vulnerable, and really unprotected.”
Updated 3-30-20, 5 pm EST: This story was updated to reflect the current number of coronavirus deaths in New York City.
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