Coronavirus cases are surging in Stanislaus County. Why don’t nurses have enough masks?
Hospitals in Stanislaus County are treating a growing number of patients for COVID-19 illness during a shortage of protective equipment for frontline staff, which was largely created by the pandemic.
Gov. Gavin Newsom in April arranged the purchase of 150 million N95 respirator masks and hundreds of millions of surgical masks from contractors, so the state did not have to rely on the federal government for supplies.
The Modesto Bee looked into the available supply of medical grade masks at Stanislaus County hospitals after hearing nurses were reusing single-use masks for days.
Right now, the county has more hospitalized COVID patients than larger counties in the Bay Area. But its allocation of those N95 respirator masks has been 518,000 to date, compared to 6 million distributed to Santa Clara County and 1.6 million to San Francisco.
A spokesman for the California Office of Emergency Services said the allocations to counties are based on requests from county public health agencies. If more of the respirator masks are needed by local hospitals, the county needs to ask, said Brian Ferguson, a spokesman for Cal OES.
“The state is standing by, we are ready to assist,” Ferguson said. “We have millions of masks that need to be deployed.”
A Stanislaus County spokesman said the local public health agency could place more orders to the state for N95 masks. But it doesn’t have additional requests from local hospitals.
The county’s public health agency said earlier this week it has received 350,000 of the N95 masks from the state. The masks protect nurses and doctors against contagious disease by filtering out 95 percent of small air particles.
Cal OES reported on July 7 a distribution of 402,000 N95 masks to Stanislaus County and the total increased to 518,000 in an update Tuesday.
County public health agencies play a role in delivering personal protective equipment from state and federal stockpiles to hospitals, nursing homes, first responders and other sectors that need PPE.
Royindar Singh, a spokesman for Stanislaus County public health, said the county has allocated 90,000 of those N95 respirators to local hospitals. The county dedicated 100,000 of the N95 masks to agriculture, an essential industry, for use in pesticide applications.
The county has also provided hundreds of thousands of state-purchased disposable masks to protect farmworkers from coronavirus infection.
Singh said the county provided 3,525 of the N95 masks to fire departments and other emergency responders. The breakdown also included 8,325 to nursing homes, 9,730 to other medical facilities such as physician offices, and almost 1,000 to county departments.
The county is holding 138,700 masks in inventory to satisfy a state requirement for the county’s application in May to progress in the phase II reopening process. To get state approval for reopening businesses, Singh said the county needed to have a 14-day supply of PPE for nursing homes.
An intensive care nurse in Modesto said as local hospitals geared up for a surge in COVID-19 patients, she had expected nurses to have an ample supply of medical grade masks and gowns to keep from getting infected while working closely with patients.
Now that the hospitals are burdened with 235 patients confirmed or suspected to have COVID-19, there’s a shortage of protective masks and gowns, hospital staff members have told The Bee.
“We were given all this time to prepare and why don’t we have (the N95 masks)” the nurse said, speaking on condition of anonymity. “They are putting us at risk.”
Doctors Medical Center is now requiring its nurses to put their names on N95 masks after caring for COVID patients during their shifts. The masks are then sterilized and reused. The respirator masks are thrown away after two more cycles of decontamination and reuse, according to an internal hospital notice.
Nurses at Kaiser Modesto Medical Center are using N95 masks three times with two sterilizations. Information on mask reuse at Modesto’s Memorial Medical Center was not available.
In statements this month, local hospitals did not deny the challenges of providing enough PPE to staff amid national and global shortages created by the pandemic. The N95 respirator masks are generally designed for single use, but sterilization and reuse is permitted under contingency measures adopted by the Centers for Disease Control and Prevention.
Sterilization and reuse of N95 masks is not ideal
“Our healthcare workers absolutely need the highest level of protection,” said Jan Emerson, a spokeswoman for the California Hospital Association. “There is a global shortage of the appropriate PPE. We need more N95 masks, but also more gowns and gloves.”
Health care corporations like Kaiser Permanente and Sutter Health purchase large amounts of PPE from makers like Honeywell and 3M, and can move supplies within their hospital systems to where it’s needed the most, Emerson said. Because of the national and international demand for masks and other PPE, the normal supply chains have broken down for hospitals.
When the supplies are depleted during periods of high demand, like a pandemic, hospitals can go to county public health agencies for additional supplies.
Emerson said sterilization and reuse of masks is an accepted practice under the circumstances, but it’s not ideal. A nurse may feel a need to remove and discard contaminated PPE after an invasive procedure such as intubating a COVID-19 patient. A patient may exhale a large amount of viral particles when staff members try to insert a breathing tube.
At midday on Thursday, Singh said county public health received an additional 96,000 N95 masks this week.
He said a delivery of 10,000 masks was going out to Doctors Medical Center and Emanuel Medical Center in Turlock, which are owned by the same company. It’s unclear how long the fresh supply of respirators will last given the ongoing patient surge.
A spokesperson for the two hospitals said they had ordered more masks from the state and were expecting delivery.
Sacramento-based Sutter Health, affiliated with Memorial Medical Center, said its network of hospitals has an adequate supply of N95 masks “thanks to the work of our supply chain management teams” and it does not have to rely on state or county resources at this time.
Sutter added: “We continue to closely manage our supply of PPE and work around the clock to secure additional PPE.”
Singh said the 96,000 masks are for meeting requests that come in from hospitals, first responders and others that need it.
Singh explained that a county stockpile of PPE is managed like a store. It has items available for local entities that request them. The county places orders with the state from time to time to replenish the warehouse.
Singh was also asked why the county has not requested more N95 masks from the state. The spokesman said the county had no other pending requests Thursday from local hospitals or other organizations.
Masks supplied to farmworkers in Stanislaus County
The county Agricultural Commissioner’s office has made a push to provide infectious disease protection for farmworkers and food production employees. It has distributed 238,000 disposable masks for those workers, including 50,000 delivered this spring to migrant camps in Patterson, Westley and Empire, Ag Commissioner Milton O’Haire said.
Labor contractors and large growers also picked up masks for agriculture workers. The Ag Commissioner’s office has N95 masks that are required for pesticide applications on farms.
With the arrival of the pandemic in March, O’Haire said county ag commissioners thought it might be difficult for growers to obtain N95 masks this year for safe use of pesticides and brought their concerns to the state. Some of the respirator masks distributed by the state are for that purpose.
O’Haire said he expects the supply of masks distributed to farmworkers will be exhausted before long, as the face covering may be discarded after a day’s use. His office has ordered an additional 75,000 from the state.
Ferguson said Thursday the state has distributed 83.4 million N95 masks to counties and 278 million surgical masks to health care, public agencies and other critical sectors across California.
Farmers in Stanislaus County who need face coverings for employees or N95 respirator masks may call the Agricultural Commissioner’s office at 209-525-4732.
This story was originally published July 17, 2020 at 4:30 AM.
