COVID-19: How a PPE shortage could cripple the healthcare system

Healthcare workers on the front lines of the COVID-19 pandemic are telling a grim story—a story of death and a scarcity of lifesaving medical supplies, including personal protective equipment (PPE). Across traditional news outlets and social media platforms, physicians and other medical personnel are sharing off-the-books tips for creative solutions amidst the lack of protective gear and supplies. For instance, some healthcare workers have taken to wearing trash bags in the absence of hospital gowns. It’s clear that during a time when supplies are needed most, our healthcare workers don’t have enough to protect themselves and provide patients with the best possible care.

In some areas across the United States, particularly rural regions, responders are rationing PPE to conserve supplies due to the national shortage. What’s more, projections from the Institute for Health Metrics and Evaluation (IHME) have shown that even if we continue strong social-distancing measures, we’ll face a severe shortage of hospital beds and ventilators. The challenge is compounded by the fact that when healthcare workers are not adequately supplied, they face increased risk of infection. Thus, physicians and nurses might soon be in short supply, too.

It’s an uncomfortable truth that raises an important and difficult question: How does this supply shortage impact the ability to fight the COVID-19 pandemic?

Consequences of the PPE shortage

Rationing PPE goes against well-established protocols designed to improve infection control. But, for many healthcare workers, it’s the best available option amid the current shortage. Still, it brings increased infection risk and other avoidable consequences:

Increased healthcare worker infections. Asia and Europe offer a glimpse into how COVID-19 takes a tremendous toll on healthcare workers. More than 3,000 physicians were infected in China, and more than twice as many were infected in Italy. Roughly 14% of novel coronavirus infections in Spain were attributed to 5,400 healthcare workers. Stories emerge daily suggesting the United States is on a similar path, but states lack key data that could clarify the exact number of infected medical professionals in the country. When appropriately trained doctors and nurses fall sick, healthcare systems look for support from retired and specialty physicians, raising questions about the quality and capacity of care.

Increased patient-to-patient transmission. Local and regional health departments continue to urge healthcare workers to ration PPE, putting physicians and nurses who would normally dispose of equipment between patient visits at increased likelihood of transmitting disease from one patient to another. N-95 masks, for example, are in notoriously short supply. Many medical personnel are being asked to wear the masks until they break, despite the fact that N-95s are intended for one-time use and disposal. There have even been some reports of healthcare workers sharing the same gown per patient room, with some reusing PPE for over a week. The challenge is heightened by the fact that it can take 13 days to receive test results for COVID-19, leaving physicians and other medical staff unsure of whether their interactions with patients pose a transmission risk. Even worse, some healthcare systems are denying COVID-19 testing to employees, instead directing them to outside providers such as urgent-care centers, which are also reluctant to test.

“On one side, they won’t test you in the hospital. On the other side, they won’t test you in the urgent care [centers],” said one mid-level healthcare provider in an exclusive interview with MDLinx.

Healthcare worker burnout. Scarcity of PPE and other critical medical equipment puts physicians and nurses face to face with a moral dilemma—they could be forced to ignore one patient’s needs to better serve the needs of others. According to the authors of a recent article in the New England Journal of Medicine (NEJM), removing a patient from a ventilator or ICU bed is justifiable as long as the action maximizes survival benefits for other patients. In fact, some frontline clinicians and health experts are now re-examining whether ventilation is really the best treatment strategy for critically ill patients with COVID-19, given the recent evidence showing that a significant proportion of patients who are put on ventilators ultimately die. 

Nevertheless, steps need to be taken so that “individual physicians are not faced with the terrible task of improvising decisions about whom to treat or making decisions in isolation.” The authors also noted that “[p]lacing such burdens on individual physicians could exact an acute and life-long emotional toll.” Burnout is likely to increase stress not just on workers, but also on the hospitals. Studies suggest that physician burnout costs the US healthcare system $4.6 billion per year and causes a two-fold increase in unsafe patient care.

Heightened curve. More sick and exhausted healthcare workers coupled with increased hospital transmission means more sickness overall. As hospitals become inundated with more patients and extend beyond capacity, resources like beds and ventilators become scarcer, further diminishing the quality of care and increasing the likelihood of poor outcomes. “If physicians and nurses are incapacitated, all patients—not just those with COVID-19—will suffer greater mortality and years of life lost,” according to the authors of the NEJM article.

Making the most of the scarcity

Organizations like the American Medical Association (AMA) are working to mitigate the core issue by lobbying the White House for increased medical supply production and delivery. “The AMA continues to urge the Administration to ensure manufacturing of PPE is operating at maximum possible capacity and create a national tracking system of acquisition and distribution of critical PPE supplies,” said AMA President Patrice A. Harris, MD, MA.

The WHO, meanwhile, is calling on governments and industry to increase PPE manufacturing by 40% to meet rising global demands. “Without secure supply chains, the risk to healthcare workers around the world is real,” said WHO director-general Tedros Adhanom Ghebreyesus, PhD. “We can’t stop COVID-19 without protecting health workers first.”

Until supply shortages can be resolved, the AMA and other organizations are issuing guidelines on healthcare resource allocation, and are urging healthcare leaders to put procedures in place to help reduce the decision-making burden on physicians.

Call to action

During the COVID-19 pandemic, physicians and other healthcare workers make difficult decisions by the second. This increases the already high burden of care, spreads health and safety risks, and could lead to unprecedented levels of burnout and disease. That’s why leaders must do everything within their power to advocate for increased availability of supplies in line with WHO and AMA guidelines. Failing to do so could cripple the healthcare system’s ability to continue caring for sick patients.