By Don McIntosh
Remember the proverb about the kingdom that was lost for the want of a horseshoe nail? Today, America is in crisis over the want of a 60-cent mask. More than two months after the coronavirus epidemic arrived in the United States, what was once the world’s mightiest industrial power can’t keep health care workers supplied with the N95 respirator masks they need to protect themselves. Across the country, health care workers in contact with coronavirus patients are being directed to ration and reuse disposable masks.
“Everything we know about the right way to use PPE (personal protective equipment) has been completely thrown out the window,” said OHSU ultrasound technologist Kasey Zimmer-Stucky, a steward with AFSCME Local 326. Two months ago, OHSU staff would have faced discipline for using the same mask with more than one patient. Now, they’re being directed to do so. Nurses say reusing PPE puts non-exposed patients — and co-workers— at greater risk of infection.
Underprepared and under-protected, more than 9,000 U.S. health care workers have been infected with the virus, including at least 446 Oregon health care workers as of May 10. And over 170 health care workers have died of COVID-19 nationwide, according to National Nurses United.
The PPE shortage comes after decades in which U.S. corporations were allowed to offshore production and shift to just-in-time supply chains.
“This is not a problem our employers can solve,” says Kaiser Permanente critical care nurse Jamie Dawson, an active member of Oregon Federation of Nurses and Health Professionals (OFNHP). “They’re having a very hard time acquiring the masks. Pretty much all hospitals in the United States are short, for some basic structural reasons. They’re not manufacturing them domestically any more. And the commercial distribution supply chain is operated on just-in-time principles, which means that there isn’t a warehouse in Vallejo or Long Beach that has a six-month supply lying around.”
In response to the shortage, Dawson authored a union resolution calling on elected leaders to get serious about protecting health care workers. Passed unanimously by the OFNHP board April 11, the resolution calls on President Donald Trump, Oregon Gov. Kate Brown and Washington Gov. Jay Inslee to use their executive authority to start local and domestic production of masks and other PPE using union paper mills and processing plants.
Greg Pallesen, president of the Association of Western Pulp and Paper Workers (AWPPW), says local paper mills could produce material for some kinds of PPE with retooling.
On April 30, Pallesen, Dawson, and newly elected OFNHP President Jodi Barschow made that pitch by conference call to two top staffers in the office of Gov. Brown — deputy chief of staff Berri Leslie and workforce and labor policy advisor Christian Gaston. In response to a question from the Labor Press, Brown’s spokesperson Charles Boyle said the governor’s office is following up with manufacturers to learn more about their capacity to help.
The PPE shortage was a key reason Brown ordered a halt to non-urgent medical procedures from March 19 to April 27. Adequate supplies of PPE are also one of the three criteria laid out by Brown before her stay-at-home order can be lifted. Under Brown’s return-to-work plan, hospitals must have a 30-day supply of PPE, and they must report daily to the Oregon Health Authority about their PPE supplies.
By early May, Kaiser Permanente Northwest had begun using hydrogen peroxide fogging machines to re-sterilize PPE, says Kaiser surgical nurse Paul Seer, who serves as a representative on OFNHP’s Kaiser COVID task force. Kaiser is also administering COVID-19 tests to patients two to three days before surgeries that involve sedation or intubation, to avoid the need for higher levels of PPE when there’s no risk of infection.
“I never in my lifetime expected to see doctors wiping down gowns with bleach wipes and hanging them to dry,” said OFNHP member Sarina Roher, an emergency room nurse case manager at Kaiser Permanente Sunnyside hospital. Roher said she’s seen co-workers wearing home-made hair bonnets and masks, and gowns they bought for themselves on Amazon. “Why are we in this predicament? I don’t think it’s our hospital system that failed.”
Is it time to federalize the medical supply chain?
The national AFL-CIO says it’s time to federalize the medical supply chain. A bill to do that, the Medical Supply Transparency and Delivery Act, is cosponsored by 46 Senate Democrats, including Jeff Merkley and Ron Wyden of Oregon and Maria Cantwell and Patty Murray of Washington, and is backed by the AFL-CIO, SEIU, National Nurses United, and United Steelworkers. The bill would put a new executive officer in charge of production and delivery of PPE, ventilators, testing supplies and equipment for the duration of the crisis— with support from uniformed and civilian personnel in the Department of Defense. The executive officer would be authorized to use the Defense Production Act to direct manufacturers to produce PPE and other supplies.
Bad idea in hindsight: Letting U.S. companies offshore PPE production
Made to the specifications of the National Institute for Occupational Safety and Health (NIOSH), an N95 respirator is a single-use disposable mask made of non-woven material—typically polypropylene fibers bound together mechanically, thermally or chemically—that blocks at least 95 percent of very small (0.3 micron) particles. Twenty years go, most N95 masks used in the United States were made domestically. Today the brand names—3M and Honeywell—are still American, but most are made in East Asia, with China alone accounting for nearly half the world supply. In hindsight, we can now see that letting 3M and Honeywell shift production overseas endangered national security, because as the COVID-19 epidemic spread, China imposed export restrictions to conserve masks to protect its own citizens.
Facing a mask shortage, labor unions step up
AFT procures millions of masks for health workers
Oregon’s two main nurse unions are both affiliates of American Federation of Teachers (AFT). After weeks of hearing from AFT members in health care about shortages of personal protective equipment (PPE), AFT in late March found a source and spent nearly $3 million to procure close to half a million N95 masks, 1 million surgical masks, and 50,000 face shields from 3M and other overseas manufacturers. The supplies will be delivered to AFT members in New York, New Jersey, Washington, and Oregon in the coming weeks.
Sheet Metal union manufactures nose pieces
With standard store-bought masks so difficult to obtain, a vast volunteer network has sprung up to manufacture and donate cloth masks. One useful component of the homemade masks is a 3-inch-long, 1/4-inch wide aluminum strip that helps masks keep their shape and fit snugly around the wearer’s nose. Seeing a need, the Sheet Metal, Air, Rail and Transportation Workers (SMART) union created a nationwide online request form through which volunteer mask-makers can request the strips. Local affiliates like Portland’s SMART Local 16 then fill the orders.
Responding to an appeal from Local 16, three Oregon sheet metal contractors volunteered to manufacture the strips, covering the cost of labor and materials. By mid-May, TCM Corp. in Portland, Robert Lloyd Sheet Metal in Independence, and Harvest Valley Specialties in Eugene had cut close to 90,000 strips. Local 16 staff pick up the strips and mail them out. Local 16 rep Brian Noble estimates the local union has fulfilled roughly 250 requests so far, mailing out shipments ranging from as few as 10 to as many as 5,000 nosepieces.
HOW TO GET NOSE PIECES FOR FACE MASKS Are you or your crew volunteering to make facemasks? Request aluminum nose strips here.
Subject: Solution to millions of disposable N95 Masks and contamination reduction
Headline: An estimated 10,000 healthcare workers have been infected and a growing number are paying the ultimate sacrifice. Why so many?
When you supply one person with a disposable N95 face mask CDC states that specifications is 8 hours of continuous or intermittent use for safe function but must be discarded following close contact with any patient co-infected with an infectious disease. CDC stated, consider using a cleanable face shield (preferred) over an N95 Respirator Mask. CDC also states touching a contaminated respirator has been identified as the primary hazard of extended use and reuse of N95 respirator masks. N95 masks have a shelf life of 3 to 5 years from manufactured born date (stockpiling issues). Importantly, extended use, re-use, or re-processing of masks all affect the filtration capacity of the mask.
In the first picture, the man standing in the background is not covering his nose. In the last picture, the guy in the orange shirt is not even wearing a mask.