Oregon Providers, State Worried As Supply Of Protective Gear Dwindles

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Oregon is erecting a field hospital at the fairgrounds in Salem to treat an expected overflow of patients due to the coronavirus epidemic, but that’s not going to be enough.

The state is scrounging for more protective masks and suits for health care workers, but officials acknowledge they’re running out of options.

Many nurses, doctors and other practitioners feel left out of the information loop -- and they’re worried about being exposed to the virus. They’re facing an immediate future of working around the clock and setting aside their families and their own personal safety in an effort to save patients in hospitals without enough supplies or beds.

“We are all concerned as front-line workers,” Dr. Fred Cirillo, an emergency room physician at Kaiser Permanente, told The Lund Report. “We’re concerned for our personal safety and what we’ll be bringing back to our families.”

Two Oregon Health Authority physicians -- an epidemiologist and Oregon’s chief medical officer -- held a webinar on Wednesday for 1,000 providers that covered a range of topics, from an expected surge of infected people at hospitals to obstacles to stepping up telemedicine visits. But the hour-long event, which was a first, lacked details. For some physicians, it reinforced their concerns about how the response to the pandemic is being managed.

“We need a centralized source where front-line providers can go for reliable and up-to-date information, be able to ask questions, and get answers,” said Dr. Sharon Meieran, an emergency room physician and Multnomah County commissioner. “I would think the OHA would want to engage with health care providers to get an accurate picture of what is happening on the front line.”

Cirillo, who’s married to Meieran, said that half of his shifts lately have involved remote telemedicine visits with patients.

“Many people are staying away,” Cirillo said. “It all feels like the calm before the storm. We are (talking with) a good number of patients who have all the clinical symptoms of COVID-19 but are not ill enough to be hospitalized.”

That’s likely to change. Oregon’s case count rose to 75 on Wednesday -- up 28 patients from two days ago. So far, three people have died. Oregon is testing about 1,200 people a week, but it is still limiting tests to people who are hospitalized with COVID-19 symptoms. 

Dr. Tom Jeanne, deputy state health officer and epidemiologist, said during the webinar that two-thirds of patients who tested positive are over 55.

“We definitely have predominance there,” Jeanne said.

That trend may continue but the total patient count is expected to soar. 

'This Will Last For Months'

“We’re in the initial phases of what’s expected to be an unprecedented health care crisis,” Patrick Allen, director of the Oregon Health Authority, told a special coronavirus legislative committee on Wednesday. “This is a situation that will not last for weeks. This will last for months and potentially a lot of months.”

He said state stockpiles of crucial supplies have plummeted.

A few weeks ago, Oregon had nearly 590,000 N95 respirator masks that filter out harmful airborne particles. Providers have used 28%.

“We’re down to 421,000,” Allen said.

The supply of surgical masks has dropped from 49,000 to 18,000.

And more than 80% of the 23,000 surgical gowns the state had have been used. Once a provider uses the equipment, it must be tossed over contamination fears. Studies show the virus can live on some surfaces  up to several days. The rate of equipment usage is a nightmare for providers who face a potentially deadly bug for which no vaccine or cure exists.

Allen said the state has flipped through its options, from Plan A, using existing supplies, to Plan B, using state stockpiles, to Plan C, using federal stockpiles to Plan D, relying on the U.S. military and emergency managers. 

It is now at Plan F, Allen said, which involves looking “creatively in our own backyard” for protective gear used in the high tech industry, for example, or ramping up statewide production.

“While pursuing all of those things, in the absence of a significant change, we’re going to run out of personal protective equipment,” Allen said. “There is no plan F available for us to access.”

He, too, is worried.

“I’m concerned that in a few short weeks, we will have providers who need to treat patients without masks, without face shields and those kinds of things,” Allen said.

A few hours after he spoke, Gov. Kate Brown announced an order for “all Oregon hospitals, outpatient clinics and health care providers, including veterinarians and dentists, to cease all non-emergency procedures, in order to preserve personal protective equipment such as surgical masks, gowns, and gloves, for health care workers treating COVID-19 patients.”

The order also limits hospital visitors.

A Field Hospital In Salem

Amid the announcements, meetings and webinars, state employees hauled pallets of medical gear to the Oregon State Fairgrounds. The pallets contain hospital beds, medical dispensers, pharmaceuticals and other gear for a field hospital that will go up in the Jackman Long Building. With 250 beds, it should be erected by Friday, Allen said. It’s not clear when it will be ready to accept patients.

It needs water, power, cleaning contractors and medical staff, Andrew Phelps, director of the Oregon Office of Emergency Management, told The Lund Report.

“(That’s) another mission we’ll be working on to get those wrap-around services,” Phelps said.

In a statement on Thursday, the Oregon Health Authority said it will be staffed by the volunteers on a state registry and the Oregon Disaster Medical Team. It will have enough personnel for 24/7 operations.

Phelps is working closely with the health authority and governor’s office to manage Oregon’s response to the pandemic. In terms of protecting public health, the Oregon Health Authority is in charge.

Allen said his agency is considering erecting facilities in parking lots, for example, or using hotel rooms or dorms for patients who might not need hospital care but need a lower-level of service, like rehab, or for people who are infected and need to stay away from a care facility or their home.

Brown has said that all options are on the table.

A letter sent to Brown last week by more than 400 physicians suggested the state take several steps, including creating a call center to coordinate patient transfers and forming a team specialized in ethics to decide how to ration care and an information line for providers. The health authority plans to offer weekly webinars for providers instead.

Dr. Maxine Dexter, a critical care and pulmonary physician at Kaiser Permanente, said the governor’s office has been receptive to the suggestions. 

“People are working as hard as they can to figure out how we're going to fill the gap,” Dexter told The Lund Report. “Nobody has a clear, thoughtful, pragmatic approach to how to address an unprecedented event.” 

You can reach Lynne Terry at [email protected] or on Twitter @LynnePDX.

 

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