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Nurses in Sonoma, Marin counties voice outrage over shortage of protective masks, other equipment

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Nurses in Sonoma and Marin counties on the front lines in the local coronavirus outbreak are preparing for the day they may have to cut surgical scrubs into makeshift masks to protect themselves from contracting the widening infectious disease at work.

Others are leaning on family members to provide homemade protective masks fashioned out of cloth and filters bought online, multiple Kaiser Permanente nurses said Thursday.

At Kaiser's San Rafael Medical Center, when N95 masks are given out, nurses are instructed to store them in brown paper bags between reuses, Colleen Gibbons, a surgical nurse there, told the Marin Independent Journal. Such respirators because they better control the flow of air have been deemed more effective than surgical masks in protecting workers from the virus.

“They’re basically taking away the N95 masks and telling us we can use a simple mask,” Gibbons told the publication. A group of Kaiser nurses protested outside the hospital Thursday afternoon.

MarinHealth Medical Center in Greenbrae is following a similar procedure, Lynn Warner, a critical care nurse there told the newspaper.

Administrators at both facilities told the Independent Journal they are following Centers for Disease Control guidelines for what to do in a shortage of N95 respirators. Previous guidelines dictated that health care workers don N95 respirators around patients who tested positive for the COVID-19 virus, and the patients were put in negative-pressure isolation rooms, but now the CDC is recommending N95 masks and such isolation only when those patients are undergoing procedures for the deadly pneumonia symptoms that can put the virus into the air.

"Everyone is on Plan B," Marin County Public Health Officer Matt Willis told the Independent Journal.

That’s how bad the global shortage of respirator masks appears to have become locally amid the viral pandemic sweeping the world, straining the supply of health care equipment relied on by nurses and physicians to safeguard themselves, patients and others from a deadly disease.

In Sonoma County, the shortage of safety equipment has prompted an outcry from nurses who are demanding better protective measures, including greater access to a tightening supply of respirator masks, and more information at the local hospitals where they serve as primary staff in the pandemic response.

Without proper gear, the nurses fear for their ability to protect themselves, their colleagues, patients, neighbors and loved ones at home.

“Nurses have become extremely frustrated and angry because there isn’t clear communication. There isn’t clear transparency,” said Deborah Burger, a nurse at Kaiser who is co-president of National Nurses United and president of the California Nurses Association, which represents nurses at the Sutter and Kaiser Permanente hospitals in Santa Rosa.

Nurses at Sutter Health Santa Rosa Regional Hospital have signed a letter accusing the hospital of failing to protect workers and demanding they follow strict state guidelines that call for them to use respirator masks — not looser-fitting surgical masks, and definitely not bandanas or scarves, which the Centers for Disease Control and Prevention now is suggesting as face masks of last resort.

Those complaints echo criticism from local nurses at Kaiser Permanente and Santa Rosa Memorial Hospital and come as nurses and doctors around the country are pleading for help dealing with a shortage of critical personal protective equipment, including respirator masks and face shields that can help prevent transmission of the coronavirus.

They are worried both about getting sick and being unable to provide care that’s needed like never before, and about inadvertently spreading the coronavirus to others because of inadequate protection.

Burger, the union official, said she was aware of nurses sending letters to hospitals all over the state to follow California rules that are tougher than relaxed CDC regulations.

Equipping nurses with masks that are inferior to N95 respirator masks — so well known to local fire survivors — is like giving a garden hose to a firefighter facing a blaze or sending a police officer out onto the street without a bulletproof vest, she said.

“I keep using the word ‘obscene,’ ” she said. “I can’t think of a stronger word.”

A Sutter spokesperson, in a written statement, declined to provide specific information about how much personal protective equipment such as masks, gowns or gloves was available or how many hospital officials anticipated they would need.

“Our commitment to keeping our patients and health care workers safe never changes,” Sutter said in its statement.

The statement also acknowledged the shortage of protective equipment “is a significant concern being felt acutely by health care organizations across the nation, including us,” and alluded to “a number of proactive measures to address equipment needs while maintaining patient and staff safety.”

“Sutter’s supply chain is working to secure additional PPE (personal protective equipment) from conventional and unconventional sources, including receiving donations from the community,” the statement said. “We are also moving supplies around the system to ensure all our facilities have PPE.”

The respirator mask shortage should be treated like an emergency, said Jaci Cederberg, a Kaiser nurse who volunteered to work on the floor where patients are being treated for COVID-19, the respiratory disease caused by the coronavirus.

Hospital managers have told nurses that, assuming masks run out in the coming weeks, they may need to sew surgical scrubs into masks, said Cederberg, whose account was confirmed by another Kaiser nurse who requested anonymity. Cederberg’s mother, a seamstress, is sewing her a mask, and her brother, an engineer, paid $250 to overnight a box of masks from Portland, Cederberg said.

“I can’t believe it’s come to this,” she said, noting the county was still in the early days of an outbreak. “This is not even bad. It’s going to get much, much worse.”

Kaiser Permanente, in a written statement, did not say how many masks it had available or how many it needed while alluding to efforts to conserve its supplies.

A spokesman did not respond to a specific request for comment about plans to cut up scrubs to fashion masks.

“As the virus is now spreading quickly through our community, equipment and supply needs have increased dramatically,” Kaiser Permanente said in the statement. “We are prudently managing our resources to ensure this equipment is available for our health care workforce for the duration of the pandemic. We are committed to the safety of our patients and staff now and into the future and we appreciate the efforts of the community to support or patients and health care workers.”

The CDC is not recommending members of the general public wear N95 respirator masks, stressing instead the importance of less technical measures like washing hands with soap and hot water. But many members of the public have snatched up masks to wear out and about, adding to the strain on the supply chain.

The World Health Organization warned more than two weeks ago of “severe and mounting disruption to the global supply of personal protective equipment” that “is putting lives at risk from the new coronavirus and other infectious diseases.”

But that hasn’t been enough time to replenish stocks, prompting the CDC’s advisory on makeshift face masks as well as guidance from the U.S. Food and Drug Administration to health care providers on how to conserve personal protective equipment, including gowns and looser-fitting surgical masks.

Nurses at Santa Rosa Memorial Hospital, which is run by St. Joseph Health, have reached out to Cal/OSHA to express their frustration about the shortage of protective equipment.

“I wish we had enough supplies to do our jobs,” said Laura Hensley Hanson, a Memorial nurse and board member of the Staff Nurses Association union, which represents nurses at the hospital. “It’s hard, it’s scary, but we are nurses and we get out there and we do it.”

Hanson said it’s particularly important to protect health workers from the coronavirus, which “is in the halls of hospitals if it’s anywhere.”

She noted that the U.S. is not alone in experiencing a shortage of masks.

“Italy is draining supplies. China drained supplies and now it’s hitting the United States, so we’re at the end of the supply chain,” she said.

St. Joseph did not respond to phone and email messages seeking comment about mask supplies and nurses’ access to personal protective equipment.

On Thursday night, Gov. Gavin Newsom said the state would be ramping up its effort to distribute as many as 10 million stockpiled respirator masks to health care facilities to help meet demand.

Vice President Mike Pence, who President Donald Trump has tapped to lead the nation’s response to the coronavirus pandemic, has called on the construction industry to donate N95 masks to hospitals and to stop new orders of the protective devices.

Meanwhile, nurses and doctors across the country have ramped up appeals to the general public for masks, hoping to stay healthy while bracing for the spread of the virus.

Donations from builders or any field would be welcome, said Jesse Rael, a radiologist at Sutter, noting that any donated masks should be brand-new. Anyone seeking to donate a mask can email him at jesserael@mac.com.

“If somebody has a number of boxes, maybe by chance we can pry a box out of them,” Rael said. “We medical people would be extremely grateful to have the masks.”

Cederberg said she’d already received four boxes of N95 from a local construction company. She said she’d passed them out to her colleagues with a message: “Keep it in your lunch box — for when the time comes.”

You can reach Staff Writer Will Schmitt at 707-521-5207 or will.schmitt@pressdemocrat.com. On Twitter @wsreports.

This story has been updated with reporting from the Marin Independent Journal.

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