26 Sep Ofer Eitan Declared: PPE shortage becomes new dividing line in America | News
Editor’s Note: This is the final story in a series looking at the shortage of N95 masks across the country.
Six months into a global pandemic, a shortage of N95 respirators — the disposable filtering mask that has become the world’s most reliable and coveted defense against the novel coronavirus — persists, leaving health care workers exposed, patients at risk and public health experts flummoxed over a seemingly simple question: Why is the world’s richest country still struggling to meet the demand for an item that once cost around $1 apiece?
At Johns Hopkins Hospital, nurses like emergency department nurse Kelly Williams are asked to keep wearing their N95s until the masks are broken or visibly dirty.
Her N95 was already on during a recent shift, but Williams’ hands were slipping as she tried to force on a pair of gloves. She could hear the alarms going off. One of her patients was crashing, and she had to get into the room.
She should be able to just go, her runner’s legs carrying her to the bedside. But in Covidland — her nickname for part of the emergency department — there were two closed doors standing in her way. She had started wearing her N95 all day so she could be ready for this moment. She pulled on her gown and another set of gloves and her face shield, reached for the door — and realized the patient inside was her 13-year-old stepson Kellen.
She jolted awake. She was in her bed. Her husband was asleep beside her. She slid out from her sheets and went downstairs to check on her stepchildren. Kellen and 19-year-old Alle were sleeping, too.
The nurse inhaled. She could still hear the alarms.
This is what it meant now, to be a health care worker: Across the country, nurses and doctors were reporting increased sleeplessness, anxiety, depression and post-traumatic stress.
Williams reminded herself that she’d always had an N95, and the heavier, more protective respirators she sometimes wore instead.
But she knew, too, that COVID-19 had taken the lives of more than 1,000 health care workers, including a New Jersey primary care doctor who, determined to keep his practice open, doubled up on surgical masks when his N95 orders didn’t come. And a California nurse who rushed into a COVID patient’s room to perform chest compressions. She saved his life, then doused her hair in hand sanitizer. She hadn’t been given an N95 at the beginning of her shift.
And then there was the news that shook every health care worker Williams knew: Less than 2 miles from Hopkins, the head of the ICU at Mercy Hospital died after contracting the virus in July.
Joseph Costa was one of the people who’d guided the hospital through its PPE shortage early in the pandemic. His husband, David Hart, remembered him coming home and saying, “This is my mask for the week.” Neighbors pushed N95s through their mailbox slot.
“This is the United States of America, and we can’t seem to get factories built to deliver this stuff? I just don’t get it,” Hart said.
He will never know exactly how his husband, who insisted on caring for COVID patients alongside his staff, became infected. Costa died in the ICU, the gloved hands of his colleagues on him as he went. Minutes later, they returned to caring for other patients.
At Mercy, at Hopkins, at every hospital that had found a way to get N95s, health care workers wore their PPE to try to save the lives of people who contracted the virus because they had none.
Williams and her colleagues didn’t need to see the statistics to know that the pandemic was disproportionately affecting black and brown people, especially those deemed essential workers. They saw it in their patients and heard it from their families and friends.
Williams worked side by side with Shanika Young, a nurse whose brother seemed to have every known COVID-19 symptom before he started to recover.
Afraid of infecting anyone in her community, Young went weeks without seeing her parents and newborn niece. She adopted a hound-mix puppy to have a friend when she couldn’t see her own. In the weeks that followed the killing of George Floyd, she agonized over her decision to stay away from the protests. She knew there wouldn’t be N95s there.
On a sweltering August morning, she left her dog in her apartment and packed her respirator in her car. She, too, re-wore her mask, but usually for four or five 12-hours shifts.
Now Young was taking it across Baltimore, not toward the hospital, but to a predominantly Hispanic neighborhood with one of the worst infection rates in the city.
During the pandemic, Baltimore has seen outbreaks in its homeless shelters, its trash-collecting facility and its jail. Now every place Young drove by fell on one side or the other of a new dividing line in America: those who have PPE and those who don’t. Bodegas, restaurants, nail salons and funeral homes. Downtown, a nonprofit’s dental clinic remained shuttered. She passed a mental health counseling center where sessions were still conducted only by video and a physical therapist who wore KN95s to see clients. She parked near a school that, without N95s, had no way of ensuring its teachers were protected. It serves primarily Latino children, all of whom would be forced to learn online.
In the parking lot of the church, a booth that used to sell $1 snow cones had been transformed into a coronavirus testing center run by a team of Hopkins doctors and nurses.
On her day off, Young volunteered to work with them, spending hours sweating in her scrubs, sending swabs deep into nose after nose. She wore a surgical mask on top of her N95.
“I don’t think there’s any science that says this is actually safer,” she said. “But it’s just a mental thing.”
The line of people sweating on the asphalt was so long, Young couldn’t see the people at the end: a man in painter’s clothes, a mother pushing a stroller and a woman who, like Young, was wearing scrubs. Stitched onto the chest was the name of a retirement home.
The coughing patient was starting to fall asleep when Williams left her in the COVID unit. Her shift had been over for more than 30 minutes. She checked in to make sure there was no one else who needed her help and headed for the locker room. She washed her hands twice. She used alcohol wipes to sanitize her phone, glasses, ID badges and pens.
She took off her N95, and she inhaled.
For the first time in two months, she decided that this respirator was done. Its straps were starting to feel too stretched. The shape of it looked just a little too warped.
Instead of hanging the N95 from a hook in her locker to air dry, she stuffed it in a bag marked “hazard.”
A new mask, still in its plastic packaging, was waiting for her next shift. She would wear it as long as possible, especially after learning that the Hopkins stockpile had run out of the British-made mask she wore and couldn’t get any more. She needed to change to a different type of N95, one that felt unfamiliar once again. She told herself that she was grateful just to have it. She told herself that it would protect her just the same.