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    • A healthcare worker in PPE holds a Covid-19 test.

    • Used N-95 masks in the trash.

PPE Shortages 101: A (Very) Brief Overview

Anushree Vashist '21 Lead News Editor
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The United States Covid-19 pandemic has been marked with a consistent failure: chronic personal protective equipment (PPE) shortages.
Ever since the crisis was declared a pandemic in March 2020, American news has been riddled with stories on PPE shortages. In addition to traditional news stories, healthcare workers turned to social media to share their subpar work conditions. For example, pediatrician Dr. Vidya Ramanathan spoke about reusing masks and face shields and running short of disinfectants. In an NPR article, an ER physician in New York City suggested that being in the hospital is “ like walking into Chernobyl without any gear.” Nurses demonstrated their frustration with the lack of access to PPE through marches across the nation. That these struggles were widespread is evident in the results of a survey of approximately 23,000 nurses conducted by National Nurses United (NNU), which found that 87% of test subjects reused single-use masks and respirators.

In an examination of the causes for PPE shortages, Jennifer Cohen and Yana van der Meulen Rodgers argue that the lack of PPE is not simply a workers’ rights issue but “a system-wide public health problem.” Healthcare workers without ad- equate protection are more likely to contract Covid-19, thus leading to “a decline in the supply of healthcare due to worker illness” while also adding to viral transmission, thus “increas[ing] the demand for care while simultaneously reducing health system capacity.”

The unsatisfactory circumstances resulted in movements like Project N95 and Get Us PPE. The latter establishment is “the largest national organization getting personal protective equipment (PPE such as masks, gloves, and isolation gowns) to frontline workers who need it most.” Additionally, Get Us PPE also provides updates regarding the status of PPE shortages nationwide. Their recent statement, titled “The PPE Shortage Crisis and Rationing,” outlined the dramatic increase of 260% in the company’s requests for PPE between November and December 2020. Nitrile gloves, disinfecting wipes, and hand sanitizer consist of the most requested commodities, with surgical masks and N95 respirators remaining in high demand." The piece continues, “The rationing and reuse of PPE are profound and continue to be utilized among many facilities, placing their frontline workers at risk.”

Cohen and van der Meulen Rodgers identified four major causes of the shortage: “a dysfunctional budgeting model in hospital operating systems [that] incentivizes hospitals to minimize costs rather than maintain adequate inventories of PPE;” “a major demand shock triggered by healthcare system needs as well as panicked marketplace behavior [that] depleted PPE inventories;” the failure of the U.S. federal government in “maintain[ing] and distribut[ing] domestic inventories;” and the “major disruptions to the PPE global supply chain [that] caused a sharp reduction in PPE exported to the U.S.”

The federal government was already unprepared for a large public health crisis before the pandemic’s start. George Burel, the former Director of the Strategic National Stockpile (SNS), stated that the program was not prepared for a crisis of this magnitude. Additionally, the former Trump Administration had only sparingly used the Defense Production Act to help increase PPE production, leaving states to compete with one another for equipment. Without federal intervention, the United States was not capable of handling supply shortages, in part because of the budgeting model and sudden increase in demand, but also because the U.S. is the largest importer of face masks.

Public health experts are calling for the use of medical protective gear for the general public. In July 2020, Andy Slavitt, a  senior adviser to President Biden’s Covid-19 response team, said that “[b]y now every American should have access to N-95 quality masks,” before outlining the “epic failure of indifference of our government” in a 16-tweet Twitter thread.

Now, given the rise of the B.1.1.7 and B.1.351 variants, more scientists are calling for the universal wearing of medical-grade masks. Former Director of the Centers for Disease Control and Prevention (CDC), Dr. Tom Frieden, stated: “N95 masks are the most protective masks, followed by three-ply surgical masks, then fabric masks. A fabric mask is a lot better than no mask, but we may need to step up our mask game if contagious Co vid variants start to spread widely.”

Former Commissioner of the Food and Drug Administration (FDA) Dr. Scott Gottlieb agrees, suggesting that “Quality of mask matters more now. N95 best, or double masking.”

Dr. Abraar Khan, Dr. Ranu Dhillon, and Devabhaktuni Srikrishna published an op-ed in STAT news titled, “Along with vaccine rollouts, the U.S. needs a National Hi-Fi Mask Initiative.” The use of higher quality masks for everyday people is becom- ing more common in other countries; Germany and Austria require those using public transportation or in supermarkets to wear N95-equivalents or surgical masks.

The Biden Administration has outlined an approach different than its predecessors in combatting the PPE shortage. Biden’s National Strategy for the Covid-19 Response and Pandemic Preparedness states: “To make vaccines, tests, Personal Protective Equipment (PPE), and other critical supplies available... the President has directed the use of all available legal authorities, including the Defense Production Act (DPA), instructing departments and agencies to expand the availability of critical supplies, to increase stockpiles so that PPE is available to be used in the recommended safe manner, and to start to fill all supply shortfalls immediately.”
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