Hospice supply lines have been strained to the limit due to the COVID-19 pandemic, as has the U.S. health care system at large. Providers of all types are reporting serious shortages of necessary materials, including essential personal protective equipment (PPE) to prevent infections, such as masks, face shields and sterile gloves.
“This is really unprecedented in the past century. There’s shortages of virtually everything that’s needed. There’s shortages of what I would call low-tech equipment, such as PPE — things like the masks, gowns, the face mask to protect the eyes, because the coronavirus can also get into the mucous membrane of your eyes — and even things like swabs for doing the testing,” Thomas Cornwell, M.D., told Hospice News “And then there’s the high-tech shortages, things like ventilators. I’ve not heard of there being significant shortages of ventilators or hospital beds yet. The concern is that we’re not at the peak [of the pandemic] yet.”
Cornwell, an Illinois-based physician, is executive chairman of the Home Centered Care Institute, senior medical director for Village Medical at Home, and founder of Northwestern Medicine HomeCare Physicians
The shortages are so extreme that many providers have advised staff to sew together makeshift masks out of cloth or allowing staff to use bandanas to cover the nose and mouth. None of these materials are as effective as an actual surgical or N95 mask, but evidence suggests that they do offer some measure of protection.
A 2013 study in the journal Disaster Medicine and Public Health Preparedness evaluated the effectiveness of various materials that health care providers could use to make masks. The study found that each material filtered out at least 50% of particles. The most effective materials included Vacuum cleaner bags (95%), dish cloths (83%), cotton blend shirts (74%), and 100% cotton shirts (69%).
Surgical masks filtered out 97% of particles, according to the study, though N95 masks have been shown to be more effective. One caveat on these data is that the study was designed to test protection against influenza rather than COVID-19.
Though PPE is critical to protect staff from the contagion, hospices are low on many more types of supplies. Many have called on the public for donations as well as assistance from states and the federal government.
“People need to check with the county where they are located. We received 1,500 surgical masks from the county, which was great as our supplier was unable to get us any; 1,500 is not many. We gave out bags for people to be able to reuse surgical masks.” Christy Whitney, CEO of Colorado-based hospice provider HopeWest told Hospice News. “We are having problems with obtaining cleaning products for equipment and office — our DME supplier ran out and could not get any — but with our [group purchasing organization] we found some products that will assist us. We cannot get thermometers or thermometer covers for our machines”
A number of companies such as 3M and the clothing manufacturer Hanes have begun to produce masks and other PPE in larger quantities, but to date the supply has not kept up with demand.
President Trump recently invoked the Defense Production Act via an executive order, which would give the president the authority to order companies to switch their operations to make necessary supplies in response to a crisis. However, the president indicated in a press briefing that he is loath to give such an order to private industry and noted that some companies were voluntarily devoting more resources to health care PPE.
“There’s always going to be people praising and people condemning our government, but I really think there has been a strong response from our federal government, including declaring a national emergency,” Cornwell said. “There’s also been companies that have stepped up like even distilleries switched over production to make hand sanitizer, and some of them are giving it away for free. People with 3D printers are making parts for ventilators.”
Stakeholders in the hospice space are continuing to call for more PPE from local, state and federal agencies and the private sector, as well as deployment of more testing kits and swabs which are also in short supply. Hospices need the kits to determine whether patients, family members or staff have become infected.
“PPE shortage is real. We need protective equipment now. Not only in hospitals and nursing homes, but in the community,” National Hospice & Palliative Care Organization President & CEO Edo Banach said in a Tweet. “Social Workers, aides, therapists, chaplains and nurses should not have to raid Home Depot for supplies.”