WHITE PLAINS, N.Y. – New York nurses on the front line of the coronavirus outbreak are afraid their safety is being sacrificed so hospitals can stretch dwindling stockpiles of protective equipment.
Central to the fear are new Centers for Disease Control and Prevention guidelines seeking to help hospitals conserve medical masks as thousands of New Yorkers are infected with COVID-19, the disease caused by the virus.
Some nurses asserted hospital officials asked them to make a typically single-use surgical mask last a week, leaving them to store it in paper bags between shifts.
Other nurses described begging for access to higher level N95 masks and watching fellow nurses get quarantined after suspected COVID-19 exposures amid shortages.
Mostly, they talked of living in constant dread of infecting themselves or loved ones with the virus that has killed more than 18,000 across the globe and confirmed cases mounted in New York, surpassing 30,000 on Wednesday.
“We’re really just beginning this, which is the scary part,” said Mary-Lynn Boyts, a nurse at Westchester Medical Center, about 30 miles north of New York City. “I feel like we’re going into a battle we’re just not prepared for."
Even with millions of masks being distributed since last week in the greater New York City area, Gov. Andrew Cuomo warned hospitals could run out in coming weeks.
“The burn rate on this equipment is very, very high. I can't find any more equipment. It's not a question of money. I don't care what you're willing to pay,” he said at a news briefing Tuesday. Cuomo said about 2 million N95 masks could shore up supplies at the hardest-hit hospitals for anywhere from two to six weeks.
To avoid that grim fate, Cuomo has urged the federal government to take control of protective equipment production and get more supplies to New York as soon as possible.
He noted that the shortages threaten countless other communities across the country just starting to get hit by the virus.
Cuomo also praised health care workers and first responders for their bravery.
“Most of us are in our home hunkered down, worried. They're worried and they're going out there every day despite their fear. ... Overcoming their fear, and not for their family, they're doing it for your family,” he said.
What nurses say about equipment shortages
Some nurses described a disconnect between Cuomo’s comments at daily news briefings and what some hospitals are demanding of workers.
“They’re being asked to do things that jeopardize their health and make it hard to take care of their patients,” said Boyts, who gathers Westchester Medical Center nurse grievances for the New York State Nurses Association union.
“You wouldn’t ask police to go into a gun battle without a gun, but we’re being asked to put our lives on the line each day without the equipment that we need to do it.”
Lori Glazer, a registered nurse from Ossining, also is worried by the lack of gear.
"We don't have N95 masks, we just have (surgical masks). They're protecting other people, not us," Glazer said. "It's scary going in because you never know when you're going to get sick."
At Montefiore Health’s hospital in the Bronx, nurses with suspected COVID-19 exposures are being told to break the typical 14-day quarantine and return to work early, according to Karine Raymond, a Montefiore nurse and union leader.
The order apparently came as the CDC recommended loosening quarantine rules for medical workers, joining the already diminished infection control practices that nurses say put them at risk.
“They keep lowering the guidelines as we fall sicker and sicker. I’m afraid we’re going to lose some of our colleagues,” Raymond said.
The federal agency in late February recommended extended use and reuse of masks connected to COVID-19 related shortages, deviating from long-held infection control standards. The quarantine strategy for medical workers was last updated on March 16, records show.
It is all part of what state and federal health officials say is a dire attempt to keep hospitals afloat in the face of potentially overwhelming COVID-19 infections.
Yet amid debate over the emergency actions, nurses at Montefiore were being warned they could be fired if they didn’t adhere to the hospital’s new protective gear rules, according to Montefiore records reviewed by the USA TODAY Network – New York.
Eventually, Montefiore sent out a message Friday canceling the original order threatening termination and said it was "sent in error," the records show.
Michele Brailsford-Paul, a home care nurse for Montefiore, said she recently filed a complaint with federal worker safety regulators in Tarrytown about the shortages in protective equipment.
She compared the crisis to workers sickened while working at Ground Zero after the terrorist attacks on Sept. 11, 2001.
"What's at the back of my mind is 9/11 and the trouble those workers had in getting health care coverage, so I wanted to take an active role in noting the lack of protective gear," Brailsford-Paul said.
What hospitals say about nurses’ equipment complaints
Montefiore officials asserted the Bronx-based health system with 15 hospitals is following CDC guidelines on COVID-19 and prepares for all types of emergencies.
“Comprehensive plans have been in place to reduce risk of potential exposure to our patients, staff and community,” the officials said in a statement.
Westchester Medical Center Health Network officials disputed that nurses have limited access to N95 masks and asserted the health system with 10 hospitals across the region is following CDC guidelines.
"Like every other hospital and healthcare organization, we are managing our supply pipeline and use very carefully,” the officials said in a statement.
They added the health system’s workforce is “coming to work every day to help and serve their friends and neighbors. They truly are healthcare heroes.”
Montefiore likewise disputes the allegations that nurses are short of protective gear.
“Protecting our staff is also of utmost importance so we can continue to provide care as this pandemic continues to worsen. We are working tirelessly with state and federal governments to secure appropriate protective gear for our providers and equipment for our patients”, the Montefiore officials said in a statement.
Meanwhile, some nurses criticized the CDC guidelines for giving hospitals the green light to limit access to protective gear, regardless of the safety ramifications.
“What they’re telling us to do is not based on the science of the virus; it’s based on what is available for any given day,” Boyts said.
CDC officials didn’t immediately respond to a request to comment on the nurses’ complaints in New York.
The state Department of Health would not say if it is investigating complaints from nurses about the conditions at hospitals. It noted the CDC continues to issue revised guidance regarding the use of protective gear.
"The (Health) Department takes the safety of New Yorkers very seriously and is also working to provide additional guidance to hospitals,” agency spokeswoman Jill Montag said in a statement.
How one hospital adjusted protective equipment rules for COVID-19
Hospital officials, in many ways, have been tasked with finding the balance between implementing the new CDC guidelines for stretching protective equipment supplies and worker safety.
One is Dr. Erick Eiting, vice chair of operations for emergency medicine at Mount Sinai Downtown, which includes an emergency department and urgent care in New York City that handles about 97,000 patients a year.
Eiting compared the effort to implement new mask-use guidelines to the rapidly evolving outbreak response in New York.
It is all seemingly part of a daily stream of drastic actions, such as converting the Javits Center in Manhattan into a temporary hospital, aimed at helping prepare the health system to handle surging infections.
“A lot of it is there is so much anxiety about this because we’re dealing with a totally new phenomenon and trying to take the best practices we’ve built with other diseases and apply them here, but we’re also learning on the fly,” he said.
For example, the rise in potential COVID-19 patients is forcing Eiting and colleagues to devise ways for some staff in high-traffic roles to use N-95 masks more efficiently.
“We’re having to come into contact with so many different patents in such a short time. … Does that mean keeping that mask on the whole time?” he said.
Medical workers typically had used the N95 masks for brief periods to care for the limited pool of patients with airborne infectious diseases, such as tuberculosis.
“It’s an adjustment, because anybody who’s worn one of these masks before knows just having to keep them on for a few minutes isn’t the most comfortable thing, but having to keep it on for the entire shift is something else altogether,” Eiting said.
The decisions at Mount Sinai are made by a team of doctors and nurses with infectious control expertise, Eiting said, adding the practices in place protect staff and patients.
Eiting on Monday noted Mount Sinai hasn’t faced protective equipment shortages yet. But the need to gear up more often to handle people walking into the ER with COVID-19 symptoms is running through stockpiles at a historic rate, he said.
“I think that creates an anxiety and knowing the supply chain has been disrupted adds to the uncertainty,” Eiting said. “We have a lot of work to do to make sure we continue to secure the equipment.”