Nurses, doctors and other front-line staff had to reuse N-95 masks, sometimes for days at a time, when metro Detroit became a COVID-19 hot spot in late March and early April. Others couldn't get N95 masks at all.
Some health care workers were infected with COVID-19. Among 6,700 adults hospitalized with COVID-19 from March 1-May 31 in the U.S., about 6% were health care workers, according to a report published last week by the U.S. Centers for Disease Control and Prevention. Of them, 36% were nurses and 4% died.
As COVID-19 case numbers spike again in Michigan, and hospitalizations rise, Michigan's health care leaders say they're cautiously optimistic that their supplies are better stocked for another crush of critically ill patients.
"Over recent months, hospitals have increased their PPE inventories with a goal of having a 90-day supply of five main PPE items to account for a second surge," said John Karasinski, a spokesperson for the Michigan Health and Hospital Association, which represents all 133 community hospitals in the state. Those items include N95 masks, surgical masks, gloves, gowns and protective eye wear.
"Hospitals also better understand the rate at which PPE is consumed and what daily needs look like."
However, the numbers tell a different story.
While some hospital systems have amassed at least 90 days of critical PPE supplies, the volume at other hospitals is so low, they'll be exhausted within a week, according to a statewide database and Free Press interviews with hospital leaders.
Addiction treatment becomes casualty of war on COVID-19
Masks, gloves in short supply
At Ascension Michigan's 16 hospitals, surgical masks are in short supply, with only enough to stretch up to six days, according to state data.
The health system, which includes St. John Hospital in Detroit and Providence hospitals in Novi, Southfield and Rochester, reports enough gowns in stock to last a week or two, and enough N95 masks, gloves and eye protection to last at least 21 days. Its spokesperson did not respond to Free Press requests for comment.
Ann Arbor-based Michigan Medicine has enough surgical gloves to last only up to six days. It has a seven- to 14-day supply of surgical masks. The health system, which is affiliated with the University of Michigan, is better stocked when it comes to N95 masks and eye protection with at least 21 days of supply.
"We currently have adequate PPE supplies now, and we have never had to limit PPE," said Mary Masson, a spokesperson for Michigan Medicine. "We continue to reassess daily and monitor this closely."
Although Michigan Medicine has a low supply of one-time wear disposable gowns, it purchased washable medical gowns made of a polymer fabric that can be laundered up to 100 times before they need to be discarded.
It also joined with two other health systems — Henry Ford Health System, and St. Joseph Mercy Health System — to open a new laundry facility in Detroit that can manage 700,000 pounds a week of hospital linens such as scrubs, bed sheets, blankets and towels — as well as the washable gowns.
That's just part of the innovation that has taken place since the pandemic began to solve some of PPE shortage problems hospitals across the state are facing.
Many diversified their supply streams — which previously came almost entirely from overseas — to include domestic suppliers, and found new vendors who offered creative options to meet their needs, Karasinski said.
At Midland-based MidMichigan Health, there are enough medical gloves and N95 masks to last seven to 14 days, said spokesperson Millie Jezior. Its surgical mask supply is expected to last 15-30 days, and it has more than 30 days' supply of gowns and eye protection.
"We currently have adequate supplies — anywhere from seven to 30 days of everything that we need," said Dr. Lydia Watson, senior vice president and chief medical officer of MidMichigan Health, which has medical centers in Alpena, Clare, Gladwin, Gratiot, Midland, Mount Pleasant and West Branch.
But if there's a huge increase in patient loads because of COVID-19, it might not be enough, she explained.
Statewide, COVID-19 hospitalizations rose 44% in a span of nine days, from 1,177 on Oct. 21 to 1,728 on Friday.
And with more patients, "we're using more supplies," Watson said.
"We are concerned because we do have continued sporadic back orders of a variety of supplies. And just like most of the other U.S. health care systems, we're heavily, heavily reliant upon supplies coming from overseas. And so because of that, we never know if what we think is going to arrive actually will arrive.
"And so that's why we are monitoring it very closely and still have some concerns," Watson said, "especially about nitrile gloves and the N95 masks. Those are probably the two that we worry about the most."
That's an overarching concern among the state's hospital leaders, too.
"An increased surge of COVID-19 patients, particularly for a prolonged period of time, can quickly deplete these inventories and again stress an already vulnerable supply chain," Karasinski said. 'In addition, the available supply for surgical gloves will not meet demand for at least several more months."
At Hurley Medical Center in Flint spokesperson Laura Jasso said it has at least 30 days of N95 masks, surgical masks, gloves, gowns and eye protection.
Although Beaumont Health reported a seven- to 14-day supply at each of its eight hospitals of N95s, surgical masks, gowns, gloves, eye protection, it also has stockpiles with enough N95s, earloop masks, isolation gowns, gloves and eye protection to last at least another 90 days at a warehouse it added to its Wayne campus to store a backup stock of PPE, said its spokesperson, Mark Geary.
In a crisis, the state government also has a stockpile of PPE that can be tapped in emergencies, said Lynn Sutfin, an MDHHS spokesperson.
"The purpose behind the creation of Michigan’s PPE stockpile is to protect the state’s front-line workers during a public health emergency when the supply of these lifesaving items is not immediately available," Sutfin said.
"The state stockpile is reserved for emergency use and hospitals and other medical care facilities are encouraged to establish their own inventory. As requests are received from the Healthcare Coalition Regions for PPE, those requests will be evaluated and supplies provided."
State health officials urge every health system to have at least a 90-day supply of essential PPE stocked.
"We realize this is a lofty goal and could prove challenging to both a facility’s budget as well as storage capacity," she said. "However, based on the surge in COVID-19 cases and hospitalizations that occurred this past spring, that is the current recommendation."
Henry Ford Health System has exceeded that PPE goal. It has enough of those crucial supplies to last at least 100 days, said Dr. Adnan Munkarah, executive vice president and chief clinical officer.
"We don't want to be unprepared," he said. "We have learned from the first time."
So far in the pandemic, more than 174,000 Michiganders have had confirmed cases of the virus and more than 7,300 have died, according to the MDHHS.
Staffing still a concern
Having enough PPE isn't the only concern hospital systems face with a looming threat of rising hospitalizations from COVID-19.
Staffing — especially nurses and respiratory therapists — and available hospital beds — especially intensive care unit beds — also are stress points.
"Having physical beds available is not a concern, but having enough staff throughout the state to care for and treat those patients is a worry," Karasinski said. "There is national demand for direct patient care staff, including nurses and other clinicians. Many existing front-line workers are also still recovering from physical and mental stress, as well as trauma resulting from the first wave."
Beaumont Health's Chief Operating Officer Carolyn Wilson said it has been especially challenging to keep enough nurses on staff given the difficulties they face both on the job and off.
"For a lot of our nurses and staff members, their children are still not in school," she said. "They're trying to homeschool. ... They've had to reduce hours because there's just so much happening in their personal lives.
"We've been seeing some staff go from full time to a more flexible schedule. ... And on the flip side, some of our staff are working more hours because maybe their significant other was laid off or not working. It's been a bit of a dance and taken coordination, but we're trying to do everything that we can to support our team to work when and how much they can."
And when employees get exposed to COVID-19 or contract the virus themselves, that piles on to the difficulties in trying to adequatey staff the hospitals.
"Community spread is occurring and health care workers are not exempt, Karasinski said.
There are shortages, especially, Wilson said, among respiratory therapists and critical care nurses. "We still need them desperately."
This comes as several hospitals in Michigan are reaching capacity as beds fill up with sick patients.
As of Friday, state data showed several Michigan hospitals were more than 80% full:
Hurley Hospital was at 97% capacity, with 29 hospitalized COVID-19 patients, of whom six were in the ICU. Covenant HealthCare was at 92% capacity with 66 hospitalized COVID-19 patients, of whom 15 were in the ICU. Prime Health was 90% full, with nine hospitalized COVID-19 patients, two of whom were in the ICU. Holland Community Hospital was at 89% capacity with 23 hospitalized COVID-19 patients Michigan Medicine was 86% full, with 29 hospitalized COVID-19 patients, of whom 12 were in the ICU. Ascension Michigan's hospitals were 83% full, with 216 hospitalized COVID-19 patients, of whom 49 were in the ICU.
Of the state's 2,459 adult intensive care unit beds, just 471 remained available on Friday.
The region with the fewest number of available adult ICU beds was Region 1, which is in the lower central part of the state and includes Clinton, Eaton, Gratiot, Hillsdale, Ingham, Jackson, Lenawee, Livingston and Shiawasee counties. It had only 22 available adult ICU beds Friday, according to the state Department of Health and Human Services.
"We are incredibly concerned about the increasing cases and hospitalizations," said Lynn Sutfin, a spokeswoman for the state health department. "Although our hospitalizations are not what they were during the spring surge, over half of COVID-19 inpatients are outside of southeast Michigan. We are concerned about what may happen if hospitals become overwhelmed.
"We are actively working with hospitals on understanding their surge plans and needs, and will continue to work with them throughout the pandemic."
Up North areas prepare for spread
Jen VanSkiver, chief communications officer for the independent, 81-bed North Ottawa Community Hospital in Grand Haven, is watching closely what's happening with coronavirus cases and hospital admissions in nearby Muskegon and Grand Rapids.
"We've had fewer than 10 COVID admissions since March. We are in a bubble," she said. "But look about 45 minutes to the east in Grand Rapids, they're approaching capacity. And 20 minutes to the north at Muskegon Mercy, they're also on the rise."
"Our hospitalizations have increased, but not with COVID patients," VanSkiver said. "The amount of people coming into the ER with respiratory issues, and the overall volume is increasing, but not disproportionately with COVID."
She attributes that to a community that has largely followed the public health guidelines, is wearing masks, social distancing and avoiding large gatherings.
But VanSkiver looks to the future and wonders how long Grand Haven will be able to keep COVID-19 at bay. It feels as if the virus is closing in.
"We feel very fortunate that we've been able to stave off these cases, hyperlocal here as long as we have," VanSkiver said. "But we are considering the likelihood that eventually, it will find its way here."
If the need arises in the days and weeks ahead, she said North Ottawa may be called on to take sick COVID-19 patients from neighboring hospitals to help share the patient load. They're preparing for that.
Although the hospital is licensed for 81 beds, VanSkiver said it can't adequately staff a patient load that high.
"When we filed our COVID emergency plan, we said that we could take about 35 patients to be at capacity," VanSkiver said. "And really what that comes down to isn't space, it's staff. ... We had to impose that ceiling because we felt that's what we could manage safely."
Safety is at top of mind for many hospital systems who must consider how they'll give patients the best care they can through another COVID-19 crisis, said Dr. Zigmond Kozicki, a professor at the University of Detroit Mercy.
Kozicki and Dr. Stephanie Baiyasi led public health and community health students in a research study surveying 24 Michigan hospitals and 27 public health organizations from June 30-Sept. 16 about the COVID-19 response.
The survey revealed that 87.5% of hospitals and 96% of public health agencies said COVID-19 had caused "significant stress to operations" and 92% of hospitals reported they needed help in the form of donations from the public and the federal government to supplement PPE supplies, financial assistance in the form of federal funding and donations and assistance from public health departments.
"I thought, this is a cry for help," Kozicki said. "We're already facing financial crisis, all kinds of other issues, staffing shortages. We need help.'
"We don't have enough ICU beds right now," Kozicki said. "Staff is going to get burned out. Mistakes are going to be made.
"We can't just watch this train wreck take place again. We have to really do something different. We have to alert the public that if you don't want to go through the train wreck we just went through, change."
Public health departments need to get out the message that wearing masks, social distancing hand hygiene and avoiding large gatherings is effective at slowing the spread of this infectious disease, he said.
And they must be willing to enforce the public health mandates to ensure people understand mask-wearing isn't optional.
"It's not going to come from the governor because she's being attacked as being political," Kozicki said. "It has to come from local public health directors and agencies. They have a stake in this. This has to be a bottom-up kind of a thing right now. "
Contact Kristen Jordan Shamus: kshamus@freepress.com. Follow her on Twitter @kristenshamus.
Correction: This story has been updated to correct the title of Dr. Lydia Watson, who is senior vice president and chief medical officer for MidMichigan Health.
This article originally appeared on Detroit Free Press: As COVID-19 cases rise again, are Michigan health care providers ready? It's complicated.
___
(c)2020 the Detroit Free Press
Visit the Detroit Free Press at www.freep.com
Distributed by Tribune Content Agency, LLC.
