Now, seven months after Georgia confirmed its first coronavirus cases, Dr. Maxey is still spending triple the time she used to getting her office enough protective equipment.
Nationwide, that desperate shortage of personal protective equipment has ebbed some, and the headlines have faded. But the shortage isn’t over. Health care providers from hospitals to doctors' offices to nursing homes are still having to search for PPE and ration its use.
For some, the initial fear and panic over the shortages has yielded to a drudging routine. Grady Memorial Hospital has a sterile room in its basement now devoted to manufacturing extra disinfecting wipes. A Stockbridge-based ambulance company has given an employee the full-time job of managing PPE. Nurses and doctors are still re-using masks that were designed to be used once and tossed away. Maxey has suspended plans for implementing an upgrade in her practice’s patient communications, because she needs to spend her time instead sourcing PPE.
In some places, the situation is ominous. According to recent federal data, 34 Georgia nursing homes reported they lacked a one-week supply of N95 masks. Fourteen nursing homes reported they lacked a one-week supply of gowns and 13 reported they lacked a one-week supply of gloves. Some of the nursing homes with the worst outbreaks are among those reporting shortages.
All this, as flu season looms, with no one sure whether it will compound the epidemic.
So medical workers like Maxey keep at it. They have no other choice, she said.
“This is a time when our patients really need us,” said Maxey, who serves as the pediatric office administrator. "This is where the rubber meets the road.”
Still not normal
Early in the pandemic, nursing homes in Georgia bought dust masks from tractor supply companies. They bought raincoats to use as makeshift hospital gowns. Paramedics snatched up painter masks at hardware stores. Hospitals drew up policies for who should get a ventilator if two patients needed one and only one was left.
That was spring and early summer. The U.S. solved the ventilator problem: President Trump in April invoked federal emergency law to help manufacturers get materials to ramp up production of the machines. Hospitals now report having more than enough.
But the Government Accountability Office last month reported that PPE shortages persist nationwide and said the Department of Health and Human Services and FEMA should develop specific plans to help mitigate the supply gaps.
GAO also noted that the Trump Administration pulled $6 billion from the $16.7 billion originally allocated to the Strategic National Stockpile to replenish stocks of PPE, ventilators and testing supplies, to use the money for its vaccine push.
Dr. Susan R. Bailey, president of the American Medical Association, said it’s hard to believe the country is still dealing with some of the same PPE shortfalls experienced during the pandemic’s early weeks. The reasons, she said, are “painful and plentiful.”
Health workers' need for new PPE is continuous and can’t be satisfied with a one-time bump in supply. And there’s no centralized U.S. buyer for small users like Maxey. She still competes not only with other Georgia health care businesses but with people across the globe. Supplies are usually made overseas, making it tougher to find suppliers and easier for suppliers to play buyers off against one another.
Big buyers, like hospital systems, have stockpiled. Grady has opened up new warehouse spaces off campus.
Maxey, a small buyer with little leverage, scours the market.
Sometimes her suppliers run out. It can change week to week. For about 90 minutes each week, she reaches out to vast contacts amassed over her 35-year-career. She gets on the Amazon Business website. Sometimes suppliers there are out of stock, too, so she tries again, and again. If she hits a score, she must research any new sources to make sure they are legitimate.
Maxey estimates she’ll spend $20,000 more on PPE this year. That’s partly because she is using so much more, masking up for every patient in case one might be infected. And it’s partly because the cost of products has risen, sometimes almost overnight.
Before the pandemic, a box of exam gloves cost $97. Now, that box costs $120, or even $140. A canister of disinfecting wipes, which used to cost $11, now costs $50 to $75.
According to data from Premier, a health care group purchasing organization which works with about 3,600 hospitals and 120,000 other providers, during a typical year, U.S. health systems buy about 25 million N95 masks. Demand this year will exceed 300 million N95 masks, Premier told the AJC.
FEMA has said that the supply of N95 respirators for medical use is not expected to catch up with demand until January.
Get Us PPE, a nonprofit group that connects health providers to available medical gear, said that pleas from Georgia for its extraordinary help had decreased dramatically since the early months of the pandemic —but has not stopped. Earlier in the pandemic, more than half of the requests came from hospitals. But last month, all the requests came from non-hospital facilities, including nursing homes, home health agencies and homeless shelters.
Georgia nursing homes' and personal care homes' level of PPE use is 20 times greater than what it was before the pandemic, said Tony Marshall, president and CEO of the Georgia Health Care Association. He knows of no nursing home that has actually run out in recent weeks. But homes are still facing dwindling supplies, backorders and price hikes.
Early in the pandemic, Atlanta Beats Covid (ABC), a group of Atlanta makers who banded together to create PPE, worked to address desperate shortages at hospitals. Volunteer Skyler Holobach, who works full-time at Salesforce, spent seven hours every evening pouring and molding plastic in a spare bedroom to make face shields. That went on for months.
In recent weeks, requests for shields have slowed and are now coming outside health care settings, including schools and polling places. So volunteers with ABC are planning to sunset the group by Nov. 1. But many of the volunteers will continue to make needed supplies, including the Maker Station Marietta, which plans to make isolation gowns.
“We will see how things go, and we will be ready to go and be able to quickly ramp things back up if need be,” said Holobach, who is now sewing and donating masks.
Hospital administrators in charge of PPE supplies also are watching and waiting to see what unfolds as flu season begins, cold weather drives people into enclosed spaces and holidays tempt people to gather.
“The sense of fear is I think abated," said Dr. Robert Jansen, chief medical officer of Grady. “I think the only anxiety that currently remains is still not knowing what the next few months is going to bring.”
Jansen hopes people wear masks and follow protective practices. He also hopes the supply system improves.
“We just want there to be adequate manufacturing so we’re not dependent on overseas," Jansen said. "The whole world is wrestling with the same problem. We need PPE, they need PPE.”
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