Utilizing the Defense Production Act will save health care workers' lives

Utilizing the Defense Production Act will save health care workers' lives
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My colleagues on the frontline fighting coronavirus are facing a drastic shortage of personal protective equipment (PPE).

To protect them — the doctors, nurses and other health care providers treating critical patients every hour of every day — the federal government must immediately mobilize the Defense Production Act and the Strategic National Stockpile.

Yesterday the president ordered General Motors to make ventilators under the Act. He must do the same for PPE. Only by ordering U.S. industries to increase the supply of PPE will we ensure all health care workers have access to the tools we need to stay safe during this pandemic. Otherwise many of us — myself included — are at exceptionally high risk of being exposed and infected. 

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PPE is equipment like masks, gowns, and eye protection that health care workers use to prevent infection when we're caring for patients. Right now, it’s the best protection clinicians have against coronavirus.

I might be seen as an unlikely defender of PPE and that’s because it failed me. While treating Ebola patients in West Africa, I followed every PPE procedure and I was meticulous in putting on and taking off my PPE to minimize infection. Never once did I improvise or deviate once from the protocol. 

And yet, 10 days after I saw my last patient, I was diagnosed with Ebola. Thankfully, my story is an outlier. Rigorous observance of protocol and a continuous supply of PPE protected thousands of my colleagues in West Africa from a similar fate as mine. Without PPE, the death toll among Ebola providers would have been markedly higher than it already was. 

Although Ebola and coronavirus are different viruses, the critical role of PPE is the same. As I learned in West Africa, PPE does not prevent all health care workers from infection. In China, thousands of health care workers have been diagnosed with coronavirus.

The same is true in Italy, where clinical providers make up over 8 percent of the country’s reported infections. With the shortage of PPE, we're already experiencing here, the number of infected health care workers here in the U.S. will likely be substantially higher

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Hospitals have been scrambling to procure more equipment to protect their staff. But global PPE consumption on top of trade restrictions has radically affected supply chains.  

For all of us working on the coronavirus frontlines, the impact and danger of strained supplies is clear. My colleagues at nearly every hospital in NYC are reporting severe restrictions in PPE available during clinical work. Some are receiving only one surgical mask per shift and one N95 mask to re-use per week. The CDC recommends not using these masks between patients, but providers have no other option. Many health care workers are making their own PPE and wearing it to work.

While we scour the globe for more supplies, we are forced to lower our expectations. The University of Nebraska Medical Center — a renowned leader in preparedness for emerging infectious diseases with experience treating Ebola patients — “began an experimental procedure to decontaminate its masks with ultraviolet light and reuse them." 

Researchers at Stanford Medicine reported that masks can be disinfected for reuse by heating them in the oven. Reusing disinfected masks is not ideal, but undoubtedly better than new CDC guidance recommending bandanas and scarves as a last resort. 

Local communities are getting creative about helping increase supplies. Groups are exploring 3D-printing of masks. Others are collecting masks from private citizens and research laboratories to donate them to hospitals.

There has also been a significant effort at the state level. Last week, New York state announced it was offering to ‘buy [masks] at a premium’. And last Saturday, Governor Cuomo (D) announced the state was sending a million masks to New York City, the epicenter of the U.S. outbreak.

But we need more. The federal intervention will help to mobilize the masks we need right now and the estimated 3.5 billion masks us health care workers will need if this pandemic continues into next year.

Only a fraction of the requested and desperately needed stockpile supplies are trickling out. A full mobilization would make 12 million medical-grade N95 masks and 30 million surgical masks available to hospitals now. We must urgently prioritize getting this essential PPE to current coronavirus hotspots.  

This will get more PPE to providers, but this alone is not sufficient. The president must keep using the Defense Protection Act and drastically scale up the production of PPE. 

If we don’t take decisive and aggressive action now, many more of my colleagues will be infected. This means fewer providers on the frontlines when patients with complications of the coronavirus or coronary artery disease come streaming into our ERs and ICUs.

While carrying out the exhausting and dangerous task of caring for Ebola patients in West Africa, I never once worried about access to PPE. My colleagues battling the coronavirus response deserve the same security.

Craig Spencer, M.D., MPH, is the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center. Follow him on Twitter @Craig_A_Spencer.