When Metairie's Sophia Thomas, president of the American Association of Nurse Practitioners, told President Donald Trump on May 6 that the availability of coronavirus protective gear is sporadic, she spoke from firsthand knowledge. As a practicing family nurse practitioner in a rural practice, I can attest that personal protective equipment, or PPE, is not readily available. While increased production of N95 masks, gloves, face shields and gowns have eased the shortage, especially in acute care settings, the lack of availability persists in many areas.
Many health care practices are small businesses and have had to wait for money promised under the CARES Act for financial support to maintain minimal operations. PPE is expensive and not reimbursable for routine patient care. Even when available, many suppliers sell in large quantities, making purchase unaffordable. In addition, increased focus on the production of face masks has exacerbated the shortage of other PPE — specifically gowns which are made from similar material.
Rural and underserved areas, such as where I practice, are especially vulnerable. Infection rates to date have been higher in urban areas, but our nation’s most at-risk populations — those with co-morbidities and less access to health care and affluence — are consistently underserved, and sporadic distribution of PPE is no exception.
What happens in practice is that the limited supplies of N95 masks and gowns are re-used and rationed. We know that health care workers experience higher rates of infection due to increased exposure and from inadequate supplies of PPE.
One of the challenges of this epidemic has been variances in testing as well as exposure to asymptomatic individuals. The variable exposure risk makes it difficult to know the patients with whom providers should exercise the most caution. Early guidance advised saving N95 masks for procedures most likely to have aerosol-generating spray, but how does one know that your patient is going to cough or sneeze during a throat examination?
As rates of COVID illness vary across the country and future outbreaks may occur in an unequal distribution, there needs to be a coordinated nationwide response to both the availability and distribution of PPE. Beyond advocating that basic supply to meet the demand is met for health care providers, all members of the community can help.
While public debate rages regarding the severity of the pandemic and governmental restrictions, everyone can help by always wearing a mask when out in public. In health care, we use the universal precautions approach when dealing with any bodily fluid — meaning all fluids are handled as if infectious. A common sense, caring approach is for everyone to assume that we need to be vigilant. In this way, we can care for both our health care workers and neighbors.
LAURIE ANNE FERGUSON
dean and associate professor, Loyola University College of Nursing and Health