For nurses, housekeepers and other hospital personnel on the front lines, the shortages are frightening.
“We’re taking a chance every day with our lives going to work, cleaning rooms,” said an environmental services worker at a suburban Maryland hospital, who spoke on the condition of anonymity for fear of reprisal from her superiors.
She has asthma and, in the past, routinely picked up N95 masks — which are especially effective protection — and discarded them after one use. Now, she has to sign for them and reuse them.
“I’m scared, not knowing if a patient has [the virus],” she said.
United Medical Center nurse Debra Washington described the same concern. In the past, she said, reusing an N95 mask “was unheard of — that was an infectious disease nightmare.”
The workers’ concerns are not unfounded. As area hospitals brace for a surge of acutely ill covid-19 patients in coming weeks, authorities are hopeful, but not certain, of having enough medical equipment and personnel to handle the peak.
The region’s unsteady response to the pandemic has exposed vulnerabilities in what is generally considered to be a first-rate regional health-care system.
Like many other metropolitan areas in the country, our region faltered in containing the virus in the first place. That’s largely due to an inadequate testing program that still must be fixed to reopen society.
It’s a disappointing picture for a region that boasts many world-class hospitals and is home to the National Institutes of Health, Walter Reed National Military Medical Center, Johns Hopkins University School of Medicine and a growing biotech industry.
One source of weakness has been budget cuts at the region’s public health agencies, which form a first line of defense against epidemics. The cuts started with the 2008 recession and were never fully restored.
The health departments of Maryland, Virginia and the District reduced staff by a combined 2,178 employees, or 16 percent, from 2010 to 2019, according to the Association of State and Territorial Health Officials.
In addition, during a pandemic, the Washington region, like other areas, depends on the federal government to oversee testing, supply medical equipment and coordinate its delivery.
In this case, the feds performed poorly, and the region didn’t have the resources on hand to cope with increased demand for trained workers, hospital masks and other necessities, according to local health officials and experts.
“There were very limited resources put into this [federal response], and obviously it wasn’t implemented very well,” said Boris D. Lushniak, a former acting U.S. surgeon general who now is the dean of the University of Maryland School of Public Health.
Said Lynn R. Goldman, dean of the School of Public Health at George Washington University: “We’re great at handling patients who need critical care, who need to be on a ventilator, who need highly sophisticated medical treatment. What we haven’t been good at doing is really putting in place surge capacity.”
United Medical Center Vice President Toya S. Carmichael said the hospital is accepting donations of masks and meals, and it was following national federal guidance in allowing the reuse of masks.
United Medical Center has had more than its share of financial troubles in recent years, but Carmichael said its experience with covid-19 is typical.
“We are in the middle of a pandemic. There is a shortage of PPE around the country,” Carmichael said, referring to personal protective equipment. “UMC is no different from any hospital in the country.”
Two unions that represent UMC employees — the District of Columbia Nurses Association and 1199 SEIU — have suffered four covid-19 deaths among their members in the region, all at hospitals other than UMC.
Many local health authorities are unwilling to say with confidence that they will have enough resources to cope with the anticipated influx of covid-19 cases. Instead, they cautiously say that they’re “hopeful.”
“A lot of things are working together to hopefully stem the tide and not overwhelm the hospitals,” said Fairfax County Director of Health Gloria Addo-Ayensu.
Said Maryland Hospital Association President Bob Atlas: “We’re all very hopeful that the surge will not be a New York-style spike, and we’ll be able to handle the surge. . . . There’s no denying that the supply chain was weak for PPE and for the testing supplies. The national stockpile was not an effective resource.”
Such wariness was not universal, however. The U.S. military and Northern Virginia’s Inova hospital system were more optimistic.
“We have a strong PPE posture,” said Air Force Brig. Gen. Shanna M. Woyak, who oversees Walter Reed and other facilities serving 300,000 military personnel, dependents and retirees in the national capital area. “Our inventory is quite adequate for . . . the volumes we’re seeing.”
Inova President J. Stephen Jones said the system’s five hospitals “still have significant capacity, and I think most of the hospitals do.” He said Inova has added “dozens” of negative-pressure rooms used to treat covid-19 patients.
But Jones acknowledged that PPE scarcities and inadequate testing have been significant challenges.
Jones also said that many hospital rooms used for non-covid-19 patients are emptier than usual, apparently because people are reluctant to go to the hospital for fear of getting infected.
“Our concern is patients are not coming in for heart attacks or strokes,” he said. “Patients are not coming in with chest pain who should be coming in.”
The fight against the coronavirus could have gone better, had the initial response, containment, been more robust. That’s the phase where state and local health departments play a critical role, doing the testing and “contact tracing” to identify people who might have been infected and urging them to isolate themselves.
“In the midst of an infectious disease disaster, the tip of the spear is this whole idea of how many resources can you put into the containment phase,” said Lushniak, the U-Md. dean.
But governments at all levels have skimped on investing in public health.
The budget for the federal Centers for Disease Control and Prevention dropped from $8.1 billion in 2010 to $7.28 billion in 2019, after adjusting for inflation, according to a report by the nonpartisan Trust for America’s Health.
State public health agencies have reduced their total budget by 15.6 percent since fiscal 2016, according to the Association of State and Territorial Health Officials.
Local health departments reduced staff by 56,360 jobs from 2008 to 2017, according to the National Association of County and City Health Officials.
“You not only have jobs being eliminated, but also the expertise of people who have gone through similar crises in the past,” said Adriane Casalotti, government affairs chief for the association.
The coronavirus crisis is certain to reverse the trend, but maybe not permanently, Lushniak said.
“We are very much crisis-oriented when it comes to health issues of our nation,” he said. “We wait for them to happen. We then surge with both money and interest in issues of public health, and then we go back to normal.”
He added: “The normal tends not to cherish the health of our community as a priority.”