The prognosis is grim. We're all anticipating that the situation is going to get worse, says Elissa Schechter-Perkins, an emergency room physician at Boston Medical Center. As the coronavirus spreads across the United States, health care workers are reckoning with how to protect themselves while helping Covid-19 patients in increasingly harrowing circumstances. Access to personal protective equipment (PPE) is severely limited in many parts of the country, testing remains inadequate, and the likelihood of shortages of everything from masks to ventilators to hospital beds has left many workers stressed out, angry, and, in some cases, resigned to endure bedlam.

Ideally, we would be wearing full PPE for all patients that we're seeing in the emergency department, Schechter-Perkins says. Yet, in many cases, they are not. She has witnessed patients come in for unrelated reasons only to later show signs of infection, after theyd already been looked after by hospital staff. Some of them have gone on to become confirmed cases of Covid-19. Because the nurses and doctors attending to these patients didnt immediately categorize them as coronavirus cases, she says colleagues wound up completely unprotected.

We have known, kind of from the beginning, that there is not a sufficient supply of PPE and there's not a confirmed supply chain for getting more anytime soon, Schechter-Perkins says. So right from the beginning, we have been placed in really difficult circumstances in which we need to ration our PPE in ways that are potentially quite unsafe.

Across the country in Los Angeles, an emergency room physician is aghast at the equipment limitations he and his fellow health care workers face. (The doctor asked that his name not be used.) When asked whats on short supply, he rattles off a list: masks, goggles, face shields, copper equipment, glovesand disinfectant wipes. Were using diluted bleach and a spray can instead, he says. Not as effective. All of this adds up to a hospital staff that is especially vulnerable amid a pandemic. Increasingly, this is the norm at hospitals in cities with surging Covid-19 outbreaks. In California, most ER physicians are classified as independent contractors. This can impact what kind of equipment they have ready access to. The ER doctor says one of the companies contracting him offered a stipend of $250 for personal protective equipment rather than obtaining it for the medical staff. I went out and bought my own goggles on eBay.

Even when the correct protective gear is provided, it is often in short supply. Schechter-Perkins is one of several doctors and nurses who told WIRED theyre reusing N95 masks, which are thick, particle-filtering face coverings designed for single use. We are storing them in paper bags in between patients, she says. Then, at the end of the shift, we are storing them in paper bags so that we can use them the next day.

In parts of the country where the coronavirus has yet to turn into a full-fledged outbreak, doctors are faring significantly better. Everybody is working on their own timeline through this, James Beckerman, a cardiologist in Portland, Oregon, says. When I was on call last weekend, we had what we needed, but its a moving target right now. Infection prevention epidemiologist Saskia Popescu, who is currently working in Arizona, hopes hospitals currently outside of hotspots can see what is going wrong in other regions to avoid their own catastrophes. So many of us are looking at New York and seeing what they are going through, which is devastating, and trying to use that as a teaching moment, she says. New York is a warning for a lot of us.

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New York City is now the frantic heart of the coronavirus outbreak in the United States, with more than 790 confirmed deaths, and so its the part of the nation where health care workers are in the most jeopardy. After Kious Kelly, a 48-year-old assistant nurse manager at Mount Sinai West, died this week in what appears to be the first coronavirus death among New York nurses, his coworkers emphasized their lack of protection on social media. One nurse captioned a photograph of Kelly on Facebook with a hashtag: #GetUsPPEs. Another nurse decried the official response in her own Facebook post: We do not have enough PPE, we do not have the correct PPE, and we do not have the appropriate staffing to handle this pandemic. And I do not appreciate representatives of this health system saying otherwise on the news. The public needs to know that we are not prepared, that this is serious, that they need to stay home to flatten the curve. How many more of my friends have to get sick, have to die, for the world to take this seriously?!

The hospitals are trying to catch up. Nurse practitioner Peggy Desiderio, who works at Mount Sinais Morningside location, says the protective gear situation there isnt sufficient, but that access has improved as frontline medical workers have asked for additional supplies. Im not saying that its great, or that its going to last forever, or that we wont get shortages, she says. But theyre listening. (Mount Sinai did not respond to a request for comment.)

However, many New York hospital workers continue to eye their limited equipment with worry. Recently, doctors and nurses at Queens Elmhurst Hospital Center began speaking out about the conditions they are facing as a surge of critically ill patients arrive. Benjamin Laitman, an ENT resident at Elmhurst, has seen the strict budgeting of protective gear firsthand. Its a crisis mode, he says. The hospital isnt out of anything yet, but the scarcity is an enormous preoccupation. We have it because weve been rationing it.

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The Race to Keep Health Care Workers Protected From Covid-19 - WIRED