Some Canadian hospitals are limiting front-line staff to one or two disposable masks a day and asking the public for donations of protective gear as they prepare for their wards to be flooded with patients made severely ill by the new coronavirus.
The rationing of paper surgical masks is happening despite Ottawa and the provinces promising that more personal protective equipment is on the way.
However, government officials have not said exactly when the fresh masks, gloves, gowns and other gear will arrive, leaving some physician leaders and hospital administrators in Toronto to craft their own mask-conservation policies and launch donation drives for equipment.
“It should not be survival of the fittest for each hospital,” said Michael Warner, medical director of critical care at Michael Garron Hospital in Toronto. “It may end up that way if we don’t have ... an actual plan [from the Ontario government].”
Dr. Warner, who said health-care workers are experiencing “huge stress” about gear shortages, said the province has not done enough to communicate with hospitals about when they will receive shipments of additional supplies.
Michael Garron Hospital is issuing two ear-loop masks per shift to all staff who deal directly with patients, according to Jeff Powis, the hospital’s medical director of infection prevention and control.
The policy will actually result in many more health-care providers wearing a mask all day than is normal, which is part of the reason the hospital is trying to control the number of disposable masks that individual doctors and nurses burn through in a day.
Michael Garron and other Toronto hospitals who’ve adopted widespread masking policies are trying to prevent the coronavirus that causes COVID-19 from being spread by doctors and nurses who don’t know they’ve been infected because they have yet to experience symptoms.
Dr. Powis said he would also like to give one mask per shift to “non-patient-facing staff” and to the few visitors still allowed inside the hospital. "But I don’t have the supply to be able to do that and keep my staff safe during the duration of this pandemic,” he said.
Several other Toronto hospitals are also expanding the number of staff required to wear surgical masks while at the same time limiting them to one or two of the disposable masks a day, with exceptions allowed if masks become soiled.
“The prevalence of COVID-19 is increasing in the community and there are reports of outbreaks in long-term care homes,” said Jennifer Stranges, a spokeswoman for Unity Health, which includes St. Michael’s and St. Joseph’s hospitals.
“The main value of masking, like self-screening, is protecting others more than ourselves. It reduces the risk of staff and physicians with very early infection spreading disease to others.”
Unity Health, which is allotting two masks per shift, implemented the policy Tuesday.
Sinai Health System, which includes Mount Sinai Hospital and the Bridgepoint rehabilitation hospital, told staff in a memo Monday night that everyone working in ambulatory care, in-patient clinical units and the COVID-19 assessment centre would now be required to wear a mask.
"It is important that we conserve procedure masks for the duration of this pandemic, which will go on for some time. For this reason, a single procedure mask will be issued per day,” said the memo, which described the policy as temporary until a pandemic masking plan is in place.
Doctors and nurses performing riskier procedures, such as intubating patients, will still be required to wear N95 respirators.
Vicki McKenna, the president of the Ontario Nurses’ Association, said she has already heard concerns from members in the Greater Toronto Area and beyond about one-mask-per-shift policies. Some nurses are being asked to use the same mask for two days, she added.
“This is not the time to scrimp," Ms. McKenna said. “We need effective personal protective equipment.”
The coronavirus pandemic has put a worldwide squeeze on medical supplies such as surgical masks, N95 respirators, gloves, gowns, ventilators and swabs for testing.
Prime Minister Justin Trudeau on Wednesday said his government and the provinces needed to do a better job working together on getting more personal protective equipment to the front lines.
“There has to be more co-ordination between the provinces and the federal government and that will ensure that we can meet people’s needs wherever they are in Canada,” he told reporters.
In Ontario, Travis Kann, a spokesman for Health Minister Christine Elliott, said the province has recently procured 12 million more sets of gloves, one million more N95 respirators, and nearly six million more surgical masks, on top of the extra supplies promised by Ottawa.
“We expect these supplies to be delivered at various times over the coming days and weeks,” Mr. Kann said by e-mail.
Until then, hospitals are looking to unconventional sources to fill their supply closets.
On Wednesday, Ontario Power Generation said it would donate 500,000 surgical masks and 75,000 N95 respirators purchased as part of its pandemic planning efforts to help address equipment shortages.
Dr. Warner of Michael Garron Hospital launched a donation drive for personal protective equipment last weekend, and since then tattoo artists, construction workers, dentists and others who use protective equipment have been dropping off supplies at the hospital.
“We just want to make sure that we have the very basic, basic equipment to be able to provide patients with care,” Dr. Warner said. "Nothing fancy. Just gown, gloves, mask and eye protection. That’s all people are asking for.”
The Globe and Mail
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