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As the caseload of patients with the new coronavirus grows, masks and other personal protective equipment are in short supply — and nurses in Washington state are resorting to workarounds to try to stay safe.

Wendy Shaw, a charge nurse for an emergency room in Seattle, said her hospital and others have locked up critical equipment like masks and respirators to ensure they don’t run out.

Shaw is the de facto gatekeeper, and is now required to run through a list of questions when anyone comes to get a mask: “What are you using it for? What patient? What’s the procedure?”

“I have become a ‘jailer’ in a sense of these masks,” she said.

“We now have to learn how to work with less, and how to be good stewards of the resources that we have,” Shaw said.

For Shaw, there’s a very personal stress driving her to be careful. She has Type 1 diabetes, and so does her young son, which puts her at high risk for complications if she were to be infected.

“I am cleaning like I have never cleaned before. I am hyperaware of what I touch, who has brushed up against me,” said Shaw. “We think about this all the time. Every day I wake up without a fever or a cough is a win for me.”

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At some hospitals, nurses and doctors said they are being told that, contrary to standard protocol of disposal after a single use, they should try to clean and reuse their N95 masks, a respirator that protects the face from airborne particles and contaminated liquid.

Meanwhile, office staff at the corporate headquarters of Providence St. Joseph Health in Renton, Washington, have opened an ad hoc workshop where they are assembling masks and face shields on their own, to bolster resources.

“At any given time, we are days away from running out of personal protective equipment,” said Melissa Tizon, with Providence St. Joseph Health.

Tizon said the health system has already delivered 500 face shields to Providence-affiliated hospitals in Seattle and Everett, Washington, and plans to start sewing masks in the coming days.

Some nurses are even crowdsourcing masks.

Bobbie Habdas, an ICU nurse at Swedish Medical Center, took to Facebook asking for help from her community.

“I never thought that we’d necessarily be doing this,” said Habdas.

Her post gained lots of attention, and she collected more than a hundred masks to share with co-workers.

“Honestly, it shocked me and it really touched me — it’s extremely appreciated,” she said.

The outpouring was a bright spot, but Habdas wonders why nurses have to scrounge for supplies, in addition to their regular duties.

“There is a huge feeling of panic, not only externally, but also internally within the hospital,” said Habdas.

She said spending time looking for supplies during her shift doesn’t help with the stress of responding to the coronavirus pandemic. Patients have died from the disease in Washington, with at least 74 COVID-19 deaths recorded across the state as of Thursday afternoon.

Sally Watkins, executive director of the Washington State Nurses Association, said nurses are being forced to make do with less.

“They are not being protected at the level that they should be,” said Watkins. She hopes the region will get more supplies from the federal stockpile soon.

Communication Breakdowns

After 39 years as an intensive care nurse, Mary Mills has dealt with other infectious disease crises, but her hospital’s response to the coronavirus outbreak feels different. She remembers helping to intubate HIV patients in the early days of the AIDS crisis, when there was still a lot of fear and unknowns about that illness.

“Everybody was on the same page,” Mills said. “There was clear communication.”

Mills works at one of the five hospitals run by Swedish Medical Center in the Seattle area. “I hate to say I don’t feel particularly supported now,” she said.

Like many health care workers, Mills feels frustrated because the guidance on when to use personal protective equipment, or PPE, keeps shifting, sometimes daily.

“What they decide I need, in terms of my safety, is being changed based on availability of product, rather than the science,” Mills said.

“This is super contagious. We can spread it to our kids, our parents and grandparents,” she added.

Worries About Health Care Worker Exposure

Mills believes that hospital managers have not been taking nurses’ concerns seriously enough, especially when it came to testing patients and staff in the early days of the outbreak.

She said two nurses she works with have already become sick with what seemed to be COVID-19.

“One went out with a cough and a fever, all the classic five symptoms,” Mills said. “On the eighth day, they finally agreed to have her tested for COVID-19.”

Mills said this type of response only erodes nurses’ trust in hospital leadership, harming a relationship that is critical as the entire Seattle-area health care workforce is called upon to care for an increasing number of patients with the disease.

Health care workers being exposed to coronavirus is a central concern throughout the region. Multiple hospitals in the Seattle area have reported cases among staff at their facilities. An emergency room doctor in Kirkland was hospitalized after being infected.

Dr. Chris Dale, the chief quality officer for Swedish, said his hospital system is focused on caregiver safety.

“We cannot effectively provide safe care for patients if our caregivers first aren’t safe,” said Dale.

The hospital just launched pop-up clinics where staff and patients can get tested. He said that testing around Washington has improved significantly as more labs have come online in recent days. Currently, results are coming back within three to four days, he said, compared with earlier, when it took a week.

He said the number of Swedish Medical Center health care workers who have contracted COVID-19 remains “low,” but did not give specific numbers.

“With this extraordinary pandemic, and the squeeze that we are seeing on supplies, we need to balance both supply and the very real need to keep caregivers safe,” said Dale.

Swedish follows the World Health Organization guidance when treating patients with suspected or confirmed cases of COVID-19, he said.

Staffing Issues

Nurses from Swedish Medical Center began confronting this pandemic at a time when they were already locked in a divisive labor dispute, related to staffing levels. In January, thousands of health care workers from their union went on a three-day strike, unrelated to the coronavirus crisis. The nurses contend that chronic understaffing inside the hospitals can negatively affect patient safety.

Dale said Swedish has recently hired about 300 temporary nurses, called travel nurses, and is actively recruiting more. But Mills still worries there won’t be enough nurses to handle the surge in patients.

“It is not just about physical beds or ventilators,” said Mills. “A room and a ventilator don’t mean anything if you don’t have a nurse.”

Mills said she hopes management starts dealing with these urgent issues. After decades of working in the ICU, she said her No. 1 commitment is to her patients. Already, she has treated some patients with COVID-19 who died in isolation — sometimes with no family members there in-person.

The hospital’s policy currently does not allow any visitors to COVID-19 patients for safety reasons, though the hospital said it makes exceptions “in extreme circumstances.”

“The tragedy of not having family there to support the super sick … you feel a greater burden to deliver some form of compassion to these people who are totally isolated,” said Mills. “The only people there are the ICU nurses.”

This story is part of a partnership that includes NPR and Kaiser Health News.