Health care workers in Arizona report they are re-using, rationing and arguing over protective masks as they try to treat patients while avoiding illness themselves.

And the situation won't get better soon.

A federal shipment of protective gear for Arizona health care workers won't be enough to handle a surge of patients infected with the new coronavirus that causes COVID-19, and state officials are tapping the private sector for help. But that can't happen immediately.

Nurses and health care workers at hospitals throughout the Phoenix area say they are seeing rules shift almost daily on when to use protective gear. Health care professionals have been asked to share personal protective equipment or even go without it in certain situations to conserve resources.

In Flagstaff, Coconino County officials shut down one of two coronavirus testing sites this week because of a lack of both testing kits and personal protective equipment for health care workers, spokesman Matt Rudig said.

The Arizona Hospital and Healthcare Association, an industry group, said in an emailed statement the organization is "concerned about ongoing supply to Arizona hospitals."

On social media, health care workers around the country are pleading to the federal government for more supplies, using hashtags such as #moremasksnow and #sendmoremasks.

Others, including an Arizona Facebook group called Mask Phoenix, are pooling supplies and recruiting people to sew masks for the health care workforce.

IN HIGH DEMAND:How Arizona sewing enthusiasts are helping solve the face mask shortage

In a March 21 letter to President Donald Trump, leaders of the American Hospital Association, the American Medical Association and the American Nurses Association, asked for an increase in the domestic production of medical supplies that front line providers "so desperately need."

"Even with an infusion of supplies from the strategic stockpile and other federal resources, there will not be enough medical supplies, including ventilators, to respond to the projected COVID-19 outbreak," the letter states. "We have heard of health care providers reusing masks or resorting to makeshift alternatives for masks."

The U.S. Centers for Disease Control and Prevention has issued guidelines on how to optimize and preserve PPE, including reusing masks that were designed for a single use.

As a last resort, the guidelines say providers may consider using a bandanna in place of a mask, but some medical experts caution against that advice, because the effectiveness of bandannas and other homemade masks has not been proven.

Maricopa County gets 60% of federal shipment

State officials in Arizona and other states are under intense pressure to bring in more protective equipment. Supplies from a federal stockpile won't fill the gap, so they are turning to partnerships with the private sector.

Arizona Gov. Doug Ducey said this week that the state received part of its allotment of the national stockpile, including 60,900 high filtration N95 masks. A surgical mask protects the wearer from spreading germs, and provides a measure of protection against droplets, but an N95 mask filters at least 95% of air particles and provides wearers a higher level of protection from contracting disease.

The allocation of supplies has been divided among the state's 15 counties with the largest share — nearly 60% — going to the most-populous Maricopa County, where most of the state's cases of COVID-19 infection have been reported.

Pima County will receive 15.3%; Pinal County will receive nearly 6%; and Coconino County will receive 2.1%, a state breakdown shows.

"It was an overwhelming amount of resources. But still, it's not enough," Ducey said Monday. "There is a surge in need for all of these things, from testing, to hospital capacity, to personal protective equipment. ... I don't think there will be a point in time right now where we'll check a box and say that we have what we need."

Dr. Cara Christ, the Arizona Department of Health Services director, said partnerships with the private sector are going to be essential in identifying "rapid ways" to get additional masks, gloves, gowns, face shields and other supplies for health providers on the front lines of the COVID-19 pandemic in Arizona.

On Tuesday, the state announced progress in that direction — a new partnership between Arizona, the BStrong Initiative partnering with the Global Empowerment Mission, a disaster relief organization, and the Verstandig Family Foundation created by health care entrepreneur Grant Verstandig to secure up to 1 million N95 masks and other equipment for Arizona health care professionals.

“Arizona is proactively seeking innovative and resourceful ways to ensure our medical professionals and first responders have the protection they need,” Ducey said in a written statement. “For doctors, nurses and other personnel providing testing and care, these protective supplies are critical."

The first 250,000 N95 masks will be donated by the Verstandig Foundation, with anticipated arrival in Arizona within 10 days, the Governor's Office said Tuesday.

Hospital warns of shortages

As the crisis has grown, health care facilities have been changing their standards for usage of protective equipment, from when to wear it to how long to wear it.

Hospitals, including Phoenix Children’s Hospital, have warned health care professionals about shortages of masks and gowns last month and implemented new standards for when to wear them.

“We are recommending to limit PPE use in hospital settings to direct patient contact in isolation rooms,” the hospital’s Infection Prevention & Control Department wrote in a Feb. 26 email.

Phoenix-area emergency room nurse Rachel Basham has worn the same N95 mask three days in a row, even though its efficacy drops after a couple hours, she told The Arizona Republic.

Basham, who did not want to identify the hospital where she works, said staff members are arguing over supplies and that the hospital has started locking away protective gear, requiring approval from top managers for any distribution.

"We’ve been burning through a lot of personal protective equipment," said John Swagert CEO of Mountain Park Health Center, a group of seven Valley clinics largely serving low-income patients. "And we're getting no new shipments from our normal supplier."

When Mountain Park staffers have reached out to suppliers to ask for more, they "mostly hear silence," he said. The clinics have been rationing surgical masks to only two per staffer each day, he said. Normally, masks would be changed after every patient visit.

Ducey last week ordered the halting of all elective surgeries in the state, a decision he later said was made to help preserve personal protective equipment for health care workers, he said.

Banner Health, which is Arizona's largest health system, says its supplies of PPE are adequate right now, and that the company is closely monitoring its stock of equipment and supplies.

The nonprofit, Phoenix-based company says it is making recommendations for using PPE based on evidence-based guidelines intended to keep health care workers safe, "and avoid unnecessary use," and to preserve supplies.

"Like others across the industry, we agree that supply levels are very concerning," Jim McVeigh, a Mayo Clinic in Arizona spokesman, wrote in an email. "We are actively engaging our staff in conservation and continually monitoring supply levels in preparation for a potential surge in patients."

The state appears to be making an earnest effort at getting more PPE supplies, and has already shown success, said Robin Schaeffer, executive director of the Arizona Nurses Association, citing the shipment from the national stockpile.

Schaeffer said the association wants to ensure nurses in Arizona are safe, which includes having the protective equipment they need.

"Everyone is kind of scared, including our nurses. ... We are all in unchartered waters here," Schaeffer said. "I don't think anyone would argue we are where we want to be in terms of PPE resources."

The association does not advocate for using home-sewn masks. However, they can be used to give to non-medical businesses that use them, and swapped out for surgical level masks to give to health care workers.

"The biggest part is that hospital administration has got to have open lines of communication with nurses," she said.

Basham, the emergency room nurse, said her hospital is not overrun with COVID-19 patients right now. People with less serious medical issues are staying home, which has freed up beds, she said.

But, she added, it feels like the calm before the storm.

Arizona Republic reporter Robert Anglen contributed to this article.

Have concerns about testing, medical supplies or treatment of COVID-19? Reach health care reporter Stephanie Innes at Stephanie.Innes@gannett.com or at 602-444-8369. Follow her on Twitter @stephanieinnes

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