Doctors, nurses and other caregivers at Open Cities Community Health Center in St. Paul are running dangerously low on the face masks they need to protect themselves from infection as they test patients for coronavirus. So low, in fact, they’re once again contemplating closing their doors.

“There’s a huge likelihood that we will have to stop services altogether,” said Dr. Cynthia Woods, medical director of the federally-backed health center, which survived a financial crisis in December with community help.

Open Cities CEO Dr. Ritesh Patel said he engaged in a conference call Friday with other community health centers that serve low-income, high-risk populations in the Twin Cities, and at least one west metro health center also was contemplating closure.

All are struggling through the same dilemma, one that is touching medical centers large and small. Caregivers have a duty to help the sick, but if they themselves become sick, they could end up transmitting the virus to vulnerable patients.

Health experts say the national run on face masks is complicating life on the front-lines for doctor, nurses and other care providers, without much added benefit for everyday people who wear them.

Open Cities Health Center deals with the particularly vulnerable — poor, elderly, uninsured and others likely to have health conditions that will compound Coronavirus. They’re down to enough face masks for 12-15 more flu or Coronavirus tests. Then they’ll have to close. pic.twitter.com/EgQeSjnOUU — Frederick Melo, Reporter (@FrederickMelo) March 16, 2020

“We have them in stock, because we ordered many boxes before the outbreak happened, but there’s no way you can get more in stock,” said Raul Noriega, clinic manager at Southside Community Health Services in Minneapolis. “Hopefully, ours last for the next month. Otherwise, I don’t know what we’re going to do.”

Allina Hospitals have had to remove face masks that were made available to visitors at entrances because of hoarding.

“That’s definitely been a problem,” said Dr. Alison Peterson, an operations chief at Allina’s Incident Command Center in Minneapolis. “People are taking supplies, and they’re using them inappropriately. We have seen people take more than is appropriate.”

DOWN TO 60 FACE MASKS

On Monday afternoon, Open Cities was down to about 60 surgical face masks — a paltry total, given that it takes roughly four people in masks to greet, swab, evaluate and monitor a patient undergoing a virus test, with a fifth mask reserved for the actual patient.

“That gives us, at max, 12 tests that we can perform for coronavirus or even the flu,” said Chief of Strategic Development Summer Johnson.

Elevating concerns, community health centers receive federal funding to work with low-income, uninsured, elderly and immigrant populations — the groups at special risk for coronavirus, which is compounded by pre-existing conditions such as diabetes and hypertension.

In light of the pandemic, Open Cities already has asked non-essential staff to work from home and temporarily halted its dental services, Saturday clinics and off-site services at Catholic Charities, the Union Gospel Mission and the Mexican consulate in St. Paul.

LOOSENED GUIDELINES ANGER NURSES

“The widespread trend that we’re hearing about is a lack of personal protective equipment,” said Rick Fuentes, a spokesperson for the Minnesota Nurses Association.

The federally-regulated surgical masks that medical health centers are in need of are more specialized than run-of-the-mill face masks, but some nursing advocates say they’re not enough.

In light of the national shortage, the Centers for Disease Control responded last week by loosening guidelines for personal protective equipment and other conditions surrounding treatment of patients diagnosed with the novel coronavirus.

Instead of the close-fitting N95 respirator mask, the new guidelines effectively encourage nurses and other healthcare providers to don standard, more loose-fitting surgical masks.

‘NOT THE TIME TO GET IT HALF-RIGHT’

That’s a serious concern for the Minnesota Nurses Association and other nursing groups across the nation, who have called for the more specialized N95 respirators — federally-regulated devices whose edges are designed to form a tighter seal around the nose and mouth.

“Now is not the time to get it half-right,” said Minnesota Nurses Association President Mary Turner, in a written statement on Friday. “The difference between optimal measures and sub-optimal is lives at stake, people affected, and hospitals full of patients. If nurses are not protected, there will be no nurses to care for patients.”

The CDC does not recommend that people who are well wear a face mask to protect themselves from coronavirus. On its website, the U.S. Food and Drug Administration — which regulates both surgical masks and N95 respirators — details why.

The website states: “While a surgical mask may be effective in blocking splashes and large-particle droplets, a face mask, by design, does not filter or block very small particles in the air that may be transmitted by coughs, sneezes or certain medical procedures. Surgical masks also do not provide complete protection from germs and other contaminants because of the loose fit between the surface of the face mask and your face.”

Just as importantly, the masks degrade and are not intended to be used more than once.

PROTECTIVE MEASURES

Despite those concerns, healthcare facilities are rolling out other precautionary measures. Testing and swabbing at medical facilities is generally done at drive-up locations in the parking lot by trained staff in protective medical gowns, gloves and masks.

At Open Cities, patients who have to come into the facility are segregated in special quarantine rooms, which are sanitized for an hour after their departure, Patel said.

On Friday, Allina Health — parent company to United Hospital and Abbott Northwestern Hospital — announced general visitor restrictions — children under age 12 and sick people are not allowed to visit patients, and all patients are limited to two visitors per day, though “compassionate exceptions” are possible with permission from a patient care manager.

And for patients who are being tested for the coronavirus or who have been confirmed to have it, no visitors are allowed at all.