Mary Turner was up in the middle of the night last night, worrying about PPE.
The acronym for personal protective equipment that used to be hospital jargon has become a household term during the COVID-19 pandemic. It's also a concern that's never far from the minds of health care workers dealing firsthand with the virus.
Turner, an ICU nurse on a COVID unit at North Memorial in Robbinsdale and president of the Minnesota Nurses Association, was already tired as she got ready for her Friday night shift.
"That’s the kind of nightmare that wakes you up in the middle of the night," she said. "Having a vision of seeing a person that needs help immediately, and you’re making this decision whether to go into the room or not, because you don’t have any protective equipment."
With COVID-19 cases rising aross the country, Minnesota is beginning to experience reemerging testing supply chain issues. The state is also bracing for what could be next - more PPE shortages.
Minnesota Department of Health (MDH) officials have been sounding the alarm on testing supply shortages as the global supply chain is stretched thin, an issue that was critical early on in the pandemic but had been recently largely alleviated.
This week, MDH began warning that those shortages could extend to the PPE that health care workers and first responders need to care for and respond to COVID patients.
MDH said on Wednesday that they are "looking to source" more high-quality masks and gowns that they anticipate needing as COVID-19 cases climb and flu season approaches.
As of Friday, the publicly available MDH dashboard showing critical care supplies showed that millions of face masks, N95 respirators, gowns and gloves are "past due."
Supplies past due or diverted
MDH does not yet know whether the federal government has diverted any of its PPE orders to be sent to "hot spot" states like Texas, California and Florida, but MDH Infectious Disease Division Director Kris Ehresmann said that has already been the case with some testing supplies.
As for the PPE the state is waiting on, state data show 2.2 million face masks, over 48.7 million gloves, nearly 2.9 million N95 respirators and 148,000 gowns that are listed as "past due."
"We have had some instances of supplies that have been ordered that were expected that have not been delivered, and some supplies that have been delivered that didn’t meet quality standards," MDH Commissioner Jan Malcolm said. "So that is part of what’s elevated our concern about that."
Ehresmann said it was masks that didn't meet quality standards. Malcolm said they have "decent supplies on hand."
"But our concern levels about how much more we may need for the rest of the year have increased because of some of these emerging supply chain challenges," she said.
Malcolm said that the health systems around the state have supplies on hand, and they do have some in a state reserve capacity. She said they can project rates of use, not just at the current capacity, but as a potential surge hits.
"We feel like we have a pretty good line of sight into what’s going to be needed where, at least into the next month or two months or three months," she said.
Dr. Rahul Koranne, CEO of the Minnesota Hospital Association, said that hospitals have done a "pretty good job in conserving supplies over the last many months."
"As cases pick up in other parts of the country we are starting to see supply shortages and that’s inevitable because other states are requesting more testing supplies, are requesting more personal protective equipment," Koranne said.
Koranne said he believes if hospitals continue to preserve PPE, "we should be able to get through this."
Allina Health told KARE 11 they have "adequate PPE supplies to manage through a surge of patients" in most cases. They are working to increase their supply of specific sizes of isolation gowns, and disinfectant wipes. KARE 11 has reached out to Fairview, Essentia Health and North Memorial as well.
Malcolm said MDH is beginning to think about what more they can do, especially with types of equipment that are "more vulnerable" to supply chain disruptions.
'Demand severely outstrips supply.'
3M, the country's largest manufacturer of N95 respirators, is making more of the surgical masks than ever before.
A 3M spokesperson on Friday said that some health care facilities have increased their consumption of PPE by up to 20 times.
"The reality is the demand in the U.S. and global demand for PPE continues to far exceed supply for the entire industry," the statement said. "While we can deliver more products as we invest in more manufacturing infrastructure to serve the public, demand severely outstrips supply."
Medtronic, another Minnesota-based company that is working to meet the rising demand for its ventilators, has increased production of the COVID-necessary devices by five times, now producing 1,000 per week.
The company has also made the plans for its PB560 ventilators available for free online, to help increase the overall global supply. They had more than 200,000 downloads between early April and late June.
'More and more is needed'
Mary Turner has been at the frontlines of the PPE shortage discussion since COVID-19 came to Minnesota, both as an ICU nurse and as a member of the governor's task force.
At North Memorial in Robbinsdale, where she works on a COVID unit, she said they are faring better than they were earlier in the pandemic.
Now at North Memorial, Turner said they have stopped reusing isolation gowns but still have to use the same N95 mask for five shifts before they throw it away or have it cleaned. Weeks ago, it was 10 shifts.
"That's not the way it's supposed to be," she said.
Turner said her hospital is moving toward decreasing the number of shifts masks have to be worn, but with looming supply chain issues, she worries that effort will be stalled.
"Even if the hospitals get all of their supply chains - here in Minnesota - if we get it all established and we feel a little bit more comfortable, it is not back to optimal PPE that we’re using," she said. "We’re still reusing. People seem to be shocked by that. Because they’re thinking by now this should be solved. But the problem is more and more is needed."
Turner said right now, she's seen a decrease in COVID ICU cases. MDH data reflects that trend in recent weeks, as well.
"That could change on a dime," she said.
In fact, state health officials expect it to change. Earlier in the week, MDH warned that hospitalizations are expected to rise as younger people pass on the virus, maybe unknowingly, to older age groups.
State epidemiologist Ruth Lynfield said on Wednesday, "I do expect to see an increase in deaths in the coming weeks."
Turner said she is "not surprised" that supply chain issues are looming on the horizon, given the rise in cases in several U.S. states. But she said it's important to note that even before those issues become more acute, hospitals are already "crunching numbers" to figure out how to make the current supply stretch.
"The worst-case scenario for me as an intensive care nurse who works in the COVID unit is to come on one night and have to go into that patient’s room, because I need to be there to do the cares for that person, and not have an N95," Turner said.
She said when she thinks about states getting hit harder than Minnesota right now, that's what she thinks about.
"I tell you what, most nurses are gonna go in and help that person," she said. "But at the risk of what?"