After completing another shift as an emergency physician treating many patients with influenza-like illnesses amid the COVID-19 global pandemic that has reached every state in the nation, Megan L. Ranney, MD, MPH, changes her clothes before heading home to her husband and their two children, 11 and 8 years old.
She leaves her shoes outside, along with a plastic bag filled with her clothes, then immediately gets in the shower to wash away the pandemic gunk before touching another soul. She wipes down her smartphone, her keys and the steering wheel of her car.
But what remains safely stored inside her car’s trunk, tucked inside of a paper bag, are two increasingly precious items in a world wracked by a global shortage of personal protective equipment (PPE): a procedural mask and a medical grade N95 respirator.
The items, designed to be used once and then disposed of, will be reused “for as long as possible,” Dr. Ranney said in an interview.
“Our hospital has protective equipment—for now,” said Dr. Ranney, an AMA member who practices at Lifespan Rhode Island Hospital in Providence. “But we are reusing for as long as possible. We’re reusing N95s until they are soiled or don’t fit anymore—so, potentially, for days.
“We store them in paper bags between patients,” she added. “We are reusing surgical masks for as long as we possibly can. We are reusing face shields. We’re trying to use reusable gowns as much as possible. We are doing our best to conserve supplies because we don’t have an adequate supply and we don’t want to run out.”
Dr. Ranney is the director and founder of the Brown Emergency Digital Health Innovation program and an associate professor of emergency medicine and health services, policy and practice, at the Warren Alpert Medical School of Brown University, of which Rhode Island Hospital is a teaching affiliate.
She knows of dozens of physicians and others working in health care across the country who have tested positive for COVID-19, the disease that has killed more than 18,000 people around the globe, according to the World Health Organization.
Dr. Ranney also knows the tally of doctors and other health professionals infected will only rise with time. In China, where SARS-CoV-2—the novel coronavirus that causes COVID-19—was first identified, more than 3,000 health workers have been infected and at least 22 have died.
“It is frustrating and anxiety-producing,” Dr. Ranney said. “I was a Peace Corps volunteer. I’ve worked in resource-poor settings. I never imaged my daily practice in the U.S. would be similar to how medical workers sometimes must work in low- and middle-income countries. This pandemic may be unprecedented, but it was certainly predictable. We did not have to be in this situation.”
Dr. Ranney is one of many physicians and other health professionals who have helped raise visibility of the issue with the #GetMePPE social media hashtag. With the recently launched getusppe.org, Dr. Ranney and her colleagues aim to send, receive and coordinate donations for PPE among the community and medical professionals and unite the maker community to validate designs that can be widely shared among the medical community and easily printed in local manufacturing facilities.
“It was really a spontaneous collection of physicians and nurses on the front lines who came together through social media and said, ‘We need to do something because we’re all running short on protective equipment.’ It emerged over the course of 24 hours,” Dr. Ranney said, adding that she has been getting emails and text messages from “colleagues across the country who have either run out of PPE or are about to run out.”
Time for results is now
The AMA is pressing the Trump administration to “leverage every tool at its disposal, including fully employing production and distribution mechanisms of the Defense Production Act,” as AMA President Patrice A. Harris, MD, MA, wrote in an op-ed published in Modern Healthcare.
The president last week signed an executive order to exercise his authority under the Korean War-era law, but Dr. Harris wrote the president “now must provide clarity about how that authority is being utilized.”
Shortages of PPE, ventilators and other critical equipment pose huge risks to patients and the health professionals who care for them, Dr. Harris wrote.
“Put bluntly: If we lose our physicians and nurses to illness, we will have no line of defense to fight this disease as access to health care services will diminish rapidly,” the AMA’s president wrote. “We must act immediately.”
Doctors and other health professionals “are putting themselves in danger, or putting patients in danger, because if we run out of that equipment we are going to get sick and won’t be able to take care of the every day emergencies that Americans are always going to have,” she added.
Find out what Dr. Harris personally told President Trump about what’s needed to effectively fight COVID-19. The AMA’s president also has spoken out in numerous national TV interviews, including on NBC’s “Today” show, in which she said “it’s not enough to talk about what we’re going to do or say the right words.
“We really need action, and we need that action to lead to results,” said Dr. Harris, an Atlanta psychiatrist. “And those results are that physicians and nurses have the equipment they need.” She reported the situation at one Georgia hospital that has used six months of PPE supplies in five days.
Dr. Harris has called for a World War II-style ramp up of production to get physicians and other health professionals the PPE and other equipment they need to save lives amid the COVID-19 pandemic.
Learn more about how the AMA is supporting physicians on the front lines of COVID-19.
Meanwhile, JAMA has put out a call for ideas on how to conserve the supply of PPE that already has generated hundreds of responses. The AMA Code of Medical Ethics offers foundational guidance for health care professionals and institutions responding to the COVID-19 pandemic.
Motto for trying times
For Dr. Ranney, she knew in choosing emergency medicine that she could be called upon to treat any patient at any time. But she never imagined that she would do so without a ready supply of PPE. As trying as the circumstances are, she draws some inspiration from an unlikely source.
Her 8-year-old, attending class virtually through videoconferencing, joined in chorus with classmates in reciting their daily pledge.
“I will show respect, responsibility and readiness, and will make this situation the best it can be,” they said.
“My heart is full,” wrote Dr. Ranney on Twitter.