HOUSTON — “Much like everywhere else, supplies are our biggest issue...we are last on most lists on when to get supplies,” wrote Dr. Lane Aiena from Huntsville Family Medicine. “As of right now, our clinic has a handful of surgical masks left and a handful of gowns. No N95s whatsoever.”
Aiena’s situation is not unique. He and others have either written or called the Texas Academy of Family Physicians, a group that represents about 15 percent of practicing doctors in the state, sharing safety concerns because of the lack of personal protective equipment. Tom Banning runs the organization, which is typically an advocacy and education group.
“I'm truly pissed off at how this has worked and how we have treated our frontline physicians, our nurses, our E.M.S. workers and our other first responders,” Banning said. "Because you wouldn't put a soldier into battle with nothing. And that's what we've done.”
Since COVID-19 hit the country, Banning has become a procurement and distribution expert.
“I’m not in the procurement business, nor do I want to be,” Banning said. “The system we have in place has completely failed us. Our supply chain has failed us. Our distribution chain has failed us.”
“We learned that there was, you know, a really a global Hunger Games-esque competition going on for this PPEs,” he added.
Recently Banning got lucky, as he describes it.
“A friend of mine that I play golf with called me. He said, ‘You know, I've got a truck of masks coming up, surgical masks coming up from Mexico tomorrow. Do you know anybody who might need who might need them?’ And I was like, ‘Yeah, kind of like the whole state.’”
Banning said he received -- and with some help -- distributed more than 500,000 masks across the state.
“I immediately got on the phone and called some practices that I knew were ramping up their testing capabilities,” Banning said. “They all said, ‘Yes, we will take what you can get.’”
Banning, who lives in Austin, said some people came from Dallas to get the supplies. He delivered cases to San Antonio and Houston. He said he drove around Austin as well, distributing all he could to a community health center that he believes was two days away from running out of supply and closing up a couple of offices. He also sent some to a local hospice that was in desperate need of masks.
The masks were not FDA certified. But Banning said they are better than a bandana.
“Something is better than nothing,” he said.
Houston Methodist Executive Vice President Dr. Robert Phillips sent an email to every Houston Methodist physician and every Houston Methodist employee this week outlining the hospital system’s PPE count and use.
“We must take some extra measures now as we are running low on some PPE,” Dr. Phillips wrote. “We are using 14,800 gowns per day, which leaves us with only seven days' supply. We are using 4,600 N95s per day, which leaves us with 23 days' supply.”
Phillips encouraged staff to conserve gowns until new ones arrived and use recycled N95s, which the hospital is now decontaminating.
Part of Firas Zabaneh’s job as the Director of System Infection Prevention and Control is to make sure all eight Houston Methodist Hospitals have enough PPE.
He told KHOU 11 the hospital system stocked up on PPE to be prepared for the spillover of the Ebola outbreak in the Democratic Republic of Congo. Houston Methodist also trained its staff to care for Ebola patients.
“We’ve increased our PPE stockpile by significant amount,” Zabaneh said. “Until recently, we were in a very good situation related to PPE.”
Zabaneh also mentioned the hospital system has been coming up and using innovating way to reduce its reliance on disposable personal protective equipment.
“We've had three different devices built already here at Houston Methodist to deploy as an alternative to PPE,” he said. “We're also working with the Texas A&M University, the College of Engineering, specifically the biomedical engineering school, to come up with more ideas for sustainable alternatives to PPE.”
Some of the things Houston Methodist is exploring is replacing filters in N95 masks.
They’ve built a “personal protective pod” that allows medical personnel to treat a COVID19 patient and not have to wear a lot of PPE.
“We've come up with a device that we call a specimen collection pod, that anybody that is collecting a specimen in our in one of our clinics does not require having to put on PPE other than gloves because there are behind a Plexiglas box that they're completely protected,” Zabaneh said. “We've developed an intubation box that is equipped with an ultrafine filtration device that removes the viral particles from the chamber where intubation is taking place. And that's to reduce the risk of aerosolization and the having the aerosols reach the person that is doing the procedure.”
Zabaneh said Houston Methodist is still receiving PPE shipments and has tried to help physicians who have asked for help.
“We are sharing all the designs of the innovations that we put together,” Zabaneh said. “One of them we've already posted and that's the intubation box. If there is any assistance that we can provide to anybody, I know that there are some physicians that reached out to us and asked for help. And we did. And we're willing to help.”
Zabaneh said Houston Methodist has not asked the state for supplies, but that might change.
“Right now, we are getting in a situation where we may have to ask for help and hope to be able to receive it,” he said.
Zabaneh said the hospital is fortunate to have resources.
Resources smaller doctors’ offices don’t seem to have. That’s why Banning turned to procuring masks wherever he can get them.
“We should be doing so much more,” Banning said. “But we weren't we weren't prepared for it. And frankly, we did not design a system that could provide at a statewide community level the support that we need.”
Friday, while announcing his efforts to re-open Texas, Governor Greg Abbott said, “we have a steady supply of PPE like facemasks.”
That statement doesn’t add up with what many Texas medical professionals have been telling KHOU 11. We reached out to the governor’s office for clarification.
We also asked the question to the Texas Division of Emergency Management which distributes PPEs through the Regional Advisory Councils across the state.
The Texas Health and Human Services website lists 22 RACs in the state. They are “administrative bodies responsible for trauma system oversight” within certain Texas areas. Council members are generally local professionals and citizens interested in improving and organizing trauma care. Each is organized differently by design.
“As the Governor correctly pointed out, the supply is steady,” wrote Seth Christensen, Chief of Media and Communications for TDEM in an email. “We continue to see the links of the supply chain becoming stronger each day. Through the Texas Supply Chain Strike Force, the state has pushed over 21 million pieces of PPE across the state of Texas. In the last week, that included over 6.4 million masks, over 694 thousand face shields, and over 2.8 million gloves. --- I’ll reinforce again, these resources are being delivered to the RACs across the state who determine how to distribute these resources across their regions locally. The community doctors should be working with their RACs and local emergency management offices to request any resources that they may need. “
John Wittman, Director of Media Relations for Governor Abbott emailed KHOU 11 the breakdown of what the strike force has shipped in the last 7 days.
Face shields: 694,379
KHOU 11 followed up asking if any gowns were distributed as well. We’ll update the story when we hear back.
E-MAILS FROM PHYSICIANS
Many of us are struggling to maintain our practices, while keeping our patients and our staff healthy and safe. This is becoming more of a struggle each day, with the rules changing sometimes by the hour. I am one of these practices that will need to start letting staff go (even though it goes against every fiber of my being, in not being able to financially support my staff during these difficult times). But as my volume has plummeted and virtual visits are not paid at the same rate, we are struggling to maintain financial viability. Keep up the important fight for us, and we will work to maintain the front lines.
I am feeling left out of this supply chain! ;) Local ladies have made cloth masks for us, which I require my staff to wear over their 1 surgical mask I can allocate to them each day. We only had 1 box of 100 surgical masks on Monday last week and my local PHO sent us another box on Thursday (they have been pooling resources for the community docs when able). I was working with 1 N95 mask in the entire office for the last 2 weeks. My friend from up north found an unopened container in his garage of 3 small N95 masks, so now I have more to use for my other staff. However I will continue to wear a surgical mask and then a cloth mask on top of my N95 whenever the possibility of aerosolizing the virus occurs by provocative testing in the office (I need to save the N95 and can wash the cloth masks). However gowns and hand sanitizer remain a problem here. I might need to move to rain coats like other PCPs in my area since my attempts to order gowns from MULTIPLE sources over the last 2 weeks have all been cancelled. We are one of MANY tiny independent offices trying to do the right thing by keeping patients out of the ED and using telemedicine when appropriate, so are often forgotten in the supplies chain. My staff are just as important to me as family, so keeping them protected is paramount.
Dr. Emily Briggs, Briggs Family Medicine
Much like everywhere else, supplies are our biggest issue. Huntsville is a small community, so we are last on most lists on when to get supplies. The problem is we're only a 70 mile straight shot from Houston, one of the hardest his areas in Texas, so we could really use them. As of right now our clinic has a handful of surgical masks left and a handful of gowns. No N95s whatsoever. The hospital isn't fairing much better as they're reusing what limited supplies they have. Luckily, when all of this broke I ordered a P100 painter's mask, so one other nurse and I have become the only "COVID testers" in our clinic to limit supply usage.
A close second on issues are the test kits. We were initially given FIVE SWABS that were supposed to last 2 weeks. You want to talk about rationing??? We have no idea what the real number of COVID is. We finally switched lab companies as the one we had been using has been a total flop for supplies. We got in the Abbott test kits that could be done on site, but no sooner that we got them we were told "they were upgraded and no longer CLIA waived, so send them back." It has been beyond frustrating for us and the patients.
From a monetary standpoint, we're doing "ok" so far. We started Telemedicine three weeks ago, which has helped immensely. We also (around that time) had all staff start taking two half days off, cutting our pay expenses by about 20%. While it all seems obvious now, the initial emergency meetings to come up with this got tense to say the least. Change is never easy; sudden, drastic change is far harder.
We have multiple safety precautions we have put in place for staff and patient safety. All visits are screened on the phone for COVID risk factors. If positive, we either do telemedicine, I personally room them from their car, or I see them in their car (has happened about three times). Patients wait in their cars and have their temps screened at the door. With the transition to telemedince, the burden on the waiting room was already down, and the rest of the new strategies have taken it to zero. We do not have walk ins at this time, all appointments must be screened and scheduled. Any staff member with risk factors (age, pregnancy, comorbidities) has been cross-trained on other tasks and is not rooming patients at this time.
Dr. Lane Aiena, Huntsville Family Medicine
The symptoms of coronavirus can be similar to the flu or a bad cold. Symptoms include a fever, cough and shortness of breath, according to the Centers for Disease Control. Some patients also have nausea, body aches, headaches and stomach issues. Losing your sense of taste and/or smell can also be an early warning sign.
Most healthy people will have mild symptoms. A study of more than 72,000 patients by the Centers for Disease Control in China showed 80 percent of the cases there were mild.
But infections can cause pneumonia, severe acute respiratory syndrome, kidney failure and even death, according to the World Health Organization. Older people with underlying health conditions are most at risk for becoming seriously ill. However, U.S. experts are seeing a significant number of younger people being hospitalized, including some in ICU.
The CDC believes symptoms may appear anywhere from two to 14 days after being exposed.
Human coronaviruses are usually spread through...
- The air by coughing or sneezing
- Close personal contact, such as touching or shaking hands
- Touching an object or surface with the virus on it, then touching your mouth, nose or eyes before washing your hands.
Help stop the spread of coronavirus
- Stay home when you are sick.
- Eat and sleep separately from your family members
- Use different utensils and dishes
- Cover your cough or sneeze with your arm, not your hand.
- If you use a tissue, throw it in the trash.
- Follow social distancing
Lower your risk
- Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
- Avoid touching your eyes, nose, and mouth with unwashed hands.
- Avoid close contact with people who are sick.
- Clean and disinfect frequently touched objects and surfaces.
- If you are 60 or over and have an underlying health condition such as cardiovascular disease, diabetes or respiratory illnesses like asthma or COPD, the World Health Organization advises you to try to avoid crowds or places where you might interact with people who are sick.
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