N95 masks being rationed at Minnesota hospitals, six months into pandemic

Hospitals across Minnesota resumed elective medical procedures May, but nurses say their employers still aren't giving them enough N95 masks to protect them from COVID-19.

A survey of Minnesota nurses conducted by the American Nurses Association in late July and early August found 49% of respondents felt unsafe with the N95 reuse policies in place where they work, which typically require wearing a single-use mask for five to seven days.

"They are still rationing them, just like they were back in March," said one nurse at a Twin Cities hospital, who is leaving her "dream job" until the pandemic recedes because she doesn't feel safe. "We have a stockpile somewhere in the state. But the hospitals aren't requesting it."

About 85% of the 277 Minnesota nurses surveyed said they were required to reuse disposable N95 masks, and 10% more said they were encouraged to do so. Before the pandemic, nurses could have been reprimanded for reusing single-use masks.

"It feels like a contaminated, dirty rag that I'm putting on my face," said the Twin Cities nurse, who did not want to be identified because she fears permanently losing her job.

Minnesota's reuse practices exceeded national averages. Nationwide, 88% of 14,664 nurses surveyed by the ANA said reuse of single-use masks was either mandated or suggested by employers. The number of nurses reporting mandatory reuse increased 6% since May.

"Re-use and decontamination of single-use PPE as the 'new normal' is unacceptable," registered nurse and ANA President Ernest Grant said in a statement, "given the lack of standards and evidence of safety."

Hospital officials say they are confident their reuse and decontamination methods adequately protect caregivers and patients, though they're hesitant to state publicly how many N95 respirators they have on hand.

"That number is extremely fluid because supplies are always arriving and being distributed," said Christine Hill, spokeswoman for Hennepin Healthcare in Minneapolis. "With careful conservation — including safe reuse education — we believe we have what we need for staff caring for patients."

The ANA, which is not a labor union, now agrees with the National Nurses United union that the federal government should leverage the Defense Production Act (DPA) to increase domestic manufacturing of N95 masks for front-line caregivers during the COVID-19 pandemic.

An N95 respirator is tightfitting filter that covers the mouth and nose and attaches to the face with elastic straps. When correctly sized to the wearer's head, such masks are supposed to protect the wearer from inhaling 95% of virus-carrying particles less than 0.3 microns in diameter. The masks come in medical and nonmedical models.

President Donald Trump has activated DPA powers to produce more personal protective equipment, including an April 2 order that allows the Federal Emergency Management Agency to use "any and all authority available under the Act" to acquire N95 respirators from Maplewood-based 3M Co., the leading manufacturer of such masks.

But so far, the federal actions have not eliminated supply constraints for medical-grade N95 masks, which are regulated by the Food and Drug Administration. The FDA has also allowed about two dozen companies to import KN95 masks, which are regulated under Chinese standards, for health care. (Other manufacturers' KN95s are not authorized for use in health care.)

The Centers for Disease Control and Prevention (CDC) has issued guidelines to reuse single-use respirators during supply shortages, and the FDA has issued emergency authorizations for systems that can disinfect the masks.

3M doesn't endorse reuse and makes no claim that doing so is safe. N95 masks are classified as "filtering facepiece respirators," or FFRs.

"3M cannot recommend decontamination of FFRs, because FFRs are not designed to be decontaminated, and doing so voids the regulatory approval," the company said in its latest technical bulletin. Such masks are among the key pieces of equipment used to protect health care workers from contracting the virus that causes COVID-19 at work.

As of the latest data release on Aug. 3, 8,522 health care workers have contracted COVID-19 at home or in their community since the start of the outbreak, representing about 11% of Minnesota's cases of the infectious respiratory illness.

On Sunday, the Minnesota Department of Health added 714 new lab-confirmed cases of COVID-19, bringing the statewide total to 80,587. The state also added six deaths, raising the toll to 1,857.

A research article published last week in the CDC's Morbidity and Mortality Weekly Report found 6% of health care workers tested at 13 major hospitals nationwide had developed antibodies in response to COVID-19. That came as a surprise to many — 44% of those with antibodies did not previously believe they'd been infected.

The statistically significant results suggest personal protective equipment, including N95 masks, played a role: 9% of study participants in hospitals where PPE shortages were reported had detectable levels of antibodies, compared with 6% in hospitals that did not.

"These findings highlight the importance of maintaining PPE supplies at hospitals caring for COVID-19 patients and, assuming adequate supply, adhering to policies that encourage the use of masks for all interactions between HCP [health care providers] and patients. Universal masking has been associated with a significantly lower rate of infection" among health care providers, the study concluded.

The Star Tribune asked seven major health systems in Minnesota last week how many N95 masks they have on hand; none provided a number.

"Our on-hand supply of N95 respirators is at a level that supports current need in our hospitals," Bloomington-based HealthPartners said in an e-mail. "As for new shipments, we are in allocation status, meaning hot spots across the U.S. get priority, and we can only purchase what companies are allocating to us."

State records show that collectively, hospitals, nursing homes and other health care facilities in the state have 1.3 million medical-grade N95 masks in storage, and the state stockpile in St. Paul holds 259,000 more. The state is expected to get about 100,000 masks a month through December 2021 for its stockpile, which can be accessed for free by facilities with acute shortages.

Despite having more than a million N95s in the state for health care workers, nurses in the ANA survey reported that the N95 respirator is still among the most difficult personal protective items to obtain at work, behind surgical masks, gowns, face shields and goggles. Only 21% of respondents in Minnesota said they were "fully able to get this PPE," while 9% said they were out of stock.

Five Twin Cities hospital nurses interviewed for this story reported feeling unsafe at times in part because of the reuse of masks. Several posited that hospitals' financial losses since the pandemic are more likely explanations for the continued rationing of single-use respirators.

"They are acting like we are still in pandemic crisis mode," said Andrea Lamusga, an intensive-care nurse at United Hospital in St. Paul. "Well, we are not in crisis mode in Minnesota, but our PPE supply is apparently still being treated as though we [are] in crisis."

Staff writer Kim Hyatt contributed

to this report.

Joe Carlson • 612-673-4779