One of the nation’s top cancer hospitals has informed its staff it has a shortage of masks and other personal protective equipment, even as at least five employees and three patients have been diagnosed with COVID-19.
The hospital, Memorial Sloan Kettering Cancer Center in New York, has only a week’s supply of masks on hand, according to a transcript of a staff meeting last Friday afternoon. The shortage, Kreg Koford, senior vice president of supply chain and sustaining care, told employees, is due to production and distribution delays in China, where most personal protective equipment, or PPE, is manufactured.
Hospitals around the country have been wrestling with shortages of PPE, beds, and ventilators amid mounting numbers of infected patients. But the shortage is particularly troubling at Sloan Kettering, the country’s oldest and largest private cancer hospital, because cancer treatments like chemotherapy and radiation therapy can leave patients with compromised immune systems. Preliminary data out of China suggests that cancer patients face a 5.6% fatality rate if infected with the virus, compared to 0.9% in people with no underlying conditions.
“It’s been a couple of months since new shipments have come,” Koford said of equipment. “Their manufacturing is coming back online, but we will not likely see that for four to eight weeks.” The transcript of the meeting was shared with BuzzFeed News; a hospital spokesperson acknowledged the shortage and said Sloan Kettering officials are working to find sufficient supplies from other sources.
Administrators also stressed that not all the coronavirus cases were “related to exposure at MSK,” according to the transcript, meaning at least some were a result of community exposure. The spokesperson did not offer additional details about the coronavirus cases at the hospital.
“Our focus is on continuing to provide excellent care for our patients and doing everything we can to keep our staff and patients healthy and safe,” the spokesperson said.
He added: “Balancing supply and demand for PPE is essential to a hospital and we have our supply chain experts on the frontline, tapping into all of their resources, to ensure we are continuing to have an adequate supply."
The scarcity of protective masks, eye shields, gowns, and other supplies for the caregivers on the front lines of the fight against the coronavirus has raised concerns in the federal government and at the state and local level. Last week, the CDC revised its recommendations for PPE, saying that more protective equipment including N95 respirator masks were not necessary for most health care workers other than those directly caring for infected people or individuals suspected of carrying the virus. The goal, the agency indicated, was to preserve dwindling stocks of those critical supplies for those who most need it.
In response, the American Nurses Association sent a letter to congressional leaders asking for more transparency from the CDC about the transmission of COVID-19 in order to assess whether face masks were sufficient protection for health care workers.“We are concerned that CDC recommendations are based solely on supply chain and manufacturing challenges,” said the letter.
A New York state nurses union has also sounded the alarm over the shortage of protective equipment. “We’re prepared to go forward, but at some point, we will run low on and perhaps run out of a critical care implement — the N95 respirator,” said Carl Ginsberg, a spokesperson for the New York State Nurses Association. “You really can’t care for patients without proper equipment.”
New York State declared a state of emergency a week ago and COVID-19 infections have climbed toward 1,000, although given the dearth of testing that number is almost certainly an undercount. The city has prohibited large gatherings, shuttered bars and restaurants except for delivery or takeout, and closed schools, gyms and movie theaters. According to an op-ed by Gov. Andrew Cuomo in the New York Times on Sunday, ICU beds in the state are currently at 80% capacity. And on Monday, the governor said that the health care system was facing “an avalanche” if between 40 and 70% of the state — or about 8–12 million New Yorkers — becomes infected.
“The wave is going to break, and the wave is going to break on the hospital system,” Cuomo told reporters.
At Memorial Sloan Kettering, officials have made significant shifts in patient care to address the risk of exposure to the virus. “We are already cancelling surgeries and procedures, non-essentials,” Koford told staff.
In a separate note to staff seen by BuzzFeed News, some physicians at the hospital were asked to submit prioritization lists of patients to treat. Doctors are being asked to assess the risks and benefits of bringing cancer patients with fragile immune systems into the facility for treatments like chemotherapy and radiation, given the possibility of infection and the shortages of equipment.
Sloan Kettering specializes in cancer treatment, not general medicine or urgent care, but the possibility of rationing services shows how the pandemic is rippling through the health care system. At the height of the COVID-19 in hard-hit regions, facilities were so overwhelmed that patients with complex illnesses struggled to get care. And though many COVID-19 cases are mild for people who start out in good health, the virus poses a much higher level of risk for those with compromised immune systems because of cancer treatments or other factors.
“Cancer patients, by nature of the fact that they’re receiving chemotherapy, are naturally at increased risk of infection” said Andrew Chapman, chief of cancer services of the Sidney Kimmel Cancer Center at Thomas Jefferson University Hospital in Philadelphia.
Ned Groves, Sloan Kettering’s executive vice president and hospital administrator, told staff in the meeting on Friday that it was putting as many stopgap measures in place as possible, including performing triage via teleconferencing and setting up housing and work-from-home policies for staff.
“We do not want to end up like Italy,” Groves added.
With nearly 28,000 infections and more than 2,100 deaths to date, that country has become so overwhelmed that it is no longer able to treat all patients, and some hospitals have been forced to make difficult choices about who should receive care.
Sloan Kettering administrators told staff that the hospital does not have the capacity to test all employees, even if they come into contact with a possible COVID-19 case.
Meanwhile, it is asking its employees to go to work unless they have symptoms of the disease. “Healthcare workers who have been directly exposed to a suspected or confirmed COVID-19 positive patient, and remain asymptomatic, should report to (or remain at) work,” according to an email sent to employees on Sunday night. The email added that patients with direct exposure should self-monitor depending on the level of exposure risk.
New research published in the journal Science on Monday suggests that transmission by people who are not yet experiencing symptoms of the illness may be responsible for the vast majority of documented cases of COVID-19 in China.
In response to a question from staff about pooling resources with other hospitals to stanch the shortage, Koford replied that many hospitals “are in much worse condition.”
Kreg Koford's name was misspelled in a previous version of this post.