[dabigv13]

The NYT and WaPo both had good articles on the national continued PPE shortages, that are reflective of my experience and that of my friends around the country in a variety of specialties and practice setups. 

https://www.washingtonpost.com/health/20...ves-gowns/

https://www.nytimes.com/2020/07/08/healt...e-doc.html

The fact is we remain nearly as tenuously supplied as we did at the start of the pandemic. I am lucky in that I have enough N95 masks I can go a week before I have to reuse them. I have about 7 good masks and a few ones that are pretty worn, in brown paper bags under my desk. Some have been around since February, and all of the docs in our department have stapled straps back on to get a few more days of use out of broken masks. And I am at a relatively well supplied hospital. My friends in private practice are in even worse shape. 

The revelation that the US has no domestic producers of nitrile gloves may explain why we are starting to run out of our usual brand of gloves, and have some thin D-grade gloves now (extra stocks of which are kept locked away). Our surgical head coverings are also different and with thinner, less quality material. 

If the continued rise in cases and hospitalizations continues, the situation will only get worse as well.

[dabigv13]

The NYT and WaPo both had good articles on the national continued PPE shortages, that are reflective of my experience and that of my friends around the country in a variety of specialties and practice setups. 

https://www.washingtonpost.com/health/20...ves-gowns/

https://www.nytimes.com/2020/07/08/healt...e-doc.html

The fact is we remain nearly as tenuously supplied as we did at the start of the pandemic. I am lucky in that I have enough N95 masks I can go a week before I have to reuse them. I have about 7 good masks and a few ones that are pretty worn, in brown paper bags under my desk. Some have been around since February, and all of the docs in our department have stapled straps back on to get a few more days of use out of broken masks. And I am at a relatively well supplied hospital. My friends in private practice are in even worse shape. 

The revelation that the US has no domestic producers of nitrile gloves may explain why we are starting to run out of our usual brand of gloves, and have some thin D-grade gloves now (extra stocks of which are kept locked away). Our surgical head coverings are also different and with thinner, less quality material. 

If the continued rise in cases and hospitalizations continues, the situation will only get worse as well.

[M T]

I'm not in the business of acquiring or providing PPE so I don't know first hand, but of the places I've been watching, I don't see PPE availability as worrisome yet at hospitals.  (The situation at care facilities, medical clinics, doctor's offices is likely different.  I know of a small Texas care facility that has been unable to get such supplies for more than a month.)

Houston TMC:  5 months supply of N95 (1.4M), 4.5 months of surgical masks (18.5M), 8 months of gowns (12.7M), 1 month of gloves (25.7M)
Los Angeles Co.: Most supplies: 84% of hospitals have 15 day supplies.  Gloves: 75% have 15 day supplies;  Gowns: 65% have 15 day supplies
Santa Clara Co.: 9 (of 12) hospitals have 30 days supplies; 2 hospitals do not have 30 day supply and/or cannot move forward with procurement; 1 hospital not reporting.   In the last 14 days, 3 hospitals, 26 care facilities, and 12 other health care facilities have requested PPE from the county EOC in the last 14 days.  (as of July  7)
San Diego Co.: 6, up to 8 (depending on item), of 9 hospitals have 21 day supplies;  87% of hospitals have 15 day supplies.

(You can see PPE deliveries for California at https://covid19.ca.gov/data-and-tools/ )

Personally, I have bought non-NIOSH KN95 masks for my family's use.  As they are not NIOSH approved, doctors generally won't use them so I'm not impacting their supply.  I find they fit (cling to my face) MUCH better than any of the several cloth masks I have (which I now use on top of the KN95 to protect it from dirt, etc).    I don't go out much so it hasn't been a concern to reuse them after a week.  I haven't had to throw one out yet.

In a study on filtering aerosols by masks, an artificially introduced 1% gap in a N95 mask dramatically drops the efficacy of the mask. The same gap on a surgical masks reduces their filtering efficiency on aerosols down to 10-15%. 

The study also measures filtering efficacy of cloth in cloth masks, but treats them all as perfect fit (all air going through the cloth) but at pressures for an unfitted mask; their numbers are not (IMO) realistic for a mask actually in use.  "Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of “fit” and leakage, while allowing the exhaled air to vent efficiently."   My experience is that cloth masks are often poor fits (nose, chin, cheeks), esp. during exhalation.

Rather oddly, San Mateo County excludes a N95 mask with an outlet valve as being an appropriate face covering, but does allow a bandana which has a much larger unfettered outlet (I expect less than 1% goes through the fabric.)

[M T]

I'm not in the business of acquiring or providing PPE so I don't know first hand, but of the places I've been watching, I don't see PPE availability as worrisome yet at hospitals.  (The situation at care facilities, medical clinics, doctor's offices is likely different.  I know of a small Texas care facility that has been unable to get such supplies for more than a month.)

Houston TMC:  5 months supply of N95 (1.4M), 4.5 months of surgical masks (18.5M), 8 months of gowns (12.7M), 1 month of gloves (25.7M)
Los Angeles Co.: Most supplies: 84% of hospitals have 15 day supplies.  Gloves: 75% have 15 day supplies;  Gowns: 65% have 15 day supplies
Santa Clara Co.: 9 (of 12) hospitals have 30 days supplies; 2 hospitals do not have 30 day supply and/or cannot move forward with procurement; 1 hospital not reporting.   In the last 14 days, 3 hospitals, 26 care facilities, and 12 other health care facilities have requested PPE from the county EOC in the last 14 days.  (as of July  7)
San Diego Co.: 6, up to 8 (depending on item), of 9 hospitals have 21 day supplies;  87% of hospitals have 15 day supplies.

(You can see PPE deliveries for California at https://covid19.ca.gov/data-and-tools/ )

Personally, I have bought non-NIOSH KN95 masks for my family's use.  As they are not NIOSH approved, doctors generally won't use them so I'm not impacting their supply.  I find they fit (cling to my face) MUCH better than any of the several cloth masks I have (which I now use on top of the KN95 to protect it from dirt, etc).    I don't go out much so it hasn't been a concern to reuse them after a week.  I haven't had to throw one out yet.

In a study on filtering aerosols by masks, an artificially introduced 1% gap in a N95 mask dramatically drops the efficacy of the mask. The same gap on a surgical masks reduces their filtering efficiency on aerosols down to 10-15%. 

The study also measures filtering efficacy of cloth in cloth masks, but treats them all as perfect fit (all air going through the cloth) but at pressures for an unfitted mask; their numbers are not (IMO) realistic for a mask actually in use.  "Our studies also imply that gaps (as caused by an improper fit of the mask) can result in over a 60% decrease in the filtration efficiency, implying the need for future cloth mask design studies to take into account issues of “fit” and leakage, while allowing the exhaled air to vent efficiently."   My experience is that cloth masks are often poor fits (nose, chin, cheeks), esp. during exhalation.

Rather oddly, San Mateo County excludes a N95 mask with an outlet valve as being an appropriate face covering, but does allow a bandana which has a much larger unfettered outlet (I expect less than 1% goes through the fabric.)

[warrenloui]

My daughter has been interning this summer at an engineering company that has partially pivoted and has been manufacturing face shields.  They've sent me a number of articles contrasting the effectiveness of shields vs. masks, but i was wondering if anyone can point me to some good studies comparing their effectiveness.   We've used them on our walks and they are much more comfortable (and you can see each other's expressions when you talk), but as someone over 60 with a preexisting respiratory condition (NSIP), i'm a little nervous.

Thanks.

[warrenloui]

My daughter has been interning this summer at an engineering company that has partially pivoted and has been manufacturing face shields.  They've sent me a number of articles contrasting the effectiveness of shields vs. masks, but i was wondering if anyone can point me to some good studies comparing their effectiveness.   We've used them on our walks and they are much more comfortable (and you can see each other's expressions when you talk), but as someone over 60 with a preexisting respiratory condition (NSIP), i'm a little nervous.

Thanks.

[fullmetal]

I don't think you can really compare face shields to masks as they tend to be used for different purposes.  Face shields are generally used to block larger drops or droplets (that fly through the air).  Masks are generally used to block small or aerosolized droplets (that float or hang around in the air).

As for M T's statistics, whether you believe hospital administrators' figures vs. reports of what doctors, nurses, and technicians are able to access will depend on your point of view.  Different hospitals have different definitions of "one day's supply" of PPE, and even then, your N95 mask reserve might be aggregated with your gown reserve, thus confounding the numbers to the advantage of public relations.

If your local hospital needs to staff up to accommodate a surge in ICU bed capacity, your PPE numbers aren't going to look good if they're updated...if at all.

As a non-medical professional, it is not my place to second-guess or decry the voiced concerns of medical professionals that their access to PPE is not looking good.  Hospital administrators, politicians, and hospital shareholders all have their reasons for appearing prepared and not negligent or liable.

[fullmetal]

I don't think you can really compare face shields to masks as they tend to be used for different purposes.  Face shields are generally used to block larger drops or droplets (that fly through the air).  Masks are generally used to block small or aerosolized droplets (that float or hang around in the air).

As for M T's statistics, whether you believe hospital administrators' figures vs. reports of what doctors, nurses, and technicians are able to access will depend on your point of view.  Different hospitals have different definitions of "one day's supply" of PPE, and even then, your N95 mask reserve might be aggregated with your gown reserve, thus confounding the numbers to the advantage of public relations.

If your local hospital needs to staff up to accommodate a surge in ICU bed capacity, your PPE numbers aren't going to look good if they're updated...if at all.

As a non-medical professional, it is not my place to second-guess or decry the voiced concerns of medical professionals that their access to PPE is not looking good.  Hospital administrators, politicians, and hospital shareholders all have their reasons for appearing prepared and not negligent or liable.