Mass General disaster medicine specialist shares COVID-19 preparations and concerns

April – May, 2020

March 24, 2020

As hospitals and health systems around the country race to keep up with — or prepare for — an expected surge of novel coronavirus patients, Dr. Paul Biddinger, director of the MGH Center for Disaster Medicine at Massachusetts General Hospital, told a global audience tuning in to a livestream interview on Facebook and Zoom today that freeing up hospital capacity has been one of the biggest challenges for the academic medical center.

Elana Gordon, a reporter and producer for Public Radio International's The World, fielded questions from listeners who asked about staff safety, ways to address shortages of protective gear and steps to protect patients from contracting the virus from asymptomatic heath care providers, among other topics.

Biddinger, who is also chief of the Harvard medical school's teaching hospital's division of emergency preparedness, has himself treated patients with COVID-19. He said that Mass General generally runs at more than 90% occupancy. Mass General and hospitals across Massachusetts and much of the country purposefully have pared down to essential services to free bed capacity for patients with COVID-19. Despite that effort, Mass General is still two-thirds full, he said.

"We are absolutely anticipating a large wave of patients," he said, adding that the Boston area is about a week or two behind New York City, which on the day of the web broadcast had more than 13,000 people who had tested positive for coronavirus. New York Gov. Andrew Cuomo said the rate of new infection in his state was doubling every three days. Biddinger said infections in the Boston area could peak in four to five weeks. "We are behind a couple of places in the country, but ahead of others," he said.

Mass General began experiencing shortages of protective gear for its staff a few weeks ago, when there were very few confirmed cases of COVID-19 in the Boston area, Biddinger said. The preferred N-95 respirator masks that reduce the risk that health care providers will be infected by patients with COVID-19 and other pathogens had been in short supply since January. The hospital now is low on gowns and other masks as well, he said.

To stretch supplies, Mass General issues one mask per staff person per day and allows clinicians to reuse gowns provided they are not soiled or dirty and that infection protocols are followed for taking the gowns off and on. He said supply chain managers are contacting every possible domestic and international source of protective gear in search of supplies.

Biddinger said the University of Nebraska just shared a protocol to use UV sterilization for N-95 respirators. "We are testing that ourselves. This is an unprecedented time for sharing scientific data. We need to know if we do that, that not just the mask or the respirator but actually the rubber band or the way it attaches to the user also maintains its integrity" so the strap does not snap and expose the wearer to infection.

He said he appreciates the outpouring of support for health care workers that is made evident by people sewing homemade masks for clinicians. However, using those masks is a last resort and one he hopes the hospital need not employ to protect its staff. In studies homemade face masks have not performed on par with professionally manufactured masks.

"Making our own personal protective equipment at home seems like something in this day and age we wish we didn't have to think about," he said.

He mentioned 3-D printer recipes can be used to manufacture clear plastic face shields for frontline caregivers. "Those may be the easiest for us to produce," he said. There are additional design hurdles to printing N-95 masks, which look deceptively simple but have to filter out particulates down to 0.3 microns. Teams of scientists are working on and validating the quality and safety of those potential printed products.

The Trump Administration had announced earlier in the day that it intended to invoke the Defense Production Act to propel the production of coronavirus test kits. Health care providers also have urged the government to compel companies to accelerate the production of ventilators since the expectation is that the number of patients requiring that equipment will far exceed availability. Biddinger said manufacturers need to ramp up production of all essential equipment right now. "Any solution that takes three, four, five or six months unfortunately won't help us a ton."

Gordon asked Biddinger why hospitals were not better prepared for the epidemic given their ongoing emergency preparedness efforts. Biddinger said the "geometric rise" in coronavirus cases is hard for many people to understand. One person can infect two to three people, who in turn each infect two to three people. With sustained transmission, and cases doubling every two to three days, "it gets overwhelming quickly."

The forum was sponsored by the Harvard T.H. Chan School of Public Health and The World.

Copyright © 2020 by the Catholic Health Association of the United States

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