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Open Letter on the COVID-19 PPE (Personal Protective Equipment) Petition

To President Trump and Vice President Pence,

On February 24th, health authorities from China and a team from the World Health Organization reported that 3,387 health workers (1) in China had been infected with the novel coronavirus. In Italy 2,629 health workers (2) have been infected, which reflects 8% of total cases in Italy; hospital doctor union head Carlo Palermo told Italian news (3) source ANSA on March 16 that it was a “frightful number, and this situation puts health facilities in further difficulties.”

In the U.S., where the disease is early but closely following the Italian growth curve (4), our healthcare workers, including physicians, nurses, emergency responders, food service workers and other frontline staff, are frightened – not only because of the impending stress on the healthcare system, but also because of the plummeting supply of personal protective equipment, or “PPE.”

PPE includes respirators, gowns, and gloves that protect workers from viral particles on surfaces and during other situations of close patient contact. When treating patients suspected of having coronavirus, the Centers for Disease Control and Prevention currently recommends contact and droplet precautions, which requires only a procedural mask, gloves, and eye protection. But emerging research (5) demonstrates “that viable virus could be detected in aerosols up to 3 hours post aerosolization” – and prevention of aerosolized (i.e., airborne) spread requires a specific kind of respirator mask (N95) capable of filtering out virus-containing droplets. Healthcare workers simply cannot work safely without these protections.

Right now, across the nation, even the best-prepared hospitals are low on these types of necessary protective equipment. Many clinics have run out of not just respirators but also simple procedural masks. In some hospitals providers are being asked to use a single mask for an entire 8 to 12 hour shift, even though these masks were designed for one time use with a single patient.

Due to the lack of widespread testing, nurses and doctors are sharing warnings: “Did you hear about the motor vehicle crash patient who ended up being put in the ICU with COVID-19? Four of our staff are in quarantine!” Or “The woman who came in with back pain who turned out to have a fever, and her COVID test later came back positive!” Many of us suspect we have already been exposed due to lack of widespread testing and sufficient protective equipment, and we are just waiting to develop symptoms.

Already, in the United States two emergency physicians are in intensive care, and a pathologist has died from the virus. We are all doing our best to protect ourselves and our families. Yet, we must brace ourselves knowing we will likely lose more colleagues in the coming days and weeks, and we are reviewing our own plans should we get sick: who will care for our children and who will provide for our families should we become infected or worse, die.

It doesn’t have to be this way. We still have time to protect our healthcare workforce, and to do so we must act now.

We, the undersigned, are writing to urge the federal government to do the following


Boost supply of PPE

The President has suggested that he may exercise the authority within the Defense Protection Act (6) to mobilize the resources, labor, priorities, and raw materials needed to direct production and distribution of these supplies. Additionally, future legislation from Congress should leverage financial resources to bolster the supply chain from American manufacturers to protect frontline workers (7).

Develop universal guidance on best practices for disinfecting and reusing PPE, particularly N95s and other respirators, face shields, and goggles during this pandemic.

Some research supports sterilizing N95s with bleach (8) without compromising their integrity. Use of ozone has also been approved by the FDA for some reusable medical devices. Importantly, these tactics need further research to ensure safety.

Boost supply of ventilators.

The federal government must follow the lead of South Korea, Germany, Italy, the UK, and China (9) and place massive orders immediately. Hospitals are already strained by space and personnel costs and will not be able to afford this massive surge of extra equipment, but the federal government can.

Develop a cohesive national strategy for sharing best practices, identifying which facilities need PPE and ventilators, and distributing the life-protecting equipment.

This is not a war that can be fought hospital-by-hospital or clinic-by-clinic. We need a national “war room” to coordinate – and to help already-overwhelmed healthcare providers to stay safe.

Develop and disseminate clear guidelines for healthcare providers and hospitals to limit risk of staff infection.

This guidance could include creating dedicated “COVID care areas” (as has been done in China and Italy) where providers can work while staying in their PPE, to both minimize waste and also contamination risks when removing PPE.

Urgently advise that elective surgeries and other non-urgent medical visits be canceled.

This step is needed not just to keep patients safe and minimize spread of disease, but also so that PPE normally used during such visits can be repurposed to emergency departments and hospitals. This would also free up staff, hospital beds, and medical equipment (such as operating room ventilators).

We know that a robust and organized response saves lives in this ongoing COVID-19 pandemic. Countries like South Korea have prepared and mobilized their federal and local responses in ways that maximize testing (10) to the general public while minimizing risk to our frontline healthcare providers (11). Using strict precautions including airborne, contact, and eye protection, China was able to protect 41,600 health workers (12) sent to Hubei such that none developed coronavirus. With our nation’s resources and healthcare expertise, these are strategies that we can build upon and deploy rapidly.

Without adequate protective equipment, the crucial shortage will become healthcare workers, and many people will die unnecessarily because we have no way to care for them. The only institution with the power to require adequate production of protective equipment, to distribute the equipment effectively, and to create universal guidelines on its use, is the federal government. The federal government needs to step up, right now.


Val Griffeth, MD PhD, Esther Choo, MD MPH, Seth Trueger, MD MPH, Megan L. Ranney MD MPH, Jeremy Samuel Faust MD, MS, Kyle Fischer, MD MPH, Howard P. Forman MD, MBA, Marian E. Betz, MD MPH, Adam Beckman, MS3, Suhas Gondi, MS3


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