10 physicians' creative workarounds for PPE shortages

Using snorkel masks in lieu of respirators, drones to drop off testing kits and mobilizing the community to sew reusable masks are some of the ideas physicians have proposed to address the personal protective equipment shortage during the COVID-19 pandemic.

The editors of the Journal of the American Medical Association issued a call for ideas for conserving personal protective equipment, maximizing its use and identifying new sources for supplies.

The JAMA editors requested creative suggestions and potential actions from those in the healthcare industry, especially physicians, other healthcare professionals and hospital administrators.

Here are 10 of the responses they received from physicians:

1. Paul Bergl, MD, of Medical College of Wisconsin (Milwaukee): "We are now collecting homemade bandanas (from old T-shirts, which we all have sitting in our closets and dressers), and we are asking community members to begin sewing reusable, washable masks. There is a literally an army of citizens waiting to help. If the CDC is endorsing this approach, let's mobilize all of the extra cotton in our dressers and all of the help in our communities."

2. John Healey, MD, of Memorial Sloan Kettering Cancer Center (New York City): "Personalized medicine for providers should be a priority, even while providing care in a pandemic. Well-fitting snorkel masks are a brilliant suggestion. They raise and narrow the air intake funnel by 1 foot, reduce droplet presentation, diminish aerosol exposure and prevent facial touching and viral transport. Better provider and patient protection will come from this simple form of personalized medicine."

3. Monali Vasekar, MD, of Penn State Health (Hershey, Pa.): "An easy, implementable and readily available resource could be to use smart technology such as drones and robots to administer tests to patients suspected of having COVID-19. For example, a video-enabled drone could deliver testing kits while the patient waits in their vehicle. They perform self-testing and load the kit onto the drone while a healthcare worker watches them via video to ensure adequate testing."

4. John Pearson, MD of University of Utah School of Medicine (Salt Lake City): "There is a great deal of focus on [powered air-purifying respirator] and concern about the limited supply of the air-purifying unit. The solution then is to use widely available air supply lines found in many [intensive care units] and operating rooms. This supply is typically at 55 l/min, and with a pressure regulator and splitter, can be piped to several care team members. This is already in use in industry and available from 3M and others, though it can be custom-made, too. This would allow for mobile PAPR units to be used in cases of need and stationary care to be provided by supply air systems. We are actively investigating this at the University of Utah."

5. Farokh Demehri, MD, of Boston Children's Hospital: "During this critical shortage of N95 respirators, we have been working on a method to create your own reusable respirator using only a face mask, an in-line ventilator filter, and two elastic straps. All for less than $3! Find instructions, details, and video at childrenshospital.org/surginnovation"

6. Nicholas Hackett, MD, of Northwestern University Feinberg School of Medicine (Chicago): "I think one solution is using materials that can be resterilized. Cloth masks and cloth aprons that can be put through an autoclave, for example. To be even more thrifty, we could use materials that are often discarded in operating rooms. For example, sterile blue towels that are often thrown away could be used to cover faces (attached via tying with string [for example]). These could of course be re-sterilized in an autoclave. Gloves could also be reused if washed while the person is wearing them, [for example] with alcohol hand sanitizer while still wearing the gloves."

7. Brian Lichtenstein, MD, of Sharp Memorial Hospital (San Diego): "Racquetball and other sporting glasses provide significant eye protection and are inexpensive. Cleaning may be easily performed with soap and water. Clearly, masks (both disposable surgical and N95) are a precious commodity, both for source control and prevention, which has complicated decision-making about use and reuse. Personally, I think 100 percent of our workforce should be wearing a mask continually while on the job."

8. Sharon Rikin, MD, of Montefiore Medical Center/Albert Einstein School of Medicine (New York City): "E-consults allow the primary team caring for a patient to request and receive recommendations from specialists without requiring the specialists see the patient in-person. This communication is documented in the medical record similar to a formal consult. While traditionally this has been used in outpatient settings, this model of care can easily be brought inpatient. Substituting e-consults for in-person consults reduces the number of PPE used by specialists. It also has the potential added benefit of reducing spread of COVID-19 by reducing unnecessary contact."

9. Daniel Ginsberg, MD, of MultiCare Health System (Tacoma, Wash.): "Studies show that the coronavirus can last up to about three days on surfaces. An individual could be issued four masks and four storage boxes (or hooks on a wall if space allows). At the end of the day the mask would be put back in place, and the next day they would use the next mask (or one could use eight masks and eight storage locations to change midshift) without fear of the mask being contaminated as it will have been four days since last used. Depending on the mask used, a decision would need to be made on how many times it could be used."

10. Ian Joffe, MD, of Penn Presbyterian Medical Center (Philadelphia): A central command should be established for responding to the need for medical supplies, including ventilators, respirators, masks, gowns, gloves, etc. The COVID-19 outbreak has regional and local variations at any given time. Some hospitals, even close to a regional outbreak, may not be seeing the volume of patients that another hospital is. The Johns Hopkins website tracks cases daily. The central command would partially be a repository for supplies, but would also move supplies between hospitals where needed most."

Editor's note: This article's headline was updated on March 25 at 9:31 a.m.

More articles on integration and physician issues:
Nearly half of surveyed primary care practices say they don't have capacity for COVID-19 testing
Physicians take drastic measures to protect families from coronavirus
Primary care recruitment: How 3 organizations are moving the needle

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