California has purchased about two million respirator masks to use in its sprawling prison system but just 56,000 for frontline medical workers since late February, state records show, even as Governor Gavin Newsom downgraded requirements for their use in hospitals. The state believes dwindling supplies must be rationed to prepare for a coming surge in patients with the novel coronavirus.
States are battling each other and the federal government for vanishing stock because Trump has refused to take control of the supply chain, with one hospital reporting delays of three to six months in replenishing N95s.
Many of the protective N95 masks the California Department of Corrections and Rehabilitation bought between February 28 and April 3 were part of orders for construction, painting, and welding supplies. It remains unclear whether the agency, which manages California’s thirty-five prisons and four juvenile institutions, intends to use those masks for infection control inside its facilities or for upcoming building projects, many of which would expand inmate capacity.
The Department of Corrections did not answer my questions regarding why the agency bought two million respirators during this time period or what it intends to use them for.
Brian Ferguson, a spokesperson for the Governor’s Office of Emergency Services, also could not specify their intended use, but said the two million figure “would not be out of the question” if the agency were stocking a multi-month supply of masks for its “tens of thousands of guards, inmates, medical personnel, and visitors.”
Under interim state guidelines published March 28, medical workers in coronavirus hospital wards are being told to reuse their disposable N95s with multiple patients. Staff performing “lower hazard” procedures must forgo them for ordinary surgical masks—a practice workers have criticized as dangerous for both patients and themselves.
Initially, workers had been advised to wear N95s for a variety of patient procedures and not to reuse them, in order to limit exposure to COVID-19.
California says it’s struggling to find enough N95s and other personal protective equipment for hospitals on the open market because of persistent global shortages, and the interim guidelines are meant to stretch existing hospital stocks of the coveted masks.
But public purchasing data reviewed for this article suggests that the prison system has plenty of masks. For example, on April 3, the Department of Corrections spent more than $5 million to acquire one million respirator masks. Two days before that, the agency bought 200,000 respirators for around half a million dollars. Three additional large purchases, for a combined 400,000 masks worth $1.93 million, were made on March 18 and March 20.
John Pearson, an ER nurse at Highland Hospital in Oakland, California, criticized the state’s downgraded guidelines.
“Instead of getting them, we’re getting this horrible workaround” in hospitals because “it’s easier to do nothing,” he tells me. “We’re going into rooms with patients who have infectious diseases and spreading whatever is on that gown from patient to patient,” he continued. “This is not the answer—to lower standards this way to say we’re not breaking the rules.”
Like President Donald Trump, Newsom is relying on the private sector to ramp up production of key supplies. But whether companies can deliver it quickly enough on their own is doubtful.
States are battling each other and the federal government for vanishing stock because Trump has refused to take control of the supply chain, with one hospital reporting delays of three to six months in replenishing N95s.
Meanwhile, Ferguson says, California has only secured twenty million N95s on the open market, a fraction of the amount needed to fight the virus. And while Newsom just announced that California had negotiated the manufacturing of 150 million respirators a month, these won’t begin reaching health workers for at least a few weeks.
But Pearson says respirators and other scarce protective gear are available in California right now, sitting idle in warehouses. This is because Newsom hasn’t requisitioned these supplies yet, nor has he ordered firms to manufacture them, which would speed up production. So Pearson and his colleagues have sourced some protective gear themselves, including fifteen air-purifying respirator masks. The masks are used during tracheal surgery and are more protective than N95s.
“We ended up finding it and buying it ourselves,” Pearson says, “so it’s out there and it can be obtained.”
Mawata Kamara is an ER nurse at San Leandro Hospital—which, like Highland, is part of the Alameda Health System. She says emergency department nurses there have been told to reuse N95s when treating suspected or confirmed COVID-19 patients, and to store the masks in paper bags between each use to avoid spreading the virus.
“I feel helpless in a way,” Kamara says in an interview. “It will really get dangerous if nurses start getting really sick and we don’t have nurses. That’s what I’m afraid of.”
Nationwide, more than 16,000 people have died of the coronavirus and about a half-million have tested positive. In California, fatalities hit 492 and confirmed cases topped 18,309, according to the state’s tallies for April 8, the most recent date for which data is available.
Kamara noted another change COVID-19 had wrought in her ER: fewer patients. “They’re afraid of coming to the hospital,” she says.
Whether the many reports of mask shortages have contributed to that fear is hard to say. But across the United States, oncologists are seeing a drop in patient visits because of the pandemic, according to Kevin Knopf, an oncologist and chairman of hematology and oncology at Highland.
That, he says, could delay cancer diagnoses and worsen patient outcomes, particularly for poorer people of color, who are already diagnosed in the later stages of the disease because of barriers to accessing care.