As the nation’s supplies of N95 respirator masks, gloves, gowns and other personal protective equipment run critically low, health care providers, suppliers and business leaders in Colorado are scrambling to get those vital resources to the state’s frontline medical personnel.
“Health care organizations across the country are reporting dangerously low stockpiles of PPE,” said Bruce Johnson, CEO of Louisville-based Global Healthcare Exchange LLC, which provides a cloud-based supply chain platform for the health care industry. “Colorado is no exception.”
The crisis caused by the shortage of PPE deepened last week. Wednesday, as the number of COVID-19 cases in the U.S. climbed above 200,000, President Trump said the national PPE stockpile was nearly depleted. Colorado Gov. Jared Polis revealed the state has received no ventilators from the federal government.
Thursday, President Trump invoked the Defense Production Act to force six companies to produce more ventilators. In a separate order Thursday, the president authorized Federal Emergency Management Agency Administrator Pete Gaynor to “use any and all authority available under the Act” to get N95 masks from The 3M Co.
This came as the Wall Street Journal reported Thursday that monthly domestic production of N95 masks — about 50 million — is just one-sixth of demand.
This means health care providers, suppliers and business leaders in Colorado have had to turn to alternative sources to find the most important medical equipment.
“The challenge is setting up a supply chain basically from scratch,” said Noel Ginsburg, CEO of Denver-based Intertech Plastics Inc. and member of the Innovation Response Task Force, which was set up last month by Polis to address supply shortages, track the spread of the virus and develop a statewide mass testing system.
To bring in much-needed supplies, Ginsburg said, the task force is pursuing dual strategies of partnering with local manufacturers and sourcing from the national and international markets. Those efforts include companies ramping up production of face shields and working on better COVID-19 tests, the latter of which include Ginsburg’s Intertech Plastics.
Denver Mattress Co. also has stepped in, using its compatible materials to make face masks. The company hopes to produce 3,000 to 5,000 masks per day for sick patients.
“In showing the medical community (our prototypes), they’re very excited to get these to put on patients coming in until they can get diagnosed,” Bob Rensink, the company’s general manager for manufacturing, told The Denver Post.
The masks do not have the same safety level as the standard N95 masks, which prevent nearly all pathogens from getting through, Rensink told the Post. While the outer material of the mattress masks — non-woven polypropylene — is roughly the same as an N95 mask, they do not have the same inner barrier material. “It’s offering some protection, but it’s obviously a non-rated face mask,” Rensink told the Post.
Such efforts help but aren’t broad enough to offer a sweeping solution, Ginsburg said. “Our maker community has been extraordinary with their willingness to do anything. That can be helpful, but if we need significant quantities, it won’t solve the problem.”
That’s especially true for devices such as N95 masks, which Colorado manufacturing can’t make at a rate that keeps up with demand. For those, Ginsburg and his task force have had to turn to the open marketplace. Doing that during a crisis such as the novel coronavirus pandemic, he added, can be dangerous as frauds, opportunists and profiteers abound.
“The risks are getting inferior products or getting scammed,” Ginsburg said.
And even when an order of N95 masks is completed, getting them here can be another issue. COVID-19 has almost completely shut down commercial air travel, which is depriving global supply chains of a vital mode of freight transportation — in the cargo holds of passenger jets.
Even given these constraints, the task force has had some early successes. Last week, it secured a shipment from China of 2 million masks — 1 million N95 masks and 1 million surgical masks — for Colorado health care providers. Another incoming shipment from Taiwan includes 100,000 masks earmarked for Colorado.
Health care providers also are taking matters into their own hands. At Banner Health, employees are making masks to be distributed to hospitals, said Sara Quale, regional marketing and public relations director.
The masks are made from a secure, sterile, 99% microbial-resistant cloth that is usually used to wrap sterile surgical equipment. The goal is for these masks to be used for general, non-COVID-19-related, tasks at Banner hospitals to free up N95 masks for people dealing with the pandemic.
Banner employees produce about 7,000 masks per day, with a goal to produce 50,000. Banner also is going the more traditional route to acquire supplies, Quale said, such as working with its existing suppliers and finding other sources.
“Our health care workers are our most valuable resource, and their safety is of the utmost importance,” Quale said. “The intent is to keep health care workers safe.”
Other area hospitals have varying policies on homemade masks. Boulder Community Health will accept homemade masks as a precaution, but as of late March did not plan put them to use for the time being. Centura Health is not yet accepting homemade masks, but has set up donation bins for PPE at its hospitals, including Avista Adventist in Louisville. UCHealth was not accepting homemade masks as of late March.
As hospitals try to get their hands on vital supplies, companies such as Global Healthcare Exchange, the world’s biggest electronic health care trading exchange with an international network of nearly 6,000 health care providers and nearly 1,000 suppliers, can help them find alternative sources for the most critical equipment.
And Bison Designs, a Longmont company that designs and supplies outdoor products such as belts, carabiners and climbing gear, has switched gears and is using its connections overseas to find personal protection equipment for health care providers who are having trouble finding sources of supply.
GHX made its clinical supplies database free to all hospitals, said Johnson, its CEO. It also created a COVID-19 information center that includes a reference list for alternative sources for important supplies.
The list is sorted by category. For example, a health care provider can click on the link for N95 masks to see hundreds of replacement vendors. The reference list also includes industry acceptable substitute equipment, as well as unvetted items that serve a “comparable purpose.”
“PPE will remain a constant priority during the pandemic as we cannot compromise the safety and well-being of caregivers,” Johnson said.
Ensuring supplies from new vendors actually work and the seller is legitimate is a whole other challenge. Johnson said the vendor credentialing team at GHX is working at twice its normal rate to get supplies to health care providers as soon as possible. While the team at GHX can vet a vendor, employees don’t actually test the products.
There is the lack of a central body to vet and vouch for alternative suppliers,” Johnson said. “While the FDA is loosening its regulatory restrictions, it’s up to the individual health care organization to conduct its own research into the legitimacy of the supplier as well as the safety and efficacy of the alternative supplies. Supply chain teams are already strapped and the clinicians they must partner with to vet these supplies are extremely overextended, making this research extremely burdensome.”
To expedite testing of supplies — normally done at the federal level — the state is turning to a lab at Colorado State University. The lab, part of the school’s Powerhouse Energy Campus, already did regular testing on N95 masks and other PPE devices used by the infectious disease researchers in the university’s Biosafety Level 3 lab, said Alan Rudolph, vice president for research at CSU. The lab is able to scale its testing to reach the volume the state needs, Rudolph added.
That shipment of 2 million masks from China that Ginsburg and his task force secured will be tested by CSU, for example. The team at CSU will conduct tests for fit and physical performance, Rudolph said. That involves ensuring the masks make a perfect seal with the user’s face, as well as measuring particle flow and pressure to ensure no coronavirus gets through the filter.
“All of the tests are made to ensure that the person wearing the mask is not exposed to the virus,” Rudolph said.
Once the lab has scaled up its testing capacity, it should be able to get through that 2 million mask shipment from China in about 12 hours, Rudolph said. This particular shipment can be expedited because the masks in it are made from a known FDA-approved material, Rudolph added. Future shipments of masks, if not made from FDA-approved material, will require more testing.
Rudolph said the lab also may start testing other forms of PPE, such as face shields, gloves and gowns. It will be the primary site of N95 mask testing in Colorado, Rudolph said. Of course, the lab’s ability to test PPE relies on the ability of the supply chain to deliver it.
“I hope that these large suppliers can keep us fulfilled,” Rudolph said.
That depends on a large, constantly developing network of suppliers, local businesses, and health care providers within and outside of Colorado, all of whom are dealing with unprecedented levels of PPE supply and demand, and all of whom are competing against entities in other states and countries that are seeking the same equipment under the same constraints — with no end in sight to the need or the shortages.
“You turn over every rock you can find, find people you can trust, and you work hard until you get success,” Ginsburg said. “That’s the formula we’ve been operating under.”