Victoria’s supplies of N95 masks for health workers have fallen to “alarmingly low” levels during the coronavirus pandemic, causing protective gear to be rationed and driving concerns supply, not safety, has dictated access to equipment.
Almost 3500 health workers have contracted coronavirus in Victoria, while a recent shortage of smaller N95 masks has prompted the state government to encourage local manufacturers to modify their machinery to make more.
Concerns have been raised over supplies of protection masks for healthcare workers.Credit:AP
N95 masks had to be rationed early in the second wave of the virus, a member of the personal protective equipment taskforce that oversees Victoria’s supply of protective gear said, with supplies at times dropping alarmingly and eating into reserves.
Throughout the pandemic, many health workers have said they haven’t always been able to access adequate personal protective equipment, including high-level, properly fitted N95 masks.
“The perception is that leaders don’t care about our safety and our lives don’t matter,” said Monash University infectious diseases lecturer Michelle Ananda-Rajah, who has co-authored a study compiling stories of more than 400 doctors, nurses, paramedics and aged care workers across Australia.
The stories, contributed by healthcare workers, who last month signed a petition calling on federal Health Minister Greg Hunt to upgrade national mask guidelines, detail a slow managerial response to escalating concerns about inadequate PPE as COVID-19 spread.
"We have had N95 masks taken out of our hands before going into positive COVID patients," one Victorian hospital physician said.
A Victorian nurse said hospitals had "remained reactive not proactive as numbers began to grow", and that staff concerns were dismissed by managers.
"After arranging our own PPE, we were told we were causing hysteria," the nurse said. "Sadly, these people got it wrong and now over 1000 healthcare workers are infected with COVID.”
It comes as a recent memo from another government taskforce revealed that there was a “constrained supply” of small N95 respirators, due to increased local and global demand.
Some small masks had been sourced from the national medical stockpile, and the Health Department had also increased orders from existing and new suppliers, according to the update from the healthcare worker infection prevention taskforce.
“The department is also supporting local manufacturers to modify machinery for production of small-sized respirators,” the September 10 memo said.
Victorian health authorities were initially reluctant to provide the higher level masks to workers unless COVID-19 patients were undergoing aerosol-generating procedures such as intubation. Hundreds of healthcare staff had been infected before agreeing to do so.
N95 masks are now required for all workers coming into prolonged contact with confirmed and suspected coronavirus patients, though not for those at coronavirus testing centres.
Previously, some nurses had reported using surgical masks while working with suspected coronavirus patients, and subsequently becoming infected.
Australian Medical Association Victoria spokeswoman Dr Sarah Whitelaw said while healthcare workers did not expect “magic” supplies of protective equipment, they wanted transparency about what was driving guidelines on their use.
“When staff are given a one-page flyer that says now you don’t need this type of PPE in this situation, with no explanation as to why that is, it causes a lot of stress and anxiety,” she said.
Dr Whitelaw said people had questioned if it was because of equipment shortages, though she had been reassured to hear from the Health Department recently that this wasn’t the case.
A medical professional who sits on Victoria’s protective equipment taskforce, and asked not to be named, became very worried about supply of N95 masks when, just before the second wave of the virus, Victoria’s Chief Medical Officer Professor Andrew Wilson started discussing the possibility of reusing masks by sterilising them, but that never went ahead.
“That tells you supplies were very short,” they said.
However, the medico said N95 masks had not been exhausted, and they did not believe rationing supplies to healthcare workers performing specific high-risk roles had contributed to the high numbers of worker infections in Victoria, where 3496 healthcare workers have so far contracted COVID-19.
Instead, many healthcare workers appeared to have been infected while putting on and taking off their protective equipment.
“In reality we found a lot of infections were happening in the staff room and changing room, not face-to-face with patients,” they said.
“Have we done enough to educate them? Probably we can do better.”
On Sunday, Premier Daniel Andrews said he did not think supply had dictated how those N95 masks were rolled out, though he said it was not an area overseen by him.
"We have massive stockpiles in … gowns, gloves, shield, masks," he said.
A Health Department spokesman said it had never based protective equipment guidance on limited supply. “All decisions about PPE use in our health services has been guided by expert advice and evidence, with the best possible protection for staff the primary consideration, and supply has always met that guidance,” he said.
“Victoria’s advice on N95 respirators was expanded in August to go above the National Guidelines due to observed risks in some of our health services where patients with COVID-19 were being cohorted in wards."
Doctors and other healthcare workers continue to agitate for mandatory testing of N95 masks to ensure they properly fit those that use them, a program rolled out to those working in COVID-19 wards on Friday, following an extended campaign.
Professor Ananda-Rajah said fit testing needed to be expanded further, and is calling on the federal government to approve reusable silicon masks that filter more particles and could replace disposable ones.
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