States given expired protective gear, workers 'hoping for the best' during CV-19

Arizona and other states are receiving old or expired medical supplies from the federal stockpile that are more likely to fail, including the N95 masks that are essential to protect health care workers from COVID-19.

The Centers for Disease Control and Prevention’s advice: Use them anyway.

The shortage of vital medical supplies, such as masks and ventilators, in the face of COVID-19 has led public health officials to advise hospital workers to reuse personal protective equipment (PPE), and to make due with what is available, relying on home-made masks and bandanas.

But as increasing numbers of health care workers contract the coronavirus, doctors and nurses are saying they need better protection, taking to Twitter with the hashtag #GetMePPE.

Last Friday, the largest union of registered nurses in the country, National Nurses United, called for a coordinated effort to release and distribute PPE from state and federal stockpiles.

The CDC issued a statement last month noting that some U.S. stockpiles included N95 respirators that exceeded their manufacturer-designated shelf life and that government officials were deciding whether to release these products.

Now states are receiving shipments from federal stockpiles with expired products, but the CDC has said they are safe enough to use.

Dr. Stephen Parodi with the health giant Kaiser Permanente said this is the new reality, and healthcare workers are learning to adapt.

“We’ve already moved toward N95 reuse, extended use. We actually accessed some of the national strategic stockpile and some of those masks are expired, so we’re actually using those as well, using CDC and local public health guidance,” he said in an interview with Journal of the American Medical Association editor-in-chief Howard Bachner.

The Strategic National Stockpile (SNS) is a $7 billion stash of emergency medical equipment the federal government has used to respond to national emergencies such as the H1N1 flu and the Sept. 11, 2001 terrorist attacks. It was originally created as a response to the anthrax scares of 2001, stocking antibiotics and antivirals, and eventually expanded to include PPE and ventilators.

States requesting shipments from the SNS have been warned that some materials may have reached their intended expiration date, according to Caroline Oppleman, a spokesperson for the Arizona Department of Health Services.

Oppleman said the equipment is still safe to use. She said SNS officials consulted with the National Institute for Occupational Safety and Health (NIOSH) and the CDC to determine whether these products should be utilized during a global pandemic where supplies are scarce.

“NIOSH performed supplemental testing on the N95 respirators and surgical gowns in the SNS, and the supplies were found to continue to perform in accordance with NIOSH performance standards,” she wrote in an email.

“In addition, the supplies were found to provide the expected level of protection to the wearer when used in conjunction with an Occupational Safety and Health Administration (OSHA)-compliant respiratory protection program, including training and fit testing.”

In Florida, state health department officials have requested 2 million N95 masks from the federal stockpile, knowing some may be old.

“The CDC has advised that [expired supplies] can be used during this time of increased demand and decreased supply,” a spokesperson for Florida’s State Emergency Operations Center wrote in an email.

But Nate Wardle, a spokesperson for Pennsylvania’s Department of Health, said that some of the expired masks tested by the CDC and NIOSH came back with higher than normal fail rates of 5 to 10 percent.

“Those with fail rates included masks that many national and state health departments had in storage from the H1N1 outbreak in 2009-2010,” he wrote in an email. “These masks either do not fit to the face properly, or the elastic band may disintegrate during testing before application.”

Yvonne Slosarski, the communications coordinator for 1199SEIU United Healthcare Workers East (Maryland/DC Division), said front-line workers may not even know if they are using expired equipment.

“The masks themselves don’t have expiration dates on them, so only the managers who have access to the often locked-away boxes might know the expiration date,” she wrote in an email.

Gerrit Bakker, senior director of public health preparedness at the Association of State and Territorial Health Officials, said part of the problem is the SNS has not been substantially replenished since the 2009 outbreak of N1H1.

“The funding has somewhat consistently gone down and they haven’t been able to keep up with the demand,” he said.

Bakker said the extent that an expiration date matters for PPE depends on the particulars of the equipment.

“For masks in particular, being passed their expirations dates means different things for different masks. It could be the coating that’s on it, which might be a bigger deal,” he said. “In other cases, it’s the elastic strap that maybe doesn’t fit as tight as it once did.”

But at this point, he said, vulnerable health care workers are “taking what they can get.”

“You hear more and more stories of places that are making their own and you see people with bandanas and other things, and they are hoping for the best,” Bakker said.