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William Glanz

Senior Writer

Coping in a Crisis: PPE Shortage Increases Risk and Anxiety

April 20, 2020 | coronavirus | COVID-19 | Comments
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Tim Swinfard (pictured), president and chief executive officer of Compass Health Network, began searching for personal protective equipment early this year in anticipation of a shortage.

Editor’s Note: The coronavirus outbreak has led practitioners to rethink behavioral health care treatment and the delivery of service. In this series, we will address the questions and concerns raised by providers and offer tips and suggestions to help you cope with problems caused by the pandemic.

Tim Swinfard knew China provided many of the masks and other personal protective equipment used by his 2,700 employees at Compass Health Network and by people who provide health care and behavioral health care treatment and services.

He also knew obtaining those masks would only become more difficult as the coronavirus spread.

“I did not predict the United States would have one million cases of COVID, or 100,000 or even 1,000. What I thought was that the supply chain was going to be broken because China was shutting down,” said Swinfard, president and chief executive officer of Compass Health Network, based in Jefferson City, Missouri.

In early February, he asked his staff to begin looking for a six-month supply of masks, gloves and gowns for the 60 medical and behavioral health clinics, residential facilities and dental clinics Compass operates. Compass ended up obtaining a two-month supply, which has allowed Swinfard’s facilities to stay about two weeks ahead of current program demands.

His decision to buy early allowed him to beat the rush of buyers now struggling to find PPE for employees.

“We were lucky,” Swinfard said.

“Begging for PPE”

Swinfard’s story – and his success – is unique.

Behavioral health care providers are scrambling to acquire PPE, which has become a treasured commodity.

“We haven’t been able to find PPE anywhere,” said Heather Jefferis, executive director of the Oregon Council For Behavioral Health, which represents 45 member organizations in the state.

The difficulty members have had finding PPE is why the National Council for Behavioral Health decided to step in and place an order for 2 million masks. A recent survey of National Council members illustrates how many clinics have identified the lack of PPE as one of their top concerns as COVID-19 races through the country. Nearly 83% of behavioral health organizations do not have enough PPE for two months of operations, according to the survey of 880 members.

Jefferis surveyed Oregon clinics separately, and responses from providers indicate that most have enough PPE to last them up to one month. But that assumes they don’t have a client who tests positive for coronavirus.

If that happens, Jefferis said, a clinic could burn through its PPE in a matter of days.

Oregon isn’t alone.

“The availability of PPE has been uppermost in our mind,” said Terry Dosch, executive director of the South Dakota Council of Community Behavioral Health, which represents 18 member organizations. “We have one member affiliated with a hospital that has access to equipment. We have another member that is private and has located some equipment. Everybody else is begging for PPE.”

Fighting for Recognition

Behavioral health care providers routinely hear the same message when they try to acquire PPE from state officials – they aren’t a priority when it comes to the distribution of PPE in their states, and hospitals are first in line.

“I don’t think we’re being ignored, but we are not being prioritized in light of the risks,” Dosch said.

That doesn’t make sense to everyone.

The failure of the states to provide behavioral health care providers with PPE is short sighted because of their ability to ease the burden on hospitals, said Brent McGinty, President and Chief Executive Officer of the Missouri Coalition for Community Behavioral Healthcare.

“I get that hospitals are a priority, but our folks are trying to keep people out of the hospitals,” McGinty said.

The challenge, then, is overcoming a significant political hurdle to ensure behavioral health care providers become a priority.

“The biggest challenge has been getting behavioral health into the discussion,” said Annette Dubas, executive director of the Nebraska Association of Behavioral Health Organizations. “We’re working with the state public health department to find PPE, and it’s being distributed on a priority basis. But behavioral health is not a priority. We just are not on their radar.”

Less PPE Means Less Safety and More Anxiety

COVID-19 has changed the delivery of behavioral health care treatment and services.

The number of in-person consultations is down, and the use of telehealth is up. But the risk remains because providers still see patients. Despite new precautions – allowing fewer people into facilities or taking their temperature before patients enter a clinic, for example – providers still risk exposure to coronavirus.

“Every time we see a patient now, we’re in full gear,” Swinfard said. “When we first started deploying masks in psychiatric facilities, staff were heavily resistant. They’re not now.”

That risk of exposure to the virus that causes COVID-19 represents one of the greatest concerns behavioral health care workers have about the pandemic.

About 9,000 health care workers tested positive for coronavirus and 27 had died as of April 9, according to the Centers for Disease Control and Prevention. But data reflecting the number of behavioral health care workers infected with the coronavirus is harder to come by. Many association executives are asking members to track infections of clients and staff, and the National Council is planning to launch a similar initiative to help shed light on the risks behavioral health care providers face every day.

Information gathered so far illustrates that infections are not widespread, but if clinics run out of PPE, that picture will change quickly.

Oregon member organizations have had about 50 employees quarantined at home with symptoms of some illness in the last several weeks, but just one employee has tested positive for coronavirus. In Nebraska, two member organizations have had employees self-quarantine. In South Dakota and Missouri, no behavioral health care workers have reported being infected with the coronavirus. Each state has had some clients test positive, which adds to the anxiety among behavioral health care workers.

“It’s been especially challenging for people engaged in crisis services and residential services because they have contact with individuals. There’s no physical distancing,” Dubas said.

Until PPE becomes readily available, clinics and association executives are coping as best they can and leveraging telehealth services whenever possible. And they’re thinking ahead.

In Missouri, McGinty teamed up with the Missouri Primary Care Association in mid-March and began placing orders for N95 masks and surgical masks. He’s already received four shipments in April.

“Our thought is that we’ll develop our own stockpile so we can be ready the next time this happens,” McGinty said.