National stockpile of SARS safety gear proposed

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Oct 8, 2003 (CIDRAP News) – Preparations for the possible return of SARS should include establishment of a national stockpile of equipment to protect healthcare workers from the disease, a Minnesota official said at a Senate field hearing today.

"We recommend that the federal government create a national supply of the personal protective equipment and other supplies required for isolating large numbers of people—including items like masks, gowns, and gloves—separate from the Strategic National Stockpile of medical supplies," said Minnesota Health Commissioner Dianne Mandernach.

If hospitals run out of protective equipment, healthcare workers might refuse to come to work, endangering the care of SARS patients and others, Mandernach said. She spoke at a hearing of the Senate Permanent Subcommittee on Investigations, chaired by Sen. Norm Coleman, R-Minn. The hearing, which presented a generally gloomy picture of SARS preparedness, was held in St. Louis Park, Minn. It was the third such session Coleman has held since last May.

Mandernach said Canadian officials reported that the response to the SARS crisis in Toronto last spring required the use of about 5,000 N-95 protective masks for each SARS patient. Hospitals typically don't stock enough supplies to isolate a large number of patients, she said.

The supply of masks could run out if SARS returns in a major way, said another witness at the hearing. Michael T. Osterholm, PhD, MPH, said, "There are very few companies that produce N-95 masks. At the height of the epidemic last year, 3M Company [which makes the masks] was backlogged by years. If we run out of N-95 masks, are we going to have healthcare workers not come to work?" Osterholm directs the University of Minnesota Center for Infectious Disease Research and Policy (CIDRAP), publisher of this Web site.

Mandernach also recommended that the federal government establish an emergency fund to cushion the financial impact of a potential SARS resurgence. That impact could be "significant and burdensome," involving increased costs for hospitals, financial risks for physicians and other hospital workers risking exposure to the disease, and lost income for people placed in isolation or quarantine, she said.

Jeff Spartz, administrator of Hennepin County Medical Center in Minneapolis, commented that a third of hospitals in Minnesota operated in the red last year. A prolonged SARS outbreak could force many hospitals into insolvency because of increased staff needs, he predicted.

Mandernach and other speakers worried about the lack of hospital "surge capacity" for dealing with SARS patients, especially the shortage of negative-pressure rooms for isolating patients to prevent SARS transmission. "Hospitals are likely to be overwhelmed during a large-scale SARS outbreak, which would drastically increase staffing needs, while reducing the number of staff available," Mandernach stated in written testimony.

Osterholm said Minnesota has a very limited number of isolation rooms available, and most are in use by cancer, transplant, and other patients on any given day. Spartz commented that 23 hospitals in the Twin Cities area have negative-pressure rooms and are each prepared to admit from one to six SARS patients.

Mandernach and Osterholm also expressed concern about the large number of people lacking health insurance—an estimated 43 million nationwide—and how that could affect the response to SARS. Quick identification and isolation of possible SARS patients are the key to containing the disease, they noted. "It's difficult for public health authorities to urge citizens who might be in the earliest stages of a disease such as SARS to seek effective medical care, if they can't pay for it," said Osterholm.

Osterholm was pessimistic about the healthcare system's ability to deal with SARS. "We must be honest with the citizens of this country in establishing the expectation that should a problem like SARS occur in any of our communities, the healthcare delivery system, just like in Toronto, has every potential to be overrun," he said. He added that the issues go beyond SARS to broad questions of healthcare financing and public expectations of the healthcare system.

In response to a question from Coleman, Osterholm said he believes the potential for a return of SARS this winter is "very, very high." He added, "Will it come to Minnesota? That's the million-dollar question, and frankly it's a crap shoot."

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