With national shortages of personal protective equipment, local essential workers like nursing home attendants and home health nurses are struggling to obtain the materials needed to shield themselves from the coronavirus.

Lorie Fussner, a third-grade teacher from Ashland, started a Facebook group called "Central MO Mask Makers" in an effort to rally local people together to make masks for health care workers on March 21. She knew there are shortages across the nation and wanted to do something to help.

Fussner teamed up with another Facebook group, Sew for Safety, to combine efforts. Together, they have created more than 400 masks for local health care workers, first responders and others.

But until recently, local hospitals haven’t been accepting sewn masks. Fussner reached out to MU Health Care offering masks early last week, but that they weren’t taking donations yet, she said. At that point, lots had already been made.

Soon after, however, she started getting requests from others in need of masks. South Hampton Place, a senior living home in Columbia, needed 30. The next day, they needed more. Heisinger Bluffs, an assisted living home in Jefferson City, needed 50. Braun Home in Fayette did too.

Sew for Safety was getting similar requests. Western Missouri Medical Center was nearly out, members said. Firefighters in Kansas City needed 1,500. Earlier in the week, Compassus, a hospice company in Columbia, requested 75 from the Boonslick Trail Quilters Guild.

Compassus is in "dire need," according to emails from nurses tasked with obtaining more of the masks.

"Everybody is out obviously but we are continuing to provide patient care and direct contact with our most at risk," hospice liaison Monica Korba wrote in an email March 19 shared on social media.

The need wasn’t just at the hospitals. It was all over.

Due to decreased exports from overseas manufacturers, distributors are reporting that personal protective equipment is being placed on allocation and orders are being filled based on historical demands for existing customers, not for the people who need masks now, according to the Centers for Disease Control.

People who wouldn’t normally need a mask, like a grocery store worker, police officer or assisted living nurse, now need them to protect both themselves and others around them as they go about their essential work.

Shortfalls may be anticipated to continue for the next 3 to 4 months, according to the CDC.

As the week progressed, hospitals that had previously said they were all right on supplies, like Boone and MU Health Care in Columbia, started accepting donations.

In a video to health care workers posted March 24, MU Health Care Chief Nursing Officer Mary Beck said the hospital system has gone through a distribution method that will supply each direct caregiver with their own N95 respirator to use.

"There are certain situations when you’re going to throw that away," she said. "Once it’s contaminated, the strap’s broken ... you’re going to get another one. And that’s the supply we have. The key thing for us right now is that we have to think about the long term."

National shortages of N95 respirators are requiring hospitals across the country to ask workers to reuse or extend the use of the masks, which are generally supposed to be single-use, according to FDA guidelines.

MU Health Care is looking to partner with the university’s textile department and reaching out to community quilting guilds, Beck said in the video.

If sewers aren’t part of a guild but want to help, they can fill out an online form, MU hospital spokesman Eric Maze said. On Friday, 250 volunteers had already completed the form.

The hospital will start handing out kits to interested volunteers this week, Maze said, but at this point, there are still more volunteers than supplies.

Alice Leeper, head of the Boonslick Trail Quilting Guild in Columbia, said MU reached out on Friday with a large order of masks to be sewn by members. They would provide materials in a kit for members to pick up, which had to be assembled in homes that were smoke and pet-free to prevent any type of infection.

Leeper said when she picked up the materials to construct the masks from MU, she asked if they were facing a shortage. They told her they weren’t.

"They're just preparing," Leeper said.

While the hospitals say they are still stockpiling donations in case of severe shortages, in some centers, the worst has already come.

Bright Star Home Health Care in Columbia is out, spokeswoman Tammy Carter said. Many workers are having to obtain masks on their own. They’re on a waiting list now for more supplies, but everything’s taking longer because of the national shortages.

"All nursing homes in the Columbia area are having trouble getting protective equipment," said Donna Bowers, executive director of The Bluffs nursing home in Columbia.

Protective gear shortages are a problem across the state, said Heidi Lucas, director of the Missouri Nursing Association. They’re a bigger problem in cities, where more cases are occurring than in rural areas.

But that means large hospital centers that treat COVID patients are first on the list when the state of Missouri makes and fulfills orders, Lucas said.

There are discrepancies in the messaging coming out of hospitals, she said.

"The hospitals are saying one thing," Lucas said. "The nurses inside the hospitals are saying something else."

Many nurses have come to her with concern over hospital guidelines telling them not to wear protective gear in general non-COVID appointments, like gynecology and oncology, out of fear of scaring patients, she said.

But those patients could still be carrying it asymptomatically, she said. Nurses tell her the situation is bad, but ask her not to share their names or employers due to fear of retribution.

"They are sending home memos telling people ‘Do not talk to the media, do not post on your social to tell people what it’s really like’," Lucas said. "We are past the point of those kinds of niceties. We need to do what needs to be done. If we don’t look out for our health care workers, what are we going to do if all of them get sick?"

In Boone County, Branaugh said the group has heard of need from long-term care facilities, volunteer or staff at facilities that support the homeless population, non-clinical hospital staff, staff from specific units at different hospitals and grocery store workers.

Adelstein had heard about the shortages, and said that although she could tell that many people were willing to help in any way they could, it was unclear what the "perfect" do-it-yourself mask looked like or consisted of.

The CDC relaxed its guidelines due to the shortages caused by the pandemic, allowing for the use of homemade face masks like a "bandana" or "scarf" as a method of last resort when no other masks are available.

But the centers don’t consider homemade masks to be protective gear, because it is unclear whether, and to what degree, they actually protect workers from the virus. They encourage workers to exhibit caution when using the method.

"There were so many tutorials popping up online about making masks and they all seemed to be guessing at what would work," Adelstein said. "The CDC did not recommend materials or methods."

She’s discovered that in a case of a shortage, the best homemade option for a health care worker is one in a duck bill or "surgical" style with a pocket, so a filter can be inserted and removed before re-washing and cloth straps that tie behind the head, she said.

But Adelstein is clear that she’s just learning, too. She wishes the CDC would come out with some guidance on what the most effective homemade masks look like.

"There is no government or health care organization that has specifically stated ‘use these materials and this design’ for the optimal protection," she said. "It would be so great if they would."

Lucas is concerned the masks could be giving workers a false sense of security, she said.

"Cloth masks are not the answer. They will never be the answer," she said.

Fussner will resume online classes with her students again this week. But many furloughed or laid-off workers will sit in their homes in the coming weeks without the luxury of being able to work from a home office.

"There is something everybody can do," Fussner said. "There are a lot of people home right now with a lot of free time on their hands. So get busy."

Columbia hasn’t started collecting homemade masks for workers, but Boone County Office of Emergency Management employee Elizabeth Thompson said a project to collect homemade protective gear donations for first responders through For Columbia is in the works.

"At this point it hasn’t reached a point where we are in desperate need of them, but we are interested," Thompson said.

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