Newfoundland and Labrador nurses say they are deeply anxious about a plan to sterilize and reuse masks at health-care facilities as the province prepares for a possible surge of COVID-19 cases in the coming weeks.
Without a guaranteed supply of masks, the largest health authority in the province has begun collecting used masks to sterilize them with vaporized hydrogen peroxide.
"It's increased anxiety in our members," said Debbie Forward, president of Registered Nurses' Union Newfoundland & Labrador.
"I had many, many emails. Lots of posts on our members-only website with concerns because, apparently, this is a very new process. Research on it has only been done very recently."
A letter was sent to all Eastern Health employees Friday, telling them bins would be set up around hospitals for them to place their masks in after they were no longer safe to use.
Supply chain 'in turmoil'
Eastern Health says its concerned about supplies, especially after U.S. President Donald Trump ordered 3M, which makes a large quantity of N95 respirators, to stop exporting them to Canada.
"We've been challenged, of course, by the recent decision coming out of the U.S. with the direction from the president around 3M," said Eastern Health president and CEO David Diamond.
"A lot of the masks that we would normally use in our supply are from 3M, and so the whole supply chain has been in turmoil since last week and we just want to make sure we have as many contingencies as we can."
The process of preparing masks for reuse — using something called a Sterrad sterilizer — is approved by the U.S. Food and Drug Administration. The manufacturers of the mask have also approved the process.
"We're waiting for Health Canada approval for this process at this point. So we are collecting the masks but not sterilizing them at this point, mostly as a backstop so if we find that the supply of masks dries up we will have a supply that we have here so people will still be safe," said Diamond
He said sterilizing and reusing masks comes at the behest of the federal government, and he understands why it might make some nurses anxious.
"We've been directed to do this by the federal government. It's not something we have taken upon ourselves. I would say that I had the same reaction [as nurses] when the idea was brought to me. It seemed like an odd thing to do and, of course, it's not something we have ever seen," he said.
"This won't be put anywhere in our supply chain until first of all we get Health Canada approval and we have a confidence level that we can do this safely."
Nurses want Health Canada approval
The province's nurse's union hasn't agreed to support the plan yet.
"We understand that [Eastern Health] is still waiting for Health Canada approval, which obviously would be critical for myself as an advocate for the health and safety of my members and I know is something that our members are concerned about as well," said Forward.
"The assurances that I have given my members is that we would never support a process that we didn't believe was safe for our members, and obviously a big piece of that is approval from Health Canada."
Forward expects facilities in all of the province's regional health authorities will begin collecting and reusing masks if Eastern Health does.
At Monday's provincial government briefing on COVID-19, Health Minister John Haggie said the province expects to hear from the federal government soon regarding reusing masks.
"The federal government have invested an enormous amount of time and effort in trying to identify ways these masks can be safely sterilized and reused and my understanding is that they will be coming out with recommendations about how to do that in the next day or two," he said.
Haggie also said Newfoundland and Labrador, with help from the federal government, is expecting a shipment of 94,000 masks from Hamilton, Ont., this week.
Haggie urging health workers to prepare for shortage
At a news conference on Sunday, Haggie said health-care providers and public health officials have to act like the next supply of person protective equipment will not arrive.
With an unsteady supply and an overwhelming global demand for masks and gloves, it's not unrealistic to assume the next shipment won't show up.
"Until they actually land in our warehouses, there is no guarantee that any of suppliers will actually be able to deliver," said Haggie, who has warned that a surge of new cases is likely in Newfoundland and Labrador.
Testing also limited by supply
The same strain and strategy also applies to testing in the province.
On Saturday, chief medical officer of health Janice Fitzgerald announced the province would open up the guidelines on testing, to allow people who work with vulnerable populations to get tested.
People across the province experiencing flu-like symptoms have reported being unable to get tested. Newfoundland and Labrador has the second-lowest per-capita rate of testing in the country with about 684 tests done per 100,000 people, surpassing only Ontario.
Haggie said the same attitude for masks has to be applied to testing swabs as well.
"There is nowhere in North America that has unlimited access to unlimited testing," he said.
"What we are doing is using those [supplies] wisely on the basis that tomorrow, our next batch delivery of swabs, [personal protective equipment] or masks may never arrive. Because if we don't, we are not being the best custodians of the public interest."
