In early March, health care workers in the United States began to sound the alarm. Personal protective equipment (PPE) was already starting to be in limited supply in hospitals and clinics across the country, and the COVID-19 pandemic had only just officially been declared.

On March 17, Esther Choo, MD, MPH, associate professor of emergency medicine at Oregon Health & Science University School of Medicine, issued a tweet calling for frontline health workers to demand PPE and tag their lawmakers. She created the hashtag #GetMePPE, and it immediately took off.

“A number of us started to sound the alarm about the need for increased production and equitable distribution of PPE across the country,” said Megan L. Ranney, MD, MPH, associate professor in the department of emergency medicine at the Rhode Island Hospital/Warren Alpert Medical School of Brown University in Providence. “We realized it was not going to happen at the scale or speed we needed.”

With Dr. Choo and other colleagues, she helped create the grassroots coalition #Get​UsPPE. Weeks later, however, what she and its numerous other co-founders initially thought would be just a stopgap effort to help get PPE to health care workers has become an extended and increasingly sophisticated measure in light of high-level failures to address critical shortages.

“The supply chain is showing no indication of becoming functional, and now we are predicting a second wave [of illness] when we relax social-distancing guidelines,” said Dr. Ranney.

The health care workers, scientists, engineers, and others behind the scenes of #Get​UsPPE have, since mid-March, been creating a centralized system for taking requests for PPE and seeing it distributed to the places it’s needed most.

“It evolved from a very rough website that basically allowed people to publicly post if they had a need for PPE and post if they had donations so they could match themselves, and now it’s a much more advanced database,” said Dr. Ranney. “We do behind-the-scenes analysis and matching on a daily basis.” To date, #GetUsPPE has fielded nearly 7,500 requests and helped distribute more than 1 million pieces of PPE.

This evolution is due, in part, to the work of #GetUsPPE medical lead Shuhan He, MD, an emergency physician at the Center for Innovation in Digital HealthCare at Massachusetts General Hospital in Boston, who helped build an on-demand database to assist with fulfilment.

“My skill set is building websites, and this caught national attention,” said Dr. He, CTO of #GetUsPPE. “I like to solve problems, and this is one that is very in the atmosphere. I [grabbed] onto it and realized it’s a big problem. Not everyone can solve every problem at once, so I focused on it.”

Evolving to Meet the PPE Need

The work of #GetUsPPE has evolved in the weeks since it started, as its volunteers began to understand the true complexity of the issues.

There have essentially been three phases of the effort. The first was handling small public donations of PPE from individual people with supplies in their basements or laboratories. The second phase involved working with domestic manufacturers and makers working quickly to produce some kinds of PPE in the United States. The third, Dr. He explained, has involved building algorithms to maximize PPE distribution once the international supply chain functions again.

“This is not what I planned to spend my months of March and April doing,” said Dr. Ranney, who is also a public health researcher. “I have never worked on supply chain issues before, but I couldn’t just sit by and watch my colleagues be put at risk.”

By now, Dr. He said he feels like he has “basically obtained a PhD in supply chain management” in a matter of weeks.

“I’ve had quite the learning experience about PPE,” he added. “Why is an N95 [respirator] different from a KN95? Why is there a difference in manufacturing processes? Why does a hospital need one type of PPE and nursing homes need others? It’s a mixing and matching of problems.”

One measure of the effort’s success, said Valerie Griffeth, MD, PhD, an emergency physician soon moving to Advocate Health Care in Chicago, can be found in the way conversations have recently shifted with respect to PPE.

“I think we have made significant progress and, in a sense, that’s reflected in the fact that PPE has become secondary to the story about testing and reopening the economy,” she said.

However, it’s “absolutely disappointing” that #GetUsPPE and other grassroots efforts, such as Project N95, have had to fill the void left behind by what she sees as a government that’s been slow to act.

In late January and into early February, Dr. Griffeth was in the midst of job interviews and her partner expressed some concern about her risks while traveling. Dr. Griffeth began looking into Centers for Disease Control and Prevention (CDC) guidance and gathering as much information as she could find about SARS-CoV-2 (called, at that point, 2019-nCoV), the novel coronavirus that causes COVID-19.

On Feb. 6, she said, the CDC posted guidelines recommending that health care workers don respirators when working with patients with respiratory symptoms. But on March 10, the CDC revised those guidelines to suggest health care workers wear simple surgical masks instead of respirators because of anticipated shortages.

“The CDC in this case got things wrong,” said Dr. Griffeth, who got involved as co-founder of #GetUsPPE after co-authoring a letter advocating for the protection of frontline workers. “This is something we saw coming and we could have prevented it if we’d taken more drastic measures.”¹

While Dr. Ranney and Dr. He have been involved in supply chain issues, Dr. Griffeth has been doubling down on her advocacy.² “I’ve been networking with politicians and grassroots organizations,” she said. “As physicians, we have a voice that people listen to and that’s true now more than ever. This pandemic has really raised our ability to get connected not just to state representatives but also to national representatives. People are taking our phone calls when, in the past, they may not have, so there’s been a lot of value in that.”

Next Steps

Today, #GetUsPPE is working to build a more robust database and to create scoring systems that can help prioritize PPE distribution equitably. The nonprofit’s goals include getting PPE to safety-net hospitals, nursing homes, tribal communities, and even detention centers where needs are acute. Smaller health care centers lack the buying power of larger health systems and institutions, the co-founders say, and physicians often have more influential voices than other kinds of health care workers. In late April, #GetUsPPE partnered with Project N95 to create the Demand Data Hub, a single site for registering PPE needs and tracking shortages.

“As more supply comes in, our hope is that we can facilitate equitable distribution across the country and make sure people are treated fairly, that PPE is not just going to the most convenient places,” said Dr. He, noting that the group should soon have news about its matching-and-distribution algorithm.

Dr. Griffeth continues to monitor and advocate for legislation working its way through Congress, looking for opportunities to address everything from PPE shortages to the lack of adequate COVID-19 testing capacity. As emergency physicians, #GetUsPPE’s co-founders say they were poised to confront this challenge. They are, after all, Dr. Griffeth said, committed to solving whatever problems come through their doors.

“I think, to me, it also speaks to the urgency we see in the emergency [department] and the kind of salience we like as emergency physicians,” Dr. He said, noting that emergency physicians are also “at the forefront of tech.”

Dr. Ranney described emergency physicians as “canaries in the coal mine” for problems in the health care system, among the first to note shortages, new diseases, and new treatments. Through her work on the board of the American Foundation for Firearm Injury Reduction in Medicine (AFFIRM), she has helped #GetUsPPE achieve 501(c)(3) status and benefit from infrastructure already in place, including the ability to accept financial donations to assist in making it to the next phase.

“We are working nationally and internationally with the supply chain to help fix it,” she said. “It highlights a lot of the systemic issues in the health care system that we in emergency medicine know so well. We’ve been putting Band-Aids on the health care system for a long time, and we’re trying to pull those Band-Aids off to fix the issues that frustrate us on a daily basis.” 

References

1. Griffeth V, Choo E, Trueger S, et al. Open letter on COVID-19 and personal protective equipment. #GetUsPPE website. Accessed April 28, 2020.
2. Ranney ML, Griffeth V, Jha AK. Critical supply shortages—the need for ventilators and personal protective equipment during the Covid-19 pandemic [published online ahead of print March 25, 2020]. N Engl J Med. doi: 10.1056/NEJMp2006141.