Hamilton health-care workers wore at least 1,000 expired N95 masks in 2020
St. Joseph's Healthcare Hamilton relied on the local warehouse and distributors while HHS bought PPE overseas
At least 1,000 expired N95 masks were used by front-line health-care workers in Hamilton during the early months of the COVID-19 pandemic.
Newly released internal documents also reveal that at various points, the supply of some N95 masks in some Hamilton hospitals wouldn't last them more than 15 days. Other pieces of personal protective equipment (PPE), like gowns or larger-sized gloves, were also "desperately low."
During the first few months of the pandemic, health-care workers consisted of almost one in four Hamilton COVID-19 cases. Local hospitals were asking staff to extend the life of their PPE and were analyzing each job to determine which jobs were more dangerous and warranted a mask.
Documents obtained through Freedom of Information Act requests, and interviews with the people leading the supply chain of St. Joseph's Healthcare Hamilton and Hamilton Health Sciences (HHS), offer a deeper look into how stricken the stock of PPE was during the first wave.
"It was a scary time," said John Aldis, senior vice-president of finance and corporate services at St. Joseph's Healthcare Hamilton. He's tasked with managing the hospital's supply chain.
Majority of St. Joe's N95 masks were expired
Aldis joined St. Joe's in April — one month after COVID-19 began wreaking havoc on daily life. Before St. Joe's, he worked at Mount Sinai Hospital in Toronto, and has worked at other Greater Toronto Area hospitals.
Right around the same time he started working in Hamilton, most of St. Joe's N95 masks had already passed their best before date. Records show on Mar. 30, 2020, St. Joe's had 85,587 expired N95 masks and 4,448 unexpired masks. That means 95 per cent of the masks were expired.
Aldis said there was a stockpile of masks because of the 2003 SARS outbreak that infected over 400 Canadians and killed 44.
While the masks are technically expired, he said, he prefers the term "non-current" because "the shelf life of these masks go far beyond the labelled best before date."
Overall, Aldis said roughly 1,000 expired N95 masks were deployed for front-line use late in the summer, but only after they were deemed to have the proper elasticity, foam padding and nose clip.
At the time, the Registered Nurses' Association of Ontario and Ontario Medical Association were also suggesting the use of expired masks in "lower risk areas."
He said there was no procedure to determine who would or wouldn't use an expired mask. But everyone, including the union, was told when it was time to use those masks, he said.
Each of those masks also had a green dot on them to show they were expired, he said. At times, St. Joe's also sent facilities, like local long-term care homes, expired masks for fit testing and educational use.
New masks on request
When St. Joe's staff complained about using an expired mask, Aldis said, they were provided with a new one.
At the same time, HHS had just developed a PPE task force.
Kelly Campbell, vice-president of corporate services and capital development at HHS, was in charge of the supply chain and securing as much PPE as possible.
"It was a stressful time for everybody ... unfortunately, our supply chain in Canada is very reliant on other countries and partners in the U.S.," she said.
The Trudeau government actually threw out two million N95 masks in 2019 because they were expired. In April 2020, the government also acknowledged the federal stockpile wasn't ready for a pandemic to strike.
How HHS and St. Joe's sourced PPE
Still, Campbell says HHS had 570,000 N95 masks at the start of the pandemic and none had passed their best before date.
Both hospital networks also say no one ever reused an N95 mask, despite provincial documents advising they should prepare to use them if needed.
When COVID-19 began to spread locally, Campbell says HHS decided to avoid relying on the local warehouse for PPE.
"As COVID expanded globally, the supply chain was not able to keep up ... we aggressively started to procure on our own as our regular supplier couldn't meet our demand. We started to go out and buy directly from China, other countries, and get our own supply," she said.
That decision was a key difference in the approaches between both local hospital networks.
Aldis and St. Joe's relied on the local warehouse to ship in PPE. He said it wasn't easy trying to predict how many masks staff would need to use day-to-day, and says as he looks back, St. Joe's probably never needed to use expired masks, but they erred on the side of caution.
He said St. Joe's aimed to always have at least 30 to 90 days worth of supply of all N95 masks, but faced three challenges with the local warehouse:
- They couldn't control how many masks needed to be used on any given day.
- They couldn't control what they would receive.
- They couldn't control the demand from other local hospitals.
"It was like a surprise. Some weeks we would wait and see, 'OK, how much were we lucky to get or did we miss that one?'" Aldis said.
"It was like organized chaos ... this was as bad as I'd ever seen it."
Asking the province for help
For example, some models of N95 masks the hospitals needed didn't arrive. In other cases, St. Joe's was "desperately low" on large and extra large gloves. Gowns were also critically low. Aldis said St. Joe's had to find reusable gowns, which ended up being "a saviour for us because we would have been in desperate straits if we didn't have those."
"While I say sometimes, we'd get a fraction of what we needed, there were other times where we would get twice of what we need ... but it was a scary time. You just didn't feel like you had good visibility and because of that, we ended up stocking where we could," he said.
At HHS, the goal was to have 15 days or more of any given PPE in stock.
HHS, like St. Joe's, also had shortages with gowns, putting out memos to staff about shortages. In mid-to-late April, documents also show HHS was "critically low" on N95 masks.
Campbell says HHS called on the province to provide them with PPE — which was a last resort — fewer than five times. St. Joe's, meanwhile, needed to call on them roughly 10 times.
PPE supply not an issue anymore
Local hospitals were also depending on each other and sharing resources.
"We would be doing overnight shipments to help others out, again with the understand they would help us out if it came to that. It was a really good feeling to have that backstop," Aldis said.
Aldis says now St. Joe's is "swimming in PPE." Campbell echoed those sentiments about HHS and said those issues are now behind them.
"It was that uncertainty of 'how long am I planning for? What's coming next?'"
"We're in a whole other realm of this pandemic now. PPE is not the issue, now it's variants ... and getting people vaccinated."
- A previous version of this story stated expired N95 masks were sent to facilities, like local long-term care homes. An updated version clarifies they were sent for fit-testing and education, not for use with patients.Feb 19, 2021 1:33 PM ET