Faced with a potential critical  shortage of pandemic supplies – such as masks, shoe coverings, gloves and gowns – Maine hospitals are scrambling to conserve what they have, add supplies and keep workers healthy to treat COVID-19 patients.

Whether hospitals will be overrun or able to handle an influx of COVID-19 patients depends on whether they can build capacity to meet demand and whether social distancing techniques put in place by the state – such as canceling schools, working from home, closing dine-in for bars and restaurants and limiting large gatherings – work quickly enough.

Gov. Janet Mills on Thursday sent a letter to the Trump administration urging the federal government to send more pandemic supplies to Maine and also to address a shortage of supplies needed for COVID-19 testing.

Steven Michaud, president of the Maine Hospital Association, said hospital officials around the state are worried about running out of supplies needed to care for patients.

“If this surges, we will have a critical shortage of PPE (personal protective equipment) without question,” Michaud said.

Michaud said the hospital association started to do a survey last week of Maine hospitals about what supplies they had on hand, but scrapped the survey because it so quickly became outdated. He said what’s certain is that there’s not enough.

In Washington state and New York – two of the national hot spots for COVID-19 infections – hospitals are reporting acute shortages of supplies, and are having to reuse them for longer than was intended. Some hospitals are even hand-making supplies to try to keep up.

Maine has 52 novel coronavirus cases through Thursday, and four hospitalizations, the Maine Center for Disease Control and Prevention reported. Michaud said the problem is not the number of patients now, but if infections grow exponentially and hundreds of patients show up at hospitals needing services all at once.

“Our only hope is if social distancing works to avoid us getting swamped,” Michaud said.

Chuck Hays, MaineGeneral Health president and CEO in Augusta, said supplies are a constant concern.

“Your needs are constantly changing as the epidemic increases,” Hays said. “We are concerned about our future supplies, and we evaluate them every single day. We have enough for the short term.”

Public health experts also are sounding the alarm about a nationwide shortage of  ventilators, which buy time for patients with the most acute symptoms to fight off the virus. Michaud said the first priority is the protective equipment and the testing, but ventilator supplies also are a concern.

The Maine CDC is compiling a database of ventilator supply at Maine hospitals, but it has not yet been released. Dr. Nirav Shah, director of the Maine CDC, said it will be publicly available as soon as it is completed.

Maine Medical Center in Portland maintains a pandemic supply warehouse, with supplies built up from the H1N1 outbreak in 2009 and since, but hospital officials said they still are concerned about whether they will have enough supplies when the virus peaks. The hospital recently eliminated locations where visitors could pick up a mask, and required visitors who need a mask to get them at nurse stations, because people were taking too many masks and the masks need to be conserved for health care workers. Many visitors to the hospital do not need to wear a mask, but people were taking them anyway.

Hospitals also are working to repurpose existing spaces into rooms where COVID-19 patients can be treated, but building enough capacity to meet demand will be difficult.

A statistical model done by Harvard Global Health Initiative shows that in Maine, if 40 percent of people are infected within a year – the middle-of-the-road projection by Harvard – Maine hospitals will suffer from a critical shortage of hospital beds. The Portland area would need to increase hospital bed capacity by 97 percent, while a 73 percent increase would be needed in the Bangor area. Maine has 2,893 hospital beds, or 2.5 per 1,000 population, which is slightly above the national average of 2.4 beds per 1,000, according to federal statistics.

Shah said social distancing works, but it’s too early to tell if Maine’s efforts – in place for less than a week – are being effective. Scientists have said it takes about two weeks for social distancing to take hold because that’s the incubation period for the virus.

“Social distancing is most effective before there is widespread community transmission,” Shah said. “The more aggressive we can be now (with social distancing), the more we can flatten that curve.”

If distancing measures don’t work and patients overwhelm Maine’s health care system, running short on supplies will cause other problems.

Doctors, nurses and other health care workers could become infected themselves, which is not only dangerous for them, but also reduces the health care system’s capacity to treat patients, Michaud said.

Hospitals are trying to marshal and preserve resources by delaying elective surgeries, postponing routine appointments at primary care and using more telemedicine – measures that will help maximize the number of employees available to handle a potential crisis and also save on pandemic supplies.

Mills on Thursday urged the Trump administration to quickly disburse more supplies from the Strategic National Stockpile to states. Maine has received one shipment, but it was a modest amount, Shah said.

“The rollout of personal protective equipment is not as fast as it needs to be,” Shah said at a Thursday news briefing. “What we are asking them to do is open up the doors.”

Shah said another way to make resources stretch is to evaluate whether some patients who are candidates for hospitalization can instead recover at home through telemedicine monitoring.

“We are evaluating who should be in the hospital and who can be safely isolated and recover at home,” he said.

Hays, the MaineGeneral president and CEO, said redeploying the workforce to respond to the pandemic and retooling rooms may increase capacity by about 20 percent.

Testing also is being hampered by a national shortage in reagents, a component needed for testing. Maine has so far tested 2,056 patients, with 2,004 of the test results coming back negative. Maine has tested the second-highest number of patients among New England states – only Massachusetts has done more testing – and the reagent supply shortage will affect Maine’s ability to test in the future, Shah said.

“The reagents are kind of like the baking powder (in a recipe),” Shah said. “It’s the chemical that makes the reaction go.”

Hays said MaineGeneral Hospital had tightened its criteria to receive a test at the hospital to avoid depleting the supply of tests.