Nurses like Jessie Lambert and other health care providers on the front lines of Maine’s battle with coronavirus are worried, frustrated – even scared.

They’ve seen the news from around the world and the chaos that’s descended on their counterparts in places like Italy and Spain. They know they don’t have enough personal protective equipment and have seen others scramble to fashion makeshift face masks, face shields and gowns.

Jessie Lambert, a nurse at Northern Lights Eastern Maine Medical Center in Bangor, is concerned about a shortage of personal protective equipment.  Photo courtesy Jessie Lambert

“Saying something is better than nothing is not the same as saying it’s safe,” said Lambert, 38, an acute care nurse assigned to the newly created COVID-19 unit at Northern Lights Eastern Maine Medical Center in Bangor.

As of Tuesday, 43 Maine health care workers had tested positive for COVID-19, the disease caused by the virus. That represents one in seven of the 303 positive test results in Maine, or about 14 percent of known infections, about equal to the percentage of workers employed in health care in the United States.

It’s a percentage similar to that for health care workers in Spain and Italy, two of the countries hardest hit by the pandemic in Europe, and places where severe shortages of equipment have left front-line health care providers often unprotected, according to reports in The Washington Post and The New York Times. More than 12,000 health care workers in Spain have tested positive, with Italy seeing similar numbers, according to the most recent data available from the World Health Organization and each of those countries’ respective health information services.

So far, the federal Centers for Disease Control and Prevention has not released data on the number of health care providers who have become infected on the job in the U.S., although reports of providers becoming ill and even dying from the virus are widespread in national and local media.

The Maine Center for Disease Control and Prevention will not specify the occupations of health care workers who have tested positive. Robert Long, a spokesman for the agency, said that information is being withheld to protect privacy.

However, on Saturday Pen Bay Medical Center in Rockport announced two of its doctors had contracted COVID-19 and that both were experiencing mild symptoms from the illness. The hospital said both also had minimal contact with patients and had put themselves into isolation at home as they experienced their first symptoms, in line with CDC guidelines.

Dr. Nirav Shah, director of the Maine CDC, pointed out at a recent media briefing that it’s not just doctors, nurses or others providing direct care to patients who face exposure to the virus.

“It’s also the health care workers we don’t often acknowledge,” Shah said. “These are the custodians, the cooks in the kitchen, the environmental care workers who are sanitizing the linens – the people you might not see when you or one of your loved ones goes into a hospital.”

In New York City, where the virus is raging, hundreds of health care workers have fallen ill, at least two nurses have died and several hospitals have been so severely hit by the illness their administrators have made desperate pleas or even threats in attempts to keep the people most needed to treat victims of the virus on the job.

Dr. Charles Pattavina, an emergency department doctor at St. Joseph’s Hospital in Bangor, said he had yet to hear of any Maine health care facilities running out of personal protective equipment. But Pattavina said there was growing anxiety about the issue, and he has received messages from friends and colleagues in New York City, where infections among staff have been so high that there is concern hospitals are not stopping the virus and actually may be spreading it.

One friend wrote Pattavina, “I think we are now the vectors of the disease.”

He said a shortage of protective equipment or not using it soon enough in the complicated COVID-19 equation, with its long incubation period, is troublesome.

Dr. Charles Pattavina, past president of the Maine Medical Association, has heard from colleagues in New York City who are concerned that hospitals may actually be spreading the coronavirus because of a lack of personal protective equipment. Photo courtesy of Maine Medical Association

“Not much keeps me up at night,” Pattavina said. “But that kind of doomsday scenario, that’s the sort of thing that keeps me up.”

A past president of the Maine Medical Association, Pattavina believes Maine may still be able to weather the pandemic by learning quickly from the experiences of others around the country and the globe. Pattavina said the conservation of protective equipment and other steps like decreasing staff contact with infected patients and increasing the use of telemedicine and remote diagnostics will help.

However, doctors and nurses can’t always diagnose or treat patients remotely. Setting a broken leg or doing a life-saving surgery can’t be accomplished “from 6 feet away,” Pattavina said.

Shah said the state received another shipment of protective equipment from the federal government strategic stockpile Monday night, including an additional 60,000 N-95 face masks, the mask providers are recommended to use while treating those with symptoms of COVID-19. But how long those masks and other protective equipment will last, will depend on how fast the outbreak spreads in Maine.

Every day as he briefs reporters on Maine’s response to the virus, Shah emphasizes that Maine is not getting all the equipment he and other health care experts believe it will need to protect workers on the front lines. He said the shipment Maine received Monday, its third from the federal stockpile, could be the last it gets for some time.

“We are hoping that is not true,” Shah said on Monday. “But hope is not an operational strategy.”

He said the state was also taking its own actions to secure equipment through other sources both inside and outside of the U.S. while Maine’s manufacturing industry also was beginning to retrofit and ramp up production of that equipment here.

Shah said the Maine CDC was investigating the cases where health care workers in Maine have fallen ill with the virus, but there was still too little data to determine precisely whether they contracted it from patient contacts in the line of duty or from someone outside their workplaces.

Nurses like Lambert, a wife and the mother of a 2-year-old son, worry not only about contracting the illness herself but also about possibly spreading it to others, such as co-workers, family, other patients or the broader community. “I’ve got to go to the grocery store just like everybody else,” Lambert said.

She said stopping the spread of the virus depends on keeping health care workers from catching it themselves. And she was skeptical of relaxed guidelines that allow health care workers to wear less-protective surgical masks when treating patients who have been tested but not yet confirmed as coronavirus cases.

“It seems to me the new guidelines from the CDC are supply-based and not science-based,” Lambert said.

The issue has become a talking point for National Nurses United, the largest union of nurses in the U.S., with 150,000 members across the country, including members in several Maine hospitals.

On Friday the union and Be a Hero, a political action committee, launched an online ad campaign featuring nurses in California who highlight the dangers they face without adequate protective equipment. The ad aims to raise pressure on the Trump administration to more quickly release protective equipment from the federal strategic stockpile.

Shah said there is no doubt those working daily on the front lines of the crisis are taking a risk.

“These folks, who are racing to the front lines every single day while many of the rest of us are attempting to stay home, they themselves are grappling with that same personal and emotional impact even as they are showing up to work every day to keep Maine people safe,” he said.