As of Thursday morning, more than 100 healthcare workers in Boston have tested positive for coronavirus. At the Kaiser Permanente hospital in San Jose, California, more than half of the patients have tested positive for coronavirus.

Taking those facts together, it would seem that it’s a terrible time for healthcare workers to have their use of personal protective equipment (PPE) limited.Yet, nurses at Kaiser Permanente in San Diego were given this directive in their morning huddle.

EXCLUSIVE: Kaiser San Diego is rationing nurses' use of masks, gloves – only allowed when caring for patients on droplet or airborne precautions. They call it prioritizing "rational use of PPE equipment/supplies." I call it putting lives at risk. Story to follow. #coronavirus pic.twitter.com/G4tGaoUWyh

— Jennifer Van Laar (@jenvanlaar) March 26, 2020

It reads:

As a result of the global Corona Virus Pandemic – demand of certain PPE items are exceeding available supply.

Kaiser San Diego is seeing an unprecedented increase in the utilization of essential PPE supplies (masks and wipes) despite our normal patient capacity.

In order to ensure we are prepared now and in the future, we must preserve our supplies and ensure we prioritize rational use of PPE equipment/supplies.

All KP employees should exhibit social responsibility and assist in actively and proactively preserving PPE equipment.

Please note:

• Masks should only be worn when clinically indicated for patient care (droplet or airborne precautions)
  • Wearing a mask all day places you and our patients at risk.
• Masks should not be used by hospital staff as a preventative measure and while not providing patient care.
• Managers may ask staff to explain the use of masks.
• Taking of equipment for personal, family or home use is not permitted and will be considered in violation of our fraud, waste, and abuse policy

To help us preserve equipment:

• Minimal PPE supplies will be kept on in-patient units.
• Visitors of droplet isolation patients will be required to check in with the nurse before entering and the nurse will provide them with a mask to use.
• Bleach and Sani Wipes will be kept in stocked isolation cabinets and isolation carts.
• A small supply of bleach and sani wipe containers will be kept on every unit on the PPE cart in the unit equipment/supply rooms.
• Charge nurse and unit managers/assistant managers will round on PPE carts frequently and ensure CDR delivers more supplies if needed.
• Nurse Leader Rounding will be increased to ensure masks are not being worn by employees for inappropriate care of patients.

So, let’s get this straight. At this point, Chinese coronavirus cases are doubling every three to four days in California. San Diego County is among the hardest-hit counties (277 cases, 2 confirmed deaths as of press time). We know that people can be contagious yet asymptomatic, and that COVID-19 test results aren’t immediate. In fact, the Massachusetts Nurses Association sent a letter to state officials saying that all patients should be assumed to be COVID-19 positive:

“At this point, we should assume all patients are COVID-19 positive. The inability to effectively segregate patients quickly, as well as the lack of available testing with quick results, has left us with co-mingled patients and the virus is ahead of us.

“The shortage of PPE is widely known at this point. Our health care workers are being put in the position of caring for their patients without the proper supplies to protect themselves and their patients,” the letter says.

“Some health care facilities are making dangerous recommendations informed by supply shortages, not science,” the letter adds.

Knowing all of that, Kaiser San Diego’s administration wants mid-level nurse managers to serve as equipment monitors, taking their time away from clinical duties at a time when their resources are already stretched to the limit? Kaiser’s administration wants its nurses to deliver patient care to people who could very well be infected and put their lives and the lives of their families at risk? This is insanity, and it will kill people.