At Providence hospitals in the Spokane area, personal protective equipment is being kept under lock and key.

Nurses and doctors are required to wear face masks for as long as federal guidelines allow.

And masks designed to filter out tiny particles – like the novel coronavirus – are reserved for only a handful of respiratory procedures.

Elaine Couture, the chief executive overseeing Providence hospitals and clinics in Washington and Montana, said the rationing measures are necessary to ensure there will be an adequate supply of personal protective equipment, or PPE, when hospitalizations due to COVID-19 surge in the coming weeks.

“There is a shortage of PPE nationwide,” Couture said in an interview with The Spokesman-Review on Monday, adding that “Providence is not alone in trying to really deal with that shortage.”

Some nurses at Providence Sacred Heart Medical Center and Holy Family Hospital have been dismayed by frequent changes in PPE policy.

The latest change came Monday, when Providence announced that local nurses and doctors may wear “cloth or personally sourced” masks when treating patients who aren’t isolated due to infectious disease symptoms.

Previously, Providence had barred caregivers from bringing in their own masks, citing concerns about sanitation. But caregivers argued homemade protective gear is better than none at all. The Centers for Disease Control and Prevention has for weeks suggested that health care workers wear bandanas or scarves as a last resort.

“As we learn more and more, we continuously are changing our policy and adjusting our operations to meet the needs of personal protective equipment,” Couture said.

Over the weekend, supervisors at Sacred Heart and Holy Family Hospital began collecting masks, gowns and other equipment from supply carts and locking those items in offices.

“We’re starting to lock up our supply of PPE, and then it’s going to be distributed to the floors,” Couture said. “And there’s a reason for that, and that’s because we’ve had people who have stolen things out of the PPE supply, and we need for that PPE to remain there for the people that need it.”

Some of the greatest concerns have centered on the availability of N95 respirators – which, unlike regular surgical masks, are designed to fit tightly around the mouth and nose and filter out tiny particles like the coronavirus. N95s are in short supply globally.

Illustrating the shortage, Couture said one Providence hospital has used about 250,000 face masks in the first three months of 2020. That’s about the same number used by all Providence facilities – 51 hospitals and more than 1,000 clinics – in all of 2019, she said.

Providence spokeswoman Liz DeRuyter confirmed N95s are being used only for patients with suspected or confirmed cases of COVID-19, and only during certain procedures when bodily fluids are most likely to become airborne. Those procedures include intubating patients to place them on ventilators, and the use of nebulizers, which turn liquid medications into a mist to be inhaled.

DeRuyter and Couture emphasized that Providence is following current CDC guidelines for reusing masks and wearing them beyond their typical lifespan. Some masks are sent to companies to be cleaned and given a second life. Hospital officials are working with manufacturers to replenish their supply of PPE. Donations of PPE are being accepted at the Spokane County Fair and Expo Center, where health officials have established a drive-thru COVID-19 screening site.

Several Sacred Heart nurses spoke to The Spokesman-Review on condition of anonymity, citing fear they might lose their jobs or face other discipline for airing concerns about Providence’s coronavirus preparations.

Several of the largest unions representing Providence health care workers in Washington – including the Washington State Nurses Association, SEIU Healthcare and UFCW 21 – this week launched an online petition calling for better access to PPE and hazard pay for those exposed to the virus, among other demands.

Similarly, the American Medical Association has urged President Donald Trump’s administration to “ensure manufacturing of PPE is operating at maximum possible capacity and create a national tracking system of acquisition and distribution of critical PPE supplies.”

“Federal coordination is necessary to ensure adequate supply and will limit situations where states compete against each other at inflated prices for limited essential supplies,” Dr. Patrice Harris, the association’s president, said in a statement Saturday.

Providence also has postponed elective surgeries and restricted visitors. Many more clinic visits are taking place by remote video feed, and some patients who might have been hospitalized in the past are being sent home to be monitored remotely. Couture said all of those measures have helped reduce demand for masks and other PPE.

Sacred Heart nurses said some of their colleagues who are accustomed to working in operating rooms are nervous about the prospect of working in the intensive care unit. Couture said if the surge of COVID-19 cases requires an all-hands-on-deck approach, those nurses likely would work under the direction of a pulmonologist, an ICU physician or a registered nurse specializing in critical care.

“Not every single nurse is going to feel comfortable to go ahead and take care of critically ill patients, and we understand that,” Couture said.