On Friday, Mount Sinai Health System announced in an email to staff that it had its first “big breakthrough.” But it was not about new drug trial nor a medical advancement. Instead, it was about the restocking of supplies, in particular, the procurement of N95 masks, one of the most precious medical commodities in the era of coronavirus.

“In our first big breakthrough, at 3 a.m. this morning, two airplanes landed at Teterboro Airport with about 130,000 N-95 respirator masks,” Dr. Vicki LoPachin, Mount Sinai’s chief medical officer, wrote. “That approximately doubles our supply. I will save the heroic story about what it took to get this done for another day. I promise you it is worth the wait.”

The arrival of the masks comes after Mount Sinai workers have spoken out about a lack of personal protective equipment this week following the death of Kious Kelly, the nurse manager at Mount Sinai West

One emergency room doctor at a Mount Sinai hospital in Manhattan said that last week, hospital staffers were being given only N95 mask per week with no specific guidelines on how to clean it.

“We were trying to clean it and put it back on our face. It smelled terrible and who knows if it was even working," said the doctor, who asked that his name be withheld because he did not have permission to speak to the press.

The story about Kelly’s death and the rationing of personal protective equipment at one of the city’s premiere hospital systems is a reflection of some of the hard and shocking changes that healthcare workers, even those in typically well-resourced facilities, are grappling with during the COVID-19 crisis. Mount Sinai has a major presence across the city with hospitals and clinics in Manhattan, Queens, and Brooklyn, including The Mount Sinai Hospital, a 1,134-bed teaching hospital in Harlem. Mount Sinai became the largest private hospital system in the city following its 2013 merger with Continuum Health Partners and serves a wide swath of New Yorkers, from the poorest to those able afford the best medical care.

The emergency room doctor at Mount Sinai said he has seen a surge in coronavirus patients at his facility. He said the shortage of personal protective equipment isn’t as dire as it was a week ago, but that he still has to ration gear in alarming ways.

Now, he explained, he is able to switch out his N95 mask once a day (still far less frequently than he would have before) and wears a surgical mask on top of it that he changes out between patients. “I have one face shield, too, and I’m carrying it back and forth from work like it’s my lunch bag, trying to wash it down with Clorox wipes,” he described.

While he is encouraged by the increase in supplies and the broad efforts of his colleagues and the public to find new suppliers, he said he still feels under-protected.

“Working in this country, I don’t think any of us thought we’d even be contemplating rationing lifesaving resources,” he said. “A lot of us, myself included, are having trouble even processing that.”

City officials have said that hospital workers are adapting to a new reality where the future looks frightening and uncertain.

During a press conference on Friday, Dr. Mitchell Katz, the head of New York City’s public hospital system, adamantly asserted that the city has not run out of personal protective equipment but that supplies are being rationed in order to make sure that doesn't happen.

"They don't mean we don't have enough supplies at this moment," he said. "They mean we're not going to have enough supplies to get through this unless there are major restocking.”

Hospitals need to plan ahead. In fact, the supplies that arrived on Friday will make up only a small fraction of the gear that the hospital system will need over the course of the pandemic, according to LoPachin.

The health system expects to receive an additional 350,000 N95 masks within the next two days, along with 1.2 million surgical masks, LoPachin said, adding, “And we are seeing similar progress on gowns, gloves, face shields, and the like.”

But, she cautioned, “We are not out of the woods yet.”

LoPachin projected that the health system will need 3.5 million N95 masks and 20 million surgical masks before the coronavirus crisis is over.

As of Thursday afternoon, Mount Sinai was treating 767 patients who had tested positive for COVID-19 systemwide, up from 393 the previous Sunday, according to updates that leadership shared with hospital staff. There were 144 patients in Intensive Care Units, with 53 ICU beds remaining open (on Sunday there were 89 patients in the ICUs and 60 ICU beds open). Another 134 hospital inpatients were under investigation for COVID-19 Thursday.

The doctor who spoke to Gothamist said he’s particularly concerned about inadequate protective gear given that hospital staff also aren’t being regularly tested for coronavirus. Mount Sinai has developed its own rapid test for the disease, which can be processed at an in-house lab within hours. But, in line with city and state guidance, the health system is heavily restricting who can be tested.

Hospital staff are being instructed to take off from work when they experience symptoms. But he worries staff who are asymptomatic could be routinely exposing patients and each other to the disease.

“There are a few people in the hospital who have gotten sick and it’s been obvious and they’ve gone home, but the day before, I was working with them and eating in the lounge together and then gowning up to go [treat patients],” he said.

“We are following New York City and New York State guidelines that apply to health care workers and the general public, which restricts testing to acutely ill patients and those who are potential plasma donors for the convalescent plasma program that has begun at The Mount Sinai Hospital,” a Mount Sinai spokesperson said Friday. “As priorities shift in the coming weeks, Mount Sinai has the capacity to perform additional testing, and we will do so, as directed from our city and state officials.”

The city has reasoned that most people should not get tested for coronavirus because going in for the test could eat up valuable health care resources and put others at risk.

“But we should at least be testing health care workers,” he said. “If I get sick, I’m going to infect hundreds of people before I even know I have something.”

He felt that so far staffing has been adequate at his hospital and workers have been able to sign up voluntarily for extra shifts to handle the surge in coronavirus patients. But he worried that there could be a shortage in a couple of weeks—when researchers predict the demand for health care services will peak—because staff are being exposed to the disease without being tested now.

“As of now, we don’t have a significant amount of staff out sick,” he said, “but I think we’re all pretty worried that’s going to happen at some point and we’re going to be stretched thin.”