As Quebec's supply of disposable isolation gowns runs low, the health system, manufacturers and distributors are racing against the clock to make the switch to reusable ones.

Premier François Legault said earlier this week that, following concerns over masks and face shields, the province is now facing its most critical shortage in disposable isolation gowns, the type of garment generally used to protect health care workers caring for COVID-19 patients.

Legault said the province is looking at the possibility of using more reusable gowns in the health care system instead.

Jeff Courey, president and CEO of George Courey Inc., a Montreal manufacturer and distributor of textile products for the hospitality and medical sectors, has already seen demand skyrocket for reusable gowns and other personal protective equipment.

"We usually kept between 75,000 and 100,000 reusable isolation gowns in stock in case of an emergency," he said. "Within the first two-three days, we were pretty much sold out."

Not once, he said, has the company's emergency stockpile run out before.

"Never, not even close." 

George Courey Inc. is now producing 500,000 reusable isolation gowns — about 10 times as many as the company usually sells in a year — for the North American market, mostly from its facilities in China.

The company is working to get them to market "as soon as possible" but faces challenges, including competing with manufacturers all over the world to secure air transportation to get products here more quickly.

Some Quebec distributors that normally import disposable gowns from China are now making the switch to Quebec-made reusable gowns instead.

Marc Forget, president of Médi-Sécur, a medical equipment distributor for Quebec's ambulance operators, including Urgence Santé, saw the writing on the wall three weeks ago, when his clients started telling him they were facing shortages of personal protective equipment.

Forget is out of stock in disposable gowns and has been unable to import any from his usual sources in China. 

Several other Montreal distributors also list disposable gowns as out of stock on their websites.

"[Stockpiles] are melting like snow in the sun," said Forget. "They're on the verge of running out."

That's why Forget's company has already begun delivering thousands of reusable, fluid-repellent gowns manufactured in Quebec to paramedics and other first responders.

Forget said the specialized fabric to make those gowns can be imported from China or the United States, and they've had no problems sourcing it.

But another Quebec company has pivoted from agricultural and other industrial textiles to develop its own made-in-Quebec fabric for use in medical gowns.

Francois Pépin, director of Laval-based company Soleno Textiles, said his company is working with Tricots Maxime of Baie-d'Urfe and Steadfast Inc. in Granby to develop the material, while Quebec uniform manufacturer Logistik Unicorp is currently working prototype blouses.

"We would be ready to start producing [the textiles] tomorrow morning," Pépin said, adding that his company has enough capacity to produce millions of metres of fabric without any difficulty.

Making the switch to reusable gowns would come with some logistical changes, but would be manageable, according to distributors and others in the healthcare system.

But Forget, a former paramedic, believes the reusable gowns have the advantage of being sturdier, as they won't tear as easily.

Courey, whose company only deals in washable and reusable products, said in addition to helping solve the current gown shortage, switching to reusable gowns would be better for the environment.

He said what are known as level two reusable gowns, those with a higher level of protection against bodily fluid, can be washed 75 to 100 times before the protective coating wears down and they need to be replaced.

"After every single wash, things like surgical garments are checked one by one, usually over a light table," he said. "You can see some light shining through when there's even a small pinhole."

Dr. Yves Longtin, infectious diseases specialist and chair of infection control for the Jewish General hospital, said most hospitals made the switch from reusable to disposable gowns about a decade ago for cost reasons and because staff were more comfortable with the idea of using a new gown each time. 

"There can be body fluid on them that you need to wash and get rid of. There can be stains on them," Longtin said.

Longtin said the Jewish General Hospital never got rid of its reusable gowns, so it does have some available to use once the stock of disposable ones gets too low. 

He said level one gowns, those without a fluid-resistant coating, are sufficient to protect personnel in most situations dealing with COVID-19 patients.

"From an infection control perspective, they are both acceptable. It is safe to use a reusable gown," he said. "I'm pretty sure that in the context of a shortage, health care workers will understand and will adapt readily."

He said it would require only minor adjustments for staff, such as remembering to untie the gowns before removing them, instead of ripping them off to dispose of them.

He said the main factor will be the logistics of getting them laundered.

"Whenever you wash them, you have to make sure there are no holes in them, that there are no needles in them, forgotten by a healthcare worker," he said.

The Jewish General hospital has its own laundry facility in house, but most other Montreal hospitals and many care homes send their linens to the Montreal Central Laundry, a non-profit organization.

Raymond Morel, who runs the laundry facility, said even if every disposable gown in Montreal was switched out for a reusable one, it would only amount to an additional five tonnes of laundry, on top of the 50 tonnes his facility usually handles.

The laundry is also only operating at 75 per cent of its capacity right now, because so many hospital beds have been freed up and so many elective surgeries have been cancelled, so fewer linens need to be sterilized.

Though Morel has had no official order from the ministry to start stockpiling reusable gowns, the hospitals have been asking the laundry for them, he said. 

Before the pandemic, Montreal Central Laundry had a small emergency stock, but not enough for its 45 health care centre clients. Now it's a scramble to get more, before hospitals run out of disposable gowns.

"I managed to put my hands on a small supply [of gowns] that should be coming in next week," he said, adding that he's also trying to source washable surgical masks.

Ultimately, one of the chief benefits of switching to reusable gowns at this point would be the peace of mind that a stable supply would bring to health care workers, according to Dr. Matthew Oughton, infectious diseases specialist at the Jewish General Hospital. 

"To me, PPE is the armour that your soldiers are wearing," he said.

"You want to know that the armour is safe and effective, but you also want to know ... that armour is going to be there whenever you need it. Not just right now, but it's going to be there tomorrow when you show up at work, and the day after and the week after."

He said the shortage of medical equipment during this pandemic should be a wake up call that Canada needs to develop its own domestic supply chain that's less reliant on imports. 

"We're getting there, but we need to be able to ramp up more quickly than this for when this happens again," he said.

"And, yes, I said when and not if."

Ainslie MacLellan is a journalist at CBC Montreal. Follow her on Twitter: @CBCAinslie.

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