If the state doesn’t act soon, physicians are concerned hospital workers will run out of the supplies needed to treat patients as the COVID-19 pandemic sprawls across Missouri.

The Missouri State Medical Association, which represents all physicians across the state and has around 4,000 members, sent a letter Monday to Gov. Mike Parson asking for a statewide shelter-in-place order.

That order, the letter said, will buy time as the disease spreads through the state. On Wednesday, the Department of Health and Senior Services reported that there were 356 confirmed infections in Missouri, up 101 from Tuesday.

Dr. Albert Hsu, an MU Health Care obstetrician-gynecologist and president elect of Boone County Medical Society, said a shelter-in-place order is like setting speed limits.

“When you set the speed limit at 60, most people try to stay under 65,” he said. “When you set the speed limit at 80, most people try to stay under 85.”

Boone County and the state’s other three largest metropolitan areas are already under stay-at-home orders, comprising about 45 percent of the state’s population.

“If things progress as is, COVID-19 patients will deplete the state's available hospital beds, ventilators and precious personal protection equipment, the medical society’s letter said.

Parson in his daily briefings, has resisted the pressure to issue the order.

Parson has banned gatherings of more than 10. But that still allows meetings of 9. Hsu referenced the 1918 flu pandemic, comparing the cities of Philadelphia and St. Louis. While St. Louis was able to “flatten the curve” and prevent a spike in cases through preventative measures, Philadelphia held a parade on the cusp of the pandemic.

“Right now, there's a lot of urgency,” Hsu said. “Not having a shelter-in-place is not quite having a parade, but it could be close.”

A shelter-in-place order would only allow people to leave their homes for essential activities, like going to the grocery store.

Ophthalmologist Dr. Amy Zguta stopped performing non-essential surgeries last week Tuesday. Boone Hospital and MU announced the official cancellation of most elective procedures Thursday.

Zguta is still seeing urgent and emergency patients, and said she plans to share extra masks with other colleagues in need, like her brother-in-law, an emergency medicine physician at SSM-St. Mary’s hospital in Jefferson City.

Right now, she said, he is storing paper bags over his masks and other protective equipment in separate paper bags in an attempt to preserve them.

“A lot of us feel betrayed that it even was able to get to this level,” Zguta said. “And now we feel betrayed by the lack of supplies we need to do our jobs and protect our lives at the same time.”

Zguta said she has heard from colleagues that some physicians are being allotted a single N95 mask that leaders at the University Hospital hope will last for the entirety of the pandemic.

“That's not appropriate,” she said. “We are no longer applying universal precautions because supplies are scarce.”

MU Health spokeswoman Jesslyn Chew said the hospital is following “strict, evidence-based protocols for mask usage.”

Masks can be re-worn between isolation patients if they remain on the face, untouched and intact, she said.

“If face masks are touched, taken down or moistened, then they must be changed,” she said.

Jeff Howell, general counsel and director of government relations for the Missouri State Medical Association, which represents physicians, said the state is on its way to running out of gear.

“On the current trajectory that we're on, we're going to run out of personal protective equipment,” he said. “Now, there's been a lot of talk about reusing it and things like that, but it's not intended to be used that way.”

Although Howell doesn’t know exactly when certain hospitals are going to run out, he said they are already making plans for when it happens.

“My wife's a nurse,” Howell said. “She just sent me to Walmart to look for this like — I don't know what it was made out of — some type of jumpsuit in the painter section. And of course Walmart was sold out of that.”

Health care workers need protections, he said.

“The physicians and nurses that work in the hospitals, they're going to be the ones that catch this disease from the patients,” Howell said. “And that creates a workforce problem.”

Christy Bertelson, a former St. Louis Post-Dispatch reporter and speech writer for the governor, tweeted Monday asking for a mask for her daughter, a nurse at University Hospital.

“My daughter is a nurse working in the COVID-19 ICU at the University Hospital in Columbia and like so many others has to reuse her N95 mask due to the shortage. If anyone has even ONE that I could purchase please contact me directly. Thank you,” she wrote.

On Tuesday, the MU Health Care said in a press conference they have enough for the time being, but are accepting donations from university partners and nearby quilting guilds that have volunteered to sew masks for employees.

Emails from Boone Hospital and Truman VA say they have enough supplies for now, but acknowledge that shortages are happening across the country.

There could also be a looming shortage of hospital beds.

According to an analysis by the Harvard Global Health Institute, the Columbia hospital referral region, which includes Kirksville, Sedalia and Jefferson City, has around 1,890 beds overall for a population of around 560,000 people.

On average, around 900 of those beds are available at any given time, and 1,400 are potentially available, the analysis said.

The area has around 200 ICU beds. At any given time, around 80 of those are available. If the hospital reduces its number of non-COVID ICU patients by 50%, around 140 could be available potentially.

The analysis makes projections about capacity based on best and worst-case scenarios. In a best case scenario, where 20% of the region’s population becomes infected with the virus over an 18-month period, 56% of the area’s average available beds will be needed, while 143% of the area’s average available ICU beds will be needed.

In a worst-case scenario, where 60% of the population is infected over a six-month period, 519% of the area’s average available beds will be needed, while 1,318% of the area’s average available ICU beds will be needed.