When the coronavirus struck Pennsylvania, news that hospitals couldn’t get the personal protective equipment (PPE) they needed spawned grassroots efforts to collect and donate masks, gowns, gloves, and hand sanitizer to frontline medical workers. Now it’s been three months, and they are still at it.

“We thought we were just going to collect a little bit,” said Artika Saharan, a Jefferson Jefferson University medical school student who helped found the charity PPE to PHL, and still is hard at it.

Health-care experts say the disrupted supply chains that left doctors, nurses, and other medical personnel treating COVID-19 patients without proper gear have improved, but not enough as cases surge in the South and West, and the threat of a second wave in the fall looms.

Large hospitals seem to be better supplied but still rely on charity to ensure safe operations. The City of Philadelphia still suffers through canceled orders for essential gear. Other sectors of health care, like physicians’ practices and long-term care facilities, are also having trouble obtaining PPE in a market that caters to large health systems that can buy in bulk.

“When you see big practices and little practices like ours that are depending on Amazon, that’s bad news,” said Max Mercado, one of two doctors running an internal medicine practice in Philadelphia.

Meanwhile, the public focus that drove donations of cash and material is drifting.

“A big part of that has been coronavirus has slowly started disappearing from the news and from social media,” said Anna Goodwin, who is collecting masks for Temple University Hospital, where her father is a doctor. “People have just straight up become bored of isolating and quarantining and social distancing.”

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Early in the pandemic, the Trump administration left states to compete on the open market for gear. Since then, the Federal Emergency Management Agency has delivered nearly 100 million masks nationwide, with nearly 10 million of those going to New Jersey and Pennsylvania, as of June 11. The demand still outstrips supply, though, and this month American Medical Association representatives and Washington Gov. Jay Inslee told Vice President Mike Pence about the supply problem.

When PPE to PHL began, Saharan said, the group coordinated with the city health department to find out where the need was greatest — which initially was hospitals and larger care facilities.

Hospital workers expressed frustration and anger at being denied N95 masks, which filter virus-size particles, or having to wear the same mask — which once would have been disposed of after a single use — for days.

At Delaware County Memorial Hospital, Angela Neopolitano, president of the nurses’ union, said clinical workers treating COVID-19 patients were given just one N95 mask for three days of work for weeks. Recently though, all staff working with COVID-19 patients have been receiving a new mask at the beginning of every shift.

Temple University Hospital workers complained of getting Chinese-made N95 masks that fit poorly and were prone to breaking. The state Department of Health eventually barred those masks from hospitals.

Since then, the situation at Temple has improved, said Maureen May, president of the Pennsylvania Association of Staff Nurses and Allied Professionals. The maternal health nurse at Temple said she recently received a standard N95 mask from the hospital.

“First time I have seen an N95 since the beginning of the COVID crisis in Philadelphia,” May said.

The Hospital and Healthsystem Association of Pennsylvania (HAP) reports even some large hospitals are still challenged. Children’s Hospital of Philadelphia, for example, is soliciting donations of cloth masks to give to arriving patients, a spokesperson said.

A survey from HAP found more than three-fourths of all hospitals anticipated shortages of N95 masks, gowns, cleaning supplies, eye protection, and other safety equipment.

“Hospitals continue to consistently report paying exorbitant prices, significant delays in the delivery of supplies, and partial fulfillment of orders,” said Rachel Moore, a spokesperson for the organization.

Project N95, a nonprofit devoted to helping health-care personnel find reliable PPE, has seen signs of improvement, though. Some Chinese-made masks were among those that didn’t make the list of FDA-approved respirators, said Anne Miller, Project N95′s sourcing team leader. And an increased supply has started slowly bringing down prices.

Philadelphia’s Department of Public Health has been supplying PPE to municipal workers and some health-care facilities, and has seen improvements since the beginning of the pandemic, when huge mask orders simply never showed up. Now some items, like hand sanitizer, have become easier to find, said Mike Dunn, a city spokesperson. Others, like disinfectant wipes that are effective against COVID-19, are more scarce, and N95 masks continue to be challenging to obtain.

“Obviously the market could change adversely if the troubling trends seen now in some Southern states grow wider,” Dunn said.

For charitable groups, the focus of support has shifted to smaller nursing homes, long-term care facilities, and hospices. They also shifted from collecting donated equipment from area businesses to using financial donations to buy gear themselves.

» READ MORE: Philly ordered a half-million masks to protect first responders and hospitals from coronavirus. They never arrived.

“I think we knew from the beginning that we would have to change and adapt as we ran out of businesses to call,” Saharan said. “We changed what we’re giving now and who we give it to, but there’s still stuff they need.”

At Inglis House, a long-term residential facility in Philadelphia for people with physical disabilities, 44 of 238 residents contracted the virus and seven died, according to state data. Donations from groups like PPE to PHL have been invaluable, said Gary Bramnick, the home’s director of communications and marketing. Even cloth masks are welcome, since they go to nonclinical staff, he said, freeing up higher-grade masks for staff who work directly with residents.

Yet PPE troubles persist.

“While the pipeline and the supply chain and those processes are improved,” Bramnick said, “they’re not there yet.”

Between the increased need for protective equipment and higher costs per unit, he estimated the home has been paying 32% more for PPE recently compared with the same period last year.

Smaller physician practices have the same problem. PPE vendors who were reliable before the pandemic have still not stabilized their supplies, so doctors are paying up to 10 times as much for material through sites like Amazon, said Mercado, the Philadelphia doctor.

“When it comes to hand sanitizers, it’s on back order,” Mercado said. “When it comes to masks? Back order.”

Small practices like Mercado’s are particularly vulnerable, said Miller of Project N95, because many suppliers require orders be a minimum of a thousand, or even tens of thousands, of units.

Project N95 is trying to remedy this by bundling orders from small practices around the country and organizing a bulk order that can then be distributed.

Goodwin, who has tried to help Temple Hospital, is concerned that the declining cases in Southeast Pennsylvania have meant fewer donations, and less awareness of the need for PPE.

“A lot of people are predicting a second wave of shutdowns and quarantines,” she said. “The need is still there.”

She and Saharan will keep going.

“I would love for the pandemic to end and our services to not be needed,” she said. “That would be amazing.”