On medical front line, healthcare workers fighting coronavirus worry about their risk
In South Florida’s hospitals and medical centers, doctors and nurses accustomed to working under pressure are dealing with a new reality: a novel pathogen they know little about that has spread across the world with alarming intensity.
At Jackson Memorial Hospital, Miami-Dade’s public hospital and the largest medical center in the state, some healthcare workers have likened the novel coronavirus outbreak to the HIV epidemic of the 1980s, which was then an unknown virus filling hospital emergency rooms with seriously ill patients — with little understood about how the disease was spreading.
“I can remember going into a room with no gloves,” said June Ellis, associate chief nursing officer for Jackson Memorial. “Was I nervous at that time? Yeah, I was nervous. I was nervous of the unknown. Then you listen to those experts that start to know and learn.”
Fast-forward to the 2000s, Ellis said, and Jackson Memorial has seen an array of novel pathogens over the past 20 years that demanded healthcare workers learn on the fly.
“We went through H1N1, we went through Zika, bird flu, SARS, MERS,” she said. “Ebola was something Jackson was in the forefront for and that was unknown to us. We did the same process. We researched, we looked to see what our experts are saying. It’s lessons learned. Am I saying that every nurse here is comfortable? No. But every nurse is committed to taking care of patients.”
Healthcare workers at risk
Like other hospitals, Jackson relies on U.S. Centers for Disease Control and Prevention guidance for protecting healthcare workers during infectious outbreaks. While the CDC’s guidelines for protection say the virus spreads through droplets, the New England Journal of Medicine recently published a letter from researchers who found that the virus that causes COVID-19 is stable for several hours to days in aerosols and on surfaces.
The results suggest that people may acquire the virus through the air and after touching contaminated objects. There also are circumstances where the science is unclear, such as during intubation and other medical procedures that could cause the virus to spread through the air.
David De La Zerda, a critical care physician and medical director of Jackson Memorial’s intensive care unit, said that under those circumstances, the hospital only allows a critical care team donned with gowns, masks, gloves and other protective equipment inside the room.
“We know from experience from China and Italy, that’s where you get most of your infections, so we take extra precautions,” De La Zerda said. “We limit who can go into the room for those procedures.”
For healthcare professionals who must interact with patients, it is nearly impossible to avoid the risks of infection during a pandemic. And while the level of risk among healthcare workers is high, there is no reliable data available about how many U.S. providers have contracted the disease.
The CDC, medical groups and healthcare worker labor unions have not yet published anything about how doctors and nurses have been affected, but media reports of the virus spreading through healthcare facilities have surfaced on both coasts, in the Seattle and New York City areas.
Other countries have already experienced novel coronavirus surges on their healthcare facilities, such as Italy, where a recent study showed that about 8% of confirmed infections occurred among healthcare workers. And in China, the country’s National Health Commission said at the beginning of March that more than 3,300 healthcare workers there had been infected.
On Tuesday, Jackson Health set up tents outside its three adult hospitals in Miami, North Miami-Dade and South Miami-Dade, to triage patients who present to the emergency rooms with cough, fever, difficulty breathing and other symptoms of COVID-19, the disease caused by the coronavirus.
Any patient who requires oxygen, or has low blood pressure or a rapid heartbeat is admitted, De La Zerda said. All other patients are advised to go home and self-quarantine while technicians await test results.
Strategies for conserving supplies
As hospitals adopt new protocols for preventing infection in their facilities, they also have initiated strategies for conserving supplies such as N95 respirator masks, which provide more effective protection against aerated viruses than surgical masks — and those policies are causing concern among some clinicians who care for patients face-to-face.
At Broward Health, the public hospital system for North Broward, N95 respirator masks must be checked out as though they were controlled narcotics, according to a source who is familiar with the protocols but spoke on condition of anonymity. Nurses are also reusing goggles — one pair per shift.
Jennifer Smith, a Broward Health spokeswoman, said that in the face of a potential surge in patients the hospital system has instituted CDC guidance for preserving N95 masks and other equipment.
“The health and well-being of our caregivers is of upmost importance,” she said. “... All of our protocols are in accordance with regulatory requirements.”
At Jackson Health, nurses who work with patients suspected or confirmed of having COVID-19 also are expected to use a single N95 respirator mask for an eight-hour shift.
Guidance published by the U.S. Occupational Health and Safety Administration or OSHA say the masks can be used safely for up to eight hours.
Martha Baker, a registered nurse and president of the labor union that represents 5,000 doctors and nurses at Jackson Health, said she has not heard complaints from doctors and nurses about shortages of protective equipment.
At Kendall Regional Medical Center and other South Florida hospitals with employees represented by the United Healthcare Workers East, protective equipment is also being tightly controlled but remains available for front-line clinicians, said Betsy Marville, a registered nurse and labor organizer based in Miramar.
“Masks, gloves and other personal protective equipment are generally being controlled very closely, but so far our reports show that everyone has been provided with what they need under the latest CDC recommendations,” Marville said in an email.
A Kendall Regional healthcare worker who spoke on condition of anonymity said nurses used to typically discard their masks after a single use, just like gloves. But since the coronavirus outbreak, the new protocol is for healthcare workers to reuse masks.
“When you go into our supply room to get a mask, there’s nothing there,” the worker said. “There’s not one box of masks there. We have to go out and say, ‘I need a mask,’ and they say, ‘Where are you going?’ We say we’re going to a patient’s room. They say, ‘Here’s a mask. Don’t throw it away.’ “
Not just hospitals
As hospitals adjust policies to protect patients and workers, the science behind the coronavirus is evolving in real time — doctors who see patients in private offices have also had to adjust.
At many primary care clinics, patients are advised to call their doctors before visiting the office or use telemedicine to communicate with doctors without seeing them in person.
Dr. Jeffrey Rosen, a family physician and clinical researcher in Coral Gables, said his practice continues to care for many patients of all ages and risk categories.
“Most are in panic mode,” Rosen said. “We are trying to limit office visits for routine care, especially for at-risk patients, but we are not turning anyone away.”
Due to concerns over protecting his staff and patients from the virus, Rosen said he is having more people work from home and has implemented telehealth that will allow him to do face-to-face encounters with patients online.
“We do not have the ideal protective gear that we need for our staff’s protection but have been able to put together some gowns, masks and eye protections that will suffice when we need to take a nasopharyngeal swab,” Rosen said, referring to an instance when the risk of droplet exposure may be at its highest.
Preparing for a surge
In addition to providing for personal protection of healthcare workers, administrators at hospitals, nursing homes and other healthcare facilities are also developing contingency plans in case of a sudden spike in COVID-19 patients.
Hospitals across South Florida are restricting visitors, reorganizing patient intake, identifying resources for handling a surge and even postponing elective surgeries to clear space.
“People looking for voluntary surgery aren’t interested in coming to the hospital,” said Carlos Migoya, CEO of Jackson Health. “The beds are actually being reduced. JMH itself is the largest hospital in the state of Florida by beds. We are also blessed to have a number of negative pressure rooms in the emergency department, ICU and regular patient beds. We are utilizing all of that.”
Migoya said Jackson Memorial recently moved its rehabilitation patients into a new facility on campus — freeing the former rehabilitation hospital as a possible place to house COVID-19 patients in the event of a surge. And he said that Jackson has joined with all of Miami’s major hospitals, including Baptist Health South Florida, Mount Sinai Medical Center, and Nicklaus Children’s Hospital, to form a consortium and share information with each other.
If there is a surge, then hospitals and healthcare facilities will rely on doctors and nurses who may already be challenged by events outside the workplace, such as school closures and child-care needs.
Gino Santorio, CEO of Broward Health, said this week while delivering an update on his hospital system’s response that he was pleasantly surprised that there were no call-outs of doctors and nurses and other healthcare professionals, and that many had leaned on their colleagues for child care and other needs.
“We’re a close-knit family here,” he said. “They’ve been able to work with each other and find alternate arrangements for their children. I can appreciate that as a new dad myself.”
For Jackson Health workers, Miami-Dade schools have committed to keeping one school open near each of Jackson Health’s three hospitals to serve the children of healthcare workers, said Matt Pinzur, a spokesman.
“We have roughly 100 kids spread among three schools,” he said.
With South Florida as the epicenter of the state’s coronavirus outbreak, and hospitals and healthcare workers at the ready, Migoya said doctors, nurses and other front-line personnel have adopted a mindset that is aware and committed to its mission.
“Is everybody concerned? Absolutely,” Migoya said. “What you don’t find around here is panic. No one here is panicking about all these things. Are people afraid? Of course. You need to be afraid. But people are taking their action. We do have a great response of people.”
Miami Herald Staff Writer David Smiley contributed to this report.
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This story was originally published March 18, 2020 at 3:58 PM.
