Nurses and other health care workers say the vast majority of the nation’s hospitals are not prepared or equipped to protect front-line employees expected to treat patients who have the new coronavirus.

As their prime example, the National Nurses United union pointed to UC Davis Medical Center where dozens of Northern California registered nurses and health care workers were told to go home, isolate themselves and monitor their symptoms after being exposed to a patient who was diagnosed with COVID-19 after a week in the facility.

“Nurses are fighting tooth and nail with their employers to talk about the risk of exposure for any number of diseases, whether it be airborne, whether it be blood-borne,” said Stephanie Roberson, a lobbyist representing California’s registered nurses. “These types of exposures exist, and right now at one of our facilities, UCD, 36 of our nurses, 88 other health care workers have now been sent home because they have been exposed to the patient that has tested positive for coronavirus, so this is extremely alarming.”

UC Davis officials said Thursday in a post on Twitter that all 89 of the workers put in isolation would be returning to work because they had tested negative for the virus. It was the first time that medical center officials cited an exact number of those affected, but they had said the union’s figure was inaccurate.

UC Davis Health CEO David Lubarsky and UC Davis Medical Center CEO Brad Simmons issued a joint statement saying they had agreed to isolate the employes out of an abundance of caution. They said their medical team is handling this patient in the same way they manage any other individuals with highly transmissible diseases.

“We are in constant communication with the state health department and the CDC and Sacramento County Public Health about the optimal management of this patient and possible employee exposures,” Lubarsky and Simmons stated. “As we regularly handle patients with infectious diseases, we have robust infection control protocols in place to handle this patient and others with more frequently seen infectious diseases.”

Roberson, however, said this situation was not contained, “not by any stretch of the imagination.” If this can happen at an academic hospital with the capacity to deal with complex diseases, why should Americans trust that smaller hospitals will be able to successfully manage such patients?

Indeed, three health care workers who treated the same patient at a hospital in Vacaville have been diagnosed with the disease. They cared for the woman, a Solano County resident, at NorthBay VacaValley Hospital prior to sending her to UCD Medical Center. In total, at least 93 workers from Solano County hospitals are being monitored for signs of the illness.

Separately in Placer County, 10 Kaiser Permanente health care workers and five emergency responders also were exposed to COVID-19 while caring for a patient prior to diagnosis. Thus far, none has exhibited symptoms of the disease, but all have been quarantined and are being monitored, county officials said.

In Sacramento County, public health officials said tests have revealed no sign of the illness in UC Davis Health workers either, but symptoms of the disease may not manifest for up to 14 days. The UC Davis employees began their isolation on Feb. 26 but were exposed to the patient as early as Feb. 19.

‘We are right back where we were’

The issue, said leaders of National Nurses United, is that hospital protocols don’t require the maximum protections, including negative pressure rooms and personal protective equipment, even though health care providers don’t know what illness a patient may have. The nurses say the precautionary principle should apply, meaning that no action or policy should be implemented if there’s no scientific consensus about the harm it could cause, particularly if there’s the potential for catastrophic harm.

“This is not our first rodeo, quite honestly, here in California,” Roberson said. “We’ve dealt with Ebola. We dealt with H1N1, and we are right back where we were when we were dealing with those diseases and protections: lack of a plan, lack of preparation, lack of information and absolutely not the necessary equipment to protect our nurses from these diseases.”

Nurses are also concerned about training and education on things like properly using protective gear and what gear is appropriate.

Sal Rosselli, the leader of the National Union of Healthcare Workers, said hospitals have not been doing a consistent job of providing refresher courses on how to handle patients who have various infectious diseases. Several NUHW members already had treated patients with COVID-19, he said, but weren’t certain of what personal protective equipment to use in certain instances. Roselli said he was putting employers on notice that they can’t take shortcuts when it comes to providing a safe work environment for employees.

“Our union ... is formally requesting that hospitals, health clinics and nursing homes, where we represent staff, immediately provide detailed information about how they intend to identify and isolate patients with the coronavirus as well as their plans for training caregivers on how to avoid contracting the virus,” Rosselli said in a written statement.

UC Davis leaders released a statement saying that its managers are trained to make the best decisions about the use of equipment and that the medical center regularly prepares for these types of situations with simulation drills. It also has plenty of protective gear, they said.

“Managers undergo regular trainings, and requests from staff who wish to use protective gear are not refused, unless the use of such supplies is not clinically indicated,” UCD officials stated. “Requests from staff who wish to use protective gear are always fulfilled when clinically indicated for the patient’s care. There are many infection control and management measures in place at all times and the medical center always takes numerous precautions to ensure the safety of our patients, staff, physicians and visitors.”

Protecting nurses, protecting patients

Simmons and Lubarsky also have said that the Solano County patient arrived on a ventilator with orders to use droplet protection because NorthBay VacaValley doctors thought she had a virus. Since the woman had no history of travel to China, she did not qualify for diagnostic testing for new coronavirus under federal guidelines in place at that time.

UC Davis’ medical team advocated for testing, though, and four days after her arrival, the U.S. Centers for Disease Control and Prevention sent someone to take specimens. A week after she arrived, the test confirmed she had the illness.

At that time, UC Davis also implemented airborne protections to protect its staff, even though epidemiologists have said there’s no indication that the new coronavirus is transmitted through the air. Rather, it is transmitted when people cough or sneeze, sending pathogen-laden droplets onto people and surfaces near them.

If health care workers aren’t protected against infection, Roberson said, then no patient in the hospital is protected from it. The National Nurses United surveyed its membership about the level of preparedness they have seen at hospitals around the country, and of roughly 1,000 nurses who responded in California:

▪ 27 percent said their employers had a plan to isolate a patient with a possible infection of the novel coronavirus.

▪ 47 percent said they didn’t know if there was such a plan.

▪ 73 percent reported that they had access to N95 respirators on their unit.

▪ 47 percent said their units had powered air purifying respirators that could remove contaminants and supply purified air.

▪ 27 percent reported that their employer has sufficient personal protective equipment on hand to protect staff in the event of a rapid surge of people with coronavirus.

In letters late last week to state and federal public officials and to the World Health organization, nurses urged the CDC to expand the capacity to test and screen for the illness, and on Wednesday, the agency announced it would be allowing physicians to determine when to do a test. The agency encouraged them, however, to first rule out other potential causes of infection.

Nurses are also asking the federal Occupational Safety and Health Administration to issue a temporary, emergency order to protect health care workers from emerging infectious diseases such as COVID-19, and they urged Congress to mandate that Americans could get — at no cost — any vaccine that is developed.

Coronavirus is spread through contact between people within six feet of each other, especially through coughing and sneezing that expels respiratory droplets that land on people nearby. The CDC says it’s possible to catch the disease COVID-19 by touching something that has the virus on it, and then touching your own face, “but this is not thought to be the main way the virus spreads.”

Symptoms of COVID-19 include fever, cough and shortness of breath, which may occur two days to two weeks after exposure. The disease is especially dangerous for the elderly and others with weaker immune systems.

As of Thursday evening, almost 100,000 people have been infected by this zoonotic pathogen, the seventh coronavirus to spill over into the human population from animals. After the Solano County woman’s positive test revealed evidence of community spread in the United States, the CDC expanded testing and Americans are now beginning to see the extent of domestic COVID-19 infections.

The number of U.S. cases have roughly tripled to 230 in that week, and 12 deaths have been attributed to the illness, including one in Placer County, the first person in California to die of the illness. Worldwide, more than 3,300 people have died.

About 80 percent of people who get the illness will either have mild symptoms or no symptoms, public health officials say. The mortality rates will not be known until CDC officials can do population surveys to determine the number of asymptomatic and mildly ill people. The virus causes coughing, fever and shortness of breath.

“Nurses are confident that we can contain this disease and prevent unnecessary deaths and suffering,” said registered nurse Cathy Kennedy, a vice president of the NNU Executive Council. “But our employers and the government need to provide us with the right guidelines, staffing, equipment, and supplies in order for us to do this work safely. We, our patients, and the public deserve nothing less.”

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