CLEVELAND, Ohio — When he gets home from work, Dr. Prakash Ganesh rushes past his 19-month-old daughter, Pia, and heads straight for the basement laundry room, where he deposits his clothes.
As he dashes upstairs to shower, Ganesh hears his daughter’s cries. But he can’t stop to soothe her.
He’s spent the day in the field collecting swabs to test for the novel coronavirus, and he doesn’t want to risk exposing his family — his daughter and pregnant wife — to the highly contagious infection.
Even though he wears a gown, a mask and gloves, when he tests high-risk populations, like nursing home residents and other health care workers, he still wants to take as many precautions as he can.
“At times, I do come home from testing people, and I’m scared to hug and kiss my daughter or my wife,” Ganesh told The Plain Dealer. “Every time we swab somebody, we start thinking about the symptoms of the people we’re talking to. It’s just scary to bring it home.”
Ganesh is a family and preventive medicine physician at Neighborhood Family Practice. But he’s volunteered to be on the front lines of the Cuyahoga County Board of Health’s coronavirus response.
“We all go into this hoping to take care of people,” Ganesh said. “Thinking about the greater good for the community would be my motivation for putting myself at risk.”
Ganesh’s reality is one that thousands of local health care workers face: a balancing act of protecting their families and serving their communities during a global pandemic.
In Ohio, 17% of all confirmed cases of COVID-19, the disease caused by the coronavirus, involve health care workers, Ohio Department of Health Director Dr. Amy Acton reported Thursday. That includes physicians like Ganesh but also dietitians, home health care workers and emergency responders. The numbers could be overestimated, Acton explained, because health care workers are tested more.
“Their risk is just as high as that of older populations,” said John Palmer, spokesperson for the Ohio Hospital Association, noting the exposure level a lot of health care workers have is through patient interaction.
The state gets information on the number of health workers affected by COVID-19 from local health departments, which call and interview people who test positive for the virus.
Starting today, the Cuyahoga County Board of Health is now sharing local level data. In the county, health care workers represent 26% of the positive coronavirus cases, said Dr. Heidi Gullett, medical director for the board of health.
A personal risk
Medical professionals are prepared to deal with infectious diseases and respond in emergency situations. But with the coronavirus, they face a new challenge.
“I think the fear for most nurses is we’re coming home to our families … Since this is so easily spread, you can bring this home,” said Doug Meredith, an ICU nurse at Cleveland Clinic Akron General and co-chair of the Professional Staff Nurses Association unit. “That’s where it crosses a different line than say a disaster like a tornado or a mass casualty.”
Because the coronavirus is new, there is no immunity to it.
The state is projecting shortages of personal protective equipment, known as PPE, which means health systems are trying to conserve gear. Even the U.S. Centers for Disease Control and Prevention has put out relaxed guidelines for health care workers because of the scarcity, which is already being experienced in places such as Seattle and New York City. To try to address the problem, Cuyahoga County Executive Armond Budish today pledged $1 million to purchase additional PPE.
Some medical professionals, like Meredith, are being told to reuse their N95 respirator masks, which are designed to be single use, and that worries him.
Meredith is one of the many health care workers who has made the tough decision to separate from his family to keep them safe. He hasn’t seen his children, his grandchildren or his girlfriend since the coronavirus pandemic hit Ohio on March 9.
“It takes an emotional toll, and we’re just in the beginning of this,” Meredith said.
Earlier this week, Gullett acknowledged those sacrifices of health care workers. During a coronavirus media briefing, she shared that she is living separately from her husband, who is a physician in a local emergency department.
“We are one of thousands of health care families making these decisions every day,” Gullett said. “Many, many families have made this decision.”
She can’t risk getting sick and being unable to lead the county’s response effort or infecting her coworkers doing the work, too.
In Toledo, the health commissioner is in self quarantine after two Toledo-Lucas County Health Department staffers tested positive for COVID-19 and another two are presumed positive, as well.
“You see how this goes. It’s a domino effect,” Gullett said.
Those working directly with COVID-19 patients are in close contact with them for several hours during a shift, said Meredith, who worked a 16-hour shift Wednesday night to handle the increased demand in his unit. In one night, he might spend six to eight hours with a person who tested positive for the disease, going in and out of the patient’s room. He worries about making a mistake in putting on or taking off his PPE.
“That’s the kind of risk you’re putting yourself at. PPE’s not perfect,” Meredith said. “ You have to enter a room emergently. If you make a mistake with PPE, you open yourself up.”
Some workers, Ganesh said, even take off their work clothes in their garages to try to keep any potentially contaminated clothes outside and away from their families.
Maintaining a health care workforce
As the health care system prepares for the surge, which Acton said, based on recent modeling, could be late April to mid-May, they are trying to ensure there’s a workforce to handle it.
Statewide, elective surgeries have been banned to preserve resources – both gear and workers. Many medical visits have been converted to phone and video appointments.
MetroHealth Medical Center has closed several of its medical offices “to redeploy staff to other locations or departments as necessary,” a spokesperson said. These include health centers in Brunswick, Gordon Square, Medina, Rocky River and North Royalton, as well as Discount Drug Mart sites in Independence, North Royalton, Olmsted Falls and Parma Heights.
Similarly, at the Cleveland Clinic, there are plans to move staff, known as caregivers, “where they are most needed” in the community, a spokesperson said.
“These reassignments will be temporary as needs present going forward,” the spokesperson said.
The CDC has relaxed its guidelines for health care workers exposed to the coronavirus and now allows those who are exposed to return to work, unless they develop symptoms.
“As the virus continues to spread throughout our communities, it is important to return personnel to work as soon as possible so we can continue caring for our patients,” the Clinic said in a statement.
At University Hospitals, where Ganesh also works as the preventive medicine residency director for the Case Western Reserve University program, more than 26 health care workers have tested positive. Statewide, there are 145 health care workers who have tested positive for COVID-19, ODH said.
Dr. Robert Salata, program director of the UH Roe Green Center for Travel Medicine & Global Health, said the system is carefully tracking health care workers. When symptomatic, they’re being tested for COVID-19, even if they haven’t had known exposure because of the widespread community-level transmission of the disease, he said.
Ganesh, who tests people, including health care workers, in high-risk locations like nursing homes and assisted living facilities where the possibility of spread is high, sometimes will perform tests outdoors, while workers are in a car, or even in an auditorium because there’s a lot of open air.
Serving during the time of coronavirus reminds Ganesh of the four years his family spent in Malawi, a country in Africa.
“It’s interesting to come back to this setting where I have to wear an N95 mask to work,” said Ganesh, who wore a respirator to work while treating tuberculosis patients. “I was always concerned about bringing that home to my daughter. Now, I’m facing that challenge again, where I’m worried about bringing coronavirus home.”
Help on the way
To support health care workers and their families, a group of medical students at Case have created a database of student volunteers who are able to care for children and pets, cook meals and make grocery and coffee runs.
The students came up with a way to match the helpers with the healthcare worker. Students share which types of services they can provide and when, and health care workers submit their needs. Then, they are matched, much like medical students are matched with residency programs, said Mitchell Thom, a first-year medical student and part of the nine-person team coordinating the volunteer effort.
In about a week, 120 volunteers have signed up, and there have been about 30 matches with workers in the field.
“There’s just so much enthusiasm and eagerness from the student body to help, to be able to give back in some way,” said Lyba Zia, a third-year medical student and an organizer of the initiative. “I think a lot of people really appreciate the idea that there is this group of people who are willing to help.”
Read more about the student volunteer effort: Case Western medical students match with health care workers in need during coronavirus pandemic
Plain Dealer reporter Rachel Dissell contributed to this story.
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