The federal government says that if someone in your household tests positive for the new coronavirus, you should stay home.
“Don’t go to work,” the Centers for Disease Control and Prevention guidance says.
Unless you’re a health care provider, that is.
Some medical professionals exposed to the virus can “continue to work after options to improve staffing have been exhausted,” the same agency said in guidance revised on March 7.
In other words, as the nation fights a virus that people can have with no symptoms, the federal government is making it easier for doctors and nurses to spread the disease than it is for the average person.
That fact, combined with a shortage of masks and other equipment, could make the coming weeks an especially dangerous time for the people charged with keeping America healthy. Faced with that challenge, some Buffalo-area medical practices are already temporarily shutting down or scaling back services.
Hospitals and the people who work in them don’t have that choice, no matter how scared they are about the new federal rules and the equipment shortages.
“It doesn’t feel safe,” said Kena Collins, an intensive care nurse at Erie County Medical Center. “And to me, it’s immoral. It’s immoral to put people at risk.”
The new rules
Local health care professionals say the worst is yet to come. More and more Covid-19 victims will likely flood into area hospitals in coming weeks — and they say that’s when, under a new federal guidance, their work could become much more dangerous.
That’s partly because of the revised guidance the CDC issued March 7.
The agency previously said that if a medical professional who was not wearing protective equipment were to come into contact with a Covid-19 patient, that health care professional should not work for the next 14 days to make sure he or she doesn’t spread the disease.
But under the change, those exposed health care providers can keep working so long as they don’t have symptoms if the medical facility desperately needs them to work.
The CDC did not respond to inquiries about the policy change, but hospitals and other health care providers had been pushing for it, fearing they would run out of staff amid the coronavirus crisis under the old rules.
That’s a legitimate fear, said Dr. Myron Glick, founder and chief executive officer at Jericho Road Community Health Center in Buffalo.
“Anyone who argues against that just doesn’t get a sense of where this is going,” Glick said. “If you went by exposure alone, we would soon lose everyone (on the staff)…And we need folks who are well to be able to do the job.”
But the change in policy also bears with it a great risk, said Debbie Hayes, a nurse who serves as regional director for the Communications Workers of America local that represents nurses at Catholic Health and the Visiting Nurses Association.
“The biggest concern is, is that you could have someone who is exposed who shows no symptoms initially and then continues to work, and possibly exposes other nurses and health care workers that are working, or other patients,” Hayes said.
What’s more, the CDC’s move gave hospitals an excuse to skimp on protective equipment, said Lisa Baum, occupational safety and health representative for the New York Nurses Association.
As soon as the CDC changed its guidelines to allow health care workers who had been exposed to the virus to keep working, “we immediately got calls saying: ‘What’s happening? They’re physically taking our respirators off our unit'” to save those protective masks for future use, Baum said.
She said that came as a shock to nurses who used the protective masks known as respirators to protect themselves when serving Covid-19 patients.
Nurses told Baum: “They said I needed that equipment to protect me yesterday but now they say I no longer need it to protect me.”
Already in Buffalo, health care managers worry about a looming shortage of respirator masks and other masks used in a medical setting.
Kaleida Health and ECMC went so far as to appeal to the public on Saturday to donate masks. Medical facilities have also taken strict conservation measures, especially regarding the N95 respirator mask, which is specifically designed to filter out small particles like viruses.
“We’re being told not to wear the N95 mask, that the surgical masks are sufficient enough,” said Collins, the ECMC nurse, who also serves as regional director of the New York State Nurses Association and chairperson for the union at ECMC.
Supplies of masks and other personal protective equipment at ECMC would run out “in a couple weeks” if there were a surge of Covid-19 patients, said spokesman Peter Cutler. The hospital is working with the county and the state to boost supplies, he said.
Meanwhile, Kaleida Health had been keeping much of its supply of N95 masks locked away in a secure location, Tim Kornacki, Kaleida Health’s director of emergency management, said just prior to the first case being confirmed in Erie County.
“We ordered way above our par levels for the N95,” he said earlier this month. “I anticipated they would be harder and harder to get.”
Catholic Health has been stocking up on those masks, too.
“I think we’re in decent shape, but it’s a challenge,” said spokeswoman JoAnn Cavanaugh.
Even keeping enough surgical masks on hand is a challenge, as some hospital employees take to using them all the time.
Kaleida Chief Medical Officer David Hughes said Kaleida employees recently used 3,500 surgical masks in a 24-hour period.
“That’s too many,” he said.
Kaleida spokesman Michael Hughes shared a flier that was circulated to staff, offering guidelines on when masks are needed, and if they are needed, which ones employees should be wearing.
“There is no need to wear masks routinely, especially when not in contact with patients,” said the notice in bold type.
And it’s not just hospitals that face a looming supply shortage. So do nursing homes and smaller medical practices.
At ECMC’s Terrace View Long Term Care nursing home facility, staffers are going through 1,500 surgical masks a day, Cutler said.
“If we do not identify sources to increase supplies in the coming week, we will need to look at rationing of PPE equipment,” he said, referring to personal protective equipment.
Jericho Road Community Health Center is also looking to buy additional masks.
“We even honestly looked at the possibility of having some of our supporters sew masks for us, you know, from cloth,” Glick said. “But that’s a challenge because they’re not nearly as good as the regular mask.”
Adding it all up, health care workers across the state are worried.
“We know from studies and reports that have come out of a number of countries that have had large numbers of cases that having the right personal protective equipment is key to protecting healthcare workers,” said Baum, of the Nurses Association. “And where you see inadequate protections, you have enormous numbers of healthcare worker infections.”
Fearing that, some healthcare workers are dialing back – either staying at home or preparing to quit or temporarily closing their practices
A social worker at a local nursing home, who asked not to be identified by name, said she only gets one surgical mask per day. By the end of the day, “we know they’re saturated,” she said. “You know they’re not protecting us.”
That being the case, she’s thinking either of getting approval to work at home or simply leaving her job. She said she ought to do one of the two to protect her family’s health.
“There’s so much stuff flying around out there that I’m not going to put my kid’s life at the risk of an overwhelmed healthcare system,” she said.
That appears to be a growing sentiment across the region’s network of healthcare providers.
“I am hearing more and more reports of primary care offices, specialists’ offices, radiology centers and medical supply stores closing due to fears about being able to safely stay open during Covid-19,” said Glick, of Jericho Road. “This is really bad news.”
He said one of his patients, who has stomach cancer, had an appointment with a radiology center for an evaluation – but the radiology center shut down, leaving the patient not knowing the status of her disease.
Such patients can’t wait for the pandemic to pass, Glick said.
“The medical community in Buffalo must have the courage to remain open and to continue to provide primary care,” he said. “Otherwise, more people will die from this lack of care than from the virus.”
Of course, hospitals can’t close. But they can become overwhelmed.
And that’s just what worries Collins, the ECMC nurse.
“We are basically we’re fighting a war that we have no ammo for, that we’re not even prepared for,” she said.
Staff reporter Scott Scanlon contributed to this story.
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