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Michigan, one of the few hospital systems conducting widespread
staff testing found that more than 700 workers were infected with
the coronavirus - more than a quarter of those tested.
More than a month after the pandemic hit the United States, the
persistent test shortages mean that health workers are treating
patients while experiencing mild symptoms that could signal they are
infected themselves, according to Reuters interviews with 13 nurses
and 2 doctors who described testing shortages at their hospitals.
Many medical centers are testing only the workers with the most
severe symptoms, according to the frontline workers and hospital
officials. As a result, nurses and doctors risk infecting patients,
colleagues and their families without knowing they are carrying the
virus, medical experts say.
The New York City nurse works at Mount Sinai Hospital, a major
institution in the national epicenter of the pandemic. Her nausea,
upset stomach and low-grade fever did not qualify her to get a test
in late March, she told Reuters on condition of anonymity. She
continued to work because her fever - at 100.2 degrees Fahrenheit
(37.9 Celsius) - was just below the threshold set by the U.S.
Centers for Disease Control and Prevention for sending health
workers home.
But she had the virus, an infection she confirmed when she took it
upon herself to get tested at a private clinic, she said.
"I knew something wasn’t right," the nurse said, "but I didn’t
really think I had it."
A hospital spokesman declined to comment on the nurse’s case but
said that mildly symptomatic employees could now get tested.
Mount Sinai Hospital's chief medical officer, Vicki LoPachin, told
staff on April 4 that the hospital would increase testing of
employees with symptoms of the virus starting on Tuesday. New York
City is home of the nation's worst coronavirus outbreak, with about
78,000 cases and 3,600 deaths as of Wednesday morning.
Nationwide, the number of infections has surpassed 400,000, with
nearly 13,000 deaths. (For an interactive graphic tracking the
virus, see https://tmsnrt.rs/2XjOZil )
The continued test shortages - even for the workers most at risk -
is “scandalous” and a serious threat to the patients they treat,
said Dr. Art Caplan, a professor of bioethics at the NYU Grossman
School of Medicine.
"It’s obvious that we should be testing healthcare workers, just as
points of infectivity," Caplan said.
On Monday, the U.S. Health and Human Services Inspector General’s
Office published a survey of 323 hospitals that found the shortages
left the facilities unable to effectively test staff and patients,
who frequently waited more than seven days for results because of
delays at outside laboratories.
In March, the U.S. Food and Drug Administration gave states
permission to approve their own tests to avoid federal regulatory
delays. It also approved the first rapid coronavirus diagnostic
test, manufactured by Cepheid, which the company says can detect the
virus in about 45 minutes without sending samples to an outside
laboratory.
The FDA did not immediately respond to requests for comment on
Wednesday about federal efforts to further address the persistent
national test shortages.
While some hospitals have announced plans to test more employees in
recent days due to increased capacity, the inconsistency across
states has created a patchwork of testing protocols based on the
supplies available.
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NYC Health + Hospitals, the corporation that operates the city’s 11 public
hospitals, said last week they would have the capacity to test all employees -
regardless of symptoms - by April 22.
In Georgia, where the nurse told Reuters she was denied testing after treating a
dying patient, the state health department said it is giving priority to
healthcare workers at new drive-through test sites. The workers, however, must
be evaluated and recommended for testing by a doctor.
The CDC advises that healthcare facilities should prioritize giving their
limited tests to hospitalized patients and symptomatic healthcare workers,
specifically those experiencing fever, cough and shortness of breath. All other
healthcare workers should receive tests "as resources allow," according to the
CDC's website.
RAPID TESTING
In Michigan - a leader among states in establishing testing programs that
deliver quick results - more than 700 staff in the Henry Ford Health hospital
system have tested positive out of some 2,500 employees tested since March 12,
chief clinical officer Adnan Munkarah said on April 6.
While the infected workers represent just 2% of the system's overall staff, the
high percentage of positive tests in the initial round signals that further
testing could reveal many more infections.
The Henry Ford system did not immediately respond to a request for comment
Wednesday.
Until rapid testing is widely available, hospitals face a dilemma: Do they test
staff with mild symptoms and keep them home for days as they await results? Or
do they keep mildly ill - but desperately needed - staff at work to treat the
rush of patients?
"It’s a different kind of triage," said Caplan, the bioethics professor. "It’s
precaution versus, 'I need staff.'"
Rapid testing of all hospital employees could possibly decimate the workforce by
revealing asymptomatic infected workers, several healthcare workers told
Reuters. But it would also protect colleagues, patients and family members.
"It’s scary to come home and not know if you’re bringing it home to your
family," said Sydnie Boylan, a nurse at Hollywood Presbyterian Medical Center in
Los Angeles.
She went to work in late March with a headache and sore throat, but no fever,
after she had been exposed to a coronavirus patient while not wearing sufficient
protective gear. Those symptoms did not qualify for testing at her hospital.
Boylan said the hospital told her to quarantine at home for 14 days because of
her exposure to the patient. The headache and sore throat persisted for six
days, she said.
Asked about Boylan's case, Hollywood Presbyterian Medical Center's head of
clinical operations Jamie Chang said in a statement the hospital is testing as
many staff and patients as possible with limited supplies. He said the hospital
follows the Los Angeles County Health Department guidelines for testing, which
recommend prioritizing patients with a cough, fever and difficulty breathing.
"Despite the severe shortage in testing capacity available to the hospital,
Chang said, "all HPMC staff have access to the same COVID-19 testing that we
offer to our patients."
Boylan said she had been tested at a drive-through site. She is still waiting on
the results.
(Reporting by Gabriella Borter; Additional reporting by Jessica Resnick-Ault,
Scot Paltrow, Nick Brown, Ernie Scheyder and Nancy Lapid; Editing by Paul
Thomasch, Ross Colvin and Brian Thevenot)
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