In Michigan, one of the few hospital systems performing large-scale screening tests 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, persistent shortages of testing mean health workers are treating patients while experiencing mild symptoms that could signal that they themselves are infected, according to Reuters interviews 13 nurses and 2 doctors who described test shortages at their hospitals.
Many medical centers only test workers with the most severe symptoms, according to front-line workers and hospital officials. As a result, nurses and doctors are at risk of infecting patients, colleagues and families without knowing they are carriers of the virus, medical experts say.
The New York nurse works at Mount Sinai Hospital, a major institution in the national epicenter of the pandemic. Her nausea, stomach upset and low fever did not qualify her for a test in late March, she told Reuters on condition of anonymity. She continued to work because her fever – 100.2 degrees Fahrenheit (37.9 degrees Celsius) – was just below the threshold set by the United States Centers for Disease Control and Prevention to send health workers to the House.
But she had the virus, an infection which she confirmed when she decided to get tested in a private clinic, she said.
“I knew something was wrong,” said the nurse, “but I didn’t really think I had it. “
A hospital spokesman declined to comment on the nurse’s case, but said the mildly symptomatic workers could now be tested.
Mount Sinai hospital chief physician Vicki LoPachin told staff on April 4 that the hospital would increase testing for employees with symptoms of the virus starting on Tuesday. New York City is home to the worst coronavirus epidemic in the country, with approximately 78,000 cases and 3,600 deaths Wednesday morning.
Nationally, the number of infections has exceeded 400,000, with almost 13,000 deaths. (For an interactive graph tracing the virus, see tmsnrt.rs/2XjOZil)
The continuing shortage of tests – even for those workers most at risk – is “outrageous” and a serious threat to the patients they treat, said Dr. Art Caplan, professor of bioethics at the NYU Grossman School of Medicine.
“Obviously we should be testing health care workers, as well as the points of infectiousness,” said Caplan.
On Monday, the U.S. Office of the Inspector General of Health and Human Services released a survey of 323 hospitals that found that shortages left facilities unable to effectively test staff and patients, who often waited more than seven days to obtain results due to delays in outside laboratories.
In March, the U.S. Food and Drug Administration authorized states 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.
On Wednesday, the FDA did not respond to requests for comment on federal efforts to further address persistent shortages of national tests.
While some hospitals have announced plans to test more staff in recent days due to increased capacity, inconsistency between states has created a patchwork of testing protocols based on available supplies.
NYC Health + Hospitals, the company that operates the city’s 11 public hospitals, said last week that it would have the capacity to test all employees – regardless of symptoms – by April 22.
In Georgia, where the nurse told Reuters that she was refused the test after treating a dying patient, the state health department said it gave health workers priority at the new driving test sites. However, workers should be evaluated and recommended for testing by a doctor.
The CDC recommends that healthcare facilities give priority to giving limited testing to inpatients and symptomatic healthcare workers, especially those with fever, cough and shortness of breath. All other health care workers should receive tests “if resources allow,” according to the CDC website.
In Michigan – a leader among states in implementing rapid test programs – more than 700 employees in the Henry Ford Health hospital system have tested positive out of some 2,500 employees tested since March 12, said clinical director Adnan Munkarah on April 6.
While infected workers represent only 2% of the overall system workforce, the high percentage of positive tests in the initial phase indicates that further tests could reveal many more infections.
The Henry Ford system did not immediately respond to a request for comment on Wednesday.
Until rapid tests are widely available, hospitals face a dilemma: do they test staff with mild symptoms and keep them at home for days while waiting for the results? Or are they keeping slightly ill – but desperately needed – staff at work to deal with the rush of patients?
“It’s a different kind of triage,” said Caplan, the professor of bioethics. “It’s precaution against,” I need staff. “”
Rapid tests of all hospital workers could potentially wipe out the workforce by revealing asymptomatic infected workers, several health 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 to your family,” said Sydnie Boylan, nurse at the Hollywood Presbyterian Medical Center in Los Angeles.
She went to work in late March with headaches and sore throats, but no fever, after being exposed to a coronavirus patient when she was not wearing sufficient protective equipment. These symptoms were not eligible for testing at his hospital.
Boylan said the hospital told him to stay quarantined at home for 14 days because of his exposure to the patient. The headache and sore throat persisted for six days, she said.
Asked about Boylan’s case, Hollywood Presbyterian Medical Center director of clinical operations Jamie Chang said in a statement that the hospital was testing as many staff and patients as possible with limited supplies. He said the hospital followed the Los Angeles County Department of Health’s guidelines for testing, which recommends prioritizing patients with coughs, fever, and difficulty breathing.
“Despite the severe shortage of testing capacity available at the hospital,” said Chang, “all HPMC staff have access to the same COVID-19 tests that we provide to our patients. “
Boylan said it was tested at a drive-through service site. She is still waiting for the results.
Gabriella Borter’s report; Additional reports from 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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