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As U.S. Preps For Coronavirus, Health Workers Question Safety Measures

Feb 26, 2020
Originally published on February 27, 2020 11:44 am

Updated at 6:52 p.m. ET

The U.S. health care system is trying to be ready for possible outbreaks of the new coronavirus, after the Centers for Disease Control and Prevention warned communities this week to prepare for the kind of spread now being seen in Iran, Italy, South Korea and other areas outside the virus' epicenter in China.

The CDC notes there are only 15 confirmed cases of the coronavirus in the United States, plus 45 more cases among Americans who were brought home from the Diamond Princess cruise ship or via flights from Asia arranged by the U.S. State Department. The vast majority of those total cases in the U.S. are travel related; there are no signs, so far, that the virus has spread beyond the CDC totals.

Still, some U.S. health care workers on the front line, including Maureen Dugan, worry they are not properly prepared.

Dugan is a veteran nurse at the University of California, San Francisco Medical Center, where two coronavirus patients were transferred this month. UCSF is one of the premier hospitals in the country, but Dugan says her frustrations are mounting because she says her employer offered little notice or training to those caring for the infected patients.

"We want to do the best. We work extremely hard to do the best for our patients, so don't set us up to fail," Dugan says. "It's not only nurses — it's all the other staff. It's nursing assistants; it's transport. Every staff member is worried."

Coronavirus has yet to sicken American health workers, as it has in China. But deaths of hospital workers in Asia have heightened scrutiny of the U.S. health care system's ability to protect people on the front line.

Dugan says the medical community wasn't fully prepared for previous viruses, like SARS and Ebola — and she's concerned that lessons learned are not being applied today. For example: The protective garments provided, she says, leave the wearer's neck exposed.

"The gowns that they're providing are inadequate," she says, with emotion. "I'm sorry — I get very passionate about this, because we've worked so hard to make sure that our nurses were protected and therefore they can protect the public."

UCSF said in a written response to NPR that it has taken multiple "extensive" safety precautions, including isolating sick patients in rooms with special ventilation systems and training staff with proper use of safety gear. In regards to the two coronavirus cases Dugan refers to, UCSF said it briefed the workers who were actually treating the patients. But the hospital does not — as a matter of course — inform general staff of incoming infection cases.

World health officials warn that COVID-19, the disease caused by the new coronavirus, may enter a new phase in the U.S. at some point. Thus far, U.S. hospitals have been able to plan for transfers of incoming patients whose condition is already known. That's very different from a spreading outbreak, where sick people walk in off the street — a far more difficult scenario for health care workers and the public they treat.

"It's the unrecognized case that comes through your hospital system or your clinics that really pose the greatest risk," says Mark Rupp, chief of infectious disease at the University of Nebraska.

Rupp's hospital is considered a model for managing infections. Its pioneering medical center is one of the few with experience treating Ebola. It has an isolation chamber that filters pathogens, and it practices dry runs, making sure respiration masks fit workers.

Most critically, he says, hospital staff verbally screen patients at the facility's entrance, asking about symptoms and travel history.

Without that sort of logistical control at a hospital's entrance, he says, a coughing patient can quickly infect medical staff and other patients waiting in the emergency room or a clinic.

But what about the thousands of other hospitals without extensive experience with the riskiest cases? How are they bracing for a potential outbreak?

Those medical centers are also preparing, says Nancy Foster, vice president of quality and patient safety for the American Hospital Association.

"Everyone I've spoken to says they've taken substantial steps to make sure they are prepared," including steps like isolating infectious patients and conserving face masks to ensure supplies last, Foster says.

But not all staff working at those hospitals feel ready.

National Nurses United is conducting an ongoing survey that as of last week found that about 31% of nearly 5,000 nurse respondents said they didn't have enough protective gear to handle a surge of coronavirus cases. Only 9% said their hospital or clinic had plans to isolate potentially infected patients.

"That's not high enough for us to feel comfortable," says Bonnie Castillo, president of the nurses union. She notes that many hospitals are already operating at capacity and that if the coronavirus spreads in the U.S., it will stress the system even more.

"If health care workers and nurses aren't protected, no one is protected," Castillo says.

Meanwhile, the White House has requested $1.25 billion in new funding to support preparedness and vaccine development. Congressional Democrats — as well as some Republicans — are calling that amount insufficient.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

AILSA CHANG, HOST:

Tonight, President Trump briefed the nation on how his administration is tackling the threat of a coronavirus outbreak.

(SOUNDBITE OF ARCHIVED RECORDING)

PRESIDENT DONALD TRUMP: We're screening people and we have been at a very high level - screening people coming into the country from infected areas. We have inquarantined (ph) those infected and those at risk.

CHANG: Now the Centers for Disease Control and Prevention says there are now 60 cases of the virus in the U.S., and the U.S. health care system is bracing for more. But some health care workers here say they don't feel prepared. NPR's Yuki Noguchi reports.

YUKI NOGUCHI, BYLINE: So far, coronavirus cases in this country have been isolated. But this week, the Center for Disease Control warned communities to prepare for an outbreak. That worries Maureen Dugan. She's a veteran nurse at the University of California, San Francisco Medical Center. This month, two coronavirus patients were transferred there. UCSF is one of the premier hospitals in the country, but Dugan says her frustrations are mounting because she says her employer offered little notice or training to those caring for the infected patients.

MAUREEN DUGAN: We want to do the best. We work extremely hard to do the best for our patients, so don't set us up to fail. It's not only nurses. It's all the other staff. It's our nursing assistants. It's transport. Every staff member is worried.

NOGUCHI: Coronavirus has yet to sicken American health care workers as it has in China, but deaths of hospital workers there have heightened scrutiny of the U.S. health care system's ability to protect people on the front line. Dugan says the medical community wasn't fully prepared for previous viruses, like SARS and Ebola, and she's concerned lessons learned are not being applied today. For example, the medical wear provided, she says, leaves their necks exposed.

DUGAN: The gowns that they're providing are inadequate. I'm sorry. I get very passionate about this because we work so hard to make sure that our nurses were protected and, therefore, they can protect the public.

NOGUCHI: In a response, UCSF said it's taken multiple extensive safety precautions, including isolating sick patients and training for proper use of safety gear. It said it briefed workers treating the patients, but the hospital does not, as a matter of course, inform general staff of incoming infection cases. Thus far, hospitals in the U.S. have been able to plan for incoming patients. That's very different from an outbreak, where sick people come in off the street. That is far more dangerous for health care workers and the public they treat.

Mark Rupp is chief of infectious disease at the University of Nebraska.

MARK RUPP: It's the unrecognized case that comes through your hospital system or your clinics that really pose the greatest risk.

NOGUCHI: Rupp's hospital is considered a model for managing infections. It's pioneering medical center is one of the few with experience treating Ebola. It has an isolation chamber that filters pathogens. It practices dry runs, making sure respiration masks fit workers. Most critically, he says, it screens patients at the hospital's entrance.

RUPP: Right at the front door, we sequester people away from the rest of the traffic.

NOGUCHI: That's one of the biggest hazards, he says. A coughing patient can quickly infect medical staff and other patients waiting at emergency rooms and doctors' offices. But what about the thousands of other hospitals without extensive experience with the riskiest cases? How are they bracing for a potential outbreak?

Nancy Foster is the American Hospital Association's vice president of patient safety.

NANCY FOSTER: Everyone I've spoken to has taken substantial steps to make sure that they are prepared.

NOGUCHI: Steps like isolating infectious patients and conserving face masks to ensure supplies last - but not all staff working at those hospitals feel ready. The National Nurses Union is conducting an ongoing survey. As of last week, about a third of nurses surveyed said they didn't have enough protective gear to handle a surge of coronavirus cases. Only 9% said their hospital or clinic had plans to isolate potentially infected patients.

Bonnie Castillo is president of the National Nurses Union.

BONNIE CASTILLO: That's not high enough for us to feel comfortable.

NOGUCHI: Castillo notes many hospitals are already operating at capacity. She worries if the coronavirus spreads, it will stress the system even more.

CASTILLO: If health care workers and nurses aren't protected, no one is protected.

NOGUCHI: Meanwhile, the White House has requested over a billion dollars in new funding to support preparedness and vaccine development. Congressional Democrats and some Republicans are calling the amount insufficient.

Yuki Noguchi, NPR News, Washington. Transcript provided by NPR, Copyright NPR.