As anxiety over coronavirus rises, front-line medical workers fear for their own health and safety even as data suggests that hospitals — both locally and nationally — might not have enough beds to handle a surge in cases.
Some health-care workers in close contact with COVID-19 patients complain that they still lack full-scale protective equipment and that what’s in stock is kept behind locked doors or otherwise guarded.
Others say the rooms of infected patients aren’t always isolated or clearly marked, which can lead to unintentional exposure by workers who aren’t on the direct medical team.
And still others are furious that every hospital staffer who interfaces with the public isn’t provided the most protective suite of gear. They worry they’ll become disease vectors, making some afraid to do their jobs.
Meantime, California has 73,899 acute-care hospital beds and some 40 million residents, one of the lowest rates per capita in the nation, according to studies.
Disease modeling done by ProPublica, the nonprofit newsroom, found that most communities in California and the nation would be quickly overwhelmed by a surge in acute cases.
In a best-case scenario, with cases of coronavirus spread out over 18 months, hospital beds would be about 95% full, according to the analysis.
In a moderate scenario — where 40% of adults contract the disease over the course of a year, and one out of five needs hospitalization — the number of available beds would have to more than double, it found.
Southern California has about half of California’s hospital beds — and residents. Most beds — 21,693 — are in Los Angeles County, with 6,034 in Orange, 3,583 in Riverside and 4,003 in San Bernardino counties, according to data from the California Department of Public Health.
Health officials say they’re prepared to handle an influx by emptying out beds, dedicating entire hospital wings to the disease and even setting up temporary treatment areas if necessary.
But some don’t find that particularly reassuring.
“Do I feel prepared? No,” said Sabrina Coffey-Smith, a telemetry technician at Centinela Hospital Medical Center in Inglewood. “If there’s an influx of patients, we’re not going to be able to deal just in terms of staffing. Worried people are leaving every day.”
Afraid to work
Doctors and nurses who work directly with COVID-19 patients are often fully outfitted with protective gear, but many other hospital workers who come close to those patients are told they don’t need such a high level of protection. Instead, they just wear surgical masks.
Marcia Santini, an ER nurse at the Ronald Reagan UCLA Medical Center in Westwood, said hospitals limit access because there’s insufficient supply of protective N95 masks, hood-like respirators and protective clothing.
“I’m on a statewide chat room with nurses and everybody is saying the same thing: There’s a shortage of supplies and there’s not access to what is available,” Santini said. “If somebody comes in, in cardiac arrest or a respiratory problem, you need a mask right now. You can’t wait to get it or we become a vector and pass it to everyone else.”
A worker from Cedars-Sinai Medical Center in Los Angeles said workers who enter COVID-19 patients’ rooms to admit, transfer or discharge are struggling with the lack of supplies.
“We’re being exposed, then we’re going out and taking care of other patients,” the Cedars-Sinai worker said. “We should all be protected to the highest level at all times.”
At Centinela in Inglewood, Coffey-Smith has helped monitor the heart of a patient who might have coronavirus, but whose test results won’t be back for days.
“If the patient does test positive, you’ve already endangered yourself and your family members with this regular mask,” she said. “Whoever is taking care of that patient should be able to use the N95 mask. These are lives we’re talking about.”
A worker at Hoag Memorial Hospital Presbyterian in Newport Beach was aghast that not all hospital workers were fully outfitted.
“We should be treating all hospital as possible contamination area and provide protective gear and enforce using it on ALL staff regardless, because viruses do not stay in one place,” said the worker by email. “If they did, we will not be experiencing a pandemic.”
The state’s COVID-19 website notes that “California made available some of its emergency planning reserves of 21 million N95 filtering facepiece masks for use in certain health care settings to ease shortages of personal protective equipment.”
And on Wednesday, President Donald Trump invoked the National Production Act to increase the manufacture of medical equipment to battle the coronavirus, which should ease the crunch — eventually. That does little to ease anxiety or increase supply in the short run.
“Why did it take so long?” asked Santini, the nurse. “We knew there was an issue at the end of December, the beginning of January.”
‘Ratchet down the panic’
Hospital officials say not every health care worker needs a hazmat suit, and urge people to keep in mind that only a fraction of those who become infected will get seriously ill.
“We’re battling misinformation minute to minute,” said Philip Robinson, medical director of infection prevention at Hoag.
First, the virus itself.
“My family asks me, ‘Is this the big thing? Should we worry?’ ” Robinson said. “And this is what I tell them:
“For the most part, 85 percent of people who get this infection do just fine. They don’t even need to seek medical care. It’s like a cold. Inconsequential. Maybe 10 percent might seek medical attention, and really only a small amount — 5 or 10 percent — would need supportive care.
“The treatment is extra oxygen, fever reducer, rest, chicken noodle soup. The vast majority who’ll get this are going to be just fine. It’s the elderly, and those with co-morbid conditions like diabetes, lung, heart and kidney disease, that we really need to concentrate our resources on.”
Then, there’s personal protective equipment, or PPE.
“There are many components to PPE, and you need the right equipment in the right circumstances,” he said. “If it’s not used appropriately, it gives a false sense of security and can increase risk.”
If a worker isn’t ill or caring for a patient with a contagious disease, the simple act of wearing a mask all the time is not recommended by the Centers for Disease Control. Masks can get contaminated, too, and wearing one all day can mean carrying germs close to the face.
“What we teach are the situations where PPE is appropriate, and we try to minimize its inappropriate use,” Robinson said.
Who needs full protection? Professionals who perform medical procedures that could expose them to contaminated body fluids — such as putting a COVID-19 patient on a breathing machine or inserting a scope into the lungs — use eye protection, masks, gowns and gloves.
There’s a roughly 30-day supply of equipment on hand, and hospitals can request more from county health care state emergency agencies.
And the fear that every health worker in the hospital might be silently spreading the disease for weeks — even while showing zero symptoms — doesn’t appear to be supported by science.
“The CDC does not believe non-symptomatic people spread the virus to a significant degree,” Robinson said. “We can find pieces of virus RNA in some people who have not developed symptoms yet. That does not mean they would easily transmit it to other people.
“Why? There has to be some sort of mechanism, some event, that propels that virus out of that person onto another. A runny nose, sneezing and coughing. If you’re not having those symptoms and you might have some virus in your nose, it is very unlikely you will transmit that to another person. Asymptomatic transmission is not very common.”
The vast majority of transmission appears to occur in patients who are symptomatic, and the goal is to identify those patients.
“The most important thing we can do is put a mask on the patient with symptoms,” Robinson said. “Then the risk is reduced significantly. That’s appropriate use of PPE.”
At Hoag, all COVID-19 patients have private rooms in a dedicated ward, he said. He finds the allegations made by anxious workers personally upsetting.
“We’ve been caring for patients with lots of infectious diseases — not just COVID — since we opened in 1954,” Robinson said of Hoag. “This is not new to us. Yes, it’s a new virus and it’s got a new name, but it’s something our facility is well prepared for.
“Our infection prevention team has been working literally around the clock to get ready for this and I’m super proud of what we’ve been able to accomplish so far. We’ve been getting ready for this really for years, drilling for these types of emergencies, planning, putting policies and procedures and all kinds of things in place.”
Officials at UCLA also sought to calm anxiety, saying they regularly provide training on prevention of infectious disease transmission.
“Just-in-time” training on donning and doffing of personal protective equipment is provided in the event of a high-risk patient, and only staff who have received training are involved in the care of high-risk patients, said a statement from Enrique Rivero, a spokesman for UCLA Health Sciences.
If people follow the CDC’s recommendations — limiting contact with other people, washing hands often, cleaning and disinfecting surfaces, not touching the face — most people will be fine.
“Please,” Robinson said, “let’s ratchet down the panic.”
