Hospital workers face prolonged COVID-19 exposure, lack equipment

After reusing face masks and sharing gowns for several days, Tinae Moore wasn’t exactly surprised when she spiked a fever at the end of her Tuesday shift at the Detroit Medical Center's Sinai-Grace Hospital. 

Drive-up testing for COVID-19 continues at Beaumont Hospital's north entrance in Royal Oak, Michigan on Friday, March 27, 2020.

The 40-year-old emergency department technician by that point had been working with suspected COVID-19 patients for more than a week. She was tested Wednesday and is awaiting the results. 

“Had I been screened before my shift, they probably would have sent me home because at the end of my shift, my temperature was over 100, and I was coughing, and I had body aches,” Moore said. 

As the number of positive COVID-19 cases surge in Michigan, doctors, nurses and aides at the front line of the state’s fight against the coronavirus pandemic are becoming paramount to the lives of Michigan residents. 

Yet, those employees are exposed to the virus more than anyone else in the state, some without the proper gear to protect them from exposure. 

Medical personnel at some hospitals are starting to test positive for the virus as the state’s number of confirmed COVID-19 cases climbed Friday to 3,657 and the death toll to 92.

"Our primary concern beyond patient care is the protection of our front-line workers," said Ruthann Sudderth, a spokeswoman for the Michigan Health & Hospital Association. "If these individuals become ill, they cannot care for the growing number of seriously ill patients in Michigan."

The majority of the state's confirmed coronavirus cases and deaths have been centered in the Southeast Michigan counties of Wayne, Oakland and Macomb, pushing some of the region's hospitals to capacity and others near it.

The state on Wednesday informed hospitals that it would take action to shift patients from overburdened southeast Michigan hospitals to outstate facilities and explore the possibility of alternate sites for patients, such as convention centers and hotels. 

Michigan residents were jolted further Thursday when a draft letter to Henry Ford Health System patients was leaked online, showing the Detroit-based system's potential policy for determining which patients would get to use ventilators should need surpass availability. 

The policy has not been enacted, hospital officials said, and will be enacted only in a “worst-case scenario” in which capacity was surpassed within the health system and among relief hospitals statewide. 

The hospital system has not reached capacity and has an adequate supply of ventilators, said Dr. Adnan Munkarah, chief clinical officer for the Henry Ford Health System. But the health system is looking at different options, such as anesthesia equipment, to supplement the hospital's ventilator supply.

“We have by no means exhausted all of our resources or all of our options to take care of patients,” Munkarah said Friday.

COVID-19 testing begins at the Michigan State Fairgrounds in Detroit on Friday, March 27, 2020.

Nurses voice frustrations 

Moore’s concerns about the workload, exposure and inadequate supplies mirror recent testimony from nurses in southeast Michigan who took to social media earlier this week.

Mary Macdonald, an emergency room nurse, described medicine and ventilator shortages, used medical masks and looming decisions about who would live and die after a shift at Ascension Providence Hospital in Southfield.

“Do you think that that sounds safe?” Macdonald said in an Instagram video that has drawn more than a million views as of Friday evening. “Because we are completely out of resources.”

An official with Ascension told The Detroit News Thursday it was taking steps to ensure it would receive supplies from its distributor and suppliers.

A second video posted to Twitter by an intensive care unit nurse in Metro Detroit described similar conditions at her workplace. Gov. Gretchen Whitmer on Friday shared the video in which the unnamed nurse said she was at the breaking point after working a 13-hour shift treating two patients on ventilators. 

“It honestly felt like I was working a war zone,” she said in the video.

The situation isn't unique to nurses and aides. Michigan doctors also face similar challenges at the hospital, said Mohammed A. Arsiwala, president for the Michigan State Medical Society. 

“Supplies are scarce," Arsiwala said. "Testing kits are limited. COVID-19 is highly contagious and cases in Michigan and around the country are rising.  Staying home helps Michigan physicians and our health care system better fight back.”

The 30-member team will include advanced practice physicians, ED and ICU nurses, paramedics, pharmacists, and logistics and supply chain personnel.

'Starting to bubble over'

One nurse at a Southeast Michigan Hospital said his hospital is filling up with COVID-19 patients, many coming from Beaumont Health hospitals that are full. He asked not to be named because he’s not allowed to speak with the media.

The nurse works on a critical care floor that cares for people recovering from heart attacks, strokes and other serious conditions, as well as patients awaiting results of COVID-19 tests. His unit will be converted next week to care exclusively for COVID-19 patients. 

“Our whole medical ICU is absolutely full (of coronavirus patients), our 10th floor is full, our second floor is full, we’re filling up unit after unit. So now they’re making my unit a hot unit,” the nurse said. “Beaumont, which is one of the hospitals that we get patients from all the time, they’re full — with just corona patients.

“So we’re starting to bubble over is what’s happening.”

Beaumont Hospital staff in Royal Oak perform drive through screenings Wednesday afternoon.

His hospital received its first shipment this week of personal protective equipment from the Federal Emergency Management Agency, but is still rationing masks, face shields and other supplies, the nurse said. When his floor converts to a COVID unit next week, he said he doesn’t know if he’ll have access to the protective equipment he needs. 

“Nurses are walking out, they’re quitting,” the nurse said. “People are saying, 'Oh, you signed up for this.'

“But no, that’s now how it works. You don’t tell a police officer to go to work without a gun, a badge, a vest. You don’t tell people to do these jobs that they were trained to do, and then not give them the supplies to do it.”

Sinai-Grace technician Moore said she’d been reusing a face mask, face shield and gown for several days prior to feeling sick. Employees sharing gowns hung them in the hallways in between usages, she said. 

Patients weren’t properly isolated and were waiting too long for beds, she said, and employees were not screened prior to reporting for work though she believed such a policy was put in place Thursday.

“All of them could care less about us right now,” Moore said. “It’s like they’re just leaving us for dead.”

The hospital has had a screening protocol in place for patients and staff for “a number of days,” DMC Spokesman Brian Taylor said Friday. 

The hospital system “is being seriously impacted by capacity issues,” he said, but patient, staff and community safety remain “our top priority.”

“We have made it clear to all staff that if they are experiencing symptoms such as a fever, cough and shortness of breath, or believe they may have potentially been exposed they should stay home,” Taylor said.

“Everyone entering our facilities is screened for signs and symptoms and if necessary, their temperature is taken. If anyone has a temperature of 100, they are not permitted to enter.”

Employee protections sought

Hospitals throughout Michigan told The News on Friday they have adopted screening protocol in the last few weeks and employees have been trained in the proper use of personal protective gear. 

But the pressing need for more personal protection gear, such as masks, face shields and gowns, was emphasized by nearly every hospital system contacted. 

And exposure, through work in the hospital or social interaction in the community, is a constant threat. 

Beaumont Health has had a “small number” of employees test positive, a spokesman said, while McLaren hospitals have had two and Sparrow Hospital in Lansing had seven. 

The DMC, Henry Ford Health System, Spectrum Health and Michigan Medicine — the University of Michigan's health system — were unable to provide a number of positive cases among staff to The News. 

Responding to the threat of exposure while juggling increasing patient loads puts hospitals in "uncharted territory," Sparrow spokesman John Foren said.

“It’s what we do,” Foren said of patient care. “But at the same time, we are concerned about our caregivers all the time. It’s not just during COVID. But this is especially a fraught time.”

While the state and health systems explore potential sites to use as relief hospitals and others facilities as field hospitals, some health officials also are exploring lodging options for doctors and nurses who don’t want to expose their family to the virus at the end of a long workday.  

Spectrum Health provides accommodations as needed, while Beaumont employees have been able to use discounted rooms from local hotels. 

Michigan Medicine will provide temporary house placement for quarantine, self-isolation or respite at locations on-campus and commercial locations such as hotels, spokeswoman Mary Masson said. 

“Lodging can also be used if an employee has been exposed to COVID-19 positive patients during care delivery and have immuno-compromised family members at home,” Masson said.