COVID-19 tests Canadian relations as health staffers cross border to work in Detroit

Hannah Hartford was given a choice last month by her Canadian employer.

The 26-year-old emergency room nurse from Windsor could keep her job at Henry Ford Hospital in Detroit or her job on the Ouellette campus of Windsor Regional Hospital — but she could no longer work at hospitals in both countries. 

As many as 2,000 Canadian health care workers cross the Detroit/Windsor border daily to work at Metro Detroit hospitals. They have been a source of concern to some Canadians as the COVID-19 pandemic has raged in U.S. border communities such as Detroit, which has been a hotspot for weeks until a recent leveling off in the growth of cases. 

With a population of about 400,000, the Windsor/Essex County region had 462 confirmed cases of COVID-19 and 27 deaths through Sunday. On the U.S. side, there were 7,604 confirmed cases and 618 deaths alone in Detroit, which has an estimated population of about 673,000. 

The counties of Wayne, Oakland and Macomb and the city of Detroit totaled 24,161 cases of COVID-19 and 1,981 deaths in a population of about 3.9 million through Sunday —  nearly two and a half times more cases and almost four times as many deaths as those in the province of Ontario, which had 10,010 cases and 514 deaths in a population of 14.3 million people. 

"This was a big topic of conversation locally because our own medical officer of health identified the border as a potential source of transmission," Windsor Mayor Drew Dilkens told The Detroit News about Windsor Regional Hospital's decision to ban its nurses from working in Detroit. 

The ultimatum was given to 57 nurses, who told the hospital they held dual positions in Detroit, Dilkens said. But hundreds of Canadian health workers who work only in Detroit continue to cross the border daily.

Canadian health care workers traditionally have helped U.S. health systems fill important staffing needs. The five-hospital Henry Ford Health System reported it employs 950 Canadian workers, while Southfield-based Beaumont Health said it has 250 workers. St. Joseph Mercy Health System has 91 staffers from Canada at its five Southeast Michigan hospitals — Livonia, Pontiac, Howell, Ann Arbor and Chelsea. 

The Detroit Medical Center and Ascension Michigan did not respond to requests about Canadian staffing. 

"We are concerned about the border closing. However, we continue to advocate that these essential health care workers be allowed to enter for work purposes," St. Joseph Health System spokeswoman Laura Blodgett said. 

The Windsor hospital's measure was intended to prevent cross-contamination between the U.S. and Canadian hospitals, Dilkens said. But it was also meant to quell growing trepidation in Windsor about essential traffic across the border during the pandemic, he said. 

"One of the underlying reasons was to try and take the focus off the border as a vector for transmission of this disease," Dilkens said. "There had been undue attention to these Canadian nurses working in Detroit as a potential source of the transmission of the virus.

Since Canada and the United States are each other's largest trading partner, one of the goals of forbidding some Canadian nurses from going to Detroit was in part to ensure the continued flow of other essential workers and goods during the pandemic, he said, noting 5,000 to 8,000 trucks cross the border every day. 

"...If there was any further restriction on trade, it would be detrimental to both economies," Dilkens said. 

Windsor or Detroit? 

Thirty-five of the 57 nurses gave up their jobs in Detroit to keep their positions at Windsor Regional Hospital. The remaining 22 nurses gave up their Windsor posts to keep working in Detroit. 

Hartford chose Windsor Regional Hospital, where she worked the most hours and which provides her with employment benefits. 

"I’ve felt supported and protected by management on both sides, so I was really upset when I had to choose," Hartford said. "I love working over in the States. I think it’s a great environment, and I’ve built relationships, too. I became a nurse for a reason, right? I want to help anybody I can.

"Honestly, my family had a huge part to do with it because they were all so worried about the exposure over in the U.S."

Similar decisions were weighed earlier this month by Canadian nurses working at War Memorial Hospital in Sault Ste. Marie on the northeastern edge of Michigan's Upper Peninsula. Some of the hospital's nurses also worked at Sault Area Hospital in neighboring Sault Ste. Marie, Ontario.

About two weeks ago, the Canadian hospital announced its nurses could no longer work on the American side. Nine nurses chose to give up their positions at War Memorial to keep their jobs in Canada, hospital President David Jahn told The Detroit News.

So far, there have been no cases of the novel coronavirus in his city, Jahn noted.

But a case was confirmed on the Canadian side — a woman who had returned through the U.P.'s Chippewa County International Airport, he said. 

"That was actually a Canadian citizen going across, but I think what Sault Area Hospital might be seeing is all the cases the Detroit area and probably getting concerned, but I’d be more worried if I was in Windsor than in Sault, Ontario," Jahn said. 

"I haven’t looked at how many people in Sault, Ontario, have contracted the virus,  but I know it's more than zero."

War Memorial Hospital has about 50 workers from Canada, including physical therapists, respiratory therapists, physicians and others, Jahn said. 

"There’s still plenty of traffic going back and forth for essential health care workers," he said. "This was a little hiccup in terms of our staffing, but if they completely closed the border to that ... that would definitely hurt our staffing for sure."

Restrictions worry workers

The calls to restrict cross-border travel by Canadian health care workers have troubled even those who only work in the United States and have not been forced to choose between employers.  

Steve Homick, a 30-year-old emergency room nurse in Detroit, said he works 36 hours per week at Beaumont Hospital-Royal Oak, another 12 at Henry Ford Hospital and then self-isolates between shifts at his house in Windsor.  

"It’s definitely a concern for me," Homick said. "When this first began, I was worried that I was going to show up to the border one day, and it was going to be closed down."

Homick said he hasn't visited a store or friends in more than a month. His parents pick up his groceries on their own weekly shopping trips and drop them off on his porch, he said. 

"For me personally, and for everybody here who’s Canadian, we do our thing, we go to work, we go home," Homick said. "I have a routine down to prevent me from spreading any COVID to anyone in Windsor.

"I’m in the E.R. so I’ve seen how sick these people are firsthand. I understand the seriousness."

Calls for more restrictions

Dr. Wajid Ahmed, medical officer of health for Windsor and Essex County Health Unit, called for tighter border restrictions in mid-March as cases of COVID-19 began to surge across the Detroit/Windsor border. 

"The WECHU hopes to work with federal and provincial governments to discuss cross border issues related to essential travel, in particular health care workers," according to a March 29 press release from the Health Unit. "With Michigan cases close to exceeding the number for all of Canada, the WECHU remains concerned about the potential risk of continued travel to and from work of our residents to Michigan and calls for stronger actions by all levels of government."

Ahmed of the Windsor/Essex Health Unit told The News he would like further restrictions, such as banning cross-border travel by Canadians to Detroit for part-time jobs. He also called for better data collection to track the number of essential health care workers who test positive for the virus after working in Detroit. 

"Our risk here is low compared to if you’re living in Detroit," Ahmed said. "Having this movement puts them at a high risk, not only for them to contract the disease but also ... they can potentially spread it to other people." 

But Windsor's mayor said placing further restrictions on Canadian health workers could spark a humanitarian crisis in Detroit in the midst of the pandemic. 

"The numbers show we have about 1,600 to 2,000 health care professionals who live in our community and cross the border every day to work, so they’re at all different hospitals," Dilkens said.

"...We know that if you were to try to stop doctors and nurses from getting to work in Detroit, you’d literally have to close down entire departments and floors and perhaps entire hospitals.

"You’d have a humanitarian crisis in the city of our neighbor, and it’s unconscionable for us to think that we wouldn’t be able to continue to provide service especially when you need us so bad right now."

kbouffard@detroitnews.com

Twitter: @kbouffardDN