Doctors Fear Being Taken Out of the Game by Infected Patients

A new sign spans the width of the entrance to Shawn Purifoy’s medical clinic. Visitors can’t miss it. “STOP,” it says, warning people with respiratory symptoms to go back to their cars and call for instructions.

Purifoy, a primary care doctor in Malvern, Arkansas, can’t risk contact with anyone infected with the new coronavirus and a two-week quarantine that would paralyze his solo practice, he said. “That’s 14 days I can’t take care of people’s heart disease and diabetes and congestive heart failure.”

The need to limit exposure is upending the operations of health care providers large and small. Some health systems have dozens of employees isolating themselves as a precaution after treating the sick — taking clinicians out of action even as hospitals brace for a possible surge of new patients.

Now health authorities are reassessing whether the precautions they took to contain the virus in the early days will be tenable as case counts rise. It’s a problem with no good solution.

Attempting to isolate any clinician who might be exposed could sideline staff when they’re needed most. Allowing them to continue working if they don’t develop symptoms could turn medical facilities into vectors of transmission.

Over the weekend, two emergency physicians were in critical condition with Covid-19, the disease caused by the new coronavirus,according to the American College of Emergency Physicians. One was in Washington state and the other in Paterson, New Jersey.

Latest Guidance

The Centers for Disease Control’s most recentguidance suggests different levels of restrictions and monitoring depending on the possibility of exposure. A nurse with more than a few minutes of contact with a Covid-19 patient is deemed to be at high risk if neither had a mask on, for example. The nurse would be restricted from working for 14 days and actively monitored for symptoms. If both were masked, the nurse could continue working.

The guidance also allows workers who were exposed but have no symptoms to stay at their jobs if hospitals have exhausted other options to improve staffing.

The CDC acknowledges that in places where the virus has spread widely, tactics like tracing contacts are no longer practical. With community spread, all health-care workers “are at some risk for exposure to COVID-19, whether in the workplace or in the community.”

At Northwell Health, New York’s largest hospital system, dozens of employees were under self-quarantine after possible exposures, spokesman Terry Lynam said in an email Friday. “That certainly poses staffing challenges, particularly in our emergency departments,” he said. Northwell is using temporary staff “to help fill the gap.”

In Los Angeles, officials at Cedars-Sinai Medical Center set up a tent outside the emergency department and posted staff to divert anyone who’s coughing or sneezing. Jeff Smith, a physician and the hospital’s chief operating officer, said separating populations is necessary. “It helps limit exposure.”

More Complications

School closures blanketing the country create more complications. “Many of our caregivers have young children at home and don’t have alternatives,” Smith said. Cedars-Sinai has a contract with a company that provides in-home childcare.

Some health care workers oppose attempts to loosen quarantine rules. After Sacramento Countyadvised that people who had contact with Covid-19 patients but showed no symptoms didn’t need to isolate themselves, the country’s largest union of nurses dissented.

Registered nurses “as well as other health care workers must have the highest level of protection to be able to do their jobs safely,” National Nurses United wrote in aletter to the county. Sticking to the two-week quarantine, the union said, is “a crucial element to keeping everyone safe and healthy.”

The calculations are complicated by a number of uncertainties. Case counts are rising swiftly, and testing shortfalls mean officials don’t know the scope of undiagnosed cases. Scientists are also uncertain about how likely people without symptoms are to spread the virus. And while rigorous use of protective masks, gowns and gloves can reduce risks, those materials are in short supply.

California hospitals have asked the state to change the precautions required for protective gear, allowing workers to use surgical masks instead of N95 respirators in some circumstances. “We’re trying to preserve that supply for those procedures in those situations where it’s truly needed,” Jan Emerson-Shea, a spokeswoman for the California Hospital Association said Friday.

In his small practice in Arkansas, with two nurse practitioners and about a dozen office staff, Purifoy doesn’t have any N95 masks, and he can’t get them now. His solution is to keep anyone with possible Covid-19 symptoms from walking in the door, even if they just have a routine cold or the flu.

“Everyone at early onset looks the same,” he said. “Once they’re inside your office, I don’t have a negative-pressure room, none of that. That’s not what happens in a family office setting. We’re having to make all these changes on the fly.”

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