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In The News: Nursing Facility Evacuated Due to Staff No Shows

April 9, 2020 by Leave a Comment

Did you hear about this one? Link: Staff No-Shows, Deaths Hit California Nursing Facilities

I heard about this yesterday. A nursing facility a few miles south of me was evacuated when the staff failed to show up for work. According to this news report nearly 3 dozen residents have tested positive for COVID-19. After many employees failed to show up for the second day in a row, all 83 patients had to be evacuated and sent to different facilities.

These workers were criticized by the county public health officer:

“Nationwide all of our health care workers are considered heroes, and they rightly are,” said Dr. Cameron Kaiser, the county’s public health officer. “But implicit in that heroism is that people stay at their post.”

Kaiser said it’s up to state regulators to determine if the workers are punished for abandoning patients.

https://www.nbcsandiego.com/news/california/riverside-nursing-facility-evacuated-after-staff-no-shows/2301888/

However, others defended the workers stating that their fear of going to work without adequate protective equipment was understandable. The article I linked above, however, does not mention this as the specific reason for the large number of no-shows by staff.

Another article I found had this to say:

Natalie Visnick, a spokeswoman for the American Health Care Association, a nonprofit group representing more than 14,000 nursing homes and other care facilities, said the Riverside issue “signals a larger, pressing issue.”

“Health care workers in long-term care are having to put their lives (and their family members who they return home to) on the line every day for their residents,” she said in an email. “Meanwhile, nursing homes and assisted living communities continue to desperately need the resources that will help them battle this virus, including personal protective equipment.”

https://www.pressdemocrat.com/news/10884395-181/riverside-nursing-facility-evacuated-after?sba=AAS

This second article seems to imply that fear of catching COVID-19 due to insufficient personal protective equipment (PPE) may have been what led to the large number of no-shows. Later the article quotes the director for the county’s Emergency Management Department:

Bruce Barton, director of the county’s Emergency Management Department, made an impassioned plea for volunteers to work at nursing facilities, promising those who sign up will get adequate safety equipment and malpractice coverage.

“We are in immediate need for help to care for our most vulnerable patients,” Barton said. “Please come join us.”

https://www.pressdemocrat.com/news/10884395-181/riverside-nursing-facility-evacuated-after?sba=AAS

So let’s assume that the no-shows were due to lack of PPE. Do I blame these healthcare workers for refusing to show up? I have wrestled with this question ever since learning about what happened and I don’t claim to have an answer. I don’t think there is a “good” answer.

When I started this post I thought that by writing out my thoughts I would be able to process the information and possibly come to some sort of conclusion. But as I’ve typed away I don’t feel any closer to a neat and clean position on this all.

Many have compared this pandemic to a war.

Sometimes, in war, there are no neat and clean answers.

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So You Think You Have COVID-19?

April 8, 2020 by Leave a Comment

There is plenty of anxiety. And many patients have made appointments with a request to be tested. But the answers they have been getting are confusing and often frustrating as well. What should you do if you think you have COVID-19 (the disease caused by the novel coronavirus aka SARS-CoV-2)?

The first step is figuring out if you need to go to the emergency department. If you are feeling short of breath and/or having trouble breathing, this is definitely an indication (or a reason) to go to your nearest emergency department for evaluation. Having low oxygen saturation (or hypoxia) may necessitate supplemental oxygen usually being provided by a nasal cannula.

The second step is to call your primary physician and check with your county’s Department of Public Health. These two resources should help you understand the testing capabilities of your locale and unfortunately this will be a big determinant of who can get tested if they are not “sick enough” to require hospitalization.

Many of my visits have involved advising patients about the realities of our situation and lack of adequate testing. I have had to advise patients that have symptoms that they ought to stay at home and assume they have COVID-19 and self quarantine at home. The reasoning for this is that we assume many people who have COVID-19 will be in the spectrum from asymptomatic to mild/moderate disease that does not require admission to the hospital. If people who are well enough NOT to require a hospital admission, then the information obtained from testing will not change the treatment (self quarantining and treating the symptoms).

What symptoms should one look out for? That question is tricky. As we learn more about the disease we are seeing more and more symptoms that can be caused by COVID-19. For example, early on we advised patients to be on the lookout for a new cough, fever, or shortness of breath. However there have been reports of other symptoms including diarrhea, loss of taste/smell, etc. As this is changing, I would recommend the following sources:

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I’m Baaack

April 7, 2020 by Leave a Comment

This week I returned to work after needed to stay off and isolated for the last week. While I didn’t come to work, I wouldn’t consider it a vacation. My days were filled with taking care of the toddler (3 year old) while my wife worked from home. In one word, it was exhausting.

As far as recovering goes, I noticed improvement almost each day in terms of the severity of my cough. I was coughing less frequently each day. I never developed a fever. I also never developed any shortness of breath or difficulty breathing.

And so, here I am, back at work.

Stay safe and healthy, everyone.

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Paid Leave

March 31, 2020 by Leave a Comment

I have seen that a few companies are offering paid leave if their workers test positive for COVID19. In theory this is great. In reality, this is bogus. 

Policies are worded very specifically. Most of the statements I have seen that list paid leave are for patients that TEST positive for COVID19.

The problem is we do not have enough tests!

At my practice (a large, tertiary, University-based clinic in Southern California), we are operating under the assumption that most people who contract COVID19 will have a mild form of the disease that will not require a hospital admission. However, they will need to be off work for the duration to limit the spread and prevent a high-risk patient from contracting it and needing a hospital stay. 

So the majority of my patients who develop fever and cough (in cold/flu season) are told to stay off work and to act/behave as if they have COVID19 but they do not have a confirmed positive test to support the diagnosis. 

Are these people going to be able to claim benefits? I don’t know the answer to this. But if not, it will be a huge disincentive for people to follow recommendations and stay home when sick. 

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Banned From Work

March 30, 2020 by Leave a Comment

This week has started off oddly. I am at home. I am not on vacation. I wish I were. Instead, I am at home in a sort of self-quarantine.

Last week, as I was getting ready to go to work I noticed that I was coughing. Initially I thought that I was had a tickle in my throat and that I just needed to clear it. But the cough persisted.

At our institution our outpatient faculty clinics had already instituted a strict screening policy. All visitors to the building were funneled to the main entrance. There, two people screen any person entering regardless of whether they are visitor or employee.

The questions each day were the same. Have you had a new fever? Have you had a new cough? Any shortness of breath? Any contact with known COVID19 patient? If all questions were answered with a negative, they would hand you a sticker that said “Cleared” and a face mask.

I knew that I would fail the screening. I also knew we had a shortage of tests. I would not be eligible for testing. And, the institutional policy for returning to work with new symptoms would require me to wait a minimum of 7 days.

So here I am. At home. Avoiding contact not only with patients but with my co-workers. I understand the reason for the policy. With the pandemic we must do everything we can to minimize spread of this COVID-19 disease.

Each day I have checked my temperature. Each day I have not had a fever. My cough has improved each day. And on National Doctor’s Day, while this pandemic rages, and my healthcare colleagues continue the fight, I sit and I wait.

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Rationing Tests?

March 25, 2020 by Leave a Comment

Rationing tests? In the U.S.A.? It may sound strange to hear that in the land of plenty we are rationing tests. But here we are, ill prepared for a global pandemic.

One of the most difficult things to say to patients who are having symptoms of cough and/or fever during this pandemic is that they need to stay home and act as if they had COVID-19. Testing, for the most part, is being reserved for the patients sick enough to require a hospital admission. I don’t think it helps that many people keep seeing things in the news touting how people can get tested without fully explaining the limitations we have. Or maybe my region of the country is the abnormality?

Ideally we could swab anyone who had symptoms. But since we cannot, maybe this will help:

  • With a limited supply of testing supplies, we should only test those in which testing will change the management or treatment.
  • It is accepted that there is a spectrum of presentation of COVID-19. Some patients may have zero symptoms. Some patients may have mild symptoms. Some patients will need extra support that requires treatment in a hospital (like supplemental oxygen, mechanical ventilation, etc.)
  • If patients are stable enough that they are breathing comfortably, they should stay home and act like they have COVID-19. They should treat symptoms and self quarantine to avoid spreading it others who might develop more severe disease.
  • Patients who have symptoms that include shortness of breath or trouble breathing should go to the Emergency Department to be evaluated. They may be hypoxic (have low oxygen saturation) and need additional support. These patients who are sick enough that they require care in a hospital should be tested.

Again, it isn’t a perfect system. We don’t have an infinite number of testing kits/supplies. We don’t even have enough test everyone we suspect of having COVID-19. But this is why testing is being limited.

Needless to say, this post is not intended to be medical advice. If you have questions about your particular case, please contact your primary care physician.

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Pandemic!

March 25, 2020 by Leave a Comment

It is painful to watch the amount of distrust or disbelief amongst the public – even among those who are in healthcare. Last week I saw an article about young people still going on about their usual life, not willing to put things on hold. One of the people interviewed was a nurse.

I saw another article from this week that beaches remain open in Florida for spring break. Parties were just told that they must keep their groups to 10 or less. However, the article also showed a picture taken on a Florida beach in Clearwater that showed pretty crowded situations (the picture was taken on 3/27/2020).

Sometimes I just want to face palm.

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