Hospitals in state get prepared
Gear, policies vital to protect front-line workers, they say
Health care workers will need masks — the right kind, called an N95 respirator — and gowns and gloves should the coronavirus outbreak arrive in Arkansas.
Leaders at medical systems in the state are bracing for the possibility of treating patients who have covid-19, the respiratory illness caused by the newly identified coronavirus, the spread of which now appears inevitable.
Part of that planning is the need to protect the health of thousands of doctors, nurses, medical technicians and staff members who will be on the front lines of the response. Last week, administrators said they are mostly prepared, but a few unknowns remain.
“We feel like we can’t have enough [protective equipment], and we are concerned about the national shortages that are, really, being created by hoarding,” UAMS Medical Center chief executive officer Dr. Steppe Mette said.
“We just can’t predict what’s going to happen downstream. … It’s not like we have a six-month supply
right now. We have a threeweek supply. Which, honestly, is probably not quite enough.”
Mette said the UAMS system is working with vendors to acquire more equipment “ethically” as it becomes available. Other organizations are inventorying items and corralling them in a central location to control distribution.
“I don’t know that anyone really knows how many of those supplies we’re going to need because we just, at this point, are not sure how this is going to play out across our country,” said Dr. Kasey Holder, vice president for medical affairs at St. Bernards Healthcare in Jonesboro.
As the illness first recognized in Wuhan, China, advances in the U.S., health care systems are arming the battlements, readying to navigate challenges such as the need — seen at some California hospitals — to quarantine dozens of workers.
Health professionals’ welfare is of special concern not only because those individuals are needed to help patients, but because they are at higher risk. During the high-profile struggles of similar workers in China, at least 1,700 got sick and several died, Reuters reported.
No cases of covid-19 were confirmed in Arkansas as of Saturday afternoon, according to the Health Department, but nearly 400 cases are documented in several states, including neighboring Texas and Tennessee.
UAMS, which also is the state’s largest public employer, will require all 10,500 employees to sign off on its preparedness plans, with special instructions about precautions for clinicians and staff members who have contact with patients, Mette said.
At Baptist Health, medical director of infection prevention Dr. Amanda Novack wrote in an email that the nonprofit system is reeducating workers on some of the basics, including “hand hygiene” and “cough etiquette.”
Administrators said they are hearing some worries from clinicians and staff members that are similar to concerns brewing in the general public.
Among our employees, “I do think there is an appropriate amount of concern and anxiety with this new illness and infection that we’ve never really seen or dealt with before,” Holder said.
“I am hearing them ask very appropriate questions. They are wanting to be informed and involved and engaged.”
For CHI St. Vincent — a nonprofit group that has hospitals in Little Rock, Morrilton and Hot Springs — officials said in a statement that they’re conducting exercises and offering additional training on covid-19 to protect their staffs.
A spokesman said the group is not publicly sharing those internal communications, but signs posted in patient and employee areas at the hospitals spell out the difference between flu symptoms and symptoms associated with the new illness.
Chancellor Cam Patterson told University of Arkansas System trustees Thursday that UAMS benefits from partnerships, such as with Baptist Health, so there’s less local competition for what may be needed to shield workers and treat cases.
But the subject is clearly on the minds of hospital administrative personnel, and Mette said every worker who may have to visit a possible covid-19 patient will be fit-tested for a protective mask.
“[We are] conserving medical supplies and personal protective equipment that might be in short supply in the coming months — either as a result of Chinese manufacturing impacts or increased demand worldwide,” Novack wrote.
Last month, The Associated Press reported on a global shortage of face masks attributed to supply-chain interruptions and demand.
LIKE ANY EMERGENCY
Preparations to protect medical staff members who may work with covid-19 cases benefit from protocols developed during the Ebola scare that began in 2014, the H1N1 flu pandemic in 2009, and SARS in 2003, Arkansas administrators said.
Those include determining the best way to isolate patients to slow spread of infections and limit the number of workers exposed, such as using only a certain area of the hospital or having providers solely treat covid-19 cases.
Existing “surge plans” also can be deployed if many workers get sick. That’s sometimes a concern during flu season, when employees can abruptly be “out of commission,” Holder said.
Those plans include possibly calling in workers from other area hospitals or from staffing companies, she explained. They also could draw on practices that go into effect for large patient influxes after events like tornadoes or hurricanes.
Baptist Health is updating its relevant plans and policies, including those crafted to handle an influenza pandemic, Novack wrote.
In recent years, Mette said UAMS got some practice when it looked as though it might receive as many as 100 patients during Hurricane Harvey, which caused major flooding in Texas and Louisiana in 2017.
On Friday, the Little Rock health center conducted emergency preparedness training specifically geared toward covid-19 scenarios, though that exercise was closed to the media.
Mette, who is also senior vice chancellor for UAMS Health, pledged that the group will be candid with employees on preparedness efforts, including if supply shortages crop up, vowing to be “totally transparent” to retain their confidence.
‘DON’T COME TO WORK’
One issue that has special relevance for health sector workers is how they should proceed if they become ill.
As part of covid-19 guidance issued last month, the federal Centers for Disease Control and Prevention says employers should “actively encourage” sick workers to stay home.
“Employees who appear to have acute respiratory illness symptoms (i.e. cough, shortness of breath) upon arrival to work or become sick during the day should be separated from other employees and be sent home immediately,” the agency’s website says.
Mette echoed that advice for UAMS employees.
“If you’re not feeling well yourself — regardless of what you have — don’t come to work,” he said in an interview.
Advice to stay home, either from illness or if self-quarantine is needed after being exposed to covid-19, raises questions about how employees will be compensated for that time off.
Vacation leave and sick time at UAMS are set by the UA System, spokeswoman Leslie Taylor wrote in an email.
“We do not have plans to offer any additional paid sick or time off for UAMS employees should they need to undergo quarantine or stay home sick in the event of a COVID-19 outbreak,” she wrote.
“However, employees whose job responsibilities allow them to work from home will be allowed to do that.”
A St. Bernards Healthcare spokesman said covid-19 absences will not count against an employee’s attendance record, and that workers can make use of the group’s paidtime-off donation program.
Baptist Health’s spokeswoman did not immediately respond to an email asking about employees’ compensation if they have to miss work for covid-19-related reasons.
NOT TIME TO RELAX
As the coronavirus has turned up in more states, national medical groups have stressed the importance of workers’ safety.
The American Medical Association, which is the largest physician’s professional organization, has been sharing with its members federal Centers of Disease and Control and Prevention recommendations on protecting oneself and hosting regular information calls for doctors.
On Thursday, the largest U.S. nurses union held a news conference in California to call on employers, legislators and the Occupational Safety and Health Administration to make sure nurses are protected.
National Nurses United asked that Congress pass a spending package that covers protective equipment and sick leave payments, as well as guarantee that a vaccine, when made available, will be free.
“Nurses are confident we can care for covid-19 patients, and even help stop the spread of this virus, if we are given the protections and resources we need to do our jobs,” said Bonnie Castillo, a nurse and the union’s executive director.
“This is not the time to relax our approach or weaken existing state or federal regulations. This is the time to step up all of our efforts.”
During a survey of 6,500 nurses in 48 states, 63% said they had access to N95 respirators, but just 19% said their employers have plans to address employees exposed to covid-19, the union reported.
In Arkansas, Mette urged providers to report any suspected covid-19 cases to the Health Department right away. The public health agency is leading the state’s response efforts.
As UAMS prepares, he said he is continually impressed by the “selfless” commitment to patients he sees among its employees.
“Their professionalism is shining through and surpassing their anxiety,” he said.
“[But] there is that palpable sense of the unknown — and having to suppress the concerns that we all could be victims as well.”