Could testing of health care workers bring back patients?
Hospitals, clinics hope to bring people — and their money — back in for nonessential care
Thousands of Stanford Health Care employees, from billing clerks to surgeons, have been pouring into clinics in the past few weeks to have swabs shoved up their noses — all in the name of reassuring patients that it’s safe to seek care again at their hospitals and clinics.
The massive effort by one of the Bay Area’s behemoths of health care to test all 14,000 of its employees for the coronavirus is generating a debate among medical providers desperately scrambling to bring back patients scared off by the deadly disease: Will testing an entire workforce soon be a must to keep patients safe? Or is it merely a marketing ploy for deep-pocketed institutions to win back trust while smaller medical practices struggle to keep up?
“I hope it makes people feel more comfortable,” said Stanford Health Care CEO David Entwistle. “Quite frankly, the testing goes a long way for individuals to know that they don’t have the virus. We also felt it was important to do that for our employees, to show them they’re healthy as well.”
Testing kits have been in high demand and short supply during the pandemic, with many health care providers saying they must limit who can be tested or risk running short on key supplies. But Stanford, unlike some of its peers, has been able to increase its testing capability in recent weeks. Walnut Creek-based John Muir Health, UC San Francisco, Sutter Health and Kaiser are generally limiting testing to symptomatic workers.
Stanford’s initial results are relatively comforting. As of Wednesday evening, 12,122 of the system’s roughly 14,000 workers had been tested, with only 124
testing positive. Just 0.3% of those without symptoms have tested positive.
Santa Clara County, too, is aiming to test its 8,500 hospital and clinic employees and other county health system workers for both the virus and antibodies that would indicate a person has had it and might have some level of immunity. So far, of 1,517 tests for the virus conducted, just five have come back positive.
“The expanded testing will improve our ability to protect our health care workers, provide additional security and safety for our patients and help us understand the prevalence of the virus within our workforce and in the community,” said Santa Clara Valley Medical Center Chief Executive Officer Paul Lorenz.
Part of what makes the virus so sinister is that people without symptoms can unwittingly spread it to others. So despite temperature checks at entrances and screening questions, patients and even doctors and nurses themselves have said they are scared of becoming infected at medical offices.
Bringing patients in the door is key. This week, the California Hospital Association told lawmakers in Sacramento that the state’s hospitals have lost as much as $14 billion by temporarily stopping elective surgeries and procedures to create space for a surge of coronavirus patients. And while they’re pushing for federal and state aid, hospitals will rely heavily on patients and their insurance providers for badly needed revenue.
Doctor’s offices and dentists have also been hemorrhaging cash, and some health experts say they expect to see some small private practices consolidated into larger health systems that are better able to weather future crises and others closing up shop altogether.
For now, Stanford’s testing employees for the virus and antibodies is a one-time thing. But that could change if the number of Bay Area cases starts to rise.
But not all hospitals or clinics have the ability to test all their employees even once, and not all think it’s necessary.
During a conversation hosted by UC Berkeley on Monday about the coronavirus’s impact on public health, Sutter Chief Medical Officer Stephen Lockhart said he worried about wasting valuable resources by testing asymptomatic people, especially just for marketing purposes.
Instead, Sutter has rearranged waiting rooms to prevent people from sitting too close together and, for outpatient care, rolled out a system where patients tap an arrival button on their phone when they park at a clinic rather than languishing in a communal waiting room.
John Muir, like other providers, limits visitors and requires people to wear masks. As of April 28, patients scheduled to come in for surgery have to undergo a coronavirus swab test beforehand. Stanford also requires such testing.
“We have many precautions in place to help keep everyone as safe as possible, including patients who are with us for visits, surgeries and hospitalizations unrelated to COVID-19,” said Irving Pike, the system’s chief medical officer.
The coronavirus pandemic has posed particularly difficult challenges for dentists — who have not had access to Food and Drug Administration-approved testing kits for their staff or patients.
“We do want to do it,” said Cynthia Brattesani, a dentist in San Francisco. “We would love it.”
Instead, Brattesani is taking other precautions to keep her patients and staff safe when she hopes to reopen next month for nonemergency appointments. She’s scheduling visits far apart to minimize the number of people in her office, screening people for coronavirus symptoms when they arrive, rearranging the office space itself and asking her staff to wear not only respirator masks but face shields. Where possible, she’s scheduling visits over video chat.
“We’re ready. We’ve got this,” Brattesani said. But, she acknowledged, “It’s going to be totally changed.”
Anthony Wright, executive director of Health Access, a statewide health care consumer advocacy coalition, thinks those precautions are just as important as testing, particularly when testing isn’t done routinely.
“It’s important for health care providers to provide all the assurances that they can,” Wright said, noting that he visited a clinic this week that only had every fourth chair in the waiting room open and staff wearing masks and other protective gear. “I think that goes a long way.”
He does want to see testing ramped up, too — so it happens quickly and frequently and not just at clinics and hospitals. But a one-off test, he said, is just a snapshot of a single point in time.
“If people go back home to their families, who may have had some encounters,” Wright said, “then that raises the possibility of transmission.”
Whatever health care providers are doing, Wright said, they need to reassure anxious people that, just as trips to the grocery store are necessary, so are trips to the doctor.
“If providers can be diligent but also project that security of being diligent,” Wright said, “that’s important.”