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As hospitals take drastic action to conserve masks, staff worry they’re putting themselves and patients at risk

Chip Brownlee | The Trace

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Some health care workers at DCH Health System’s facilities in Tuscaloosa County are being told not to wear personal protective equipment like masks as the number of COVID-19 cases in the state continues to rise and hospitals rush to prepare for what’s ahead.

Now a clinician in one of these units is showing symptoms of the virus.

Hospitals are increasingly redirecting scarce supplies needed to prevent infection to units of their hospitals on the front lines — to places like emergency rooms and ICUs devoted to screening, testing and treating suspected COVID-19 patients.

But the redirection of protective equipment to these front-line units and the increasingly drastic measures hospitals are having to take to conserve supplies are opening up the possibility that other units not directly on the front lines could be new epicenters of infection.

One health care worker at DCH’s Northport medical center in Tuscaloosa County, who spoke with APR on the condition of anonymity because they were afraid of reprisal, said the increasingly severe nationwide shortage of masks led administrators to go so far as suspending an employee last week who refused to follow supervisors’ directions to stop wearing a mask — even as they were caring for older patients in a rehab unit.

APR confirmed this story by reviewing documents and emails.

DCH is not the only health care facility in the state, or the country, prioritizing masks for parts of the hospital where patients who are suspected of having COVID-19 are being treated.

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DCH spokesperson Andy North said the hospital has experienced a shortage of masks, but health care workers who need to wear masks in the situations that require them, in accordance with CDC guidelines, are able to do so.

“DCH is following the most up to date guidelines from the Alabama Department of Public Health and CDC for the use of personal protective equipment (PPE),” said DCH Health System’s spokesperson. “The use of PPE is being strictly enforced due to shortages, but it is not limited to suspected or confirmed COVID-19 cases. Because of our judicious and appropriate use of PPE, we plan to be able to continue to provide safe care to our community while keeping our staff safe as well. PPE recommendations vary based on location and the job of the employee.”

Administrators and supervisors are telling these health care workers in lower risk units that wearing masks is wasting scarce protective equipment and causing unnecessary “panic” among the staff and patients. Some staff who had previously been required to wear a mask because they were not immunized against seasonal influenza are now being told not to wear masks.

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President Donald Trump this weekend said he wouldn’t use emergency powers to compel companies to make more masks and other protective equipment hospitals need, even as the widespread shortage has prompted physicians, hospital administrators and medical workers to take to social media and the traditional media to beg for more PPE supplies.

Vice President Mike Pence said the government has placed orders for “hundreds of millions” of N-95 face masks, but hospitals across the country are having to make hard decisions about how to allocate supplies right now. Community groups, including one in Birmingham, are organizing via social media to sew homemade masks for health care works.

In Alabama, clinicians and other health care workers in these non-front-line units say they’re worried the directive not to wear PPE when caring for their patients — who are disproportionately at risk for adverse health effects if they contract COVID-19 — is putting people in danger.

“We work with a bunch of 60- to 70-year-old-plus individuals with a lot of preexisting conditions,” the clinician said. “These are the cases that the CDC and the WHO (World Health Organization) are saying, ‘Please stay away from these people,’ because if you infect them, you may cause them to die.’”

Under a recent order by the Department of Public Health, all elective dental and medical procedures must be postponed in the state, but certain outpatient care has been allowed to continue.

Recordings of some of these tense interactions between administrators and health care workers obtained by the Alabama Political Reporter appear to show hospital officials going to drastic lengths to try to conserve their supply of PPE. Managers in the non-front-line units are being told to direct their staff not to wear any masks at all, and that there is little to no risk of COVID-19 spreading in the facility.

Meanwhile, Tuscaloosa County has reported seven confirmed COVID-19 cases. There are sure to be more that haven’t been confirmed by tests. Testing has been limited and hospitals have been reporting they are experiencing a “severe” shortage of testing supplies.

These workers in units deemed as low-risk aren’t being allowed to supply their own PPE, either.

Last week, CDC posted recommendations that health care workers do whatever they can to protect themselves and their patients if they fear a patient may have COVID-19. These recommendations even include wearing a bandana or a scarf as a makeshift mask as a last resort when caring for COVID patients. (Updated Monday at 4 p.m. to clarify the CDC’s guidelines.)

“In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort,” the CDC wrote. “However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.”

The clinician who spoke with APR said medical workers aren’t being allowed to sanitize and reuse masks they’ve already worn. The hospital spokesperson said the health system is following CDC guidelines that require providers to limit the number of times they wear a single mask.

The directives are leaving the health care workers in the facility concerned that they could be infected, and they could infect their co-workers, patients and families. Another health care worker at the hospital said the situation is “crazy.”

DCH’s spokesman said allowing staff to use their own PPE or makeshift masks could cause more harm than good. “There are several reasons but the main one is it is difficult to provide quality control oversight for personally provided PPE, which could lead to unintended unsafe situations,” the DCH spokesperson said when asked why hospital staff isn’t being allowed to furnish its own PPE.

Hospitals across the state are already struggling under the strain of the pandemic — severe personal protective equipment shortages, new cases arriving into emergency departments and the potential that their facilities may not have enough beds and ventilators.

“But the idea that we don’t have enough PPE so we’re just going to take it away from anybody who’s not literally in direct contact with someone we specifically know to have the disease — that flies in the face of the current idea that we do have asymptomatic carriers, that we do have people that have symptoms that may not be confirmed,” the clinician said.

Only N-95 masks are effective at preventing infection. Public health experts say surgical masks are not effective at preventing infection of COVID-19, but they are at least somewhat effective at preventing the transmission of the virus from the person wearing the mask.

“I can’t be certain that I myself am not a carrier,” the clinician said. “I’ve been out in the community.”

In Alabama, the Department of Public Health has reported that 157 people have tested positive for the virus, as of Sunday afternoon.

The number of COVID-19 cases in the state is believed to be much higher, but testing has been limited, and medical facilities are running out of testing supplies like viral transport media and nasal swabs.

The Tuscaloosa hospital system’s directive prompted a complaint to the Occupational Health and Safety Administration, but OSHA does not appear to have the authority to intervene.

As managers and administrators directed hospital staff not to wear masks to avoid panic and save supplies, patients with severe respiratory problems and fevers were being treated in the facility, symptoms that line up with those of COVID-19.

“We had two patients with respiratory issues that came up within two days,” the clinician said. “To our knowledge, it didn’t seem as though anyone had tested them at that point. I’m talking fever, cough, shortness of breath. One of them had recently been in acute respiratory failure and on a ventilator.”

“The nurses on the floor as well as all the therapists seem to get that. There’s beginning to be some unrest, especially with the lack of testing that we’re seeing with patients,” they said.

The clinician who spoke with APR said they are now displaying symptoms of COVID-19 including cough and shortness of breath.

“I came down with a cough and a fever and shortness of breath, and now I have to go get tested,” they said. “My biggest worry is that we’re putting our patients in the direct path of this thing right now. Everything else comes secondary to that. These people come to us to get stronger, to be able to go back home and return to their previous level of function, but if we’re risking them this way, we may even be sending people back out into the community from here that may have been exposed that are unaware.”

Updated at 4 p.m. with clarifications regarding DCH’s policies and CDC guidelines.

Chip Brownlee is a former political reporter, online content manager and webmaster at the Alabama Political Reporter. He is now a reporter at The Trace, a non-profit newsroom covering guns in America.

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Health

Alabama has fourth highest rate of coronavirus cases

Alabama has the fourth-highest per capita rate of COVID-19 cases in the country, trailing only fellow Southern states Louisiana, Florida and Mississippi.

Brandon Moseley

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(STOCK PHOTO)

Alabama has the fourth-highest per capita rate of COVID-19 cases in the country, trailing only fellow Southern states Louisiana, Florida and Mississippi.

Alabama has so far recorded at least 29,896 cases per million people, which amounts to 2.9 percent, nearly 3 percent, of the people in Alabama.

The Alabama Department of Public Health on Monday reported that 818 more Alabamians have tested positive for the coronavirus. This takes our state up to 145,780 diagnosed cases. At least 61,232 Alabamians have recovered from the virus.

But 82,109 Alabamians have active coronavirus cases. This is the ninth-highest raw total in the nation, trailing only Florida, California, Georgia, Arizona, Virginia, Maryland, Missouri and Texas — all states with higher populations than Alabama.

Alabama’s high rate of infection is not due to the state doing more testing. ADPH announced 5,500 more tests on Monday, taking the state up to 1,059,517 total tests.

Alabama is 40th in the nation in coronavirus testing.

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Tests as a percentage of the state’s population is just 22.8 percent. Louisiana on the other hand has 47 percent — the fifth highest rate of testing in the nation. Even Mississippi, at 26.4 percent, is testing at a higher rate than Alabama and are 29th in testing. Florida is 37th.

On Monday, ADPH reported two more Alabamians have died from COVID-19, taking the state death toll to 2,439. Alabama is 21st in death rate from COVID-19 at almost .05 percent.

New Jersey has had the highest COVID-19 death rate at .18 percent of the population. At least 257 Alabamians have died in September, though, to this point, September deaths are trailing both August and July deaths. At least 602 Alabamians died from COVID-19 in August.

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Hospitalizations from COVID-19 are also down. 780 Alabamians were hospitalized with COVID-19 on Sunday, down to levels not seen since before the July 4 holiday. At least 1,613 Alabamians were in the hospital suffering from COVID-19 on Aug. 6.

Alabama Gov. Kay Ivey’s July 15 mask order is being credited with decreasing the number of coronavirus cases in the state, which had soared to a seven-day average of 1,921 cases per day on July 19. The current seven-day average is 780 cases per day but is little changed in the last ten days.

The mask order expires next month, but most observers expect the mask order to be continued into November.

High school football and the Labor Day holiday weekend did not lead to a surge in cases; however, public health authorities remain concerned that colder weather and the return of flu season could lead to another surge in cases.

President Donald Trump has expressed optimism that a coronavirus vaccine could be commercially available this fall. A number of public health officials, including the CDC director, have expressed skepticism of that optimistic appraisal.

At least 969,611 people have died from COVID-19 globally, including 204,506 Americans.

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Health

Study: Those with COVID twice as likely to have dined in restaurants

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes. 

Eddie Burkhalter

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(STOCK PHOTO)

A recent study by the Centers for Disease Control and Prevention found that adults who tested positive for COVID-19 were twice as likely to have eaten in restaurants, which builds upon known factors about how the disease is transmitted, experts say, but the study has limitations.

The study surveyed 314 adults in 10 states and found that those who tested positive for COVID-19 were twice as likely to have eaten at restaurants within the previous 14 days. Researchers found that there was no significant difference between those who tested both positive and negative and who said they had gone to gyms, coffee shops, used public transportation or had family gatherings.

“Masks cannot be effectively worn while eating and drinking, whereas shopping and numerous other indoor activities do not preclude mask use,” the study notes.

Dr. Bertha Hidalgo, an epidemiologist and associate professor at UAB’s School of Public Health, told APR on Wednesday that the study lends evidence to what the medical community knows are potential risks for contracting COVID-19, which include being indoors and unmasked, but there are nuances to each of those activities that can either increase or decrease that risk.

The study did not differentiate between indoor and outdoor dining, and infectious disease experts say being outdoors decreases the risk of contracting COVID-19.

“It’s also hard to know what policies are in place where these people were recruited from for this study,” Hidalgo said. “Whether they’re required to be masked or if there’s a decreased capacity in a restaurant.”

Monica Aswani, assistant professor at UAB’s School of Health Professions, said she would be cautious about interpreting the study through a causal lens.

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“People who are willing to dine in restaurants are also likely to engage in other risky behaviors, such as not wearing masks. Since this is a survey, there is not enough evidence to suggest that the source of exposure was restaurants without contact tracing to supplement it,” Aswani said. “Likewise, respondents may have misreported their behaviors, given the sensitive nature of the questions. The authors note this as a limitation and highlight how participants were aware of their Covid-19 test results, which may have influenced how they responded.”

Aswani also noted that the questions about dining did not differentiate between indoor versus outdoor seating, “which represent different levels of risk to exposure.”

“Participants who visited a restaurant on at least one occasion, regardless of the frequency, are also considered similar. Consequently, in the two weeks before they felt ill, someone who dined on a restaurant patio once and someone who ate indoors at five different restaurants are indistinguishable in their data,” Aswani said.

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Hidalgo said that while there are clear limitations to the CDC’s study, the findings do back up what the medical community knows about the transmission of the disease.

“I would very much look at this from the big picture perspective, and say we know that indoor activities are an increased risk for COVID-19. This study lends evidence to that,” Hidalgo said.

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Economy

Report: Transitioning to electric vehicles could save Alabama millions in health costs

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

Micah Danney

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(STOCK PHOTO)

Alabama could save $431 million in public health costs per year by 2050, if the state shifted to an electric transportation sector between now and then, according to a new study by the American Lung Association.

Such a transition would reduce other health-related issues, said the organization, which used data on pollution from vehicles and from oil refineries to calculate its findings.

Alabama would experience approximately 500 less asthma attacks per year, about 38 fewer premature deaths and prevent more than 2,200 lost workdays annually.

The transportation sector is one of the main contributors to air pollution and climate change, said William Barrett, the association’s director of advocacy for clean air and the study’s author.

“We have the technology to transition to cleaner cars, trucks and buses, and by taking that step we can prepare Alabama for the future while also seeing the health and economic benefits forecasted in ‘The Road to Clean Air,’” Barrett said. “Especially as our state faces the impacts of climate change, such as extreme storms, this is a powerful and practical opportunity to take action to improve our economy, our health and our future.”

Trading combustion-powered vehicles for electric ones could result in $11.3 billion in avoided health costs across southern states by mid-century, the report estimated, and prevent roughly 1,000 premature deaths.

Nationally, Americans stand to save $72 billion in health costs and $113 billion in avoided climate change impacts, the ALA said.

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The path to that future depends on leaders factoring public health effects into decisions about transportation, Barrett said.

That involves steps like pursuing electric vehicle fleets when purchasing decisions are being made and supporting the creation of enough charging stations along highways, roads and at truck stops.

Investing in that infrastructure can drive wider economic benefits, Barrett said. He cited California’s increased manufacturing of electric vehicles.

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Tesla is the most well-known producer that has located there, but Barrett said that makers of trucks and buses have also chosen to locate their facilities in the state.

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Health

CDC director: Vaccine won’t be available to general public until mid-2021

Eddie Burkhalter

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CDC director Robert Redfield (VIA CSPAN)

The director of the Centers for Disease Control and Prevention during testimony Wednesday before a U.S. Senate Appropriations subcommittee said a vaccine won’t be widely available to the public until mid-2021. 

Wearing a mask is the most important public health tool we currently have in the fight against the deadly disease, he said.

“I might even go so far as to say that this face mask is more guaranteed to protect me against COVID than when I take a COVID vaccine,” CDC director Robert Redfield told lawmakers.

Asked during the hearing by Sen. John Kennedy, R-Louisiana, when a vaccine will be ready “to administer to the public,” Redfield said that he believes there will be a vaccine that will initially be available some time between November and December. 

“But very limited supply, and it will have to be prioritized,” Redfield said. “If you’re asking me when is it going to be generally available to the American public, so we can begin to take advantage of vaccine to go back to our regular life, I think we’re probably looking at late second quarter, third quarter 2021.” 

Redfield said it will take time to expand vaccinations out from those who need them most direly to the larger public, and said there are about 80 million people in the U.S. who have underlying health conditions that put them at greater risk and need the vaccine first. 

President Donald Trump has repeatedly said there will likely be a vaccine available to the public possibly before the November election or even sooner. 

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When asked about Redfield’s statements that one won’t be available to the public until the summer or early fall of 2021, Trump said during a press conference Wednesday that Redfield was mistaken. 

“I think he made a mistake when he said that. It’s just incorrect information,” Trump said. “And I called him, and he didn’t tell me that. I think he got the message maybe confused. Maybe it was stated incorrectly. We’re ready to go immediately as the vaccine is announced, and it could be announced in October. It could be announced a little bit after October.” 

Trump refuted the CDC head, and said the vaccine will be made available to the general public “immediately” once one is approved. Asked for Trump’s timelines as to when a vaccine will be ready to administer to the wider public, an official at the press conference seated near Trump said that will likely occur by the end of March. 

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The Trump administration on Aug. 14 announced that the McKesson Corporation would be the central distributor of COVID-19 vaccines in the U.S. The company distributed the H1N1 vaccine during the 2009-2010 pandemic. 

AstraZeneca’s COVID-19 vaccine trials were put on hold worldwide on Sept. 6 after a volunteer in Britain experienced a serious health problem. The company’s vaccine trials resumed in the United Kingdom on Saturday.

The company in a statement said it was working with global health authorities to “be guided as to when other clinical trials can resume.” 

The drugmaker Pfizer Inc. on Tuesday announced that those enrolled in the clinical trial for the company’s own COVID-19 vaccine were experiencing mild to moderate side effects, but that an independent monitoring committee has not yet recommended pausing the study.

There have been 2,392 COVID-19 deaths in Alabama since the pandemic began, according to the Alabama Department of Public Health.

At least 193,000 people in the U.S. have died from coronavirus, according to The Washington Post.

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