The U.S. health care system is trying to be ready for possible outbreaks, after the Centers for Disease Control and Prevention warned communities Tuesday to prepare for the kind of spread now being seen in Iran, Italy, South Korea and other areas outside the virus’s epicenter in China.
As of Wednesday, the CDC notes in its website, there are only 14 confirmed cases of the new coronavirus in the United States, plus 45 more cases among Americans who were brought home from the Diamond Princess cruise ship or via flights from Asia arranged by the U.S. State Department. All but two of those 59 total cases in the U.S. are travel-related; there are no signs, so far, that the virus has spread beyond that.
Still, some U.S. health care workers on the front line, including Maureen Dugan, worry they are not properly prepared.
Dugan is a veteran nurse at the University of California, San Francisco Medical Center, where two coronavirus patients were earlier transferred this month. UCSF is one of the premiere hospitals in the country, but Dugan says her frustrations are mounting, because she says her employer offered little notice or training to those caring for the infected patients.
“We want to do the best; we work extremely hard to do the best for our patients, so don’t set us up to fail,” Dugan says. “It’s not only nurses, it’s all the other staff. It’s nursing assistants, it’s transport. Every staff member is worried.”
Coronavirus has yet to sicken American health workers, as it has in China. But deaths of hospital workers in Asia have heightened scrutiny of the U.S. health care system’s ability to protect people on the front line.
Dugan says the medical community wasn’t fully prepared for previous viruses like SARS and Ebola — and she’s concerned that lessons learned are not being applied today. For example: The protective garments provided, she says, leave the wearer’s neck exposed.
“The gowns that they’re providing are inadequate,” she says, with emotion. “I’m sorry, I get very passionate about this, because we’ve worked so hard to make sure that our nurses were protected, and therefore they can protect the public.”
UCSF said in a written response to NPR that it has taken multiple, “extensive” safety precautions, including isolating sick patients in rooms with special ventilation systems, and training staff with proper use of safety gear. In regards to the two coronavirus cases Dugan refers to, UCSF said it briefed the workers who were actually treating the patients. But the hospital does not — as a matter of course — inform general staff of incoming infection cases.
World health officials warn that COVID-19, the infection caused by the new coronavirus, may enter a new phase in the U.S., at some point. Thus far, U.S. hospitals have been able to plan for transfers of incoming patients, whose condition is already known. That’s very different from a spreading outbreak, where sick people walk in off the street — a far more difficult scenario for health care workers and the public they treat.
“It’s the unrecognized case that comes through your hospital system or your clinics that really pose the greatest risk,” says Mark Rupp, chief of infectious disease at the University of Nebraska.
Rupp’s hospital is considered a model for managing infections. Its pioneering medical center is one of the few with experience treating Ebola. It has an isolation chamber that filters pathogens, and practices dry runs, making sure respiration masks fit workers.
Most critically, he says, hospital staff verbally screen patients at the facility’s entrance, asking about symptoms and travel history.
Without that sort of logistical control at a hospital’s entrance, he says, a coughing patient can quickly infect medical staff and other patients waiting in the emergency room or a clinic.
But what about the thousands of other hospitals without extensive experience with the riskiest cases? How are they bracing for a potential outbreak?
Those medical centers are also preparing, says Nancy Foster, vice president of quality and patient safety for the American Hospital Association.
“Everyone I’ve spoken to says they’ve taken substantial steps to make sure they are prepared,” including steps like isolating infectious patients, and conserving face masks to ensure supplies last, Foster says.
But not all staff working at those hospitals feel ready.
The National Nurses Union is conducting an ongoing survey which, as of last week found about 31% of nearly 5,000 nurse respondents said they didn’t have enough protective gear to handle a surge of coronavirus cases. Only 9 percent said their hospital or clinic had plans to isolate potentially infected patients.
“That’s not high enough for us to feel comfortable,” says Bonnie Castillo, president of the National Nurses Union. She notes many hospitals are already operating at capacity, and if the coronavirus spreads in the U.S., it will stress the system even more.
“If health care workers and nurses aren’t protected, no one is protected,” Castillo says.
Meanwhile, the White House has requested $1.25 billion in new funding to support preparedness and vaccine development. Congressional Democrats — and some Republicans — are calling that amount insufficient.