US nurses who can't get tested fear they are spreading Covid-19

CORONAVIRUS | In New York City, an intensive care nurse treated patients for three days after she started displaying symptoms of Covid-19 but couldn't get a test from her hospital. In Georgia, a nurse was denied a test after treating an infected patient who died.

In Michigan, one of the few hospital systems conducting widespread staff testing found that more than 700 workers were infected with the coronavirus - more than a quarter of those tested.

More than a month after the pandemic hit the United States, the persistent test shortages mean that health workers are treating patients while experiencing mild symptoms that could signal they are infected themselves, according to Reuters interviews with 13 nurses and 2 doctors who described testing shortages at their hospitals.

Many medical centres are testing only the workers with the most severe symptoms, according to the frontline workers and hospital officials. As a result, nurses and doctors risk infecting patients, colleagues and their families without knowing they are carrying the virus, medical experts say.

The New York City nurse works at Mount Sinai Hospital, a major institution in the national epicentre of the pandemic. Her nausea, upset stomach and low-grade fever did not qualify her to get a test in late March, she told Reuters on condition of anonymity. 

She continued to work because her fever - at 37.9 Celsius - was just below the threshold set by the US Centres for Disease Control and Prevention for sending health workers home.

But she had the virus, an infection she confirmed when she took it upon herself to get tested at a private clinic, she said.

"I knew something wasn’t right," the nurse said, "but I didn’t really think I had it."

A hospital spokesperson declined to comment on the nurse’s case but said that mildly symptomatic employees could now get tested.

Mount Sinai Hospital's chief medical officer, Vicki LoPachin, told staff on April 4 that the hospital would increase testing of employees with symptoms of the virus starting on Tuesday. 

New York is home of the nation's worst coronavirus outbreak, with about 78,000 cases and 3,600 deaths as of Wednesday morning.

Nationwide, the number of infections has surpassed 400,000, with nearly 13,000 deaths. The continued test shortages - even for the workers most at risk - is “scandalous” and a serious threat to the patients they treat, said Dr Art Caplan, a professor of bioethics at the NYU Grossman School of Medicine.

"It’s obvious that we should be testing healthcare workers, just as points of infectivity," Caplan said.

On Monday, the US Health and Human Services Inspector General’s Office published a survey of 323 hospitals that found the shortages left the facilities unable to effectively test staff and patients, who frequently waited more than seven days for results because of delays at outside laboratories.

In March, the US Food and Drug Administration gave states permission to approve their own tests to avoid federal regulatory delays. It also approved the first rapid coronavirus diagnostic test, manufactured by Cepheid, which the company says can detect the virus in about 45 minutes without sending samples to an outside laboratory.

The FDA did not immediately respond to requests for comment on Wednesday about federal efforts to further address the persistent national test shortages.

While some hospitals have announced plans to test more employees in recent days due to increased capacity, the inconsistency across states has created a patchwork of testing protocols based on the supplies available.

NYC Health + Hospitals, the corporation that operates the city’s 11 public hospitals, said last week they would have the capacity to test all employees - regardless of symptoms - by April 22.

In Georgia, where the nurse told Reuters she was denied testing after treating a dying patient, the state health department said it is giving priority to healthcare workers at new drive-through test sites. The workers, however, must be evaluated and recommended for testing by a doctor.

The CDC advises that healthcare facilities should prioritise giving their limited tests to hospitalized patients and symptomatic healthcare workers, specifically those experiencing fever, cough and shortness of breath. All other healthcare workers should receive tests "as resources allow," according to the CDC's website.

Rapid testing

In Michigan - a leader among states in establishing testing programmes that deliver quick results - more than 700 staff in the Henry Ford Health hospital system have tested positive out of some 2,500 employees tested since March 12, chief clinical officer Adnan Munkarah said on April 6.

While the infected workers represent just two per cent of the system's overall staff, the high percentage of positive tests in the initial round signals that further testing could reveal many more infections.

The Henry Ford system did not immediately respond to a request for comment on Wednesday.

Until rapid testing is widely available, hospitals face a dilemma: Do they test staff with mild symptoms and keep them home for days as they await results? Or do they keep mildly ill - but desperately needed - staff at work to treat the rush of patients?

"It’s a different kind of triage," said Caplan, the bioethics professor. "It’s precaution versus, I need staff."

Rapid testing of all hospital employees could possibly decimate the workforce by revealing asymptomatic infected workers, several healthcare workers told Reuters. But it would also protect colleagues, patients and family members.

"It’s scary to come home and not know if you’re bringing it home to your family," said Sydnie Boylan, a nurse at Hollywood Presbyterian Medical Centre in Los Angeles.

She went to work in late March with a headache and sore throat, but no fever, after she had been exposed to a coronavirus patient while not wearing sufficient protective gear. Those symptoms did not qualify for testing at her hospital.

Boylan said the hospital told her to quarantine at home for 14 days because of her exposure to the patient. The headache and sore throat persisted for six days, she said.

Asked about Boylan's case, Hollywood Presbyterian Medical Centre's head of clinical operations Jamie Chang said in a statement the hospital is testing as many staff and patients as possible with limited supplies. He said the hospital follows the Los Angeles County Health Department guidelines for testing, which recommend prioritising patients with a cough, fever and difficulty breathing.

"Despite the severe shortage in testing capacity available to the hospital, Chang said, "all HPMC staff have access to the same Covid-19 testing that we offer to our patients."

Boylan said she had been tested at a drive-through site. She is still waiting on the results. - Reuters

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