POST 67. November 13, 2020. CORONAVIRUS. “When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.”

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“North Dakota’s hospitals have reached their limit, and the coming weeks could push them past their capabilities, Gov. Doug Burgum said at a news conference on Monday, Nov. 9.

Due to a major shortage of health care staffing, the state’s hospitals have a severe lack of available beds. Rising COVID-19 hospitalizations and high noncoronavirus admissions, some resulting from residents who deferred health care earlier in the pandemic, have caused the crunch on medical centers.

Burgum said hospitals are implementing their “surge” plans, and some will be voluntarily stopping elective surgeries to free up staff. He added that the state will coordinate with hospitals to move nurses to medical centers in most dire need of staff.

In an attempt to alleviate some of the staffing concerns, Burgum announced that interim State Health Officer Dirk Wilke has amended an order that will allow health care workers with asymptomatic cases of COVID-19 to continue working in COVID-19 units at hospitals and nursing homes.

The move aligns with “crisis” guidelines from the Centers for Disease Control and Prevention. Since only patients with COVID-19 could receive care from doctors and nurses with the virus, Burgum said he believes there will be little risk of more spread. He added that health care workers in COVID-19 units already wear protective gear to prevent them from contracting the virus.

The Republican governor said health care providers asked the state to take the extraordinary step, adding that “apparently some (providers) had the ability to do this in other states.” “ (A)

“Burgum also announced plans to hire emergency medical services personnel to facilitate testing, as well as efforts to expand rapid testing. He has also moved all counties in the state to the orange or “high risk” level.

At his weekly virus press conference, the governor said hospitals requested that asymptomatic workers be allowed to return to staff their coronavirus units. Some hospital systems have done this at their facilities in other states, he said.

Statewide, hospitals have seen a 60% uptick in coronavirus patients in the past four weeks, and their staffs are stretched thin as workers stay home because they have tested positive or must quarantine. On Monday, the state reported 14 more coronavirus hospitalizations, a substantial increase for a single day. Throughout North Dakota, 254 people are hospitalized due to COVID-19.

Burgum said he believed allowing asymptomatic staff to work with patients hospitalized due to the virus would help alleviate capacity issues and not contribute to further spread among health care workers.

“We’re confident it can (work) under the narrow restrictions that we have,” he said, adding that workers would be dressed in full personal protective equipment.

Asymptomatic workers would be “completely isolated” from their coworkers and would enter hospitals through separate doors, said Chris Jones, executive director of the North Dakota Department of Human Services…

Hospital leaders will now have daily meetings with counterparts in their communities to address capacity issues. They might move workers from one location to another, even from one hospital to a competitor, Burgum said.

The North Dakota Department of Health will begin to hire EMS personnel at rates of $30 to $42 per hour, depending on a candidate’s licensure level, to test for COVID-19. Their wages will be paid for by federal coronavirus stimulus dollars.

Burgum said the effort will help “free up some of the nurses we have working for the Department of Health to be deployed to support in-patient care as needed” at hospitals.” (B)

“Guidance from public health experts has evolved as they have learned more about the coronavirus, but one message has remained consistent: If you feel sick, stay home.

Yet hospitals, clinics and other health care facilities have flouted that simple guidance, pressuring workers who contract COVID-19 to return to work sooner than public health standards suggest it’s safe for them, their colleagues or their patients. Some employers have failed to provide adequate paid leave, if any at all, so employees felt they had to return to work — even with coughs and possibly infectious — rather than forfeit the paycheck they need to feed their families.

Unprepared for the pandemic, many hospitals found themselves short-staffed, struggling to find enough caregivers to treat the onslaught of sick patients. That desperate need dovetailed with a deeply entrenched culture in medicine of “presenteeism.” Front-line health care workers, in particular, follow a brutal ethos of being tough enough to work even when ill under the notion that other “people are sicker,” said Andra Blomkalns, who chairs the emergency medicine department at Stanford University…

But the dilemma also strains health workers’ sense of professional responsibility, knowing they may become vectors spreading infectious diseases to the patients they’re meant to heal.

A database of COVID-related complaints made to the Occupational Safety and Health Administration this spring hints at the scope of the problem: a primary care facility in Illinois where symptomatic, COVID-positive employees were required to work; a respiratory clinic in North Carolina where COVID-positive employees were told they would be fired if they stayed home; a veterans hospital in Massachusetts where employees were returning to work sick because they weren’t getting paid otherwise…

Indeed, the pressure likely has been even worse than usual during the pandemic because hospitals have lacked backup staffing to deal with high rates of absenteeism caused by a highly infectious and serious virus. Hospitals do not staff for pandemics because in normal times “the cost of maintaining the personnel, the equipment, for something that may never happen” was hard to justify against more certain needs, said Dr. Marsha Rappley, who recently retired as chief executive of the Virginia Commonwealth University Health System in Richmond.

That has left many hospitals scrambling to find skilled staff to tend to waves of patients with COVID-19…

Federal officials acknowledge that staffing shortages may require sick health care workers to return to work before they recover from COVID-19. The Centers for Disease Control and Prevention even has strategies for it.

The CDC website lists mitigation options for short-staffed facilities, some of which have been implemented widely, such as canceling elective procedures and offering housing to workers who live with high-risk individuals.

But it acknowledges these strategies may not be enough. When all other options are exhausted, the CDC website says, workers who are suspected or confirmed to have COVID-19 (and “who are well enough to work”) can care for patients who are not severely immunocompromised — first for those who are also confirmed to have COVID-19, then those with suspected cases.

“As a last resort,” the website says, health care workers confirmed to have COVID-19 may provide care to patients who do not have the virus.” (C)

(A)With North Dakota hospitals at 100% capacity, Burgum announces COVID-positive nurses can stay at work, by Jeremy Turley,

(B) North Dakota takes steps to add staff for hospitals ‘under enormous pressure’, AMY R. SISK,

(C) Nurses and Doctors Sick With COVID Feel Pressured to Get Back to Work, By Emmarie Huetteman,

Doctor, Did You Wash Your Hands? ®  at

TWITTER @jonathan_metsch   FACEBOOK Jonathan M. Metsch    LINKEDIN Jonathan Metsch

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