Medical providers are grossly underprepared to test or treat the virus
The author of this op-ed is a nurse who works in Sacramento. The name of the author has been omitted in order to protect their identity.
We knew a pandemic was coming, or at least we should have.
We had warnings like H1N1, the “swine flu,” in 2009, when I was a young nurse in Baton Rouge caring for a female patient who would eventually become the first swine flu fatality in Louisiana. Despite her steadily deteriorating condition, the doctors treating her were repeatedly told by the state health department that she didn’t meet existing CDC criteria for H1N1 testing, a simple nasal swab. By the time she was finally tested, she was in intensive care and on a ventilator. She stays in my memory wherever I go.
Fast forward to late January of 2020, when those of us who pay attention to such things began reading about a new virus infecting people in China. By the time the CDC had already confirmed a travel-related case in the U.S., healthcare professionals knew that we may be at the beginning of a very nasty epidemic, possibly a pandemic.
I am a registered nurse (RN) who currently works exclusively with communities of vulnerable, low-income seniors in Sacramento County. I started to worry when the disposable N95 masks I use when assessing patients with flu-like symptoms were out of stock at my usual medical supply place. When I saw they weren’t available on Amazon, I was able to find them from random retailers on eBay, but the price was 10 times higher than it should have been. By mid-February, I was completely out of masks. My friends in healthcare were all seeing similar warning signs.
On Feb. 21, Sacramento County suspended its mandate requiring healthcare workers that are not vaccinated against the flu to wear masks while working. Hospitals in the area reversed basic, fundamental policies of asking employees with coughs to wear masks. Instead, a policy was issued forbidding staff from wearing masks “to prevent passing on germs if they are ill,” — if only there were any masks to be found. At hospitals all over the greater Sacramento area, N95 respirators left supply room shelves and were secured with charge nurses for rationing.
Part of my job requires that I assist seniors with the transition from hospital and nursing facility care to in-home care, which means I regularly visit Sacramento’s hospitals and nursing facilities.
On Feb. 24, I developed symptoms consistent with my seasonal allergies. That same day, I raised concerns with my employer, a non-medical non-profit, because we did not have a pandemic protocol, and it was likely that we may need one very soon. I told my supervisor and the director of human resources that most of our social support services could be provided over the phone to reduce the risk of person-to-person transmission. I was told that wasn’t how things were done. As the only healthcare professional in the organization, I asked to be part of putting our pandemic policy together. No one shared my urgency on this matter, and my input was never requested, despite my years of nursing experience.
I finished out the work week blaming the blooming trees for my symptoms. When I started running a fever on March 2, I came home early from work and emailed my doctor. I asked what steps were necessary to rule out infection with COVID-19, as I was terrified I had contracted and then unknowingly spread the virus to a large number of vulnerable seniors living in close quarters. She told me I didn’t meet the existing CDC criteria for COVID-19 testing and prescribed an antibiotic for what she assured me was nothing more than a sinus infection. I worked from home for a bit and then voted on March 3, before my fever climbed over 102 degrees Fahrenheit.
On March 4, California’s first COVID-19 fatality was recorded close to where I live in Roseville. I could barely stay awake that day, fighting a bad cough and shortness of breath as my fever nearly reached 103 degrees. I didn’t work or leave the house that day.
Early morning on March 5, I emailed my doctor and requested again that I be tested for COVID-19 because I could not recall ever being this sick as an adult. I explained again, this time with more urgency, my fear that I was infected with COVID-19 and had potentially exposed nearly 700 elderly people to the virus. My doctor admitted that she had no test kits or personal protective equipment necessary for test sample collection. She referred me to the Placer County Department of Health and Human Services to find out for myself how to get tested. I called and was unable to reach anyone in the department who could answer my questions about testing, so I directly emailed Dr. Aimee Sisson, the health officer and public health director of Placer County. She responded asking for my doctor’s information in order for them to coordinate, rule out the flu and then have me tested for COVID-19.
That afternoon, I called the emergency department at Sutter Roseville to inform them that I was an RN exhibiting symptoms of COVID-19 and had been sent there for testing after speaking to my doctor and the county’s director of public health. They confirmed I was on the list for testing and asked me to wait for a nurse to meet me by the isolation tent next to the ambulance entry. I was given a mask and told to have a seat inside the tent.
After five hours in an unheated, unsealed and dirty tent outside Sutter Roseville, I was told that my flu test was negative and that my COVID-19 sample would be sent to the Sacramento County Public Health Lab for testing, with preliminary results expected within 48 hours or so. I was told to self-quarantine at home until further notice.
When I informed my employer of the same, I asked to work from home while waiting for my results. I begged my employer to keep my work phone on, do check-ins over the phone and help sort the worried well from the symptomatic sick. I explained how doing so would take some of the burden off first responders, primary care providers, nurse advice lines and emergency rooms during a COVID-19 pandemic. It seemed obvious to me that even if I was not available in-person, I could still use my knowledge and skills to help prepare us for the virus.
I was ignored and forced to exhaust all of my accumulated paid time off. On March 11, my employer sent out an organization-wide email issuing new policies and practices “effective immediately” that were inconsistent with evidence-based best practices for pandemics.
On March 13, I emailed Dr. Sisson and her team again, asking why my test results were still unavailable after eight days. While I was already beginning to recover from being very sick, I explained my fear that my illness was due to COVID-19 and that I could have spread it to at least one nursing home and the three communities where I work.
I remain in quarantine to this day, still waiting for my results. I don’t know why there has been a delay in my results, and neither does Dr. Sisson or her team. All we know is that my test was sent to Sacramento County for processing, and that no results are available yet.
I am a healthcare professional who does important work. While doing my job, I potentially exposed a large number of elderly patients, the most vulnerable group, to COVID-19. Yet my test remains unprocessed.
My experience is common among healthcare providers in the Sacramento area, California and the broader U.S. Many of us are at home waiting on results while even more have yet to be tested. We got sick on the front lines of this pandemic, and we will be the ones caring for everyone else through the dark days ahead.
I tried to warn my employer that our organization was on a collision course with disaster. I tried to warn my patients that a pandemic was knocking on our door. Right up until I left work at lunch with a fever on March 2, I was educating others on the dangers posed by this virus and effective methods to prevent its spread. It now seems I was likely transmitting the illness while trying to prevent it.
Some of those I came into contact with during the last week of February are now sick, and some of the ones who are sick are quarantined. People I care about will die — this is all but guaranteed. The same crisis unfolding in Italy will soon happen here in the U.S.
The window of opportunity to prepare has already closed. There aren’t enough masks, tests or time. There is a very real possibility that there won’t be enough ventilators. The CDC warned our government that this was coming, and instead of enacting proper precautions, the federal government offered only a naïve hope that COVID-19 would magically go away. The CDC has now issued guidance for healthcare workers on using bandanas and scarves as masks due to extreme shortages of masks, one of the most basic forms of protective equipment.
President Donald Trump’s willingness to repeatedly lie to the public has contributed to the speedy spread of the virus. On Feb. 26, Trump told the public not to worry because the number of COVID-19 infections in the U.S. was “going very substantially down, not up.” Statements like these directly contradict the warnings issued by global and domestic health officials who urged us to be proactive. When the president suggests that the virus and threat it poses will magically disappear in the spring, it is no wonder that the eventual response is too little, too late. Those with the power and resources to contain the virus have already failed to do so, and the scale of this failure has yet to be fully understood.
In what has quickly become an uncertain time, the only certainty is that life as we know it will continue to change. When this pandemic is eventually taught in history, there will be a clear distinction between life before and life after the virus.
As we watch disaster unfold, I urge that we learn from the arrogance and ignorance that landed us here. We are doomed to repeat the same failures if we don’t.
Written by: An anonymous nurse in Sacramento
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