You wait a day in the emergency room, with no one to answer the phones, no one to take out the trash. And every day more patients arrive.
That’s the scene playing out in some Southern California hospitals, after the wave of COVID-19, triggered by Omicron, has led to a shortage of doctors, nurses and other health care workers. Although Omicron is causing significantly fewer serious illnesses than last year’s winter surge, the unprecedented number of infected people has stretched medical infrastructure to the limit.
State officials are trying to fix California’s staffing shortage through a policy overturn that allows asymptomatic health care workers who have tested positive for the coronavirus to return to work immediately, without the need for isolation or testing. The policy, which will be in effect until February 1, is designed to keep more health workers on the job at a time when hospitals are expecting more patients.
Some experts say California’s position is an unorthodox but necessary solution to a difficult problem. However, many health workers and community members say the policy is not only ill-advised, but potentially dangerous.
“The situation is desperate,” said Erin McIntosh, a rapid response nurse at Riverside Community Hospital. “I entered the health sector wanting to help people, but now I am the vector. Someone comes to me for help, and I could be giving them COVID.”
McIntosh said Monday that more than 300 nurses and many other hospital staff are furloughed by COVID-19, and those who remain are stretched thin. Some nurses are having too many patients to attend to, while others can’t even find an assistant to help get patients to the bathroom.
But potentially exposing patients to hospital workers who have tested positive — even if the workers don’t feel sick or show symptoms — isn’t the solution, McIntosh said. You’ve already heard of coronavirus-positive workers caring for laboring mothers, chemotherapy patients, and neonatal intensive care patients.
“Now they are even more vulnerable,” he said.
The California Department of Public Health said hospitals are reaching capacity, and the decision was prompted in large part by staffing shortages that make it difficult to provide essential care.
“Given those conditions, the department is providing temporary flexibility to help hospitals and emergency service providers respond to unprecedented surges and staffing shortages,” the agency said.
Under the guidelines, hospitals must exhaust all other options before resorting to the new policy, and workers who have tested positive for the virus must “preferably be assigned to work with COVID-19 positive patients.” They should always wear N95 masks.
The announcement was met with outrage by many in the healthcare industry.
The decision is “irresponsible and a huge mistake that will endanger everyone’s health,” said Rosanna Mendez, executive director of SEIU 121RN, a union that represents workers in Southern California. “This plan is unscientific and dangerous, and given what we know about the transmissibility of the new variant, we believe it will put healthcare workers and patients at unnecessary risk.”
But some experts say patients cared for by asymptomatic workers who follow proper protocols are relatively safe, and that the policy — while not perfect — is a necessary act to prevent the system from collapsing.
“Is it the ideal situation? No,” said Dr. Robert-Kim Farley, an epidemiologist and infectious disease expert at the UCLA Fielding School of Public Health. who cares for patients, versus having staff who care for them and who may have COVID? Yes, it is the lesser of two evils.
Kim-Farley said the policy is an acknowledgment of the significant strain hospitals are experiencing amid rising patient numbers and declining staff. The chances of transmission by an asymptomatic worker are minimal, he considered, especially since he would take precautions, such as the use of high-quality medical masks.
But, he added, “when the patient load starts to decline, and so does the staffing shortage, we should drop this extraordinary approach.”
The situation in many hospitals already appears untenable, with some healthcare workers pointing out that the new policy is creating more stress for an already overtaxed workforce. Others said it was hypocritical for the state to ask employees with coronavirus to report to work after instituting a vaccination mandate that cost some workers their jobs.
Gabriel Montoya, an emergency medical technician at Kaiser Downey, said when he arrived at work one day last week, there were still patients in the waiting room who had been sitting there when he left the night before.
All beds in the emergency room – including 80 in the emergency room and 20 in a tent outside – have been full since the beginning of the year, he said. Cleaning staff, environmental service workers, delivery people, and even lab workers processing COVID-19 tests are sick.
However, the policy change fails to take into account the reality of day-to-day patient care, which often requires “working inches apart,” he noted. Instead of solving the problem, it could make it worse.
“The result will be that there are more sick people,” Montoya stressed. “That’s what’s going to happen.”
What’s more, he said the change exposes not only patients and workers, but also their loved ones. Montoya cares for her mother at home.
“The workers feel that they are being devalued, that their own lives and those of their families are being disrespected,” he said. “And then they’re ‘retraumatizing’ themselves by having to go back to the workplace facing obstacles that we didn’t have to face the day before.”
Dr. Joanne Spetz, director of the Philip R. Lee Institute for Health Policy Studies at the University of California, San Francisco, said the novelty of Omicron makes it difficult to compare the risk of staffing shortages with the risk of patient exposure. , as there is little data on the new variant.
What is clear, however, is that understaffing poses a significant risk to patients. Research has revealed that staffing shortages lead to more deaths, more morbidity, and more accidents and errors, he said.
“Hospitals find themselves between a rock and a hard place, with staffing shortages and rising patient volumes contributing to the crisis,” says Spetz. “What do you do in a situation like this?”
Some hospitals, including Los Angeles County-USC, the largest public hospital in Los Angeles, are weighing the options. The Los Angeles County Department of Health Services is reviewing the proposed guidelines but has not yet issued an official policy, hospital officials said in an email.
“As always, when addressing any changes to our intended practices, the LA County Department of Health Services will make adjustments that follow data-driven science and uphold our responsibility to the well-being of staff, patients and the communities they serve. we serve,” they said.
California Health and Human Services Secretary Dr. Mark Ghaly also said Monday that the guidelines are not a requirement and asked health systems to use the measure only if they have explored all other options.
But on Tuesday, nurses and representatives from the SEIU 721 union rallied outside the Los Angeles County Board of Supervisors meeting downtown to speak out against the measure. The California Nurses Association said it was also planning a “day of action” on Thursday to condemn the state’s decision.
Dr. Ileana Meza, president of the SEIU union and a nurse practitioner at Los Angeles County-USC, said the situation for staff at the hospital was dire. When he got to work on Monday, the parking lot seemed empty because there were so many sick people. Thirty emergency room nurses and 40 operating room nurses quit last week, and some patients are waiting up to 20 hours to be admitted.
But there are safer solutions to the staffing crisis than asking healthcare workers who test positive for the coronavirus to care for patients, he said, such as investing in more staff, making efforts to improve compensation and morale, tightening controls of visits, cancel all non-elective and non-critical procedures and focus on telemedicine.
“With this new decision, if you come to the hospital for a routine check-up, you may be checked in by an employee who is positive, your vital signs may be taken by a nurse who is positive, you may be seen by a doctor who is positive,” he said. table.
“That means that you arrive at the center without the virus and you can contract it,” he stressed. “This is not the way to push back the pandemic.”
Times staff writer Gregory Yee contributed to this report.
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