Nurses Union Claims Nurses Suspended For Refusing To Enter COVID-19 Patient Rooms Without N95 Masks
[guest post by Dana]
Nurse Mike Gulick was meticulous about not bringing the novel coronavirus home to his wife and their 2-year-old daughter. He’d stop at a hotel after work just to take a shower. He’d wash his clothes in Lysol disinfectant. They did a tremendous amount of handwashing.
But at Providence Saint John’s Health Center in Santa Monica, California, Gulick and his colleagues worried that caring for infected patients without first being able to don an N95 respirator mask was risky. The N95 mask filters out 95% of all airborne particles, including ones too tiny to be blocked by regular masks. But administrators at his hospital said they weren’t necessary and didn’t provide them, he said.
His wife, also a nurse, not only wore an N95 mask, but covered it with a second air-purifying respirator while she cared for COVID-19 patients at Cedars-Sinai Medical Center across town in Los Angeles.
Then, last week, a nurse on Gulick’s ward tested positive for the coronavirus, which causes the disease COVID-19. The next day doctors doing rounds on their ward asked the nurses why they weren’t wearing N95 masks, Gulick said, and told them they should have better protection.
For Gulick, that was it. He and a handful of nurses told their managers they wouldn’t enter COVID-19 patient rooms without N95 masks. The hospital suspended them, according to the National Nurses Union, which represents them. Ten nurses are now being paid but not allowed to return to work pending an investigation from human resources, the union said.
Note:
Guidelines from the Centers for Disease Control and Prevention don’t require N95 masks for COVID-19 caregivers, but many hospitals are opting for the added protection because the infection has proven to be extremely contagious. The CDC said Wednesday at least 9,200 health care workers have been infected.
Three days ago, the CDC updated it’s website, with regard to Infection Control:
Major distributors in the United States have reported shortages of PPE, including N95 respirators, facemasks, eye protection, gowns, and gloves. Healthcare facilities are responsible for protecting their HCP from exposure to pathogens, including by providing appropriate PPE.
In times of shortages, alternatives to N95s should be considered, including powered air-purifying respirators (PAPRs), other classes of disposable FFRs, elastomeric half-mask, and full facepiece air-purifying respirators where feasible. Special care should be taken to ensure that respirators are reserved for situations where respiratory protection is most important, such as performance of aerosol generating procedures on patients with suspected or confirmed COVID-19 or provision of care to patients with other infections for which respiratory protection is strongly indicated (e.g., tuberculosis, measles, varicella).
The anticipated timeline for return to routine levels of PPE is not yet known. Information about strategies to optimize the current supply of N95 respirators, including the use of devices that provide higher levels of respiratory protection (e.g., powered air-purifying respirators [PAPRs]) when N95s are in limited supply…
Some procedures performed on patients with known or suspected COVID-19 could generate infectious aerosols. Procedures that pose such risk should be performed cautiously and avoided if possible. If performed, the following should occur: HCP in the room should wear an N95 or higher-level respirator such as disposable filtering facepiece respirators, PAPRs, and elastomeric respirators, eye protection, gloves, and a gown.
St. Johns released a statement, which indicated that
[A]s of Tuesday it’s providing N95 masks to all nurses caring for COVID-19 patients and those awaiting test results. The statement said the hospital had increased its supply and was disinfecting masks daily.
“It’s no secret there is a national shortage,” said the statement. The hospital would not comment on the suspended nurses.
Here’s what happened to one nurse:
Angela Gatdula, a Saint John’s nurse who fell ill with COVID-19, said she asked hospital managers why doctors were wearing N95s but nurses weren’t. She says they told her that the CDC said surgical masks were enough to keep her safe.
Then she was hit with a dry cough, severe body aches and joint pain.
“When I got the phone call that I was positive I got really scared,” she said.
She’s now recovering and plans to return to work next week.
“The next nurse that gets this might not be lucky. They might require hospitalization. They might die,” she said.
Although the report doesn’t confirm that Gatdula was infected directly by one of her patients, it does speak to the serious problems nurses (and healthcare workers) are facing, and the seeming double-standard in the distribution of N95s.
Finally, the report also reminds us that, due to the shortage of N95s in the U.S., the CDC had lowered its standards, and recommended that health care workers use bandannas if masks were unavailable.
–Dana
Hello.
Dana (0feb77) — 4/16/2020 @ 11:40 amDoes this virus kill common sense, too?
Dealing w/medical stuff can be icky and repugnant to many. But these selfless, courageous, healthcare workers, doctors, nurses, pramedics and so on – so many of them young- are literally risking their ‘lives, fortunes and sacred honor’ not for some abstract glory nor for economic benefit or a transient political cause–but to care for the sick and save human lives.
They’re patriots in a class all their own.
DCSCA (797bc0) — 4/16/2020 @ 12:14 pmMy sis is an ICU RN. Her hospital has been all over the map.
First the doctors told staff the Wuhan virus was not as bad as the flu (this was in early March). Then they told them not to wear masks unless treating a positive patient.
Now they seem to be doing better but sis said the nurses had to fight for almost every added safety step.
Sitting at home cooped up doesn’t seem so awful.
harkin (358ef6) — 4/16/2020 @ 12:42 pm_
Good thing Trump & Co. sent 18 TONS of PPE to China in February.
Dave (1bb933) — 4/16/2020 @ 12:55 pmR.I.P. Brian Dennehy, damn fine actor
Icy (6abb50) — 4/16/2020 @ 1:10 pmTrump also promised to send some to Russia.
Time123 (457a1d) — 4/16/2020 @ 1:12 pmIn Trump’s defense, I think he means after we’re geared up to make tons of the stuff. We had to gear up really fast while flattening the curve to buy time, but now that we are making tons of it, why not share it with the rest of the world? Make what we can of the investment.
Honestly, it’s amazing how industrious Americans are. Half the garages in my neighborhood could build and repair most of the stuff they come into contact with. We should get back to manufacturing. I don’t mind globalism if it means the globe is buying American goods.
Dustin (c56600) — 4/16/2020 @ 1:18 pmThe usual dishonest cherry picking… the complete quote:
“We’re going to be helping other nations. We’re going to be helping Italy, Spain, France, other nations, and we’re going to be helping them strongly. I think Russia is going to need ventilators. They’re having a hard time in Moscow. We’re going to help them. We’re going to help other countries that need ventilators. We’re going to have a lot. You see it with General Motors, you see it with other companies that are producing… We’re going to have hundreds of thousands of ventilators and it’s a great thing to have.”
Colonel Haiku (2601c0) — 4/16/2020 @ 1:26 pm@7,that’s a good point.
Time123 (f5cf77) — 4/16/2020 @ 1:48 pmI’m really confused as to why we’re still having supply chain issues on a critical substance this far into the crisis.
aphrael (7962af) — 4/16/2020 @ 1:54 pmWorse many hospitals are running out of money and are about to go bankrupt as elective surgery and emergency services are where they make their profits which have been curtailed.
asset (878aa9) — 4/16/2020 @ 1:59 pmIt is perplexing. I found one of these N95 masks on my miter saw in my garage. I had no idea what it was and just picked it up at the hardware store many years ago, but it has N95 printed on the front of it. It’s such a simple item. Molded fiber.
I have to imagine part of this is FEMA stockpiling in case we need more, given all the reports of feds grabbing supplies. The problem is that if they do that too much, and nurses spread the disease or get sick, we need more supplies in the long run.
It might be easier to just sell rolls of the fiber and let people adapt it into masks.
Dustin (c56600) — 4/16/2020 @ 2:05 pmPut this on the wrong post.
The key thing on the Opening America Great Again Again Plan for Opening and Not Closing America Plan
These are criteria, from the Trump Administration
So even by the Admins guidelines, the clock isn’t even going to start for days. If you’re not testing as much this week as last week, and we’re not, and the cases are still going up, a May 1st opening date is not possible under Trump’s admin own guidelines.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 2:05 pm> I had no idea what it was and just picked it up at the hardware store many years ago, but it has N95 printed on the front of it. It’s such a simple item. Molded fiber.
It has to be a certain *kind* of fiber, though, to make sure that it filters sufficiently small particles. I suspect the issue is partly related to how we maintain confidence that they actually filter particles of the size they claim to.
I had some from the fires last year because they were helpful in filtering smoke particles on the days when it was unhealthy to be outside. they’re gone now, of course.
aphrael (7962af) — 4/16/2020 @ 2:11 pmI found that you could still get the more durable P95 and R95s for longer than the N95s, normally they were more expensive, but until mid Feb they were still available and cheaper. I even found some P99 and P100’s at the Menards last week, they weren’t in the normal paint/carpentry area, buried among the bolts. Since everyone is specifically looking for N95’s I guess folks just didn’t bother to look a layer deeper into what masks do different things.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 2:18 pmAlso, after the 14 days elapsed before you can actually start to reopening phases, it’s 46 days to phase 3, in a perfect world, 60 days from the first day of decrease. So you can’t know what day to start counting until the 14th day in a row elapses.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 2:35 pmSimply from a malpractice POV, all HCP should wear those masks. If the nurses become vectors — one is contagious before symptoms occur — and carry the virus to previously uninfected patients, the hospital’s standard of care will be called into question.
Were I considering going to a hospital, I’d sure choose Cedars or a UCLA hospital instead of St John’s. I note that St John’s has fallen in respect since it went into BK a few years back.
Kevin M (ab1c11) — 4/16/2020 @ 2:48 pmTrump also promised to send some to Russia.
He also mentioned a number of other countries at the same time.
Kevin M (ab1c11) — 4/16/2020 @ 2:53 pmThe usual dishonest cherry picking… the complete quote
This is a problem I have with partisans picking up on anything that seems to harm Trump, without investigating the facts (and similarly by Trump’s partisan fans). There are enough things Trump does poorly that it’s not only unnecessary to peddle crap, but actively dilutes the value of the stuff that IS true.
Kevin M (ab1c11) — 4/16/2020 @ 2:55 pmI’m really confused as to why we’re still having supply chain issues on a critical substance this far into the crisis.
Because it takes a while to ramp up or start production of nearly anything. But once you do, gangbusters. At the end of WW2 we were making planes and boats and guns and such at an amazing rate. It actually caused a recession when we stopped.
Kevin M (ab1c11) — 4/16/2020 @ 2:58 pmSounds like the Private Practice episode from hell (St. John’s of SM sounds like the inspiration for the fictional St. Ambrose Hospital of that show..now you know I’ve scraped into the narrow of the Netflix bone).
urbanleftbehind (c972d2) — 4/16/2020 @ 2:59 pmI had some from the fires last year because they were helpful in filtering smoke particles on the days when it was unhealthy to be outside. they’re gone now, of course.
I bought 5 in January, a box found on the top of the overflow shelf at Walmart. I wear one only in stores, for maybe a half hour every three days and after the 3rd or 4th use I replace it. I also had most of a box of nitrile gloves I bought for handling some silver age comic books last year. I wear those and discard them before I get back in the car.
Kevin M (ab1c11) — 4/16/2020 @ 3:02 pmUp until a few years ago, St John’s was considered a fine hospital. The people who live in Santa Monica expect only the best. Since its financial problems, it fell out of the class of Cedars or UCLA/Ronald Reagan Medical Center (the best hospital west of the Mississippi). It’s still not a bad hospital, just not as good as some.
Kevin M (ab1c11) — 4/16/2020 @ 3:07 pm#13: PDFs should have a PDF extension, for gawdssakes.
Kevin M (ab1c11) — 4/16/2020 @ 3:10 pmKevin M (ab1c11) — 4/16/2020 @ 2:55 pm
Don’t point this out more than once, or too effectively. It will trigger a series of Donald Sutherland Invasion of the Body Snackers replies.
frosty (f27e97) — 4/16/2020 @ 3:18 pmaphrael (7962af) — 4/16/2020 @ 1:54 pm
It gives you some impression of how brittle the supply chains we rely on are. It’s going to be hard unwinding from China.
frosty (f27e97) — 4/16/2020 @ 3:22 pmInvasion of the Body Snackers
Not before dinner, you kids!
Colonel Haiku (2601c0) — 4/16/2020 @ 3:28 pmThis is a problem I have with partisans picking up on anything that seems to harm Trump, without investigating the facts (and similarly by Trump’s partisan fans). There are enough things Trump does poorly that it’s not only unnecessary to peddle crap, but actively dilutes the value of the stuff that IS true.
Yes. 20/20 hindsight armchair quarterbacking aside, if one doesn’t know that Trump is a highly flawed individual by now, there’s not much the medical professionals can do for you. I hold out hope that these folks who find much to criticize about the current administration’s approach to anything will be even half as critical about the criminal actions of the ChiComs re: the Wuhancoronavirus as the story unfolds. And support harsh measures and sanctions against these insane monsters.
Colonel Haiku (2601c0) — 4/16/2020 @ 3:40 pmDid you catch the map with color coding in the CV briefing. Indiana has been “green” as in low incidence the whole sample time, but has a lower population and lower infection rate than Ohio, and more actual cases than Ohio. What in the world was the map trying to communicate? Because the numbers, the legend, all argue against what the colors say.
8,414 cases in Ohio, 2,429 in Kentucky, 9,542 in Indiana, all are currently in the “green”. I’m not saying Indiana’s the same as NY, but with 50% more population, but 400% more infections than KY, I don’t think they should be the same color.
Tennessee is yellow, with the same basic population as IN, 6.5M vs 6.8M, with Tennessee being bigger, but only 6,262 cases. Might it be that Pence is presenting this? I don’t know, but it’s definitely not communicating actual meaning.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 3:41 pmLower population, and higher infection rate than Ohio.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 3:44 pmThey gonna keep Kentucky closed until they can send teh revenooers in to clean the place up.
Colonel Haiku (2601c0) — 4/16/2020 @ 3:44 pmVox asks What Went Wrong With The Media’s Coronavirus Coverage? They conclude that the media needs to be better at “not just saying what we do know, but what we don’t know”. This raises some important questions. Like: how much ink and paper is there in the world? Are we sure it’s enough? But also: how do you become better at saying what you don’t know?
In case you’ve been hiding under a rock recently (honestly, valid) the media not only failed to adequately warn its readers about the epidemic, but actively mocked and condescended to anyone who did sound a warning. Real Clear Politics has a list of highlights. The Vox tweet saying “Is this going to be a deadly pandemic? No.” Washington Post telling us in February “Why we should be wary of an aggressive government reponse to coronavirus (it might “scapegoat marginalized populations”). The Daily Beast complaining that “coronavirus, with zero American fatalities, is dominating headlines, while the flu is the real threat”. The New York Times, weighing in with articles like “The pandemic panic” and “Who says it’s not safe to travel to China”. The constant attempts to attribute “alarmism” over the virus to anti-Chinese racism. Etc, etc, etc.
https://slatestarcodex.com/2020/04/14/a-failure-but-not-of-prediction/
Colonel Haiku (2601c0) — 4/16/2020 @ 3:51 pmTrump just said that some states could be opening tomorrow. Uhh, based on the guidelines they just announced, zero states should be opening May 1st, which is after tomorrow.
I don’t think anyone explained to him what the guidelines actually say.
TL:DR
Colonel Klink (Ret) (305827) — 4/16/2020 @ 4:04 pmHe’s not involved, so it’s not his problem.
CDC Director Robert Redfield:”The major thrust of how we’re going to control and make sure that we continue to keep this nation open is early case recognition, isolation and contact tracing.”
3 things we’re barely doing.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 4:20 pmTrump says there are places with “wide open plains” and spaces “where you’re not going to have to do” early diagnoses, isolation and contact tracing.
We test people not acres and spaces, just like voting, it’s the people stupid. Trump doesn’t understand the difference.
Colonel Klink (Ret) (305827) — 4/16/2020 @ 4:33 pmAgain, these are the criteria BEFORE you start phase one.
Proposed State or Regional Gating Criteria
(Satisfy Before Proceeding to Phased Opening)
SYMPTOMS
Downward trajectory of influenza-like illnesses (ILI) reported within a 14-day period
AND
Downward trajectory of covid-like syndromic cases reported within a 14-day period
CASES
Downward trajectory of documented cases within a 14-day period
OR
Downward trajectory of positive tests as a percent of total tests within a 14-day period (flat or increasing volume of tests)
HOSPITALS
Colonel Klink (Ret) (305827) — 4/16/2020 @ 4:39 pmTreat all patients without crisis care
AND
Robust testing program in place for at-risk healthcare workers, including emerging antibody testing
He was.
Last quarter (before things got crazy) I had an optional movie night for my Modern Physics class and we watched Day One: Before Hiroshima and After, in which Dennehy steals the show as General Leslie Groves.
Dave (1bb933) — 4/16/2020 @ 5:06 pmOn a totally different, but relevant, topic:
Universal vote-by-mail doesn’t benefit any political party, study finds
Republican officials in recent weeks have sought to portray universal vote-by-mail as a partisan issue.
President Trump said in March that the policy would mean “you’d never have a Republican elected in this country again.” Georgia’s Republican speaker of the House said vote-by-mail would be “extremely devastating to Republicans and conservatives in Georgia.” Partisanship concerns also motivated Wisconsin Republicans’ refusal to expand absentee voting in the state’s primary election last week.
….(A)ccording to a study that reaffirms and expands upon years of prior research: No party benefits when a state switches to universal vote-by-mail.
……
In a number of these states, vote-by-mail was rolled out at the county level on a staggered basis. This setup allowed a team of political scientists at Stanford University to conduct a natural experiment: “By comparing counties that adopt a vote-by-mail program to counties within the same state that do not adopt the program, we are able to compare the election outcomes and turnout behavior of voters who have different vote-by-mail accessibility but who have the same set of candidates on the ballot for statewide races,” they write.
To test partisan effects, they compiled a data set containing county-level election results as well as public voter file data containing the party registration of voters in California and Utah. The data covered elections from 1996 to 2018.
After controlling for county-level differences, the data showed “a truly negligible effect” on partisan turnout rates. The effect on partisan vote share was similarly indistinguishable from zero.
One thing they did find was a modest boost in across-the-board turnout. “Vote-by-mail causes around a 2-percentage-point increase (estimates range from 1.9 to 2.4 percentage points) in the share of the voting-age population that turns out to vote.”
The Stanford study, however, “should increase our confidence in these views,” the authors write, “both because our data permits a stronger research design than was previously possible and because our data set runs through the 2018 midterm elections, allowing for the most up-to-date analysis available.”
The study does come with one big caveat: It can’t predict what (if any) effect universal vote-by-mail might have in the midst of a pandemic, simply because that situation throws so many additional variables into the mix. Would older people fearing for their health be more likely to participate with vote-by-mail, thus creating a partisan advantage for Republicans? Would otherwise disaffected younger voters be more likely to vote, creating an advantage for Democrats? It’s impossible to say.
Nonetheless, the findings do underscore that partisan opposition to vote-by-mail over electoral concerns is a standpoint with no basis in empirical reality.
RipMurdock (d2a2a8) — 4/16/2020 @ 5:35 pmHow an outbreak on the USS Theodore Roosevelt became a defining moment for the U.S. military
As a coronavirus outbreak swept through a U.S. aircraft carrier crippled off the coast of Guam, the ship’s commander tapped out an email urging senior Navy leaders to evacuate most of the 4,800 sailors onboard.
Capt. Brett Crozier opened his March 30 message to three admirals by saying he would “gladly” follow them “into battle whenever needed.” But the skipper of the USS Theodore Roosevelt shifted to his concern that the Navy was not doing enough to stop the spread of the virus, and acknowledged being a part of the sluggish response.
“I fully realize that I bear responsibility for not demanding more decisive action the moment we pulled in, but at this point my only priority is the continued well-being of the crew and embarked staff,” Crozier wrote in previously unreported comments obtained by The Washington Post. “. . . I believe if there is ever a time to ask for help it is now regardless of the impact on my career.”
The email, copied to a handful of Navy captains, is at the heart of a crisis that erupted into public view after a four-page memo attached to it was published in the news media.
The note set off a chain reaction that included acting Navy secretary Thomas Modly’s decision to relieve Crozier of command and Modly’s resignation amid an outcry after audio emerged of him insulting the captain in an address to Roosevelt sailors.
While the attachment circulated widely, Crozier’s email did not. The email shows that Modly mischaracterized the message, accusing Crozier of sending it to 20 or 30 people, as he cited it as justification for removing him from command.
This account of the Roosevelt’s crisis is based on memos, emails and text messages obtained by The Post, as well as interviews with about two dozen people familiar with the case, including senior defense officials, sailors and their loved ones. Many of them spoke on the condition of anonymity because of the sensitivity of the issues and concerns about retaliation.
……
Six more sailors are hospitalized, including one in intensive care, the Navy said. Thousands of others are quarantined in hotel rooms under guard, with food that is often cold delivered a couple of times per day.
Adm. Michael Gilday, the chief of naval operations, opened an investigation of communication breakdowns after Crozier’s memo emerged, and is reviewing the results. He is expected to decide Crozier’s future as he responds to the investigation’s findings as soon as this week.
RipMurdock (d2a2a8) — 4/16/2020 @ 5:44 pm……..
Doing your job honorably is a ticket to early retirement in the Trump administration.
Dave (1bb933) — 4/16/2020 @ 5:49 pmIowa is predicted to end up at 20 deaths per 100K, 5 times worse than OH or CA (~4/100K), but much better than NY (at 75/100K).
Kevin M (ab1c11) — 4/16/2020 @ 5:54 pmThey conclude that the media needs to be better at “not just saying what we do know, but what we don’t know”.
They seem to be excellent in saying what they don’t know, but want us to believe.
Kevin M (ab1c11) — 4/16/2020 @ 5:56 pmDoing your job honorably is a ticket to early retirement in the Trump administration.
Failing to adequately toady seems a more likely path to the exit. How would Trump know you were being honorable?
Kevin M (ab1c11) — 4/16/2020 @ 5:57 pmThe email shows that Modly mischaracterized the message, accusing Crozier of sending it to 20 or 30 people, as he cited it as justification for removing him from command.
If so, and if the content of the email was also mischaracterized in the press, I think a lot of people will re-evaluate their positions. I’ll note that the press reports were very vague about where the information the printed was coming from. That’s a problem when the reporter won’t state his sources.
Kevin M (ab1c11) — 4/16/2020 @ 6:01 pmKevinM-
The article has a copy of the email and attachment, so you can determine that yourself.
RipMurdock (d2a2a8) — 4/16/2020 @ 6:10 pm