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Marilena Santana got a phone call from her director at St. Petersburg General Hospital a few days ago to let her know she’d been caring for a patient who tested positive for COVID-19.
The 34-year-old registered nurse recalled that the man had been sick when he arrived in the hospital’s emergency room. But because of testing delays, they sent him home and told him to stay in isolation for 14 days while waiting for the results.
Despite her exposure to the disease, Santana’s supervisor said she should still come into work. So she did.
"There was no way to get tested. It’s pretty scary,” Santana said. “I have four kids at home. The idea of bringing this home to my kids, that is pretty heavy on me.”
Hospitals across Tampa Bay say they are ramping up as the coronavirus threatens to test the local health system as never before.
But in interviews with the Tampa Bay Times, many of the frontline health workers hailed as heroes in that cause say they fear their hospitals are under-prepared for what’s ahead, and are not doing enough to protect them.
In addition to a lack of testing that has hamstrung the response from the start, these workers report that hospitals are already rationing supplies. They also say that changing directives on protective gear have put them at risk and do not inspire confidence.
The accounts come from dozens of Tampa Bay area health workers who have contacted the Times in recent days. More than 20 of them were interviewed, with most saying they did not want their names used because they feared repercussions at work. Some, like Santana, agreed to be identified.
She and others report having to re-wear masks for several days while treating patients, a complaint heard in many communities around the nation. And when they offered to bring in their own protective equipment, the local nurses said, they were told they could not.
Nurses from multiple hospitals in Tampa Bay said they were already being told to save N95 masks for use over several days. As one of them phrased it, some nurses are getting “signed out one mask a week." Under normal operations, nurses would wear a new N95 mask every time they entered the room of a potentially contagious patient.
Many said they had not been allowed to protect themselves with the proper gear for fear of causing panic among hospital visitors. They also said it was clear their hospitals did not have enough supplies or equipment to meet the demand if patient volumes were to increase rapidly in the coming weeks.
"Hospitals have been slow to respond and they are putting us at risk,” said Martin Peebles, a registered nurse at Largo Medical Center, which is part of the 15-hospital HCA West Florida chain based in Tampa.
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In response, hospitals say they are trying to stretch supplies to last through an expected surge of coronavirus cases in a time of severe equipment shortages. They said they are following guidelines from the U.S. Centers for Disease Control and Prevention, which recently advised health care workers to wear a bandana as a “last resort.”
In recent weeks, they also have taken other steps to prepare, including screening patients, limiting visitors and canceling non-essential procedures to save resources for when the virus reaches its peak.
Still, many health workers say they have witnessed conditions they fear could lead to the same dire circumstances that have overwhelmed some New York hospitals over the last two weeks.
Rosanne O’Malley, a registered nurse at HCA’s free-standing emergency room in Palm Harbor, said she feels more vulnerable than at any time in her 33-year career.
“I’ve never felt the urgent need for protection like I do now," she said. "I’m concerned about not having N95 masks available. Every day is a challenge. I leave my house to go to work with a lot of trepidation.”
HCA, one of the largest hospital operators in the country, has changed its policies as the pandemic has grown more serious. Nurses from Largo Medical Center, the Medical Center at Trinity and St. Petersburg General said management initially said they could wear only simple surgical masks, which offer a lower level of protection than N95 masks.
Workers also weren’t allowed to wear masks outside of patients’ rooms, and were told not to bring in masks or protective equipment they purchased or made on their own, said Peebles, the Largo Medical Center nurse, who also is a union representative for National Nurses United.
“The policy keeps changing, but we’ve been told if we were found wearing an unauthorized mask that we would have to report to the CEO’s office," he said. "That is downright threatening. What’s more important to you, your job or your life?”
After the nurses’ union announced demonstrations this week, HCA allowed masks outside of patient rooms, and the mask allowance was upgraded to one N95 mask a day, union members said.
HCA spokeswoman Deb McKell said that all caregivers are wearing masks as recommended by the CDC and the Florida Department of Health. She did not elaborate on the hospital network’s evolving policies.
“The safety of our caregivers remains a priority to ensure they can continue to care for our patients, and we have changed practices in screening, visitor control and non-essential travel, to name a few, as we continue to prepare for coronavirus,” McKell said.
Late Thursday, the chain announced more changes, including a service to clean health workers’ scrubs before they go home and free hotel stays for those who have been exposed to COVID-19 patients and prefer not to put loved ones at risk.
Nurses at Moffitt Cancer Center in Tampa thought they’d begin wearing masks with every patient as soon as the coronavirus began spreading in Florida. And, even if they couldn’t get N95 masks, they expected they could wear a paper mask or bring their own.
But managers said no. Then a few weeks later said yes.
In a March 26 email to the Times, Moffitt spokesman Steve Blanchard said the decision limiting masks to certain situations was for good reason, and based on CDC guidelines. “There is no evidence that masks are protective during close contact with asymptomatic people,” he wrote, adding that the hospital needed to “preserve our scarce resources.”
That changed five days later. On Tuesday, Moffitt started requiring masks “during all patient-facing interactions,” Blanchard said in a followup response. Staffers are to get a fresh mask each day, and masks will be provided to all patients and visitors, he said.
The change reflects a growing awareness that as many as 25 percent of people infected with the virus might not show symptoms. The CDC on Friday recommended that Americans wear “nonmedical, cloth” masks while in public, though President Donald Trump emphasized it was voluntary and said he would not be wearing one.
Asked whether patients and staff at Moffitt were put at risk while the previous policy was in force, Blanchard said no. “As the pandemic continues to change," he said, "so does our response to ensure best practices and the utmost safety of our frontline staff.”
Moffitt has more than a two-week supply of masks and is taking donations of masks, Blanchard said.
Six nurses who work for the BayCare Health System, with 15 area hospitals, said they were told for weeks to limit their use of masks in order not to stoke panic among visitors. When they brought their own masks and gowns from home to make up for shortages, they were told not to wear them, they said.
Asked for a response, BayCare initially said the hospital was following federal guidelines and acknowledged that there were only so many supplies to go around. That changed this week.
“BayCare is handing out masks to all team members and physicians who enter our hospitals after they pass the temperature scan,” BayCare’s chief medical officer Dr. Nishant Anand said in a followup statement.
“Team members, clinical or non-clinical, are expected to wear a mask during their assigned shift in our hospitals and inpatient psych units," the statement said. "Our clinical teams wear full personal protective equipment when caring for COVID-19 patients.”
The temperature scans he referenced are conducted at hospital entrances, and anyone with a reading of 100.4 degrees Fahrenheit or higher is not allowed in.
The concerns of local health care workers come as their colleagues in other locales struggle with even more severe shortages.
New York Gov. Andrew Cuomo has urged nonessential medical offices and other businesses to donate their protective gear to hospitals. And former federal health official Andy Slavitt tweeted a request to dentists, painters, contractors and plastic surgeons, to give “all you have” in the way of masks, gloves or thermometers to local hospitals.
Nurses and doctors are wiping down and reusing supplies they’d normally toss after one use as supplies dwindle, according to a Kaiser Health News report. On social media, health workers are begging for supplies under the hashtag #GetMePPE.
A series of mid-March surveys by National Nurses United shows that nurses across the country continue to think most hospitals are still not prepared to handle or contain the spread of COVID-19.
“Clearly, the nation’s health facilities are still not ready and are in even worse shape than before in some respects to handle COVID-19,” Bonnie Castillo, executive director of the union, said in a statement. “We need to act now and act fast.”
The surveys reached more than 8,200 nurses across all 50 states. Only 24 percent said their employer had sufficient personal protective equipment such as gowns and masks on hand to protect workers if there is a rapid surge in patients.
John Couris, CEO of Tampa General Hospital, said the region’s only Level 1 trauma center is adequately staffed and prepared.
“Our people are trained. They’re ready,” he said. “We are not unaccustomed to taking care of people with infectious disease. We’re monitoring our supplies constantly.”
The hospital said its health workers are given a new mask at the start of every shift, and can wear it “even in areas where one is not normally required.”
The American Medical Association continues to press federal authorities for more resources on behalf of physicians and other health care workers nationwide.
“For days, physicians and frontline health care workers have been sounding the alarm that there is nowhere near enough PPE in the fight against COVID-19 — a shortage that endangers patients and jeopardizes the entire response to this virus,” AMA president Dr. Patrice A. Harris said in a statement.
Santana, the nurse from St. Petersburg General, now wears a mask all day when she’s at work. She said staff at the hospital are issued one N95 mask a day and they have to return the used ones.
“We sign them back in so they can repurpose the masks," she said. "They’ll clean and re-sterilize them in case of a shortage.” She said she worries about her own soiled masks, in case she actually has the coronavirus.
“Those masks are just festering in a plastic bag," Santana said. "I hope to God those never go back into use.”
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