Michigan nurses say they don't have masks, gear to keep them safe from coronavirus at work

They go to work when the rest of the nation is told to stay at home, and they care for the sick — even those who have COVID-19, the disease caused by novel coronavirus — in emergency rooms, intensive-care units, at doctor's offices.

Yet Michigan nurses say they're on the front lines, fighting the global pandemic without the proper protective gear like masks, gowns and face shields to keep themselves from getting sick, bringing the disease home to their families and potentially spreading it to other patients.

More than a half-dozen Michigan nurses from hospital systems that include Henry Ford Health System, Beaumont Health, and McLaren Health Care gave detailed accounts Friday to the Free Press about scenarios they say endangered themselves and other patients.

They all spoke on the condition of anonymity late last week because they have been told by their managers that if they talk about this publicly, they will lose their jobs.

"My division does not have N95 masks," said a Henry Ford Health System nurse who works in direct patient care, saying that her hospital is rationing supplies.

She now wears a regular surgical mask to treat patients with COVID-19 symptoms. Gowns and N95 respirator masks are being reserved for the medical staff working at the coronavirus drive-up screening tents and at hospital entrances.

"I need my job but I am risking my own health everyday now," she said. "Honest to goodness, it’s getting worse day by day.

"Patients are coughing in our faces. They are throwing up on us."

She worries that a time will come soon when there won't even be surgical masks to wear. When she and others in her department discuss their concerns with managers, she said, "We are told that they have to prioritize gowns and masks because of the shortage. But why aren't we a priority?

"They are telling us not to worry about it, and to watch for the symptoms."

The Henry Ford nurse explained that she has been exposed at least three times to patients who had COVID-19 symptoms — fever, cough, difficulty breathing. These were patients who qualified for testing for the virus. Yet she was wearing nothing more than a surgical mask.

Because it's believed that the novel coronavirus is transmitted primarily through droplets when a person coughs or sneezes, the U.S. Centers for Disease Control and Prevention initially recommended that medical staff should wear N95 respirator masks, gowns and face shields to limit the possibility of infection.

But since there is a national shortage of masks and other protective gear, the federal agency changed its recommendations to suggest regular surgical masks would work. And more recently, it issued new guidelines saying that if regular masks are not available, homemade masks, such as bandannas or scarves, should be used "to care for patients with COVID-19 as a last resort."

Dr. Betty Chu, associate chief clinical officer and chief quality officer for Henry Ford Health System, said Saturday that most hospital systems are following CDC's guidelines as they change.

"Most health systems have gone to surgical mask usage around COVID-positive patients unless you have an ... aerosolized procedure," she said. "We've been providing N95 masks when necessary for patients who are getting aerosolized procedures who are COVID positive, and again, surgical masks when patients are COVID-positive."

The changing CDC recommendations for working with COVID-19 patients drew the ire of health care workers around the nation. As of Saturday morning, more than 900,000 nurses, doctors and medical staff and their supporters signed a change.org petition calling for action to get better supplies to protect them as they care for sick patients with coronavirus.

For a Beaumont nurse, the issue goes beyond protecting herself, it's also about keeping other patients safe and limiting the spread of the disease, which, as of Friday afternoon, had infected 549 people in Michigan and killed four, according to the Michigan Department of Health and Human Services and the Oakland County Health Division.

Nationally, more than 19,285 people have confirmed coronavirus cases and 249 have died, according to the Johns Hopkins COVID-19 Global Case Tracker. As many as 147 Americans have recovered from the disease as of Friday night.

"It is not just our safety we are worried about not having the proper PPE (personal protective equipment) available, it is the safety of the other patients and the community," she said.

President Donald Trump invoked the Defense Production Act earlier this week, mobilizing federal agencies to get medical supplies to hospitals and health care workers. And Vice President Mike Pence said that manufacturers are ramping up production of face masks and other essential medical supplies. He called on construction companies and other industries to donate their stockpiles to health care workers.

Michigan recently received a shipment from the Strategic National Stockpile, a repository of pharmaceutical and medical supplies maintained by the federal government for use in a public health emergency. It included 95,000 N95 respirators; 35,000 surgical gowns; 125,000 pairs of non-sterile gloves; 43,000 face shields, and 225,000 surgical face masks, said Lynn Sutfin, a spokeswoman for the Michigan Department of Health and Human Services.

Gov. Gretchen Whitmer said Friday that her office has been working with Michigan companies to come up with supplies like ventilators, gowns and masks.

"A few companies in Michigan were able to secure and get more masks for us and I’m confident that it’s in the millions,” said Whitmer, who also signed an executive order Friday restricting nonessential medical and dental procedures in the state so the health care system could focus on managing the COVID-19 outbreak.

“By limiting elective surgical procedures, you keep people from unnecessarily exposing others to the virus and you’re also preserving supplies of gowns and masks," said Dr. Joneigh Khaldun, the state's chief medical officer.

Oakland County Executive Dave Coulter asked Saturday morning for businesses, dental offices and doctor's offices that have closed to donate medical supplies. And in Ann Arbor, the head of research at the University of Michigan Medical School issued a similar plea last week, sending an email to the research community, urging them to donate masks, gloves, gowns and other supplies to the hospital for use in the outbreak. Henry Ford Health System has made a similar call for donations.

Henry Ford's Vice President of Supply Chain Management Jim O'Conner said Saturday afternoon that the health system received 12,000 N95 respirator masks and 16,000 procedural masks on Friday for use by its hospital staff.

"Under normal, typical consumption that would last us, you know, almost a month," he said. "But under this environment, hard to predict, but days would be the accurate answer, just days.

"So, therein lies the challenge for not only Henry Ford Health System, but virtually every health system in the United States."

He said Ford Motor Co. and General Motors have donated industrial masks and are interested in supporting the manufacturing of supplies, too.

"We're working very aggressively, with a lot of support from industry as well as ... a lot of people who want to volunteer and contribute."

While the situation is changing fast, for nurses at many Michigan health systems, the relief is coming too late.

They said Friday that they are not not seeing any increases in stock yet.

There were several instances this week when Beaumont nurses said they were exposed while treating patients who later tested positive for COVID-19. They weren't given masks at all until the patients they cared for had positive coronavirus tests.

Without wearing proper gear, several of their colleagues are now symptomatic and may also now have the virus themselves, they said.

"The initial recommendations of the CDC were that staff who were exposed should be quarantined for 14 days to help stop spread," one Beaumont nurse said. "Now, the practice is you can work until you begin to show symptoms. The danger in this is that many of us are caring for both COVID and non-COVID patients simultaneously within that 14-day period."

And because research about this new form of coronavirus suggests that people can be contagious before they have symptoms, there's a chance health care workers are spreading the disease while caring for vulnerable patients who might not yet be infected.

"We're caring for people who have it and for people who don't," the nurse said. "And that makes it real easy to spread to them. And if those patients get discharged, they're going back into the community.

"And a lot of patients, especially because the highest population in the hospital are geriatric patients, a lot of them do go to sub-acute rehab or back to nursing homes. And then we have, you know, a Washington state situation all over again."

There, an outbreak of novel coronavirus in a nursing home in King County led to more than 790 COVID-19 infections and at least 67 deaths.

Some Beaumont nurses have said masks are locked up in supply rooms or are being withheld by managers. N95 masks are given only to those who are caring for patients who have tested positive for COVID-19, and each employee gets one mask to wear for the entire shift.

Others are not allowed to wear any mask at all.

"I can’t tell you how many patients we have coughing in our face every shift," one Beaumont nurse told the Free Press. "These masks would not only protect us but protect the patients and allow us to do our jobs with a little less anxiety.

"If we do have a patient who is being tested for the COVID-19 virus, which is what we call a rule-out patient, we can get a surgical mask but have to ask the assistant manager for it. ... They don’t want us wearing masks on the unit and in the hallways because it looks unprofessional."

McLaren nurses say they are given one mask to wear for an entire 12-hour shift, and they're told to wear that same mask when they go room-to-room — whether they're treating COVID-19 patients or patients who don't have the virus. That, they say, puts the patients who don't have coronavirus at risk for getting the infection.

One McLaren Health Care nurse told the Free Press that many members of the medical staff in the emergency room at her hospital have been quarantined for possible COVID-19 exposure.

And on top of that, she said, "we were also informed today (Friday) that we aren’t allowed to wear the hospital's scrubs," she said. "So I have to wear my scrubs from home and come home in them and wash them, potentially exposing my family.

"The CDC is unsure how long the virus can live on fabric. We are getting conflicting data. The virus can live on certain surfaces for hours, in some cases even days."

At one Beaumont hospital, doctors are wearing masks, but the other staff members are not allowed, a former nurse whose wife still works at the hospital told the Free Press on Friday afternoon.

"Doctors are all walking around wearing masks, but she can't have a mask," he said. "It's like they're saying, 'I'm more important than you.' But they're all breathing the same air."

The situation has gotten so bad, he said his wife is ready to quit.

"I told her to quit," he said. "Something needs to be done."

A Henry Ford nurse told the Free Press she's worried about bringing the virus home to her husband and kids, and about infecting others on the job.

She said many of the nurses don't have child care when they're at work, so they've devised a system of taking turns watching groups of children on their off days to cover one another's shifts.

"There'll be six, seven, or eight kids in a house because mom or dad worked 12 or 13 hours, and then they flip-flop, and they go to somebody else's house who just got off a shift. There's no school, and no other options, what else are we going to do? We have to keep working.

"What if one of us is exposed, and we’re watching other people’s kids? And then they are exposed, and it just keeps spreading on and on."

But as COVID-19 becomes more widespread in the community, Henry Ford's Dr. Chu says the risk of exposure is higher not only for health care workers, but for everybody. And as it did with masks, she said the CDC also is changing its recommendations about how hospital systems should deal with the risk of exposure among health care workers.

"As there's more COVID in the population, when you're out and about, and there's COVID ... potential exposure in a health care facility, the way that health systems are managing COVID exposure with health care workers is also changing a little bit," she said. "If I send an employee home for a COVID exposure who doesn't feel any symptoms, but was around a COVID patient, they would be home, in the past, for two weeks.

"They ... can be exposed just as likely from their spouse or their kids or somebody on the street, you know, in a bar or restaurant in the past when we when we had those open as much as they would have been in the facility.

"So as the incident of COVID in the population goes up. It becomes almost a moot point to do tracking of COVID patients, because the prevalence is so high not only in the hospital, but outside of the hospitals in the community."

Even though many of the nurses who talked to the Free Press on Friday said they were afraid they might have been exposed to COVID-19, none have said they were tested for the virus. And until they're sick and exhibiting symptoms, it's unlikely they will be.

That's because coronavirus testing in the United States — and in Michigan — has been limited.

Supplies of testing materials are low, and so are resources at the labs that process the tests. Health care systems and public health departments are reserving the majority of tests for the most critically ill people who are symptomatic.

That's not good enough, said Randi Weingarten, president of American Federation of Teachers, which is the nation’s second largest nurses’ union, in a phone interview with journalists Friday afternoon.

"They have to have testing, each and every one of them," Weingarten said Friday. "We know that our health care workers are the heroes. We know that we would not be able to survive this crisis without them. ... It shouldn't be that the NBA and other sports teams have the ability to have tests," but health care workers are denied.

A Henry Ford nurse told the Free Press that even though she's been exposed to patients who've been tested for COVID-19, she's not allowed to know whether those patients' test results are positive because of the federal Health Insurance Portability and Accountability Act, also known as HIPPA, which ensures patient privacy.

"I have no clue of the results," she said. " ...These patients come in and out and it’s hard to track them all. ... And even if we do remember a name or such, then it’s a privacy violation and we can be fired for looking to follow up because the HIPPA laws say if you are not giving direct patient care at that time, you cannot look."

A Beaumont nurse agreed.

"Every nurse I work with is livid and working in fear," she said. "We have patients coming up from the ER every day and who knows if they have it or not as it takes days for symptoms to show so they could be carriers and we don’t know yet."

The hospital systems deny that there's a problem protecting workers from contracting the novel coronavirus on the job.

At Henry Ford, Richard Davis, the health system's vice president and CEO of South Market and Henry Ford Hospital, said the administration is monitoring CDC recommendations, and is following guidelines.

“We acknowledge that many of our employees are anxious and we are truly grateful to all of them for their compassionate care of our patients during this public health emergency," he said in an email Friday to the Free Press.

"No one is, or has been, denied the use of PPE in our emergency department. Additionally, we have the resources our team members need to care for COVID-19 positive patients. We are actively monitoring CDC guidelines for the use of PPE as they evolve and are in constant communication with our suppliers to do everything we can to extend our supplies, including a volunteer mobilization across our health system to produce homemade protective masks for our employees.

"We were also thrilled to hear news from the federal government Thursday about efforts to speed production of equipment health systems desperately need, such as masks, ventilators and other equipment.”

Susan Grant, Beaumont Health's Chief Nursing Officer, said in an email to the Free Press Friday that all eight hospitals in the health system have "access to the appropriate PPE.”

“In these unprecedented times, we are facing changing guidance from the Centers for Disease Control and Prevention, and fluctuations in supplies," she said. "Given these challenging circumstances, we are providing the best protection and guidance to our health care workers as possible.

"Personal protective equipment availability is based on patient interaction and anticipated risk. We are currently using the CDC guidelines and the help of our corporate leadership to determine the appropriate PPE for all staff."

A McLaren Health Care spokesman told the Free Press on Friday that it, too, is following CDC recommendations.

"I can’t speak to those specifics but I can tell you that there is a national shortage of masks, gowns and other protective equipment," he said in an email. "McLaren is encouraging judicious use of supplies, including personal protective equipment which are needed to keep our front-line caregivers safe while they take care of patients."

Although the hospital systems all say supplies are adequate, the nurses tell a different story.

"I need my job, but I am risking my own health every day now," a Henry Ford nurse said.

"It’s like playing Russian roulette. We’re a major health care organization. How can we not get enough supplies? We are the United States of America."

Contact Free Press health reporter Kristen Jordan Shamus: 313-222-5997 or kshamus@freepress.com. Follow her on Twitter @kristenshamus. Free Press staff writer Kathleen Gray contributed to this report.