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Frightened Doctors Face Off With Hospitals Over Rules on Protective Gear Frightened Doctors Face Off With Hospitals Over Rules on Protective Gear
(3 days later)
Just after 6:30 on a recent morning, Dr. Henry Nikicicz, an anesthesiologist in Texas, finished an emergency intubation of a man in his 70s who was suffering severe respiratory distress. Then the doctor’s own trouble began.Just after 6:30 on a recent morning, Dr. Henry Nikicicz, an anesthesiologist in Texas, finished an emergency intubation of a man in his 70s who was suffering severe respiratory distress. Then the doctor’s own trouble began.
Stepping out of an elevator after finishing the procedure, Dr. Nikicicz put his respirator face mask back on when he saw a group of people walking down the hallway toward him — reflexively trying to protect himself, and them, should anyone have been infected by the coronavirus.Stepping out of an elevator after finishing the procedure, Dr. Nikicicz put his respirator face mask back on when he saw a group of people walking down the hallway toward him — reflexively trying to protect himself, and them, should anyone have been infected by the coronavirus.
In the days that followed, Dr. Nikicicz said, he was told that his job was at risk because policy at the hospital where he works, University Medical Center in El Paso, prohibited the use of protective masks in the hallways. “Wearing that mask is essential for me,” Dr. Nikicicz, 60, who has asthma and hypertension, said in an interview.In the days that followed, Dr. Nikicicz said, he was told that his job was at risk because policy at the hospital where he works, University Medical Center in El Paso, prohibited the use of protective masks in the hallways. “Wearing that mask is essential for me,” Dr. Nikicicz, 60, who has asthma and hypertension, said in an interview.
After he refused to back down, Dr. Nikicicz was removed from the schedule, effectively suspending him from work without pay.After he refused to back down, Dr. Nikicicz was removed from the schedule, effectively suspending him from work without pay.
As infection from the coronavirus spreads — and with it, fear — hospitals are facing extraordinary tension between health care providers and administrators. The tension comes against the backdrop of sickness and death for health care professionals, in China, Italy and Spain, and now more than 200 health care workers sick in New York.As infection from the coronavirus spreads — and with it, fear — hospitals are facing extraordinary tension between health care providers and administrators. The tension comes against the backdrop of sickness and death for health care professionals, in China, Italy and Spain, and now more than 200 health care workers sick in New York.
Mostly, staff and administrators are fighting over masks, whether they should be worn outside of treatment rooms, and which kind of masks — thinner surgical ones, or heavier respiratory masks. Should they be worn at all times? Only in procedures or while visiting patients? There is also some quibbling over testing and isolation: whom to test and when, and whom to isolate, given limited bed space? Whom to send home if a staff member has symptoms, and whom to require to work?Mostly, staff and administrators are fighting over masks, whether they should be worn outside of treatment rooms, and which kind of masks — thinner surgical ones, or heavier respiratory masks. Should they be worn at all times? Only in procedures or while visiting patients? There is also some quibbling over testing and isolation: whom to test and when, and whom to isolate, given limited bed space? Whom to send home if a staff member has symptoms, and whom to require to work?
Some hospitals allow masks outside of treatment rooms and some even make them mandatory. But a number of others say they aren’t necessary at all times and don’t allow them. The Centers for Disease Control and Prevention’s guidance has changed several times. Currently, it says medical professionals don’t need to wear masks all the time. It also says that if there’s not enough protective equipment available, homemade solutions like bandannas or scarfs are OK for health care workers to wear.Some hospitals allow masks outside of treatment rooms and some even make them mandatory. But a number of others say they aren’t necessary at all times and don’t allow them. The Centers for Disease Control and Prevention’s guidance has changed several times. Currently, it says medical professionals don’t need to wear masks all the time. It also says that if there’s not enough protective equipment available, homemade solutions like bandannas or scarfs are OK for health care workers to wear.
On Tuesday Dr. Anthony S. Fauci, a leading member of the federal government’s coronavirus response task force, told CNN that the C.D.C. was considering another change: it is reviewing its guidelines on whether the general public should wear masks.On Tuesday Dr. Anthony S. Fauci, a leading member of the federal government’s coronavirus response task force, told CNN that the C.D.C. was considering another change: it is reviewing its guidelines on whether the general public should wear masks.
Amid the confusion, furious and terrified, doctors and nurses say they must trust their own judgment. Administrators counter that doctors and nurses, motivated by fear, are writing their own rules.Amid the confusion, furious and terrified, doctors and nurses say they must trust their own judgment. Administrators counter that doctors and nurses, motivated by fear, are writing their own rules.
Some doctors believe that hospital administrators are simply trying to protect their institution’s image and don’t want to be seen as a facility where dangerous germs are rampant.Some doctors believe that hospital administrators are simply trying to protect their institution’s image and don’t want to be seen as a facility where dangerous germs are rampant.
When Dr. Nikicicz insisted on wearing a mask, he received a text from his boss, the chief of anesthesia, accusing him of overreacting. The text read: “UR WEARING IT DOWN A PUBLIC HALL. THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART. MAYBE LESS.”When Dr. Nikicicz insisted on wearing a mask, he received a text from his boss, the chief of anesthesia, accusing him of overreacting. The text read: “UR WEARING IT DOWN A PUBLIC HALL. THERES NO MORE WUHAN VIRUS IN THE HALLS AT THE HOSPITAL THAN WALMART. MAYBE LESS.”
On midday Monday, the hospital confirmed in a statement that “Dr. Nikicicz has been removed from his rotation/work schedule for insubordination.” But then, later in the day, after the hospital was asked for comment, Dr. Nikicicz said he was told by his boss he had been reinstated and could wear a surgical mask around the hospital and an N95 for procedures.On midday Monday, the hospital confirmed in a statement that “Dr. Nikicicz has been removed from his rotation/work schedule for insubordination.” But then, later in the day, after the hospital was asked for comment, Dr. Nikicicz said he was told by his boss he had been reinstated and could wear a surgical mask around the hospital and an N95 for procedures.
The circumstances leading to tension vary around the country.The circumstances leading to tension vary around the country.
An emergency room doctor, Dr. Ming Lin, wrote on Facebook that he was fired on Friday from his job at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., after making public his concerns about insufficient protections and testing at the hospital.An emergency room doctor, Dr. Ming Lin, wrote on Facebook that he was fired on Friday from his job at PeaceHealth St. Joseph Medical Center in Bellingham, Wash., after making public his concerns about insufficient protections and testing at the hospital.
The hospital said it had no comment about Dr. Lin’s dismissal.The hospital said it had no comment about Dr. Lin’s dismissal.
Administrators at a different hospital in Seattle, the Cherry Hill campus of Swedish Medical Center, threatened to indefinitely suspend an anesthesiologist, Dr. Oliver Small, for wearing a surgical mask when not directly involved in patient care, such as walking the hallway.Administrators at a different hospital in Seattle, the Cherry Hill campus of Swedish Medical Center, threatened to indefinitely suspend an anesthesiologist, Dr. Oliver Small, for wearing a surgical mask when not directly involved in patient care, such as walking the hallway.
“He got called into meetings with administration of Swedish because they don’t want to panic employees into thinking they need to wear masks for protection,” Dr. Small’s wife, Jessica Green, wrote on Facebook last week. “He is wearing a surgical mask as a precaution in case he is an asymptomatic carrier of Covid, as many people are, and he does not want to risk infection in uninfected patients.”“He got called into meetings with administration of Swedish because they don’t want to panic employees into thinking they need to wear masks for protection,” Dr. Small’s wife, Jessica Green, wrote on Facebook last week. “He is wearing a surgical mask as a precaution in case he is an asymptomatic carrier of Covid, as many people are, and he does not want to risk infection in uninfected patients.”
The hospital asked him to attend a meeting in which administrators told Dr. Small he could take off the mask or stop coming to work, Ms. Green wrote, adding, “What is wrong with our health care system????!!!”The hospital asked him to attend a meeting in which administrators told Dr. Small he could take off the mask or stop coming to work, Ms. Green wrote, adding, “What is wrong with our health care system????!!!”
Dr. Small confirmed the story but said that the hospital had since changed its position on masks and that he was “very pleased” by the outcome. Since the incident, the hospital now allows “universal masking” — the ability to wear masks in any patient area.Dr. Small confirmed the story but said that the hospital had since changed its position on masks and that he was “very pleased” by the outcome. Since the incident, the hospital now allows “universal masking” — the ability to wear masks in any patient area.
The hospital said it had no comment about Dr. Small. It said it has changed its policy as “we learn more about this disease.”The hospital said it had no comment about Dr. Small. It said it has changed its policy as “we learn more about this disease.”
“Despite a limited body of evidence showing its effectiveness, and while keeping a strong focus on reuse and conservation, we have decided to implement universal masking as a reasonable strategy, as long as our mask supplies allow,” the hospital said in an email statement.“Despite a limited body of evidence showing its effectiveness, and while keeping a strong focus on reuse and conservation, we have decided to implement universal masking as a reasonable strategy, as long as our mask supplies allow,” the hospital said in an email statement.
The intensifying tension falls into a larger context: In recent years, doctors have felt increasingly like employees working for cost-cutting companies putting profit ahead of medicine. That tension appears to have found an almost volcanic moment with the coronavirus pandemic.The intensifying tension falls into a larger context: In recent years, doctors have felt increasingly like employees working for cost-cutting companies putting profit ahead of medicine. That tension appears to have found an almost volcanic moment with the coronavirus pandemic.
Updated June 2, 2020 Updated June 5, 2020
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
More than 40 million people — the equivalent of 1 in 4 U.S. workers — have filed for unemployment benefits since the pandemic took hold. One in five who were working in February reported losing a job or being furloughed in March or the beginning of April, data from a Federal Reserve survey released on May 14 showed, and that pain was highly concentrated among low earners. Fully 39 percent of former workers living in a household earning $40,000 or less lost work, compared with 13 percent in those making more than $100,000, a Fed official said.
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
“There’s been a loss of autonomy and a denigration going on for a couple of decades now. We’ll take a lot,” said Dr. Christopher Garofalo, a family doctor in North Attleboro, Mass, who holds several regional leadership positions in medicine, including serving as the state’s delegate to the American Medical Association. More than half of physicians now are employees of hospital systems or big groups, he said, a systemic change that has left doctors feeling less empowered and frustrated.“There’s been a loss of autonomy and a denigration going on for a couple of decades now. We’ll take a lot,” said Dr. Christopher Garofalo, a family doctor in North Attleboro, Mass, who holds several regional leadership positions in medicine, including serving as the state’s delegate to the American Medical Association. More than half of physicians now are employees of hospital systems or big groups, he said, a systemic change that has left doctors feeling less empowered and frustrated.
Covid-19, he said, “is causing it to erupt.”Covid-19, he said, “is causing it to erupt.”
Doctors at a handful of institutions provided communications from administrators that show a face-off with doctors.Doctors at a handful of institutions provided communications from administrators that show a face-off with doctors.
An email sent from a midlevel manager at the Cleveland Clinic, one of the nation’s elite hospitals, to a group of doctors warned them not to “go rogue” and wear surgical masks around the hospital. “These are emotional times, and we need to control our emotions,” it said.An email sent from a midlevel manager at the Cleveland Clinic, one of the nation’s elite hospitals, to a group of doctors warned them not to “go rogue” and wear surgical masks around the hospital. “These are emotional times, and we need to control our emotions,” it said.
Dr. Jim Merlino, a top administrator and the chief transformation officer at the Cleveland Clinic, said the language was “not good communication.”Dr. Jim Merlino, a top administrator and the chief transformation officer at the Cleveland Clinic, said the language was “not good communication.”
He also said that while he was aware that some doctors at his institution and around the country were frustrated, he contended the vast majority were not.He also said that while he was aware that some doctors at his institution and around the country were frustrated, he contended the vast majority were not.
“People are afraid and what we have to do is set the record straight: It’s OK to be afraid but let’s accept we’re making the right decisions,” Dr. Merlino said. “We have to tamp the fear down. Otherwise we’ll never survive this.”“People are afraid and what we have to do is set the record straight: It’s OK to be afraid but let’s accept we’re making the right decisions,” Dr. Merlino said. “We have to tamp the fear down. Otherwise we’ll never survive this.”
He said decisions should be made based on clear scientific evidence. The Cleveland Clinic interprets that current evidence as concluding that it is not necessary to wear surgical masks unless dealing with a high-risk situation.He said decisions should be made based on clear scientific evidence. The Cleveland Clinic interprets that current evidence as concluding that it is not necessary to wear surgical masks unless dealing with a high-risk situation.
But other administrators interpret the evidence differently. Stony Brook University Hospital on Long Island just changed its guidelines to require such masks.But other administrators interpret the evidence differently. Stony Brook University Hospital on Long Island just changed its guidelines to require such masks.
“We are now recommending that all caregivers wear a surgical mask with ear loops while at work. This practice should be used in open hospital spaces,” the new guidance reads.“We are now recommending that all caregivers wear a surgical mask with ear loops while at work. This practice should be used in open hospital spaces,” the new guidance reads.