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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 |
| (about 5 hours 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.” |
| Updated June 24, 2020 | |
| Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles. | |
| A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. | A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico. |
| The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. | The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth. |
| The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. | The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave. |
| So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. | So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement. |
| 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. |
| A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. | A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study. |
| 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. | 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. |
| 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.) |
| 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. |
| “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. |
| “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. |