Op-ed: Unprotected and disrespected — The Michigan Difference

Monday, April 6, 2020 - 8:12pm

Editor’s Note: The author of this op-ed has been kept anonymous due to their fear of retaliation.

“Stay safe.” It’s a phrase that’s becoming all too familiar in the days of COVID-19. My husband says it to me as he hugs me before I leave for work. I read it in texts from friends and family who I haven’t seen in weeks. The grocery store clerk utters it through a plexiglass barrier in the checkout line. These two words are a ubiquitous mantra the whole world is crying out in desperation.

I want to tell you all today that I am not safe. I am not safe because Michigan Medicine will not let me protect myself.

I am an ICU (intensive care unit) nurse at Michigan Medicine. I am one of thousands of front-line health care providers at the hospital who are faced with the impossible task of handling the coronavirus pandemic. Similar to any other health care system in the United States, our hospital was wholly unprepared to face this unprecedented crisis.

Personal protection gear for hospital workers is limited worldwide and many health care systems have had to adapt to preserve their limited supply of masks. Unfortunately, “The Michigan Difference” here is that our hospital administration is not only rationing protective gear but also prohibiting bedside staff from using their own personal equipment to protect themselves from the virus.

So much is still not understood about COVID-19. One of the greatest areas of debate is whether the disease is transmitted through the air or through respiratory droplets. For health care providers caring for patients, appropriate droplet precautions include a simple surgical face mask, along with a gown, gloves and eye shield. Diseases with airborne transmission can easily penetrate these masks. Because of this, when a disease is airborne, a more sophisticated respiratory mask is recommended such as an N95 or N100.

The world has only known about COVID-19 for a few months. Researchers are working around the clock to study its transmission. Some studies are suggesting the virus is airborne, but there is still not a definitive consensus.

The World Health Organization and Centers for Disease Control and Prevention both postulate that COVID-19 transmission is primarily airborne and close transmission via respiratory particles is “uncertain.” However, the CDC has yet to update its recommendations and maintain that droplet precautions provide healthcare workers with adequate protection. Is this reluctance a product of insufficient evidence?

Of course, a shortage of personal protective gear is not a problem unique to Michigan Medicine. Up until recently, the hospital was recommending and supplying COVID-19 providers with N95 masks. That rug was pulled out from under us on March 19 when the administration announced that we will now be using simple face masks and N95 masks will only be used in special circumstances.

This policy change feels alarming and irresponsible. The hospital administration has shown a profound lack of transparency on showing staff what data they are using to support this change. The change has left many of us panicked. Are we really expected to just believe that a mask will protect us when there is still no consensus on transmission?

On March 30, it was announced that, in anticipation of an influx of patients, a new staffing model would be introduced to address patients exceeding our current nursing capacity. We will all be forced to work 12-hour shifts, with very few exceptions. We will work with non-ICU trained nurses to care for up to 12 patients at a time, including several patients who are critically ill. This means as bedside staff, our exposure to this virus will increase exponentially, while our only protection is a face mask that will “probably” protect us.

Maybe it’s too much to ask for a hospital to provide N95 masks to all its frontline staff during a global crisis. The shortage of gear is obviously not just a Michigan problem. But what if I purchase my own personal N95 mask or reusable respirator mask online to use at work? Many are expensive and difficult to find, but perhaps the price is worth it when you are fearful for the health of yourself and your family. Henry Ford Health System has not only allowed staff to use their own personal gear but also has allowed staff to make their own masks amid the shortage.

On March 30, the Joint Commission released a statement supporting the use of health care providers utilizing their own personal protective equipment, saying “the degree to which privately-owned masks and respirators will increase the protection of health care workers is uncertain. However, the balance of evidence suggests that it is positive.”

Despite this recommendation, on April 1, Michigan sent a hospital-wide email saying they will continue to prohibit the use of personal protection brought from home.

The CDC has also published recommendations for ways to protect providers when masks are limited or unavailable. They have even gone as far as to say that we can use bandanas and scarves as a last resort. Yet if I have an N95 mask at home for personal use, Michigan says that it is not OK to use at work. It is frustrating how our administrators can pick and choose which recommendations they will abide by.

As health care providers, we take an oath to do no harm. We did not take an oath to stand by and allow ourselves to be harmed in the process.

There is a fine line between essential employees and sacrificial staff. This week it was announced that a Henry Ford Hospital nurse died after testing positive for COVID-19. Hospital administrators are making choices around infection control, but we are the ones paying the ultimate price.

Michigan Medicine is a respected leader in health care and should be setting an example for the rest of Southeast Michigan as we fight through this pandemic. By not allowing us to wear our own gear, the hospital is being negligent and disrespectful to every single person who is putting their life on the line to help these sick patients. We have a right to do anything we can to protect our lives and the lives of those we love without fear of retribution from our superiors.

Michigan Medicine, I am disappointed in you. You already are overwhelmed, understaffed and unprepared. You will lose some of the most brilliant medical professionals in the world to this disease if you don’t allow us to become better protected. Instead of telling me to stay safe, why don’t you give me a fighting chance?