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March 10, 2020

200+ US health care workers have been quarantined for coronavirus exposure

Daily Briefing

    As cases of the new coronavirus increase in the United States, more than 200 health care workers are under quarantine because of their potential exposure to the virus—and many others on the front lines are growing increasingly concerned that they don't have the gear needed to adequately protect them from the virus.

    Our analysis: The 'recurring themes' of disease outbreaks

    About the coronavirus epidemic

    Reports of the new coronavirus first surfaced in early December 2019 in Wuhan, China. As of Tuesday, officials reported more than 116,200 cases of the virus globally. Officials said as of Tuesday there had been at least 4,083 deaths linked to the virus, and all but 946 occurred in mainland China.

    The number of newly reported cases in China has been slowing, but the number of newly reported infections from the coronavirus, which are referred to as COVID-19 cases, has been surging in other countries.

    For example, in the United States, state and federal officials as of Tuesday morning reported 747 confirmed or presumed positive cases of COVID-19, up from 231 on Friday. So far, 26 U.S. deaths have been linked to the virus.

    More than 200 US health care workers placed in quarantine

    One way hospitals are looking are looking to slow community spread of the new virus is by isolating employees who possibly were exposed to the pathogen.

    In Vacaville, California, for instance, more than 200 workers at NorthBay VacaValley Hospital are under quarantine because they possibly were exposed to the virus while providers treated a COVID-19 patient who officials believe was the first in the United States to contract the virus via community spread. The hospital eventually transferred the patient to UC Davis Medical Center, where more than 90 workers who might have been exposed to the virus have been placed under home quarantine.

    Some first responders have been quarantined, as well. In Kirkland, Washington, more than 25% of the city's fire department was quarantined after workers were potentially exposed to the virus when responding to an outbreak at the Life Care Center nursing home.

    According to KHN, public health experts are concerned the quarantines could leave hospitals and first-responder services short staffed—and some are recommending that hospital and other officials scale-back quarantine protocols for staff.

    For example, Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, said health care workers who may have been exposed to the new coronavirus but who are not symptomatic should not necessarily be quarantined. "It's just not sustainable to think that every time a health care worker is exposed they have to be quarantined for 14 days," she said. "We'd run out of health care workers."

    Similarly, Nina Fefferman, a mathematician and epidemiologist at the University of Tennessee-Knoxville, said, "There's a point where we stop trying to quarantine anyone and we just say, OK, we're going to have more deaths from the fire department not being able to fight fire than from everyone getting the disease."

    CDC on Saturday released interim guidance recommending that health care workers who might have had low-risk exposure to the virus but who are not exhibiting symptoms of COVID-19 continue working if other "options to improve staffing have been exhausted and in consultation with their occupational health program." According to Becker's Hospital Review, low-risk exposure typically occurs when a worker has a brief integration with an infected patient, or when a worker has longer contact with an infected patient who was wearing a face mask while the worker also was wearing a respirator or face mask.

    KHN reports that as health care workers become more aware of protocols for treating patients with suspected cases of COVID-19, such as wearing protective gear, their risk of accidental exposure should decline and lessen the need for staff quarantines.

    Health care workers say they don't have gear, training needed to protect them from the virus

    However, some health care workers on the front lines are worried they do not have access to the proper gear, training, and information needed to protect them from exposure to the new coronavirus, the Washington Post reports.

    National Nurses United (NNU) said a survey the group conducted of 6,000 nurses across 48 states found that just 30% of nurses said their workplaces provided them with sufficient protective gear to treat an influx of COVID-19 patients and 29% said their hospitals have plans to isolate patients with the disease.

    The New York Times reports that nurses in California and Washington have reported having to beg for N95 face masks, which can block out smaller particles than surgical masks. Other nurses reported that hospitals are keeping N95 masks and other protective gear off-site to prevent people from taking and hoarding the products, the Times reports.

    The World Health Organization last week said a shortage of medical gear, including N95 face masks, was endangering health care workers worldwide and called on governments to stock up on the supplies and halt hoarding.

    NNU said its survey also found that nurses said they weren't adequately trained on how to respond to the virus. According to NNU, fewer than half of the survey's respondents said their employers told them how to recognize and respond to potential COVID-19 cases, and less than one-fifth said their employers have a policy to handle employees who are exposed to the virus.

    "It used to be that you'd get a full day training," said Gerard Brogan, director of nursing practice at the California Nurses Association. "Now, they will send a nurse and doctor to the internet to learn how to don and doff a hazmat suit."

    Michelle Mahon, assistant director of nursing practice for NNU, said some nurses also reported that hospitals delayed informing them that a patient tested positive for the virus, while others reported having outdated screening protocols and unclear guidance.

    "We're seeing a majority of employers are not prepared," said Jane Thomason, the lead industrial hygienist with NNU's Health and Safety Division. "They have all of this stuff written down but then we go and talk to our nurses in these facilities and absolutely none of it is being implemented" (Gold, Kaiser Health News, 3/9; Mettler et al., Washington Post, 3/5; Shiffman et al., Reuters, 3/7; Stockman/Baker, New York Times, 3/6; Lai et al., New York Times, 3/10; Smith et al., New York Times, 3/10; CDC website, 3/9; Vaidya, Becker's Hospital Review, 3/9; CDC interim guidance, 3/7).

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