Signs of strain have emerged in at least one Orange County hospital tasked with handling a local coronavirus outbreak, where doctors say they need more crucial supplies and protective equipment while claiming hospital administrators aren’t properly addressing safety concerns or diverting enough resources to respond to the virus.
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Physicians at the UC Irvine Medical Center — who spoke to Voice of OC on the condition of anonymity over the weekend — say they’re being forced to reuse special respiratory masks and other protective garments while possibly being exposed to people who may be infected with the novel coronavirus strain, known as COVID-19, but are asymptomatic.
On top of that, the doctors criticized hospital administrators for continuing “elective procedures” — medical operations like knee replacements that generate revenue but aren’t considered urgent or essential — amid the crisis, and that those resources need to be redirected to COVID-19 response.
As of Monday, there were 95 total cases of COVID-19 reported by the Orange County Health Care Agency, with 35 of those cases reported as community acquired and no deaths.
Voice of OC has yet to receive multiple complaints out of any other medical center in the county.
“It is the belief of our resident cohort that our institutional decision to continue performing non-essential surgical cases at UCI Medical Center is misguided, dangerous, and unethical. Recently, the Centers for Disease Control, the American College of Surgeons and the Surgeon General gave unanimous recommendations for deferring all non-essential procedures,” reads a March 17 emailed letter from resident physicians from the UCI Department of Anesthesiology to department heads, which was provided to Voice of OC.
The letter continues: “In contrast, our approach of continuing elective cases until we experience an influx of patients seems likely to leave our institution stretched to the brink and potentially unable to provide care when patients need us the most.”
“The best available epidemiological data suggests that the United States is currently 7-10 days behind the scope and scale of COVID-19 seen in the Lombardy region of Italy, meaning that we are likely on the precipice of potentially overwhelming and catastrophic strain on our health care system,” the letter adds.
In a written statement, hospital spokesman John Murray said the medical center has already canceled or postponed “non-urgent surgical cases and clinic visits,” and that “this directive was announced to medical center staff and physicians on March 17.”
The decision of what constitutes an “urgent procedure,” Murray said, is decided by the attending physician or surgeon.
“While we have limited cases, we will continue to perform some surgery on patients whose condition causes severe pain or poses a threat to life or limb. For example, UCI Health is not denying surgical care to cancer patients,” he added.
One of the doctors Voice of OC spoke to followed up Monday morning and said that the hospital was still performing elective cases like one examination today for a years-old injury that the doctor considered “definitely non-urgent.”
Murray wouldn’t comment on that specific case, citing privacy laws, but said “every case is reviewed by an attending anesthesiologist and attending surgeon. If necessary, the case is reviewed by a three-physician panel for appropriateness before determining whether or not to proceed.”
“Sometimes that work is not clearly understood by a resident, physician trainee or someone not directly involved in the case,” he added.
The UCI Medical Center doctors who spoke to Voice of OC said they’re in dire need of protective gear like N95 masks, which are designed to be close-fitting and filter airborne particles.
General guidelines recommend that N95 masks be reused either five times or discarded within eight hours, the UCI doctors told Voice of OC, adding that they’re instead being told to reuse them either until they degrade or until the end of their 12-hour shifts, and that they don’t know how many N95 masks are available for use.
“Our personal protective equipment (PPE) practices are consistent with CDC and WHO guidelines and University of California practices. These practices conform to what infection prevention specialists call ‘droplet precautions,’” Murray said in the statement. “COVID-19 is a droplet-spread disease, and our PPE use and guidelines reflect appropriate measures to minimize the likelihood of transmission.”
He added that UCI Health has adopted “safe conservation protocols consistent with CDC and OSHA guidance for mask reuse and extended use.”
“No one who has scrubbed into a surgical case is reusing masks or any PPE. Like most major U.S. medical centers, we have asked providers who are not directly involved in a procedure to reuse clean masks and face shields when possible,” he said.
The doctors who spoke to Voice of OC said many physicians at the hospital haven’t been able to self-test for the virus and are reluctant to speak out for fear of retaliation by administrators.
“UCI School of Medicine has and will continue to offer education for residents related to COVID-19 and will always provide them an opportunity to ask questions. We value their feedback,” Murray said, adding later that “testing is available to those who meet the proper criteria, including staff, nurses and physicians.”
He added: “Any UCI staff member, professor or physician can choose to make a whistleblower complaint that, by law, remains anonymous. This is separate from the health system and is directed by the UC Office of the President. Allegations of retaliation are taken seriously.”
Anesthesiologists largely care for patients around surgeries and typically come into contact with patients’ airways during tasks like intubation, which is the inserting of ventilation tubes into patients to assist breathing.
The UCI anesthesiologists’ letter says “Intubation, and the steps leading up to it, carries the highest risk of COVID-19 transmission.”
It adds: “Health care workers are also at disproportionately elevated risk of contracting the disease (8% of all COVID-19, in recent study), with a massively increased relative risk of subsequent death, and those managing the airway are at the highest risk of any specialty for health care acquired COVID-19.”
Similar reports of supply shortages have been pouring into national news outlets from hospitals around the country, with NBC recently reporting that some hospitals are facing “life-or-death” decisions around a lack of ventilators for patients in critical condition with breathing problems.
In a March 19 phone interview with Voice of OC, CalOptima Board Member and certified anesthesiologist Paul Yost laid out a checklist of measures OC hospitals need to be taking to properly prepare for the local outbreak, such as “freeing up capacity … looking at staffing, projecting some of their staff who may become ill and unavailable … looking at the numbers of ventilators.”
He pointed to countries where the coronavirus situation has especially escalated, like Italy, which has seen its death toll number in the thousands. Health experts say the U.S. is approximately 10 days behind Italy in terms of the pandemic’s severity.
“I don’t think we’re appreciably different (from Italy) in terms of the way their healthcare system was set up. That happened in a fairly affluent part of the country, A reasonable health care system. I don’t think ours is all that different here,” Yost said.
He continued: “We’ve been fortunate that we’ve had a little bit of lead time to try to ramp up to the greatest degree that we can.”
Yost again emphasized the need for hospitals to assess their workforce: “Make sure that they stay healthy to provide care for patients under the most difficult circumstances, which are likely to be arriving shortly.”
That was four days before the UCI Medical Center doctors began reaching out with their safety concerns.
Brandon Pho is a Voice of OC reporting fellow. Contact him at firstname.lastname@example.org or on Twitter @photherecord.