As COVID-19 begins to spread in the Kansas City area, health care workers and hospitals say they are struggling with a lack of resources as they try to prepare for a potentially huge demand for care.
Citing concerns about shortage of both medical equipment and staff, the Missouri State Medical Association this week sent a letter to Gov. Mike Parson urging him to issue a statewide “shelter-in-place” order.
"If things progress as is, COVID-19 patients will deplete the state's available hospital beds, ventilators, and precious personal protection equipment. Any additional time without a 'shelter-in-place' requirement wastes crucial healthcare resources, including manpower," the letter reads.
After weeks of cautiously optimistic messages, many hospitals in the Kansas City area are now acknowledging shortcomings that are already affecting how they operate and forcing them to revise plans for dealing with COVID-19.
"In working with multiple groups, the health system — we’re talking about clinicians, physicians, leadership — we've been working daily and sometimes many times a day to truly understand what the needs are and how we can best utilize the PPE (personal protective equipment), for instance, or all of the supplies and resources that we have to maximize protection of our staff," says Michael Darling, senior vice president of supply chain management at Saint Luke’s Health System.
KCUR spoke with several health care workers who agreed to talk candidly about their concerns and experiences on the condition of anonymity.
One nurse practitioner said there seemed to be new policies and practice changes every day in response to concerns about supplies and new case data.
Lack of testing for COVID-19 tops of the list of concerns for many providers, who say that they, like their patients, worry about being infected and spreading the virus to others.
Employees are being asked at the beginning of each shift whether they have been exposed to infected people, she said, and her answer is simply that she doesn’t know.
Because they believe the illness can be spread by individuals who have been infected but don’t show symptoms, health care experts have called for greatly expanding COVID-19 testing beyond highly symptomatic people.
But the current guidelines for testing health care workers are essentially the same as guidelines for the general public: The only people to get tested are those who have symptoms and have either been exposed to confirmed cases or have traveled to an area with a widespread outbreak.
Under those guidelines, "hospital and health care workers who are symptomatic or at risk would be tested," said Dave Dillion, a spokesperson for the Missouri Hospital Association. "Given the shortage of tests overall, at this point health care workers are not being tested universally."
A study drawing on research into the coronavirus outbreak in China estimated that for every one case that was identified, between 5 and 10 cases were not – and those undetected cases accounted for 80% of the cases where the virus was transmitted to others.
When an undetected illness circulates, health care workers risk not just getting sick but also unknowingly infecting patients, family and friends.
A surgical technologist who works at a suburban Kansas hospital says that she and many of her colleagues are resigned to the likelihood that they will contract COVID-19 at some point.
"Certainly most health care workers are very concerned not just about their own health, but of course about that possibility as well. No healthcare worker wants to be the source of infections to somebody else," says Dr. Steven Lawrence, an infectious disease specialist at Washington University in St. Louis.
Testing has become more available in Kansas and Missouri during the past week as commercial labs begin testing along with public labs. But in some areas, including Johnson County, the availability of testing has been scaled back.
Some state health officials, such as Missouri Department of Health and Senior Services Director Randall Williams, have hinted the guidelines for testing may be expanded.
But Williams says substantive changes to Missouri testing guidelines probably won’t happen until April.
Health workers have also raised concerns about low supplies of personal protective equipment that health care workers need to safely treat COVID-19 patients.
A survey conducted by the National Nurses United union found that less than a third of nurses in the country work in facilities with enough personal protective equipment to handle a COVID-19 outbreak.
Many of those items, including N95 masks, are not commonly used by most health care workers. Several Kansas City area hospitals say they have enough of those supplies to meet current demand, but the rate of supply use has been accelerating rapidly, according to one local hospital.
St. Luke’s reports that in the past three weeks, its providers have used five times the normal amount of standard medical supplies.
Anticipating an influx of COVID-19 cases, hospitals have been taking unusual steps to conserve even common protective equipment.
A surgery technologist at a hospital in suburban Kansas says she and other staff members are being given one disposable mask to be used each day, then returned, irradiated and reused.
An intensive care unit nurse who has been treating COVID-19 patients at another hospital in suburban Kansas says he is also being asked to reuse N95 masks as well as other more advanced personal protective equipment.
Hospitals acknowledge they are now taking steps to extend the use of existing supplies.
"For the last week we have been looking into reusing certain PPEs … so that we can prolong the life of these PPEs, so that we can continue to have enough, so that the health care workers, when they need it for the patients that they're treating, will have it," Dr. Dana Hawkinson, a University of Kansas Health System infectious disease specialist, said this week during a press briefing.
"And so we are looking into all of those things, different ways to reuse, and continue to look at different ways we can use extended use for things like N95s and other face masks as well," he said.
Dillion, of the Missouri Hospital Association, said the state has requested additional personal protective equipment from the Strategic National Stockpile and those requests are being reviewed.
But many states that have requested supplies from the national stockpile have received only a fraction of their total requests.
Details about the Strategic National Stockpile are not publically available, but observers were disappointed this week when officials confirmed that the stockpile contained only 16,600 ventilators, far fewer than what might be needed to help cover shortages in hospitals.
President Trump has declined to order the production of more ventilators or assist ventilator manufactures in distributing them.
Some hospitals, meanwhile, have announced they are accepting donated supplies such as masks and hand sanitizer.
The intensive care unit nurse who has been treating COVID-19 patients at a suburban hospital says hospital leaders have discussed possible steps to boost capacity in the event of a surge in cases but provided few details or instruction on how to do the work that may be asked of them.
The intensive care unit nurse says he is skeptical about people jumping in to offer specialized care they are not trained and experienced enough to provide.
He says many of the challenges local hospitals have faced so far have been relatively minor compared with what has happened in places like Spain or Italy, where overrun hospitals have been forced to provide care in makeshift settings and doctors have been unable to provide critical care for all who need it.
However, he says, his own fears of those scenes playing out in Kansas City are compounded by what he sees as a lack of preparedness and adequate action so far.
Alex Smith is a health care reporter for KCUR. You can email him at alexs@kcur.org.
