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As the country reckons with the spread of the novel coronavirus—with cases climbing nationwide as more people get screened and tested—D.C.’s health care providers are doing what they can to prepare for the ever-evolving epidemic.
In the U.S., the number of confirmed cases for COVID-19—a respiratory disease that mainly spreads person-to-person—has climbed to over 100 in more than one dozen states. Nine people have died from COVID-19, all of them in Washington state. There are no confirmed cases in the District, Mayor Muriel Boswer said at a press briefing Tuesday afternoon. Since December 2019, six D.C. residents have been tested.
“At this point we continue to tell people to use common sense,” said Bowser. “And it’s worth saying again: Stay home if you are sick, wash your hands often and thoroughly.”
“The risk of residents in the District of Columbia for COVID-19 remains low at this time,” adds DC Health Director Dr. LaQuandra Nesbitt, who joined the mayor at the press conference. “We do want to encourage our residents to seek health care if they believe they have been exposed to COVID-19 because of their travel history or because they believe they have signs and symptoms.”
“It is critically important to call ahead to a provider as that is one of the key ways we will have the possibility of containing the spread of the virus,” she adds.
The executive has directed more than $500,000 from the city’s contingency reserve fund to order more personal protective equipment and emergency supplies for first responders and frontline staff. Meanwhile, local health care providers have been in constant communication with the D.C. government about COVID-19. For most people, the novel coronavirus causes mild respiratory infections, with symptoms no more severe than the common cold. Those with a pre-existing illness and the elderly are at higher risk.
“I’m living coronavirus preparedness,” says Dr. Jennifer Abele, the interim chief medical officer and chair of the department of emergency medicine at Sibley Memorial Hospital.
The Centers for Disease Control and Prevention offer information to hospitals about how workers can prepare, but each individual hospital in D.C. is coming up with its own action plan. While plans are similar, with each following guidance from the federal and local government, hospitals are tailoring their workflow. The expectation is that there is enough personal protective equipment for providers, from fluid-impermeable gowns to N95 respirators, and that workers are ready for the day when a patient with the novel coronavirus walks in the door.
Spokespersons at several hospitals in D.C.—including Sibley Hospital, Howard Hospital, MedStar Washington Hospital Center, MedStar Georgetown University, United Medical Center, and Children’s National Hospital—say staff is actively preparing as best they can. Some hospitals are already running near or at capacity, especially now as the second wave of flu hits. So far this influenza season, 2994 positive cases have been reported across seven hospitals in the District. Hospitals are not seeing many, if any, patients who are asking about COVID-19. Sibley, for example, is hearing more from primary care providers by phone who are asking questions on behalf of their own patients. Howard, alternatively, is seeing the typical uptick in patients who come into the emergency department seeking care because the flu season is in full swing and allergy season is approaching.
Meanwhile, providers who see high-risk patients are also preparing themselves. Unity Health Care, which specializes in treating patients experiencing homelessness, will be meeting later this week with the D.C.’s Interagency Council on Homelessness to make sure there is a plan in place for their patients in the event of an outbreak, says Dr. Catherine Crosland, director of homeless outreach. People experiencing homelessness are at a particular risk because they are in settings where airborne infections can easily spread.
Providers do have their own concerns.
“In terms of protective supplies, long term care providers are having some of the same difficulties as other health care providers getting masks and gowns,” says Veronica Sharpe, president of District of Columbia Health Care Association, an organization that represents all of the licensed non-federal nursing facilities in D.C. “It’s important to note that CDC does not recommend masks for the general public at this point.”
As they prepare for a possible influx of patients, hospital workers are also concerned for themselves given that they are at greater risk of being exposed to the virus through daily interactions with sick people who could have the novel virus but do not know it.
“One of the biggest problems we have right now is access to testing,” says Abele, a problem she says is plaguing the entire country.
“Only the very ill people—more high risk patients—are getting tested. So we might have community spread or community patients that we cannot detect at this point in time and that puts our hospital frontline staff—even primary care doctors—at risk because you just don’t know,” says Abele. “So it’s a lot of planning of how we can protect our health care workers.”
Patients are screened at every entry point in the hospital and asked about their travel history. Sibley and other hospitals are following the criteria set by the CDC and DC Health, but it evolves as information about the virus changes.
“All of a sudden Italy is on the list. OK, well Italy was not on the list before. Now it is. So if you had travelled to Italy, you wouldn’t have screened positive. But then the next day you would have. So it’s that ever-changing situation that makes it hard to stay on top of it,” says Abele.
During Tuesday’s briefing, Dr. Jennifer Smith with the Department of Forensic Sciences said that as of Monday, the District has the capacity to conduct in-house testing, so DC Health no longer needs to send samples to CDC headquarters in Atlanta. But just because D.C. has the ability to test people, that does not mean D.C. is testing more than it otherwise would, according to Abele and Smith. There is a criteria set by the federal government that triggers DC Health to test individuals for COVID-19. So far the six individuals who have been tested had a history of travel that triggered intervention. Abele confirmed the criteria for testing changes and has evolved in recent weeks to include patients who’ve been hospitalized with severe illness and who did not necessarily have a known exposure.
“The case definition is really limited,” says Dr. Sarah Henn, Whitman-Walker Health’s chief medical officer. “It’s misleading to say there is no community transmission because we have not been doing testing to know whether or not.”
“We are missing the boat by not testing more people,” she adds.
Henn supports more testing, especially because D.C. sees a lot of travelers. She knows of one person who has recently travelled to Italy and is at home with a fever, but is not being tested because her symptoms are mild.
Given testing limitations, Whitman-Walker Health is asking patients to call ahead of time to prepare accordingly. The provider even started a triage phone line on Monday that patients can call if they are concerned about the novel virus. The idea is to manage treatment over the phone if they can, as to not possibly spread anything to other patients and staff. Henn spoke with two patients when she was on call for three hours on Monday. Both had upper respiratory illnesses and were distressed, but were able to be managed at home. (These phone calls are not billable to Medicaid, which many Whitman-Walker Health clients use. While this is not a problem now, it can be if more patients utilize this service.)
“We just need to assume that people can be contagious and make sure we are taking proper precaution,” says Henn.
The nature of this virus makes planning and training especially critical. But that is not necessarily happening everywhere. A patient care coordinator at the emergency department in United Medical Center says that she has not been trained for a possible COVID-19 outbreak as of Sunday. The frontline worker, who has provided care at UMC for over a decade, admits she is not working at the hospital as frequently as she once was and missed the training last month. But she is still a full-time worker and is one of the first people a patient sees when they arrive at the ER. COVID-19 is discussed during huddles, but she has not been trained like she was during the Ebola outbreak in 2014. The worker asked not to be named for fear of retaliation.
“Some people have had training but I do not think a lot. I’ve asked a lot of nurses if they had the training and they said no,” says the UMC patient care coordinator. “I do not know the type of masks you should use because I’m hearing different things about this mask don’t work and this does, so we definitely need that training to protect ourselves and others.”
Another UMC employee, an emergency department technician who was trained in late February, says she is worried that the public hospital does not have the staff to handle a possible outbreak. Nurses have testified before the Council on numerous occasions that they are overworked and under-supported. UMC has held job fairs in recent months but the hospital is scheduled to close soon so prospective workers aren’t rushing to work there.
“With UMC being a D.C. government-owned hospital, I think they should make sure that we are better prepared for the coronavirus. There’s no excuse why our hospital is not prepared,” the technician, who asked not to be named for fear of retaliation, tells City Paper.
But an official spokeswoman for the hospital says staff is prepared to handle a surge of patients. It has a sufficient number of beds, personal protective equipment, and isolation rooms with negative pressure should a COVID-19 patient walk in.
Toya Carmichael, UMC’s vice president of public relations, adds via email: “Everyone in the ED has been trained on the extent of the virus, how to prevent spreading the virus, and how to protect themselves from infection.”
“[T]raining is ongoing as information is continuously being provided to all of us through the CDC and the DOH. If the employee is not participating in the training or morning meetings despite our requirements that is not a reflection on the hospital’s efforts or preparedness,” she says.