Inadequate PPE and disjointed policy heighten risk.


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By conservative estimates, more than 100,000 health care workers in the United States have been infected with COVID-19, and more than 600 have died, according to the Centers for Disease Control and Prevention (CDC).

Figure. Pairs of nur... - Click to enlarge in new windowFigure. Pairs of nurses' shoes were placed outside the White House May 7 by National Nurses United to honor nurses who have died from COVID-19 and demand the administration do more to protect frontline health care workers. Photo by Rick Reinhard / National Nurses United.

Estimates by the CDC and other tracking organizations vary widely because of gaps in data collection. The toll, the CDC acknowledges, is likely much higher. "Lost on the Frontline," a collaborative project between the Guardian and Kaiser Health News, puts the likely COVID-19 death toll among U.S. medical personnel at more than 800 people. Of those who have died, at least 144 were RNs, according to National Nurses United (NNU), which represents over 150,000 nurses nationwide.


Nurses and other health care workers have been touted as heroes throughout the pandemic and cheered on with everything from applause to bells to car horns. Yet the conditions of their workplaces have at times been dire, especially in the early months of the pandemic when access to personal protective equipment (PPE) was inadequate. Even now, supply problems persist.


An NNU survey of nearly 23,000 nurses found that because of PPE and other equipment shortages, 87% of respondents reported having to reuse single-use disposable respirators or masks with COVID-19 patients, and 28% said they had to reuse respirators that had gone through "decontamination"-a process that can diminish respirator effectiveness and expose users to toxic chemicals. In addition, of those working with confirmed COVID-19 patients, 72% reported having exposed skin or clothing while providing care, and 27% said they had been exposed to the virus without the appropriate PPE and had worked within 14 days of exposure, thereby putting patients and coworkers at risk.


"Nurses are very frustrated," said Catherine Kennedy, vice president of NNU and president-elect of the California Nurses Association. NNU has been pushing hard to get the U.S. Senate to approve the Health and Economic Recovery Omnibus Emergency Solutions (HEROES) Act, which passed the House of Representatives on May 15. In an interview with AJN, Kennedy cited several provisions of the legislation that are relevant to health care workers. One would require the Occupational Safety and Health Administration to enforce an emergency temporary standard that would prevent employers from locking up needed PPE and would require them to educate and train workers on the safe use of protective equipment. Another provision would increase the supply of PPE through the Defense Production Act, and a third would designate a coordinator at the federal level to adequately distribute supplies to the states.


According to a study published online June 10 in BMJ, PPE is highly effective in safeguarding health care workers when combined with other protective measures. Researchers followed 304 nurses and 116 physicians deployed to hospitals in Wuhan, China, who were appropriately equipped with PPE (including protective suits, masks, gloves, goggles, face shields, and gowns) while caring for COVID-19 patients. Participants in the study also followed strict infection control measures such as maintaining minimal direct contact with patients, promptly replacing contaminated gloves, and adhering to handwashing procedures. Upon returning home, all tested negative for the virus and its associated antibodies.


The pandemic "is a huge public health crisis" requiring "a national response," said Kennedy, noting that her own employer, Roseville Medical Center in California, part of the Kaiser Permanente health system, waited until mid-June before implementing universal masking. "Instead, each state is being told to figure it out on its own-it's ridiculous," she said.-Dalia Sofer