California reported its first death linked to the novel coronavirus today. Los Angeles County joined others in declaring local health emergencies, and nurses are asking for more training for health care workers.
Faced with the first death of a California patient, and growing concern the novel coronavirus is spreading in some communities, Gov. Gavin Newsom declared a state of emergency today and said testing and tracking of people potentially exposed to the virus will be the top priority.
Earlier today, Placer County health officials reported the death of a resident who likely was exposed on a cruise ship that departed from San Francisco to Mexico on Feb. 11. The person, described as an elderly adult with underlying health conditions, was diagnosed Tuesday and was in isolation at Kaiser Permanente Roseville.
The cruise ship had 2,500 people on the San Francisco to Mexico leg. Newsom said at a press conference the ship is now en route to San Francisco from Hawaii, and people on board have developed symptoms of the virus. California officials are holding the ship offshore, and flying testing kits to it. In addition, the Centers for Disease Control and Prevention is sending 10 people to help find community members who might have been exposed to the elderly adult who died, he said.
“This case demonstrates the need for continued local, state and federal partnership to identify and slow the spread of this virus,” Gov. Gavin Newsom said in a statement.
Even before the death was announced, Los Angeles County joined several other counties in declaring a health emergency, reporting it had seven patients with the virus.
Los Angeles City Mayor Eric Garcetti joined county health officials to declare the emergency, then wrote in a social media post: “I have signed a declaration of local emergency for the City of Los Angeles. While there are only a few known active COVID-19 cases in the region, the declaration helps us access state and federal funding to strengthen and support our efforts to prepare our region and keep our communities safe.”
San Diego, Santa Clara, San Francisco, Marin, Orange, Placer, and Solano counties have issued similar declarations.
In the meantime, Newsom has set aside $20 million to help contain the virus. California also will have thousands of additional tests and is administering testing in 14 labs. Newsom said Tuesday California will have 20 labs able to test in the next few days.
California’s response isn’t without glitches on the ground, however, including nurses who say they are concerned about safety training and limited access to equipment like face masks
Are health care workers ready for the virus?
Nurses, who say too many health care workers have been exposed and are in quarantine, aren’t satisfied with the coordination in some hospitals. They say they aren’t getting adequate training.
“Hospitals are leaving us out of the communication and planning around the care of these patients,” said Maureen Dugan, a nurse leader with the California Nurses Association, a political powerhouse that represents California’s nurses.
In some cases, when patients infected with the virus arrive at a hospital, only certain nurses are given on-the-spot training, Dugan said. “Hospitals are only educating and training the nurse that is right there with that patient at that time.”
Instead, she said hospitals’ nursing management should be communicating with all direct care nurses about strategy and expectations if patients start arriving in larger numbers.
“Yes, we are trained in these isolation methods every year,” Dugan said. “But they’re ignoring the fact that this is a heightened situation.” Even routine training is critical, Dugan said, such as reminders to put on and take off equipment correctly to avoid becoming infected.
On Feb. 19, a patient with the novel coronavirus was admitted to UC Davis Medical Center. In a statement, the union said 124 nurses and healthcare workers were forced to quarantine themselves because of a lag in testing and poor preparedness. The medical center has not revealed the number of workers potentially exposed, citing privacy concerns, but said the 124 number is “inaccurate.”
“The medical center routinely prepares for these types of situations with simulation drills. We have the right people, with the right training, facilities, and processes to ensure the healthiest and safest environment for everyone at all times,” the hospital said in a statement.
The California Hospital Association, which represents hundreds of hospitals across the state, said hospitals are following training guidelines from public health officials. Federal and state laws require hospitals to have comprehensive emergency response plans in place. “We drill on those at a minimum of twice a year,” said Jan Emerson-Shea, association spokeswoman.
Those plans are intended to address a variety of situations, whether it’s a wildfire or an infectious disease outbreak, she said.
“I think what may be getting missed in all of this is not every employee may be involved in the delivery of care of a suspected or confirmed coronavirus patient,” she said.
Emerson-Shea said hospitals are following the guidance of federal and state public health officials who have advised that hospitals limit the number of employees who come into contact with infected patients, which may explain why hospitals are training only some nurses as needed.
“Part of that is to obviously protect the employees, and part of that is also to really maximize the use of personal protective equipment, such as N95 masks, which everyone knows are in short supply,” she said.
Will the face mask shortage be a problem?
In a national survey conducted by the nurses union, only 27% of nurses reported their employer had enough personal protective equipment on hand for a surge in coronavirus patients. The majority, 44%, didn’t know.
But California’s public health department said this week it received approval from federal agencies to use some of its emergency reserves of 21 million N95 face masks, even though some are expired.
The expired masks were stored in “climate-controlled conditions” that helped prevent the elastic straps from degrading, the health department said. The straps are important for a proper, sealed fit.
The governor’s office had previously estimated that only about 20,000 masks had not expired. The state has ordered another 300,000 masks, but officials said high demand could result in backorders until April.
Expired masks are approved only for low-risk circumstances, but such use relieves pressure on the supply of unexpired masks for health care providers.“Releasing this supply of masks will help keep our health care professionals safe on the job,” Dr. Sonia Angell, director of the state’s public health department, said in an email to reporters.
Health officials are not recommending that healthy people wear masks in their everyday lives. But retailers started reporting shortages weeks ago.
How much do tests for the virus cost?
After media reports of exorbitant charges associated with testing, Newsom said this week he is working to prevent high charges in California. It’s not so much that the test itself is costly, but related costs like hospital visits can be, said Michael Romero, a program manager with Placer County’s Health & Human Services Department.
Individuals can be tested for free if a health provider contacts the county, which then approves and orders the test, Romero said. In that case, the county picks up the cost of the test.
But reports of costly associated charges are becoming more common: a Florida man who had recently traveled and had developed coronavirus symptoms, similar to those of the flu, took precautionary measures and checked into a hospital. He tested positive for the flu, but weeks later received a $1,400 bill, after his insurance paid its part.
Newsom said he doesn’t want fear of cost to be an impediment for Californians to test for the virus.
“We’re hearing across the country some usurious fees that are being attached to the test,” he said. “We’re trying to get those costs down to a minimum or just waive those costs.”
He said his office is working with insurers and public programs to determine whether the state has the authority to cut costs.
California could follow in the footsteps of New York, which has said it will require health insurers to waive some cost-sharing fees associated with testing, including doctor visits and trips to the ER.
The California Association of Health Plans on Tuesday said it is monitoring developments but is not yet modifying coverage or charges.
“At this time, state and federal health officials have indicated that the risk from COVID-19 is low and therefore treatment of the virus is aligned with treatment of other viral respiratory infections,” the group said in an emailed statement to CalMatters.
This story was updated to reflect new information from a 4 p.m. press conference with Gov. Newsom.