In early February, Royal Caribbean’s Anthem of the Seas docked in Bayonne, New Jersey, in need of a hospital. The cruise ship was carrying patients who had traveled from China, where an outbreak of COVID-19 had taken root. Four passengers needed to go somewhere for further medical observation.
The obvious next step was University Hospital in Newark, a major academic medical center equipped with isolation rooms. “The hospital is following proper infection control protocols while evaluating these individuals,” Gov. Phil Murphy said in a statement. The patients tested negative, but the governor was clear. The state’s first coronavirus cases would go to University.
That’s a hospital that has struggled in recent years with a critical skill essential to battling COVID-19: controlling the spread of infection.
Less than two years ago, a deadly bacteria made its way through the facility. Three babies in the neonatal intensive care unit got infected and died. Government inspectors cited the hospital for being short of staff; failing to maintain a sanitary environment, including improper hand hygiene and sterilization; and inadequately isolating patients with respiratory conditions. They determined the hospital had put patients in “immediate jeopardy.”
MedStar Washington Hospital Center in Washington, D.C., says it’s ready to screen coronavirus patients. Inspectors have cited the facility more than a dozen times since 2017, including for infection control failures. Among the violations: Staff did not wear and dispose of masks according to federal guidelines. Short staffing caused scores of patients to go without respiratory treatments. There were sewage leaks in operating rooms.
In an email, a spokeswoman said the hospital has addressed the failures: “We maintain a constant state of readiness for treating complex illnesses, including the coronavirus.”
Montefiore Medical Center in the Bronx, New York, says on its website COVID-19 patients will be immediately isolated. But it got written up back-to-back, in 2016 and 2017, for violating infection control protocol. Among the shortcomings: “Chronic overcrowding” in its emergency room, not isolating a Hepatitis B-positive patient and contaminated supplies. Infection control breaches put patients and staff at risk, one inspection report said. Hospital officials did not respond to requests for comment.
Medical experts say they wonder: if hospitals can’t control the spread of pathogens under normal conditions, what happens if they face a rush of patients with a disease as contagious and serious as the one caused by COVID-19?
During the SARS outbreak in the greater Toronto area, 44% of the total cases were among health care workers. A retrospective study, published in the journal Emerging Infectious Diseases in 2004, hypothesized that “lapses in infection control measures may be responsible,” noting that caregivers were particularly at risk during procedures like intubation.
Though COVID-19, with its estimated 2% fatality rate, is far milder than SARS, which killed about 10%, it is thought to have a similar method of transmission and will require similar methods of protection to prevent the disease from spreading throughout hospitals. Without a proven treatment or vaccine, infected patients would need to be handled with the utmost caution. They would be isolated, and caregivers would don protective gear, including gloves, goggles, gowns and masks.
Medical providers across the country told ProPublica that they’re worried about their safety and their hospitals’ lack of preparation. They spoke on the condition of anonymity because they were not authorized to speak on behalf of their hospitals.
The coronavirus arrived in Washington state “like a slap in the face,” a nurse in the Seattle area told ProPublica. Two weeks ago, her hospital was talking about the virus as something it was “watching, but with no big alarm.” Now, the state has had the first deaths in the United States and 18 confirmed cases as of Monday. The hospital is “desperately trying to get more supplies,” she said, particularly of masks and gowns. She fears that morale will drop. Already, she’s heard staff grumbling that only certain units are being allocated higher-protection masks.
An acute-care nurse in Rockford, Illinois, said that just last week, a severely ill patient on her floor initially tested negative for the flu but after nearly a week retested positive. In that period, nurses were in and out of his room, and what’s known as “droplet precautions” weren’t always taken — for example, sometimes the patient didn’t have a mask on, meaning staff members were exposed. “How easily this happened gives me serious concerns about the much more serious infection we face with COVID-19,” she said.
Another nurse, at a high-level hospital in western New York that is likely to handle severely ill patients, said the only information he’s received is via the hospital’s internal newsletter. “Management has just said, ‘We’re monitoring the situation and we’ll keep you updated.’ It’s ridiculous. They haven’t verbalized a specific plan, and that increases the anxiety of a lot of the care providers.” He said he and his co-workers are “resigned to the fact that we’re all going to get the coronavirus.”
The risk to hospital workers could have a dangerous cascading effect, said Dr. Lance Peterson, the recently retired director of clinical microbiology and infectious disease research at the NorthShore University Health System in Evanston, Illinois. He said that hospitals often keep staffing to a minimum, and that could become a problem if there’s prolonged spread of the virus. “If hospital workers start getting sick,” he said, “you don’t want them to come to work.”
Some hospitals are more prepared than others for a potential outbreak, said Dr. William Schaffner, professor of preventive medicine and infectious diseases at Vanderbilt University Medical Center. Some have spent recent weeks running drills. Officials at University Hospital in Newark and MedStar in Washington, D.C., count themselves among those.
In many ways, the United States is better prepared than many other countries for an outbreak, Peterson said. Individual patient rooms are common, which makes it easier to isolate infected patients. The SARS and Ebola outbreaks prompted many hospitals to stock up on supplies like gloves and gowns and masks, he said. And The Joint Commission, which accredits hospitals, has been monitoring their level of preparation.
But it is true there are also going to be infection control problems, he said. “Whenever you have humans in the system, there will be lapses.”