Traditional vacation destinations have seen a major influx of affluent people relocating to wait out the pandemic.

This article was published on Tuesday, September 15, 2020 in Kaiser Health News.

By Markian Hawryluk and Katheryn Houghton and Michelle Andrews

The staff at Stony Brook Southampton Hospital is accustomed to the number of patients tripling or even quadrupling each summer when wealthy Manhattanites flee the city for the Hamptons. But this year, the COVID pandemic has upended everything.

The 125-bed hospital on the southern coast of Long Island has seen a huge upswing in demand for obstetrics and delivery services. The pandemic has families who once planned to deliver babies in New York or other big cities migrating to the Hamptons for the near term.

From the shores of Long Island to the resorts of the Rocky Mountains, traditional vacation destinations have seen a major influx of affluent people relocating to wait out the pandemic. But now as summer vacation season has ended, many families realize that working from home and attending school online can be done anywhere they can tether to the internet, and those with means are increasingly waiting it out in the poshest destinations.

Many of the medical facilities in these getaway spots are used to seeing summer visitors for bug bites or tetanus shots, hiring an army of temporary doctors to get through the summer swells. Now they face the possibility of needing to treat much more serious medical conditions into the fall months — and for the foreseeable future.

Such increase in demand could strain or even overwhelm the more remote towns' hospitals and healthcare providers, threatening the availability of timely care for both the newcomers and the locals. The Southampton hospital has just seven intensive care unit beds, with the capacity to expand to as many as 30, but it wouldn't take much for the hospital to be swamped by patients.

"For healthcare, the bottom line is: As our population grows, we have to have the infrastructure to support it," said Tamara Pogue, CEO of Peak Health Alliance, a nonprofit community health insurance-purchasing cooperative in Colorado ski country.

And many communities do not.

Home Sales Soar

Sunny shores and mountain vistas are prompting people to relocate to second homes if they have them, or to purchase new homes in those areas if they don't. Renters who used to come for a month are now staying for two or three, and summer renters are becoming buyers. Multimillion-dollar residences in the ski resort town of Aspen, Colorado, for example, that once sat on the market for nearly a year now move in weeks.

"Some of the most experienced and seasoned real estate brokers have never seen activity like what we have experienced in July and August," said Tim Estin, a broker in Aspen, whose firm draws clients from COVID hot spots such as Dallas, Houston, New York, Miami, Los Angeles and Chicago.

Many destinations tried to discourage second-home owners from coming, particularly early in the pandemic after Colorado ski resorts became an epicenter of COVID cases. Gunnison County, Colorado, home to the Crested Butte ski resort, banned out-of-towners, prompting the Texas attorney general to take up the matter on behalf of Texans with homes in the area. In Lake Tahoe, along the California-Nevada border, second-home owners were told to go back to the Bay Area. And in New York vacation destinations, online messages targeted big-city transplants with classic New York aplomb.

The ski resort town of Vail, Colorado, on the other hand, welcomed them with open arms with its Welcome Home Neighbor campaign in May.

"We have long held the belief that in a resort community with so many second homes, that lights on are good, lights off are bad," said Chris Romer, president and CEO of the Vail Valley Partnership, the region's chamber of commerce.

Romer said the 56-bed Vail Health Hospital supported the campaign, particularly after visits to the town plummeted 90% in April once the ski lifts stopped running.

"We never would have launched the program if the hospital didn't sign off on it," Romer said.

Demand for Healthcare

The influx of patients to these rural areas is helping hospitals and clinics rebound from the drop in typical patient visits during the pandemic, but there is concern that additional growth could overwhelm local resources. So far, though, enough people seem reluctant to seek care during the pandemic, unless it's an emergency or COVID-related, that it hasn't reached a tipping point. Others might be seeking care with their providers in the big city through telehealth or the occasional run back to their primary residence. But the mix of patients is different.

In Leadville, Colorado, a town nestled in the mountains at an altitude of 10,151 feet, summertime usually means an influx of mountain bikers and runners.

"Leadville has these crazy 100-mile races, where we have very elite athletes from all over the planet, and they have specific medical needs," said Dr. Lisa Zwerdlinger, chief medical officer at the local St. Vincent Hospital. "But what we're seeing now are these second-home owners, people who are coming from other places to spend extended periods of time in Leadville and who come with a whole host of other medical issues."

Most of the races this summer were canceled. That meant fewer extreme athletes and more Texans; fewer broken bones and turned ankles, and more chronic conditions exacerbated by the high altitude. Nonetheless, August was the busiest month ever at Zwerdlinger's family medicine practice.

Hospitals in vacation towns typically prepare for surges during holidays, said Jason Cleckler, CEO of Middle Park Health, with locations serving Colorado's Winter Park and Granby Ranch ski resorts in Grand County. During Christmas week, the population of neighboring Summit County, which houses resorts like Breckenridge and Keystone, swells from 31,000 to 250,000. But Cleckler said the COVID surge in resort communities is drawn-out so hospitals may have to respond with more permanent increases in capacity.

In Big Sky, Montana, whose part-time residents include Bill Gates and Justin Timberlake, Big Sky Medical Center doubled its capacity to eight beds in anticipation of a surge in patients due to COVID-19. The center's two primary care doctors are completely booked. With so many new people in town, the hospital has accelerated plans to shift a third full-time doctor into the clinic.

As the wily coronavirus works its way into all corners of America, though, patients may find that not all regions have the same capacity to deal with COVID or even other complex medical problems.

Visitors to the sole clinic in nearby West Yellowstone, a gateway to the namesake national park, expect to be able to get COVID tests even if they have no symptoms or a known connection to a case, said Community Health Partners spokesperson Buck Taylor.

"There seems to be a frustration that a rural Montana clinic doesn't have the resources they expect at home," Taylor said. "That's nothing new. People come to Montana all the time and say, 'But where can I get any good Thai food?'"

Planning for What's Next

The year has been such an outlier for hospitals that it's difficult for them to predict and plan for what will happen next. On Long Island, many locals typically leave the Hamptons for Florida during the winter. But it's unclear whether those snowbirds will stay or go this year, given the high levels of COVID-19 in Florida now, said Robert Chaloner, CEO of Stony Brook Southampton. That could also change the demand for who needs medical care.

One indication that some visitors may be staying put? The jump in new students. The Big Sky school district expects a 20% increase in enrollment this fall. Leadville schools have at least 40 new students. Vail Mountain School's waiting list is its longest ever.

Many have speculated that the pandemic lockdown might fundamentally change the way companies operate, allowing more people to work from distant locations for the foreseeable future.

"Every indicator that I see is pointing to the fact that this is a shift," said Romer in Vail. "It has the potential to be permanent."

Taylor Rose, Big Sky Medical Center's director of operations and clinical services, said that, if that happens, the hospital will have to rebalance its services.

"I'd probably give it a year or two before I make any major changes," Rose said. "People are going to start deciding, 'This really isn't for me. I'm not going to stay here and deal with 6 feet of snow in the winter.'"

Markian Hawryluk: MarkianH@kff.org, @MarkianHawryluk

Katheryn Houghton: katherynhoughton@gmail.com, @K_Hought

Michelle Andrews: andrews.khn@gmail.com, @mandrews110

As the end-of-session frenzy gripped California lawmakers in late August, pandemic no-nos spiked.

This article was published on Monday, September 14, 2020 in Kaiser Health News.

By Samantha Young and Rachel Bluth

SACRAMENTO — In California, the cradle of renowned tech startups and the Silicon Valley, elementary school students have had to figure out how to work remotely, but lawmakers have not.

Since March, Californians have scrambled to comply with public health orders that required most office and school work to occur at home. But in one of the most iconic office spaces in the state — the Capitol building in Sacramento — most lawmakers and their staffers have gathered in large numbers for months (except when COVID-19 infections forced them to take unplanned recesses).

And as the end-of-session frenzy gripped them in late August, pandemic no-nos spiked: Lawmakers huddled closely, let their masks slip below their noses, smooshed together for photos and shouted "Aye!" and "No!" when voting in the Senate, potentially spraying virus-laden particles at their colleagues.

"It's terrible role-modeling," said Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Northwestern University. "Why do we have to do this if they're not doing it?"

Legislative leaders are divided on whether remote voting violates the state constitution. Nonetheless, it was authorized — should it be needed — on a limited basis by both chambers in late July.

In the last week of the session, the Democratic leader of the state Senate ordered 10 Republican senators who lunched together to vote via video after one of them, Sen. Brian Jones (R-Santee), announced he had tested positive for the coronavirus. The lone Republican senator who did not dine with them was allowed to vote on the floor.

But the remote-voting option didn't extend to others such as Assembly member Buffy Wicks (D-Oakland), who brought her newborn onto the floor for a late-night vote on Aug. 31.

Lawmakers insist the guiding forces behind their decision-making have been "science-based protocols."

But the science is pretty clear: Stay home, wear a mask that covers your nose and mouth, wash your hands and keep at least 6 feet away from people indoors. Maybe let your pregnant and nursing colleagues work from home.

Here at California Healthline, we let science and data guide our decisions, so we ran some of the legislators' behavior by epidemiologists and infectious disease experts.

This isn't (solely) to COVID-shame our elected officials for violating local, state and national recommendations governing how to conduct themselves in a pandemic — while crafting and debating the laws that govern our lives. Instead, we aim to be constructive. The pandemic rages on, and lawmakers may face similar conditions when they return in December to swear in newly elected members, or possibly sooner if Gov. Gavin Newsom calls for a special legislative session this fall.

Should Lawmakers Meet Indoors?

Health officials have pleaded with the public to stay home when possible to minimize the spread of COVID-19. The virus, they say, is extremely contagious, especially indoors.

But elected officials around the country continue to meet in person.

In California's Capitol, everyone must wear masks, the number of visitors to the Assembly and Senate floors were limited to provide more social-distancing space among members, and plexiglass dividers were installed in both chambers.

"These are absolutely unprecedented times in the California State Senate, and there was no prior experience with live remote voting or participation," Senate President Pro Tem Toni Atkins said in a statement to California Healthline. "So, we proceeded with a method that maximized participation while respecting public safety and meeting the legislature's constitutional duties, which, as you know, private businesses do not have to consider in their remote decision making."

Despite the precautions, congregating indoors is not wise, public health experts say.

"I don't think it's a good idea for any large group to have gathered, even if you were all wearing masks in an indoor environment," Khan said.

"We know that wearing a mask — consistently and correctly — substantially reduces the risk of coronavirus spread but certainly does not eliminate it," said Dr. Leana Wen, an emergency physician and visiting public health professor at George Washington University. "And in this time of a pandemic, we should all be doing what we can to switch to virtual meetings and gatherings, when possible."

Broken Social-Distancing Rules

Time after time, California lawmakers flagrantly broke social-distancing rules.

Some didn't wear masks that properly sealed their faces, or pulled their masks down to sip coffee. Impassioned senators yelled to cast votes, while their colleagues in the Assembly quietly voted at their desks by simply pushing a button. And lawmakers in both chambers huddled closely to confer.

"Physical distance is quite important, actually," said Dr. George Rutherford, a professor of epidemiology and biostatistics at the University of California-San Francisco. It's the "second layer" of protection after masks, he said.

"I realize it doesn't lend itself well to this kind of business, but you have to figure it out," he said.

Lawmakers, Rutherford noted, are prone to dramatic speeches and like to yell passionately into microphones to make a point, which is not particularly good behavior under COVID.

"I mean, the louder you talk, the greater your exhalational force, the more likely you are to overwhelm the protections of the mask," he said.

The Cry Heard 'Round the World

A baby's cry from the Assembly floor triggered national rebuke of California's legislature. When Wicks came to the floor to vote on a housing bill Aug. 31, her month-old daughter, Elly, wasn't pleased that her late-night feeding had been interrupted.

Wicks had asked Assembly leadership if she could vote by proxy but was told she was not at high risk for COVID-19. Assembly Speaker Anthony Rendon later apologized.

"Inclusivity and electing more women into politics are core elements of our Democratic values," Rendon said in a statement. "Nevertheless, I failed to make sure our process took into account the unique needs of our Members. The Assembly needs to do better. I commit to doing better."

The photo of Wicks holding her swaddled baby in her arms went viral — a rallying cry for mothers across the country balancing the demands of work with children at home. Plus, requiring that she appear in person was not only unnecessary, Wen said, but dangerous.

"Newborns are extremely high-risk because they have no immunity, other than the immunity that they obtained from their mother, said Wen, who is the mother of a 5-month-old. "Every employer, every entity needs to do everything they can to be flexible during this time of a pandemic."

Why Not Legislate Virtually?

Congress continues to gavel into session in person, and many state constitutions require legislatures to meet in person. At least 30 states have allowed remote voting, extended bill deadlines or made other legislative accommodations since the start of the pandemic, according to the National Conference of State Legislatures.

Only Wisconsin and Oregon already had rules in place for remote voting in case of an emergency.

California dabbled with online hearings this spring and summer and witnesses testified remotely. There were the usual trip-ups: mute buttons still engaged, a crackly phone line or a lawmaker caught uttering a bad word.

But the technology is available to conduct the people's business, and public health experts urged lawmakers to consider updating their rules.

"It's not the same as being in person for sure. It is really hard to accomplish things the same way," Khan acknowledged. But "in 2020, we're very blessed with a million different ways to remotely interact for video and audio that should be explored and exhausted before saying that there is no better option."

In states such as Michigan, Ohio and Minnesota, testing for the brain-damaging heavy metal fell by 50% or more this spring compared with 2019.

This article was published on Friday, September 11, 2020 in Kaiser Health News.

By Brie Zeltner

CLEVELAND — Families skipping or delaying pediatric appointments for their young children because of the pandemic are missing out on more than vaccines. Critical testing for lead poisoning has plummeted in many parts of the country.

In the Upper Midwest, Northeast and parts of the West Coast — areas with historically high rates of lead poisoning — the slide has been the most dramatic, according to the Centers for Disease Control and Prevention. In states such as Michigan, Ohio and Minnesota, testing for the brain-damaging heavy metal fell by 50% or more this spring compared with 2019, health officials report.

"The drop-off in April was massive," said Thomas Largo, section manager of environmental health surveillance at the Michigan Department of Health and Human Services, noting a 76% decrease in testing compared with the year before. "We weren't quite prepared for that."

Blood tests for lead, the only way to tell if a child has been exposed, are typically performed by pricking a finger or heel or tapping a vein at 1- and 2-year-old well-child visits. A blood test with elevated lead levels triggers the next critical steps in accessing early intervention for the behavioral, learning and health effects of lead poisoning and also identifying the source of the lead to prevent further harm.

Because of the pandemic, though, the drop in blood tests means referrals for critical home inspections plus medical and educational services are falling, too. And that means help isn't reaching poisoned kids, a one-two punch, particularly in communities of color, said Yvonka Hall, a lead poisoning prevention advocate and co-founder of the Cleveland Lead Safe Network. And this all comes amid COVID-related school and child care closures, meaning kids who are at risk are spending more time than ever in the place where most exposure happens: the home.

"Inside is dangerous," Hall said.

The CDC estimates about 500,000 U.S. children between ages 1 and 5 have been poisoned by lead, probably an underestimate due to the lack of widespread testing in many communities and states. In 2017, more than 40,000 children had elevated blood lead levels, defined as higher than 5 micrograms per deciliter of blood, in the 23 states that reported data.

While preliminary June and July data in some states indicates lead testing is picking up, it's nowhere near as high as it would need to be to catch up on the kids who missed appointments in the spring at the height of lockdown orders, experts say. And that may mean some kids will never be tested.

"What I'm most worried about is that the kids who are not getting tested now are the most vulnerable — those are the kids I'm worried might not have a makeup visit," said Stephanie Yendell, senior epidemiology supervisor in the health risk intervention unit at the Minnesota Department of Health.

Lifelong Consequences

There's a critical window for conducting lead poisoning blood tests, timed to when children are crawling or toddling and tend to put their hands on floors, windowsills and door frames and possibly transfer tiny particles of lead-laden dust to their mouths.

Children at this age are more likely to be harmed because their rapidly growing brains and bodies absorb the element more readily. Lead poisoning can't be reversed; children with lead poisoning are more likely to fall behind in school, end up in jail or suffer lifelong health problems such as kidney and heart disease.

That's why lead tests are required at ages 1 and 2 for children receiving federal Medicaid benefits, the population most likely to be poisoned because of low-quality housing options. Tests are also recommended for all children living in high-risk ZIP codes with older housing stock and historically high levels of lead exposure.

Testing fell far short of recommendations in many parts of the country even before the pandemic, though, with one recent study estimating that in some states 80% of poisoned children are never identified. And when tests are required, there has been little enforcement of the rule.

Early in the pandemic, officials in New York's Erie County bumped up the threshold for sending a public health worker into a family's home to investigate the source of lead exposure from 5 micrograms per deciliter to 45 micrograms per deciliter (a blood lead level that usually requires hospitalization), said Dr. Gale Burstein, that county's health commissioner. For all other cases during that period, officials inspected only the outside of the child's home for potential hazards.

About 700 fewer children were tested for lead in Erie County in April than in the same month last year, a drop of about 35%.

Ohio, which has among the highest levels of lead poisoning in the country, recently expanded automatic eligibility for its Early Intervention program to any child with an elevated blood lead test, providing the opportunity for occupational, physical and speech therapy; learning supports for school; and developmental assessments. If kids with lead poisoning don't get tested, though, they won't be referred for help.

In early April, there were only three referrals for elevated lead levels in the state, which had been fielding nine times as many on average in the months before the pandemic, said Karen Mintzer, director of Bright Beginnings, which manages them for Ohio's Department of Developmental Disabilities. "It basically was a complete stop," she said. Since mid-June, referrals have recovered and are now above pre-pandemic levels.

"We should treat every child with lead poisoning as a medical emergency," said John Belt, principal investigator for the Ohio Department of Health's lead poisoning program. "Not identifying them is going to delay the available services, and in some cases lead to a cognitive deficit."

Pandemic Compounds Worries

One of the big worries about the drop in lead testing is that it's happening at a time when exposure to lead-laden paint chips, soil and dust in homes may be spiking because of stay-at-home orders during the pandemic.

Exposure to lead dust from deteriorating paint, particularly in high-friction areas such as doors and windows, is the most common cause of lead exposure for children in the U.S.

"I worry about kids in unsafe housing, more so during the pandemic, because they're stuck there during the quarantine," said Dr. Aparna Bole, a pediatrician at Cleveland's University Hospitals Rainbow Babies & Children's Hospital.

The pandemic may also compound exposure to lead, experts fear, as both landlords and homeowners try to tackle renovation projects without proper safety precautions while everyone is at home. Or the economic fallout of the crisis could mean some people can no longer afford to clean up known lead hazards at all.

"If you've lost your job, it's going to make it difficult to get new windows, or even repaint," said Yendell.

The CDC says it plans to help state and local health departments track down children who missed lead tests. Minnesota plans to identify pediatric clinics with particularly steep drops in lead testing to figure out why, said Yendell.

But, Yendell said, that will likely have to wait until the pandemic is over: "Right now I'm spending 10-20% of my time on lead, and the rest is COVID."

The pandemic has stretched already thinly staffed local health departments to the brink, health officials say, and it may take years to know the full impact of the missed testing. For the kids who've been poisoned and had no intervention, the effects may not be obvious until they enter school and struggle to keep up.

Brie Zeltner: @BrieZeltner

A KHN investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID patients from those without the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead.

This article was published on Thursday, September 10, 2020 in Kaiser Health News.

By Christina Jewett

Nurses at Alta Bates Summit Medical Center were on edge as early as March when patients with COVID-19 began to show up in areas of the hospital that were not set aside to care for them.

The Centers for Disease Control and Prevention had advised hospitals to isolate COVID patients to limit staff exposure and help conserve high-level personal protective equipment that’s been in short supply.

Yet COVID patients continued to be scattered through the Oakland hospital, according to complaints to California’s Division of Occupational Safety and Health. The concerns included the sixth-floor medical unit where veteran nurse Janine Paiste-Ponder worked.

COVID patients on that floor were not staying in their rooms, either confused or uninterested in the rules. Staff was not provided highly protective N95 respirators, said Mike Hill, a nurse in the hospital intensive care unit and the hospital’s chief representative for the California Nurses Association, which filed complaints to Cal/OSHA, the state’s workplace safety regulator.

“It was just a matter of time before one of the nurses died on one of these floors,” Hill said.

Two nurses fell ill, including Paiste-Ponder, 59, who died of complications from the virus on July 17.

The concerns raised in Oakland also have swept across the U.S., according to interviews, a review of government workplace safety complaints and health facility inspection reports. A KHN investigation found that dozens of nursing homes and hospitals ignored official guidelines to separate COVID patients from those without the coronavirus, in some places fueling its spread and leaving staff unprepared and infected or, in some cases, dead.

As recently as July, a National Nurses United survey of more than 21,000 nurses found that 32% work in a facility that does not have a dedicated COVID unit. At that time, the coronavirus had reached all but 17 U.S. counties, data collected by Johns Hopkins University shows.

KHN discovered that COVID victims have been commingled with uninfected patients in health care facilities in states including California, Florida, New Jersey, Iowa, Ohio, Maryland and New York.

A COVID-19 outbreak was in full swing at the New Jersey Veterans Home at Paramus in late April when health inspectors observed residents with dementia mingling in a day room — COVID-positive patients as well as others awaiting test results. At the time, the center had already reported COVID infections among 119 residents and 46 virus-related deaths, according to a Medicare inspection report.

The assistant director of nursing at an Iowa nursing home insisted April 28 that they did “not have any COVID in the building” and overrode the orders of a community doctor to isolate several patients with fevers and falling oxygen levels, an inspection report shows.

By mid-May, the facility’s COVID log showed 61 patients with the virus and nine dead.

Federal work-safety officials have closed at least 30 complaints about patient mixing in hospitals nationwide without issuing a citation. They include a claim that a Michigan hospital kept patients who tested negative for the virus in the COVID unit in May. An upstate New York hospital also had COVID patients in the same unit as those with no infection, according to a closed complaint to the federal Occupational Safety and Health Administration.

Federal Health and Human Services officials have called on hospitals to tell them each day if they have a patient who came in without COVID-19 but had an apparent or confirmed case of the coronavirus 14 days later. Hospitals filed 48,000 reports from June 21 through Aug. 28, though the number reflects some double or additional counting of individual patients.

COVID patients have been mixed in with others for a variety of reasons. Some hospitals report having limited tests, so patients carrying the virus are identified only after they had already exposed others. In other cases, they had false-negative test results or their facility was dismissive of federal guidelines, which carry no force of law.

And while federal Medicare officials have inspected nearly every U.S. nursing home in recent months and states have occasionally levied fines and cut off new admissions for isolation lapses, hospitals have seen less scrutiny.

The Scene Inside Sutter

At Alta Bates in Oakland, part of the Sutter Health network, hospital staff made it clear in official complaints to Cal/OSHA that they wanted administrators to follow the state’s unique law on aerosol-transmitted diseases. From the start, some staffers wanted all the state-required protections for a virus that has been increasingly shown to be transmitted by tiny particles that float through the air.

The regulations call for patients with a virus like COVID-19 to be moved to a specialized unit within five hours of identification — or to a specialized facility. The rules say those patients should be in a room with a HEPA filter or with negative air pressure, meaning that air is circulated out a window or exhaust fan instead of drifting into the hallway.

Initially, in March, the hospital outfitted a 40-bed COVID unit, according to Hill. But when a surge of patients failed to materialize, that unit was pared to 12 beds.

Since then, a steady stream of virus patients have been admitted, he said, many testing positive only days after admission — and after they’d been in regular rooms in the facility.

From March 10 through July 30, Hill’s union and others filed eight complaints to Cal/OSHA, including allegations that the hospital failed to follow isolation rules for COVID patients, some on the cancer floor.

So far, regulators have done little. Gov. Gavin Newsom had ordered workplace safety officials to “focus on … supporting compliance” instead of enforcement except on the “most serious violations.”

State officials responded to complaints by reaching out by mail and phone to “ensure the proper virus prevention measures are in place,” according to Frank Polizzi, a spokesperson for Cal/OSHA.

A third investigation related to transport workers not wearing N95 respirators while moving COVID-positive or possible coronavirus patients at a Sutter facility near the hospital resulted in a $6,750 fine, Cal/OSHA records show.

The string of complaints also says the hospital did not give staff the necessary personal protective equipment (PPE) under state law — an N95 respirator or something more protective — for caring for virus patients.

Instead, Hill said, staff on floors with COVID patients were provided lower-quality surgical masks, a concern reflected in complaints filed with Cal/OSHA.

Hill believes that Paiste-Ponder and another nurse on her floor caught the virus from COVID patients who did not remain in their rooms.

“It is sad, because it didn’t really need to happen,” Hill said.

Polizzi said investigations into the July 17 death and another staff hospitalization are ongoing.

A Sutter Health spokesperson said the hospital takes allegations, including Cal/OSHA complaints, seriously and its highest priority is keeping patients and staff safe.

The statement also said “cohorting,” or the practice of grouping virus patients together, is a tool that “must be considered in a greater context, including patient acuity, hospital census and other environmental factors.”

Concerns at Other Hospitals

CDC guidelines are not strict on the topic of keeping COVID patients sectioned off, noting that “facilities could consider designating entire units within the facility, with dedicated [staff],” to care for COVID patients.

That approach succeeded at the University of Nebraska Medical Center in Omaha. A recent study reported “extensive” viral contamination around COVID patients there, but noted that with “standard” infection control techniques in place, staffers who cared for COVID patients did not get the virus.

The hospital set up an isolation unit with air pumped away from the halls, restricted access to the unit and trained staff to use well-developed protocols and N95 respirators — at a minimum. What worked in Nebraska, though, is far from standard elsewhere.

Cynthia Butler, a nurse and National Nurses United member at Fawcett Memorial Hospital in Port Charlotte, on Florida’s west coast, said she actually felt safer working in the COVID unit — where she knew what she was dealing with and had full PPE — than on a general medical floor.

She believes she caught the virus from a patient who had COVID-19 but was housed on a general floor in May. A similar situation occurred in July, when another patient had an unexpected case of COVID — and Butler said she got another positive test herself.

She said both patients did not meet the hospital’s criteria for testing admitted patients, and the lapses leave her on edge, concerns she relayed to an OSHA inspector who reached out to her about a complaint her union filed about the facility.

“Every time I go into work it’s like playing Russian roulette,” Butler said.

A spokesperson for HCA Healthcare, which owns the hospital, said it tests patients coming from long-term care, those going into surgery and those with virus symptoms. She said staffers have access to PPE and practice vigilant sanitation, universal masking and social distancing.

The latter is not an option for Butler, though, who said she cleans, feeds and starts IVs for patients and offers reassurance when they are isolated from family.

“I’m giving them the only comfort or kind word they can get,” said Butler, who has since gone on unpaid leave over safety concerns. “I’m in there doing that and I’m not being protected.”

Given research showing that up to 45% of COVID patients are asymptomatic, UCSF Medical Center is testing everyone who’s admitted, said Dr. Robert Harrison, a University of California-San Francisco School of Medicine professor who consults on occupational health at the hospital.

It’s done for the safety of staff and to reduce spread within the hospital, he said. Those who test positive are separated into a COVID-only unit.

And staff who spent more than 15 minutes within 6 feet of a not-yet-identified COVID patient in a less-protective surgical mask are typically sent home for two weeks, he said.

Outside of academic medicine, though, front-line staff have turned to union leaders to push for such protections.

In Southern California, leaders of the National Union of Healthcare Workers filed an official complaint with state hospital inspectors about the risks posed by intermingled COVID patients at Fountain Valley Regional Hospital in Orange County, part of for-profit Tenet Health. There, the complaint said, patients were not routinely tested for COVID-19 upon admission.

One nursing assistant spent two successive 12-hour shifts caring for a patient on a general medical floor who required monitoring. At the conclusion of the second shift, she was told the patient had just been found to be COVID-positive.

The worker had worn only a surgical mask — not an N95 respirator or any form of eye protection, according to the complaint to the California Department of Public Health. The nursing assistant was not offered a COVID test or quarantined before her next two shifts, the complaint said.

The public health department said it could not comment on a pending inspection.

Barbara Lewis, Southern California hospital division director with the union, said COVID patients were on the same floor as cancer patients and post-surgical patients who were walking the halls to speed their recovery.

She said managers took steps to separate the patients only after the union held a protest, spoke to local media and complained to state health officials.

Hospital spokesperson Jessica Chen said the hospital “quickly implemented” changes directed by state health authorities and does place some COVID patients on the same nursing unit as non-COVID patients during surges. She said they are placed in single rooms with closed doors. COVID tests are given by physician order, she added, and employees can access them at other places in the community.

It’s in contrast, Lewis said, to high-profile examples of the precautions that might be taken.

“Now we’re seeing what’s happening with baseball and basketball — they’re tested every day and treated with a high level of caution,” Lewis said. “Yet we have thousands and thousands of health care workers going to work in a very scary environment.”

Nursing Homes Face Penalties

More than 40% of the people who’ve died of COVID-19 lived in nursing homes or assisted living facilities, researchers have found.

Patient mixing has been a scattered concern at nursing homes, which Medicare officials discovered when they reviewed infection control practices at more than 15,000 facilities.

News reports have highlighted the problem at an Ohio nursing home and at a Maryland home where the state levied a $70,000 fine for failing to keep infected patients away from those who weren’t sick — yet.

Another facing penalties was Fair Havens Center, a Miami Springs, Florida, nursing home where inspectors discovered that 11 roommates of patients who tested positive for COVID-19 were put in rooms with other residents — putting them at heightened risk.

Florida regulators cut off admissions to the home and Medicare authorities levied a $235,000 civil monetary penalty, records show.

The vice president of operations at the facility told inspectors that isolating exposed patients would mean isolating the entire facility: Everyone had been exposed to the 32 staff members who tested positive for the virus, the report says.

Fair Havens Center did not respond to a request for comment.

In Iowa, Medicare officials declared a state of “immediate jeopardy” at Pearl Valley Rehabilitation and Care Center in Muscatine. There, they discovered that staffers were in denial over an outbreak in their midst, with a nursing director overriding a community doctor’s orders to isolate or send residents to the emergency room. Instead, officials found, in late April, the assistant nursing director kept COVID patients in the facility, citing a general order by their medical director to avoid sending patients to the ER “if you can help it.”

Meanwhile, several patients were documented by facility staff to have fevers and falling oxygen levels, the Medicare inspection report shows. Within two weeks, the facility discovered it had an outbreak, with 61 residents infected and nine dead, according to the report.

Medicare officials are investigating Menlo Park Veterans Memorial Home in New Jersey, state Sen. Joseph Vitale said during a recent legislative hearing. Resident council president Glenn Osborne testified during the hearing that the home’s residents were returned to the same shared rooms after hospitalizations.

Osborne, an honorably discharged Marine, said he saw more residents of the home die than fellow service members during his military service. The Menlo Park and Paramus veterans homes — where inspectors saw dementia patients with and without the virus commingling in a day room — both reported more than 180 COVID cases among residents, 90 among staff and at least 60 deaths.

A spokesperson for the homes said he could not comment due to pending litigation.

“These deaths should not have happened,” Osborne said. “Many of these deaths were absolutely avoidable, in my humble opinion.”