Some Colorado hospitals are postponing elective surgeries, imposing greater restrictions on visitors and telling staff to reuse protective respirator masks that are intended for one-time use.
The moves come as health care systems in the state change their focus from testing for transmission of the new coronavirus, to trying to slow the spread of COVID-19 among patients, visitors and providers while preparing for an expected surge of critical cases.
With proven community transmission of the new coronavirus in the state, visitors are no longer allowed in the cancer units and most other high-risk areas of Presbyterian/St. Luke’s Medical Center, Rose Medical Center and the other hospitals in the HealthONE system, spokeswoman Stephanie Sullivan said.
UCHealth on Sunday started limiting patients to one visitor every 24 hours, including birth centers, and children under 16 aren’t allowed unless they themselves are patients. Visitors are also banned from nursing homes and assisted living facilities under an order issued Saturday by Gov. Jared Polis’ administration.
St. Anthony Summit Medical Center in Frisco started postponing elective surgeries on Friday, Centura Health spokeswoman Wendy Forbes said. Banner Health canceled all elective non-emergency surgeries and procedures at the North Colorado Medical Center in Greeley.
Larimer County public health officials on Sunday asked that elective surgeries and non-critical medical appointments be postponed “to conserve medical resources.”
Most hospitals are limiting the number of entrances to their buildings so visitors can be questioned before they enter to see if there’s a chance they might be carrying the coronavirus without having symptoms.
UCHealth is evaluating whether to take everyone’s temperature before allowing them inside the building, said Dr. Richard Zane, UCHealth’s chief innovation officer and chair of emergency medicine at the University of Colorado School of Medicine. Fever is a frequent symptom of the coronavirus, along with trouble breathing.
On Saturday, UCHealth began requiring all health care staff in close contact with patients to wear blue or yellow disposable face masks.
“If a patient walks in and sees everybody wearing a mask, they should not be scared that they’re not wearing a mask,” Zane said. “It’s really quite the opposite. The staff is wearing a mask so they don’t infect patients in case they are infected.”
Banner notified employees on Sunday that it was implementing a new policy: “By clocking in for your shift, you are attesting that you do not have a fever of 99.5 or higher, non-allergy related runny nose or sneezing, cough, sore throat, diarrhea, nausea or vomiting.”
At least three health care workers have tested positive for COVID-19 so far in Colorado: a nurse practitioner in Crested Butte and two women employed by health care systems in Larimer and Weld counties. One of those women had traveled to Hawaii. Another traveled through South Korea, and is friends with the other woman infected.
Health care providers use protective clothing, like particle-filtering N95 respirator masks, gloves, gowns and eye shields or goggles to minimize their own risk when working with patients who have suspected or confirmed coronavirus.
Because of a worldwide mask shortage during the current pandemic, the federal Centers for Disease Control and Prevention allows the reuse of N95 masks under certain conditions, something Centura hospitals have started doing, Forbes said.
According to a document from a Centura hospital obtained by The Colorado Sun, the mask can be stored in a labeled, white paper bag when the provider is not in the patient’s room, and in most circumstances should be reworn by the provider when they return. It must be thrown out at the end of the shift.
“We do everything by the book,” Forbes said.
Because there is a risk that a health care worker may be exposed to COVID-19 on the job, the CDC outlines specific recommendations for when an employee not showing symptoms should be told to self-quarantine at home for two weeks after possible contamination.
Banner Health, which operates NCMC in Greeley, McKee Medical Center in Loveland and Banner Fort Collins Medical Center, is not following those guidelines in some instances, according to a document obtained by The Sun.
The CDC recommendations issued March 7 apply in cases of suspected coronavirus, while Banner’s policy issued March 12 is that, “No actions are required until laboratory-confirmed infection is received.”
In at least three scenarios outlined by the CDC, Banner is allowing health care providers in Colorado, Wyoming, Nebraska, Nevada and California who were potentially exposed to COVID-19 to return to work if they show no symptoms and wear a face mask, while the CDC recommends the person be excluded from work for 14 days. At its hospitals in Arizona, Banner differs from CDC recommendations in at least five scenarios.
“Banner facilities are following all recommended guidelines and protocols set forth by the CDC and World Health Organization,” Banner spokeswoman Becky Armendariz said. Armendariz declined to explain why different hospitals have different policies.
The Colorado Department of Public Health and Environment did not respond to requests for comment, and a spokeswoman for the CDC said it needed some time to review the matter.
UCHealth is planning to have some of the doctors, nurses and technicians who will inevitably be quarantined at some point help with telemedicine, using special cameras and speakers in the patients’ room connected to computers in the provider’s home. Its existing Virtual Health Service has seen a five-fold increase in use since the start of coronavirus concerns, Zane said.
Similarly, nervous patients have flocked to emergency rooms, urgent care centers and primary providers trying to get themselves tested for the virus.
Visits to UCHealth urgent care locations have risen 20% to 40% on average, spokeswoman Paula Freund said. Many of those people will leave without being tested; and a positive test result doesn’t change the treatment.
“If you have symptoms and you have a high-risk condition, we want to know if you have COVID-19. If you are being admitted to the hospital, we want to know if you have COVID-19. If you are a healthcare worker, we want to know if you have COVID-19. If you are an otherwise healthy person who has symptoms of an upper respiratory infection, self quarantine. Stay at home, drink plenty of fluid, take medicine to alleviate your aches and pains. But please do not be worried if you are not being tested or testing is not available,” Zane said.
All the hospital systems are planning for a surge in cases, reviewing how they can best group COVID-19 patients and use their space and manpower most efficiently.
Polis on Friday asked doctors and nurses out of the workforce to contact their former employers about returning, and said he had contracted to have dozens of nurses from out-of-state arrive on Monday to help with the most affected communities.
“The state of Colorado is well prepared,” Zane said. “We hope that we can limit community spread, but, if we can’t, we have resources, processes, people, tools and planning to respond.”