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Staff fears rise along with coronavirus cases at the veterans' hospital in Miami

Miami Herald - 4/9/2020

Apr. 9--The number of COVID-19 cases has risen sharply at Miami'sVA hospital among both patients and healthcare workers, raising staff concerns about protective measures at the facility that cares for military veterans.

Confirmed COVID-19 cases caused by the novel coronavirus more than doubled to 51 among Miami VA patients over the past week. But the number of positive cases among nurses, doctors and other healthcare workers quintupled to 20 over the same period, according to records kept by the U.S. Department of Veterans Affairs.

Throughout the state of Florida, there are 134 patients at Veterans' hospitals who have tested positive for the virus and an additional 54 healthcare workers who have been struck by the infection, including 38 patients and 18 staff employees at the VA facility in Orlando, another emerging area of concern like Miami.

So far, at least two Miami VA patients have died from complications due to COVID-19, including a veteran in his 80s this week, records show.

Several Miami VA employees interviewed by the Miami Herald speculate their hospital's COVID-19 figures are actually low because not everyone is being tested for the novel coronavirus.

They're also concerned that not all staff have adequate protection and they're urging Miami VA hospital officials to provide protective gear, including N95 masks, goggles and gowns, for all healthcare workers as well as universal testing to slow the spread of the deadly virus at the 372-bed hospital in the downtown area.

"We have a call to duty to take care of our nation's heroes, but our nurses and doctors are still afraid," said one Miami VA nurse on the front lines fighting the highly dangerous respiratory disease. "They're afraid to go into the hospital .... There are some who are so afraid that they are sleeping in their cars because they don't want to risk infecting their families at home."

Since the coronavirus started spreading in South Florida last month, the Miami VA has been cited among dozens of Veterans' hospitals around the country by a federal inspector general for lacking adequate personal protective equipment, especially N95 respirator masks that are recommended for guarding against the viral infection.

While Miami VA officials in late March ordered all 3,000 employees to wear surgical masks around the clock while on duty, only nurses and doctors treating patients with the coronavirus or symptoms of the disease are wearing more effective N95 respirator masks, they said. The infected patients themselves are also wearing N95 masks, they said.

A federal spokeswoman for the Miami VA and other veterans' facilities in Florida said that the entire system is following Centers for Disease Control and Prevention guidelines to protect healthcare professionals as well as patients. The CDC policy calls for N95 respirator masks to be used by healthcare workers during the pandemic but, if enough are not available, also allows for surgical masks.

"Employees providing direct care to COVID-19 patients are protected with N95 respirators as well as patients under investigation for COVID-19 for the safety of all," said Mary Kay Rutan, the federal spokeperson for the VA in Florida.

She declined to break them down those infected by profession, citing privacy issues, and argued that outside factors could explain the surge in positive tests of VA health care worker at the Miami and Orlando hospitals.

"There is sustained community spread across all of Florida," Rutan told the Miami Herald in an email statement. "It would be irresponsible to assume employees contracted the virus through work related activities. All staff are screened daily and sent home if they screen positive for any COVID-19 symptoms to reduce the risk of exposure to others."

Miami VA employees interviewed by the Herald, however, expressed doubt about community contractions, saying there had been confirmed COVID-19 cases not only in the hospital but also in the community living center, an adjacent nursing-home complex.

"It's a process of elimination as to when they were infected," said one Miami VA staffer, who did not want to be identified because of concerns about retaliation. "Most likely, they were infected in the hospital."

The Miami VA hospital, including the community living center, employs about 600 doctors and 450 nurses as well as support staff. The facility cares for about 58,000 patients annually in South Florida. But while caring for patients is the staff's primary concern, fears of catching the coronavirus without proper protective equipment are on everyone's mind, several healthcare workers told the Herald. Of the 51 veterans diagnosed with the coronavirus at the Miami VA, 18 are being treated at the hospital and the other 33 are quarantined at home, according to VA records on Wednesday.

"Everyone is upset," said one nurse who also did not want to be identified. "When we go into the hospital, they are not looking out for the employees' best interests. They are not doing enough to protect the health of their own employees."

"In a statement, Rutan, the VA spokesperson in Florida, asserted that the veterans' healthcare system has been preparing for the coronavirus outbreak since late January and has meet the escalating threat on all fronts, from medical supplies to testing for COVID-19 to screenings of everyone entering the Miami VA, including taking temperatures to detect any fever.

"The VA has robust procurement and inventory processes in place to ensure medical center needs are met," the statement said.

But the Miami VA hospital was among dozens of veterans' facilities nationwide cited by a federal inspector general for failing to maintain adequate equipment and supplies, including critical N95 masks for healthcare workers. (The inspection was done by a clinical team led by the Department of Veterans Affairs inspector general between March 19 and March 24.) The reality is, hospitals in and outside the VA system are reporting shortages of the N95 masks as well as traditional surgical masks.

Days later, on March 29, Miami VA officials started requiring employees to use surgical masks for one week, unless they are treating patients with COVID-19 or their masks become soiled. In those instances, they can ask supervisors for a replacement.

But the policy directive by the top Miami VA official did not mention the use of N95 respirator masks at all in a series of emails to staff titled "protective masks while on campus."

"Effective Monday, March 30, all Miami VA Healthcare System employees at the Bruce W. Carter VA Medical Center must wear a standard mask (typically, yellow or blue masks with elastic ear pieces) the entire time they are in our hospitals," Miami VA Healthcare System Director Kalautie JangDhari told staff in the email.

"These masks are expected to be used for a week at a time, longer if possible," JangDhari wrote. "Staff without an already issued mask will be provided a mask upon entry to the facility, which must be signed for by name and service. This applies to all staff, including administrative and support staff. Masks can be worn until damp or the exterior surface is visibly soiled. Masks may be removed while eating or drinking, but must be immediately put back on. Staff who need replacement masks should contact their supervisor.

"Please be assured we have adequate supplies of masks and other personal protective equipment (PPE) and all staff will receive the equipment they need to safely serve our Veterans and keep each other safe," she concluded, thanking the Miami VA employees for their "continued commitment to our mission during these ever changing times" and "dedication to our VA, and most importantly, our heroes."


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