PROVIDENCE, R.I. (WPRI) – When Dr. Otis Warren is ready to come home after a full day of fighting COVID-19 at The Miriam Hospital in Providence, he changes into a clean pair of scrubs.
After arriving home, he changes into a second set of clean clothes in the garage, where he leaves his shoes, scrubs and jacket before entering the house and immediately taking a shower.
Tonight, he plans to cut off all his hair to reduce the number of things that could potentially carry the new coronavirus home with him.
“To be honest, there’s been very little guidance for what to do when we go home,” said Warren, who also serves as president of the American College of Emergency Physicians in Rhode Island. The group represents 233 emergency care doctors.
“Everybody walking out of hospitals are doing something different, so there’s no coordinated method,” he added.
Warren’s new safety routine offers a window into how front-line health care providers, including doctors, nurses, lab technicians and EMT workers, are trying to adjust life and work amid the global public health crisis caused by COVID-19.
“This is unprecedented,” said Ray Sullivan, a spokesperson for the United Nurses & Allied Professionals Local 5098, which represents 2,400 nurses, therapists, technologists and other health care professionals.
“I’ve never experienced anything like this in my lifetime,” he added.
There’s widespread agreement among health care workers that they represent the front line in the battle against a fast-spreading disease that’s killing roughly 1,000 people per day worldwide. For many, there’s a lot of pride involved.
“They understand what’s at stake for their families and their patients,” Sullivan said. “They keep coming to work every day and they’re going to do that for as long as necessary.”
But there’s also underlying concerns about whether health care workers have the right resources and hospitals have the best protocols in place to respond to the disease most effectively.
Rhode Island like other states is struggling to keep up projected demand for protective gear, such as masks, which has forced hospitals to conserve resources and health care providers to wear the same equipment for several days.
With obtaining supplies from the federal government proving ineffective, the potential shortage spurred state leaders to put up a website on Thursday where the private sector can write in and volunteer to provide any extra gear they have.
“Thank you to all the businesses that have reached out,” Democratic Gov. Gina Raimondo said Friday at her daily coronavirus briefing. “The outpouring since yesterday has been unbelievable, heartwarming and hugely effective.”
Steven DeToy, director of government and public affairs at the Rhode Island Medical Society, said not having an adequate amount of gear could not only put workers at risk, but also exacerbate the spread of the virus.
“If you have the appropriate equipment, you’re not part of the problem,” he said. “If you don’t have the appropriate equipment, you could be a participating in spreading it.”
The lack of personal protective equipment, or PPE, is top of mind for many in the health care sector, who have been critical of the federal response led by President Donald Trump.
“We need masks today,” said Dr. Megan Ranney of Lifespan during an interview this week on CNN. “We are pleading on social media get me PPE to get me and my patients safe. The president may say that things are being produced, but they sure as heck are not showing up in my state or the states of my colleagues all across the country.”
On Friday morning, Ranney shared a photo of expired masks held together with elastics:
At Lifespan, the state’s largest hospital network has been forced to ration supplies.
“All front-line employees are wearing masks and we have implemented measures to train employees on personal protective equipment for situations where it is most appropriate and needed,” Lifespan spokesperson Kathleen Hart said. “We have been working proactively to ensure that we have an adequate supply of PPE, through conservation efforts, to protect our staff in the weeks and months to come.”
But there are other issues mounting behind the scenes that could become problematic, especially as the number of health care providers becoming exposed to the disease rapidly increases.
“I would assume every doctor who works in an emergency room has been in contact with someone with COVID,” Warren said. “We’re not quarantining when we treat a COVID case because that essentially puts the entire workforce on quarantine.”
Hospital rules about what health care workers should do after becoming exposed to COVID-19 differ across Rhode Island, but the general practice right now is to send home and quarantine workers who test positive for the disease and are showing symptoms, according to interviews with several nurses and doctors.
Hart said Lifespan is following U.S. Centers for Disease Control and Prevention guidelines that instruct employees not to come to work if they’re feeling sick. (Care New England, the state’s second largest hospital network, did not respond to requests for comment about protocols.)
“All employees are instructed to continually wash their hands and wear a mask when in contact with patients,” Hart said. “Screening guidelines are changing rapidly, and twice daily bulletins are sent to all employees with the latest COVID-19 information.”
On Thursday, meanwhile, public health officials confirmed health care workers made up five of what were then 44 confirmed cases of COVID-19 in Rhode Island. (The total number of confirmed cases increased to 54 on Friday.)
Unabated, the spread of the disease among front-line workers could make it increasingly difficult for hospitals to adequately staff operations, especially at some of the smaller hospitals with limited staff.
“Right now, hospitals are OK with their physician workforce, but we are very nervous particularly about the small hospitals that just have a few emergency departments doctors and ICU doctors on staff,” Warren said. “If one or two people become ill or quarantined, staffing becomes really difficult.”
The state has already entered into a reciprocity agreement with other states to allow out-of-state doctors to obtain short-term medical licenses in Rhode Island, which could help offset staffing shortages in the future. Mass. Republican Gov. Charlie Baker announced earlier this week that retired doctors could reactive their licenses.
But the reciprocity agreement also means other states could tap Rhode Island doctors for help, which is a dynamic not lost on Warren, who points out that COVID-19 outbreaks have been much worse so far in other states. New York Gov. Andrew Cuomo on Friday ordered a statewide lockdown as the number of confirmed cases surged above 7,000 there.
“We might get pulled somewhere else,” Warren said. “Look at New York.”
Warren said there’s a unique opportunity for physicians at larger hospitals with more doctors to help out at smaller hospitals if staffing gets tight. But some tweaks to coverage provided by private insurers might be necessary to make it possible, as it’s presently unclear whether treatment unrelated to COVID-19 would be covered if provided by an out-of-network doctor.
The R.I. Office of the Health Insurance Commissioner spokesperson David Laveque said the agency is already reviewing the potential barrier.
“We are reviewing the elimination, as appropriate, of regulations that could present obstacles to prompt action,” he said in a statement. “The Office of the Health Insurance Commissioner (and RI’s Medicaid Program) will be working together with the state’s insurers to review their current health professional credentialing practices to add appropriate flexibility should the need arise.”
Warren said he’s optimistic the necessary changes could happen.
“I’ve been impressed with how much everyone is actively working to get this right,” he said.
But until everyone gets onto the same page as it relates to equipment and protocols, the current plan for front-line workers is to continue to try and treat those affected by the disease, and do their best to protect themselves and their family members at home. And for many like Warren, that’s required making their own rules.
“Everybody is going to follow their own procedures on that because what’s best for my family might not be what’s best for yours,” Sullivan said. “But I can tell you that these people are among the best trained in the world working the front-line of medicine. They understand the risks.”