Fearing staffing shortages as COVID-19 hospitalizations are on track to break the state record set this spring, several major Michigan health systems are telling employees to report to work, even if they’ve recently had a close or household contact with someone who has COVID-19.
So long as they’re asymptomatic, those employees are required to do their jobs while awaiting test results, according to policies at Michigan Medicine, Beaumont Health, Munson Healthcare, and others.
Several health systems say those results are available within 24-48 hours. But in areas where testing shortages are causing delays, those results can take up to five days, including at Munson Healthcare, northern Michigan’s largest health system.
Munson employees have been instructed to report to work even if “asked to quarantine by your local health department,” as long as they’re asymptomatic and awaiting test results.
“You are an essential worker because you are in the healthcare field,” staff instructions read. “You may still work to work [sic] even after an exposure as long as you are asymptomatic.
“Other than coming to work, you should quarantine at home. This means only leaving your home to come to work. Other than coming to work, please follow the other guidelines from the Health Department. These may include self-monitoring and limiting exposure to others, even within your own household.”
For some hospitals, like Michigan Medicine, these policies were first adopted back in March during the initial surge. But now, as community spread of COVID increases, more health care workers are concerned about the risks these policies could pose to patients and colleagues.
Michigan Medicine staff recently received an internal message from the health system’s leadership, “addressing confusion” about the COVID exposure policy:
“There have been some concerns raised regarding one of the questions on the ResponsiBLUE health screening tool,” the message reads. “Currently, asymptomatic employees who have had a close or household contact in the last 14 days with someone recently diagnosed with COVID-19 are offered testing by OHS around Day 5. These employees continue to work while awaiting test results (assuming they remain asymptomatic).”
“That message really threw me off,” said a Michigan Medicine employee who works in the health system’s supply chain. (They asked not to be named to protect their job.) “It seems like it goes against everything we’re saying to the public. Why would you be encouraging hospital staff to come in if they’ve been in contact [with someone with COVID?]”
Mercy Health staff in Muskegon are also being asked to work on COVID floors while they wait for test results, says SEIU Healthcare Michigan spokesperson Kevin Lignell, due to short staffing.
“According to our [SEIU] president, if you have an exposure you are not exempt from anything unless you start showing symptoms,” Lignell said in an email Thursday. “We have [healthcare workers who are] spouses and parents [and] who are living with positive people working both COVID and non-COVID areas.”
But at Henry Ford Health System, health care workers deemed to have “high-risk exposures” are quarantined for seven days, tested on the seventh day, and if negative, can return to work the following day, says spokesperson David Olejarz.
“For exposures that are judged to be moderate or low risk, an asymptomatic employee can return to work with full PPE protection and self-monitoring for symptoms,” he says.
But some nurses say requiring exposed workers to go back to their jobs, before they receive a clean bill of health, could backfire.
"It should be a matter of basic common sense that any nurse who fears having COVID-19 after an exposure to the virus should be able to quarantine without risking income until it is clear that it is safe to return to work,” says Jamie Brown, president of the Michigan Nurses Association and a critical care nurse at Ascension Borgess Hospital in Kalamazoo.
“We can’t keep looking after our communities if we fall ill ourselves. RNs and healthcare professionals are the last line of defense in this pandemic. We need to be able to rapidly access testing so we can make sure that we are able to keep our patients, our coworkers, and ourselves safe.”
The potentially catastrophic impact of a staffing shortage
But health systems with these policies say they are necessary to avoid a looming crisis: staffing shortages. Every hospital, from small rural community sites to sprawling urban systems, shares that same concern.
“It’s really the staffing concern that's risen to the top of the list from our hospital members throughout the state,” Michigan Health and Hospital Association CEO Brian Peters said in a press conference earlier this month.
“So it's not necessarily an issue of lack of hospital beds. But it truly is a very concerning issue when you talk about availability of staff, particularly our frontline caregivers, [they] are testing positive themselves. So that that has clearly been our top concern.”
Unlike the spring, when COVID hit places like New York and the metro Detroit area hardest, this time, no area has been spared. Which means a far tighter national labor market for critical health care personnel.
“When all of us have the need [for staffing,] that will be the critical resource that we will be looking for,” Spectrum Health President and CEO Tina Freese Decker said on a November 12 press call.
At St. Mary Mercy Livonia Hospital, Chief Medical Officer Dr. Matthew Griffin says 39 staff members are out of work with COVID.
“The health care provider infection rate during this wave of the pandemic seems to be higher than it was during the spring,” Griffin said Thursday. “Most health care systems across Michigan and across the country are being affected by this.”
Dianne Michalek, the chief marketing and communications officer for Munson Healthcare in Traverse City, says she doesn’t know the current number of staff quarantining.
“...[But] I can tell you that is a fraction of a percentage of our total staff across the system, but on an upward trend as community spread increases in our region.”
Pointing to the CDC guidance, but not canceling elective procedures
Health systems also point to guidance from the CDC, which outlines “contingency capacity strategies for healthcare facilities,” including allowing asymptomatic healthcare workers “who have had an unprotected exposure to SARS-CoV-2 (the virus that causes COVID-19) but are not known to be infected to continue to work.”
When asked about their employee exposure policy, a spokesperson for Trinity Health Michigan (which includes Mercy Health) said: “As with many health systems, Trinity Health Michigan follows current CDC Return to Work guidelines for health care workers.”
Exposed employees are still required to take other safety precautions, said Aaron Gillinghman, Beaumont Health’s chief human resources officer.
“It is possible, after one of our nurses speaks to an employee who may [have] a household member or family member that has tested positive for COVID, to return to work, provided that they’re followings CDC guidelines as it relates to masking, and paying very close attention to their symptoms,” Gillingham said.
Such policies are now “common in hospital settings,” said Michigan Medicine Mary Masson, since those workers “are considered essential.
“...There are also CDC contingency recommendations for allowing exposed healthcare workers to continue working in the setting of staffing shortages.”
But many of these same health systems have held off on adopting another CDC-recommended strategy: canceling elective procedures.
“Cancel all non-essential procedures and visits,” is one of the first mitigation measures the CDC lists in that guidance. “Shift HCP [health care personnel] who work in these areas to support other patient care activities in the facility. Facilities will need to ensure these HCP have received appropriate orientation and training to work in these areas that are new to them.”
But industry leaders say canceling some of those procedures creates very real dangers to non-COVID patients, especially those with cancer or other serious conditions. And when Governor Gretchen Whitmer issued a mandatory cancellation of elective procedures in the spring, it led to major financial hardships, including layoffs.
“We clearly do not want to be in a position where we have to shut down elective procedures, or non-emergency activities, going on in our hospitals for two reasons,” said Henry Ford Health System CEO Wright Lassiter on November 12.
“The first … is we don't want Michiganders to have to delay necessary care. And so we want to be available to the communities we serve, for whatever care they need. And then secondly, the other practical issue as well, is that it has a significant impact on the financial viability of our organizations.
“And so we are obviously working very hard to ensure that, one, we can deliver the highest quality and safest care to patients, but also that we have financially viable health care institutions serving our communities.”
But for some workers, like the Michigan Medicine supply chain employee, it feels like health systems are asking staff to bear most of the burden.
“Shutting down elective surgeries, I feel like that should have been done already,” that employee said. “There are a lot of moving parts, from construction to nursing staff and what supplies they have in their unit, just to change where they’re treating patients [if additional space has to be converted for overflow COVID patients.] They’re dragging their feet on that.
“And I can’t help but think it’s for monetary gain. They want to be doing surgeries. It doesn’t feel like we’re taking the proper precautions. It feels like people sitting at home, that get to work at home, hollering at the other employees to do this and that, and not considering the environment [they work in.]”
Kristen Jordan Shamus contributed reporting to this story. The Detroit Free Press, Bridge Michigan and Michigan Radio have teamed up to report on Michigan hospitals during the coronavirus pandemic. If you work in a Michigan hospital, we would love to hear from you. You can contact Kristen Jordan Shamus at firstname.lastname@example.org, Robin Erb at email@example.com or Kate Wells at Kate@michiganradio.org.