Pregnant healthcare workers at risk for coronavirus are forced to continue working— ProPublica

Pregnant nurses and physicians have formal considerations and special protective measures to protect themselves from coronaviruses, despite being immunocompromised and data on the risk of fetal transmission are still emerging. States that they have to work without them.

Dozens of pregnant healthcare workers contacted ProPublica and said they could increase the burden on colleagues in need because they were considering whether to stay on the job that they deemed dangerous. Many said they did not pay sickness or maternity leave and could not afford a break. When talking about the COVID-19 incident at a facility, its name was not disclosed because some had spoken to the employer or had been threatened with being fired.

One of the psychiatric hospital nurses in the hotspot area stated that colleagues tested positive for the virus and others had been exposed, but the hospital refused to test employees until they had a fever or cough. did. “Unless you have the symptoms, you still need to go to work,” she said. She was told she could not wear a mask. This can only be booked by staff who test positive for the patient.

“I said,” If you don’t know who is positive, what about that? “There is no answer. “

A nurse at a long-term care facility asked her boss if she could do some of the heavy lifting from home. “They said no to me and said I would fire me if I stayed at home,” she said. Surprised by the fact that the staff had little or no personal protective equipment, she asked if she could keep her office door closed. “They said no, I had to be available to other staff.”

During the weekend, she developed coughing, sore throat, and a slight but worrisome fever. “I’m scared,” she said.

American healthcare professionals are overwhelmingly women 90% of nurses And Home medical advisor Being a woman, there are probably thousands of unknown women pregnant at any given time. Many of these nurses, physicians, and medical support staff continue to provide frontline patient care without knowing the long-term effects of the baby as the pandemic evolves.

Lack of data, guidelines for pregnant workers

Recommendations for protecting pregnant healthcare workers facing COVID-19 are modest and broad. Meanwhile, research on coronavirus and pregnancy is changing rapidly, and the latest reports are creating a new sense of urgency.

Based on very limited public data, the Center for Disease Control and Prevention and a group of specialists have so far stated that pregnant women do not appear to be more susceptible to the virus than non-pregnant women. I am. As in the case of H1N1 influenza and SARS, a weakened immune system and reduced vital capacity make it more likely that someone who will become a mother will develop severe respiratory disease, but it is still unknown Corresponds to COVID-19.

Further unknown High fever associated with miscarriages and fetal abnormalities is common, but about the effects of coronavirus in early pregnancy. Some babies born to women with COVID-19 symptoms in China were immature. so report The Coronavirus in seven pregnant patients in New York City requires four women to be hospitalized, two are asymptomatic at birth, and both have significant medical history, so intensive care units Treatment was needed. Neither of the babies born from these mothers tested positive for the virus.

Until very recently, researchers were convinced that the virus did not transmit from mother to baby in utero. But New arrival, Small scale Research from China This suggests that so-called vertical transmission cannot be ruled out yet.

“With some new evidence emerging, it may be time for pregnant moms to discuss it to take special precautions,” said Suzanne Baird, a board member. Was. Women’s Health, Obstetrics, Newborn Nurse Association Nursing Director of Consulting Group Clinical concepts in obstetrics. “It’s time to deal with this for pregnant mothers working as healthcare providers. It is imperative that pregnant women be protected at work.”

Currently, CDC Guidance for pregnant healthcare professionals It is scarce. Authorities may say that healthcare facilities may want to consider limiting exposure during pregnancy if staffing is available [providers] Patients with confirmed or suspected COVID-19 are particularly on high-risk treatment. American College of Obstetrics and Gynecology repeats CDC’s position, Currently not recommended Prevent pregnant healthcare workers from treating patients directly based on the coronavirus alone. “Pregnant women do not appear to be at increased risk for serious illness related to COVID-19,” said an ACOG statement dated March 23.

But in other countries, OB-GYN organizations are more aggressive. Royal Society of Obstetrics and Gynecology in Australia and New Zealand Recommend “If possible, assign pregnant healthcare professionals to jobs with reduced exposure to patients with COVID-19 infection or suspected COVID-19 infection.” policy In late March, she stated that all pregnant women “should provide the choice of working in a role that directly addresses the patient.” If you are in late pregnancy (28 weeks or more) or have health problems, “Highly recommended[s]”They avoid working directly with patients.

In a statement to ProPublica, the UK and Australian recommendations “are based on historical data that is not specific to COVID-19,” said Christopher Zahn, ACOG Vice President of Practice. He said the ACOG approach was “to make recommendations based on data and medical evidence specific to COVID-19.” To that end, “We actively monitor data on pregnant women and COVID-19 and frequently contact CDC and other experts to provide up-to-date information on the effects of the virus.”

Unresolved worry, incomplete workaround

ProPublica reached out to more than a dozen hospitals and healthcare systems nationwide, and demanded their written policy on pregnant workers during a coronavirus pandemic. Only two responded. In California, Stanford Medical recommends that pregnant healthcare workers “as much as possible” limit direct treatment of patients with confirmed or suspected COVID-19, a spokesperson wrote. Employees after the 37th week of pregnancy are required to completely avoid face-to-face patient care. Baylor Scott & White Health of Texas states that it follows CDC guidelines. Pregnant or nursing healthcare professionals have the option, but not required, to request a waiver of care for COVID-19 patients who have been confirmed by testing.

Most often, pregnant doctors and nurses say that employers have chosen to interpret lack of information and guidance as a reason to continue working normally, even if they raise concerns. “The lack of data does not mean that there is no risk. This is the impression I have had from my healthcare professional and is bothering me,” she said in her ninth month. Writes a primary care doctor.

She said she did not address her concerns when an ICU nurse at a large community medical center told her boss that she felt uncomfortable working at the bedside. “She was compassionate, but felt” this has a lot of unpleasant people, “” said RN in her late pregnancy. Accommodation has been created for staff with symptoms such as cystic fibrosis, but nurses need to have “ organized support ” to do the same for pregnant workers until the 9th month I was told. The nurse said she was willing to take unpaid leave, “but it was not offered. I think they are too worried about staffing.” She asserted to her boss A petition to her OB-GYN for a letter that might help to do so was denied. Doctors work in the same medical system. “They seem to be working as a human resources department, not as a health care provider,” said a nurse.

A surgeon living in the south said she had to resort to the kindness of her colleagues to keep her harmless. “Based on the hospital I’m rotating, I feel relatively safe because the people I’m working with said,” Maybe I won’t come to this room. Will handle this, “she said.

Even when organizations seek to accommodate pregnant workers, they may not be mindful of a larger public health picture. Nursing home company RN states that she is five months pregnant and is suspicious of COVID-19 in facilities where she usually works. To protect her, she was assigned to visit a hospice patient at home to take medication and change medical bandages. “Probably more than half of the patients have breathing problems,” she said. “I am not only afraid of myself and the fetus, but also concerned about harming those patients.”

A nurse, one of the recent assignments, said, “The patient had just left the COVID-19-positive unit and had to be rejected.” Homes can be crowded with families who come to say goodbye. “With all these people, I don’t know who was exposed. The more patients I visit, the higher the risk.”

Fight for personal protection

Pregnant mothers need to be especially vigilant in taking protective measures, as pregnancy suppresses the immune system. However, pregnant healthcare workers face the same PPE deficiencies and institutional barriers as other frontline providers.

“We wear gloves to contact any patient,” said a hospice home nurse. “We were given a hand sanitizer and were told to change our shoes to Lysol and change clothes before going home. We were given one mask and needed to reuse it I told you-it’s just a basic mask, not an N95 mask.When I wasn’t using a mask, I was told to put it in a Ziploc bag and put it in my car. I was told to use it. “

At a large trauma center, her late pregnancy ER nurse was assigned to work a few shifts consecutively at the triage desk as the coronavirus began to invade her community. “I was surprised,” she said. “Why do they take a pregnant woman there to sort out potentially ill patients?” At first, she complained because it was difficult to refuse the task. The next shift said, “At last it reminded me.” I’m pregnant. I’m really uncomfortable with doing this, “they said,” OK. “

The next battle has crossed the mask. She was disciplined when wearing a surgical mask outside the patient’s room. “They said no one could wear a mask without direct contact from aerosolized droplets from persons known or suspected to be infected with the virus. She said that pregnancy was not a high-risk category and had no effect on the status of COVID. “She had to remove her mask and did not wear it during the next shift. Within a few days, all staff were very worried and almost everyone wore surgical masks.

For East Coast nurses in the middle of pregnancy, the problem is not just about hospitals refusing to restrict interaction with patients who may have been exposed to the virus, or to provide appropriate PPE was. “My OB refuses to write a note requesting the employer to provide additional protection.” She was planning to work until the end of pregnancy, but the anxiety was too overwhelming It has become. “I chose to start my maternity leave early to protect me and my baby, and I no longer work at the hospital.”

One physician in her late pregnancy works as a visiting physician at hospitals across the country. In her case, always wearing a mask to prevent accidental exposure is not the answer. “I have tried on one or two patients, but the protective equipment really changes the doctor-patient interaction,” she said. “My glasses are cloudy. Patients can’t hear me. I’m pregnant and short of breath and can’t talk. It scares them, and I’m relieved of those who are already scared and hospitalized. I think it’s important to provide the feeling. “

The current hospital director has agreed that the potential case of COVID-19 should be allowed to be avoided. But that doesn’t mean she’s safe. “Throughout the day called by the ER to accept patients. There are plenty of respiratory cases and pneumonia. If you are asked to remove COVID, you will not be able to give the patient to anyone else. She said. ” “I generally think that all colleagues have this notion that exposure is imminent.”

Can’t stay at home

Healthcare providers who want to quit their work or take a break are aware that they have no resources to do so. Some people do not have paid and maternity leave. Some have had their single parents or spouses fired. It is not yet clear how coronavirus aid, relief and economic security laws will affect their choices.

“I wasn’t going to get pregnant, but if that happens, here’s where I’m,” says a travel physician who pays with a shift, albeit financially favorable. She will give birth this summer. “I’m not going to quit. It’s not reasonable. I need health insurance. I need money. I’m lucky that I’m still allowed to make money.”

Psychiatric nurses working at coronavirus hotspots find themselves with minimal paid vacation. She works at a large hospital that does not need to give her a special leave under new federal law. She recently applied for and received 14 days of medical leave, but she knows that she will soon need to return to work at risk. “COVID cases are increasing every day,” she said. “Now it’s everywhere in the hospital.”

Several women who talked to ProPublica have chosen to quit their jobs, which often carries as much guilt as relief. Lauren Paz, a nurse at a large rural hospital in central Oregon, said she was eight months pregnant with her second child, saying, “ I am ashamed that it is not comfortable to serve my community right now. “. “This is an ethical dilemma. I want to serve. In this profession we have a duty to serve and I want to be there. It afflicts me.”

But her husband is also at the forefront as a paramedic, and they are one year old at home. When the hospital began distributing face masks, she decided to stop working in 28 weeks and spent three weeks on side jobs. “To me the kicker is unknown to the baby,” she said. “I will someday be at my own risk, but I am not at risk for unborn fetuses.”

After taking a few weeks off work, she talked to her boss about her concerns. They are working to reassign her to the 24-hour COVID-19 hotline in the hospital system. This is the job she can do from home. She said she was happy with their response.

However, she could not rely on hospital policies or the CDC, and could not find the best way. “I must be my own defender,” she said.

Annie Waldman Contributed to the report.