Stepping up the fight

Faced with the first death of a California patient and growing concern the novel coronavirus is spreading in some communities, Gov. Gavin Newsom declared a state of emergency on March 4 and said testing and tracking of people potentially exposed to the virus will be the top priority.

Earlier that day, Placer County health officials reported the death of a resident who likely was exposed on a cruise ship that departed from San Francisco to Mexico on Feb. 11. The person, described as an elderly adult with underlying health conditions, had been in isolation at Kaiser Permanente Roseville.

The Grand Princess was en route to San Francisco from Hawaii, but was kept offshore when some of the 3,500 people on board developed symptoms of the virus. On March 6, Vice President Mike Pence announced that of the first 46 tests, 19 crew members and two passengers tested positive. The ship docked Monday at the port of Oakland. Passengers from California will be quarantined at Travis Air Force Base near Fairfield and a base in Southern California, while passengers from other states will be quarantined at bases out of state and those from other countries will be flown home. Crew members, however, will be kept on board and quarantined.

On Monday, Santa Clara County announced a second death from coronavirus.

As of Sunday, there were 114 positive COVID-19 tests in California, Newsom said, and the state is monitoring more than 10,000 others. On Sunday, the state released guidelines for school districts and organizers of public events, but didn’t require officials to cancel classes and gatherings. Over the weekend, the Elk Grove Unified School District, the fifth largest in California, announced it would close this week by moving up spring break after a family member living with several students tested positive. Several large companies have ordered employees to work from home.

Even before the death was announced, Los Angeles County declared a health emergency, reporting it had seven patients with the virus. Sacramento, San Diego, Santa Clara, San Francisco, Marin, Orange, Placer and Solano counties have issued similar declarations.

Newsom has asked the Legislature to set aside $20 million to help contain the virus. California also has obtained thousands of additional tests and is administering testing in 13 labs. Newsom said March 3 that California will have 20 labs able to test in the next few days.

California’s response isn’t without glitches on the ground, however, including nurses who say they are concerned about safety training and limited access to equipment like face masks.

Nurses, who say too many health care workers have been exposed and are in quarantine, aren’t satisfied with the coordination in some hospitals. They say they aren’t getting adequate training.

“Hospitals are leaving us out of the communication and planning around the care of these patients,” said Maureen Dugan, a nurse leader with the California Nurses Association, a political powerhouse that represents California’s nurses.

Instead, she said hospitals’ nursing management should be communicating with all direct care nurses about strategy and expectations if patients start arriving in larger numbers.

On Feb. 19, a patient with the novel coronavirus was admitted to UC Davis Medical Center in Sacramento. In a statement, the union said 124 nurses and health care workers were forced to quarantine themselves because of a lag in testing and poor preparedness. The medical center has not revealed the number of workers potentially exposed, citing privacy concerns, but said the 124 number is “inaccurate.”

The California Hospital Association, which represents hundreds of hospitals across the state, said hospitals are following training guidelines from public health officials who have advised that hospitals limit the number of employees who come into contact with infected patients, which may explain why hospitals are training only some nurses as needed.

In a national survey conducted by the nurses union, only 27% of nurses reported their employer had enough personal protective equipment on hand for a surge in coronavirus patients. While 44% didn’t know.

After media reports of exorbitant charges associated with testing, Newsom ordered insurers to make tests free. It’s not so much that the test itself is costly, but related costs like hospital visits can be, said Michael Romero, a program manager with Placer County’s Health & Human Services Department. Individuals can be tested for free if a health provider contacts the county, which then approves and orders the test, Romero said.