Anger in North Dakota after governor asks Covid-positive health workers to keep working

Nurse Leslie McKarney has gotten used to the 16-hour shifts, to skipping lunch, to the nightly ritual of throwing all her clothes in the laundry and showering as soon as she walks through the door to avoid potentially infecting her children. She’s even grown accustomed to triaging Covid patients, who often arrive at the emergency room so short of breath they struggle to describe their symptoms.

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But despite the trauma and exhaustion of the last eight months, she was shocked when North Dakota governor Doug Burgum said last week that healthcare workers who test positive for coronavirus but do not display symptoms could still report to work. The order, which is in line with CDC guidance for mitigating staff shortages, would only allow asymptomatic health workers who test positive to work in Covid units, and treat patients who already have the virus.

But many feel the idea endangers the workers themselves and their colleagues. It comes as North Dakota faces one of the worst outbreaks of Covid-19 and grapples with healthcare staff shortages.

“We’re worried about somebody dying, frankly, because we couldn’t get to them in time,” said McKarney, an emergency room nurse in Bismarck.

According to data from the Covid Tracking Project, more than 9,400 North Dakotans tested positive for Covid-19 last week alone. About one in 12 North Dakota residents have been infected with the virus; nearly one in 1,000 have died. In early November , the North Dakota department of health reported that there were only 12 open ICU beds in the entire state.

McKarney said Burgum’s order goes against everything she’s been taught as a nurse.

“If hospital administrators start forcing Covid-positive staff to go to work, it’s going to be very scary. We’re trained to do no harm, and asking Covid-positive, asymptomatic nurses to return to work is putting patients at risk. It’s putting fellow staff members at risk.”

Nine months into the pandemic, it’s clear healthcare workers already face increased risks. Lost on the Frontline, a joint effort by the Guardian and Kaiser Health News, is investigating the deaths of 1,375 healthcare workers who appear to have died of Covid-19 since the start of the pandemic. Nearly a third of those healthcare workers were nurses.

McKarney described long shifts in an emergency room that has begun taking on patients overnight because other wards of the hospital did not have capacity to admit them. Nurses pick up extra shifts to cover for colleagues who have gotten sick and take on multiple critical patients at once.

It is a scene playing out in hospitals across the country, as the coronavirus spreads unabated. As of 16 November, more than 11 million people in the United States had been infected with the virus, with health officials reporting 180,000 new infections in a single day. And the country is bracing for another milestone: it will soon surpass a quarter million deaths from Covid-19.

We’re trained to do no harm. Asking Covid-positive, asymptomatic nurses to work is putting patients at risk

Leslie McKarney

Healthcare workers are overwhelmed and exhausted. According to a recent survey from the National Nurses United, more than 70% of hospital nurses said they were afraid of contracting Covid-19 and 80% feared they might infect a family member. More than half said they struggled to sleep and 62 reported feeling stressed and anxious. Nearly 80% said they were forced to re-use single-use, PPE, like N95 respirators.

Inaction at the state and federal levels have left many healthcare workers feeling abandoned. When Governor Burgum issued the order that infected but asymptomatic nurses could report to work in Covid units, North Dakota had not implemented any kind of statewide mask mandate, despite expert guidance that such a measure could significantly reduce transmission of the virus.

Tessa Johnson is a registered nurse at a Bismarck nursing home and president of the North Dakota Nurses Association, which issued a statement on Wednesday denouncing Burgum’s order that infected nurses continue to work.

She said the state could have done much more to ensure patients don’t become infected in the first place. “We’ve asked and asked and asked for a mask mandate, and that hasn’t happened,” she said on Thursday.

On Friday night, Burgum did an about-face and issued a mask mandate, ordering individuals to cover their faces inside of indoor businesses public settings and outdoor public settings where physical distancing may be impossible.

“Our doctors and nurses heroically working on the front lines need our help, and they need it now,” he said in a press statement.

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Still, Johnson said there’s a disconnect between what healthcare workers are experiencing inside North Dakota’s health facilities, and how the general population perceives the virus. And that even before Burgum’s comments, some of her colleagues felt they had to choose between taking all precautions and limited time off. “One of my closest friends, also a healthcare worker, said to me the other day, ‘There’s no way I will ever get tested unless I’m very sick, because I don’t want to use my paid leave.’”

McKarney, the ER nurse, said she hasn’t had time to process the stress of the last several months. She’s focused on staying healthy, gearing up for what she anticipates will be a difficult winter, and keeping her patients alive. “We are willing to break our backs and work as hard as we physically can,” McKarney said. “But then to ask us to come in as a potential infectious source, is just stunning.”