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170 pediatric ICU staff reporting to work despite COVID exposure

An estimated 170 medical personnel in the University of Virginia Medical Center’s pediatric intensive care unit were exposed to a COVID-19 positive patient last weekend, but caregivers are continuing to work pending their own tests to avoid shutting down the unit.

Hospital officials said they implemented ‘critical staffing protocols’ that increase testing frequency for the staff, require additional personal protective gear and additional screening to keep the children’s ICU open.

Under normal circumstances, those caregivers exposed to a positive-testing patient would be placed on paid administrative leave for 14 days to quarantine. But with the majority of the unit’s staff being exposed, that was not possible, officials said.

“Because it affected our pediatric intensive care unit, the number of people that would be furloughed means that we couldn’t provide care for these critically ill children and we’re one of the few places in the state that has that level of care,” said Dr. Reid Adams, chief medical officer for the medical center. “We had to go to a critical staffing protocol in this case. Otherwise, we’d have to close the pediatric intensive care unit down and we just couldn’t do that with 17 critically ill children [in the unit].”

Officials said a child came to the hospital in critical condition and needed several emergency procedures. The child tested negative for COVID-19 upon admittance. About eight days later, a positive test of a family member was reported to the hospital and the child was retested and proved positive for the SARS-CoV-2 virus.

“The child was incredibly sick and required about a half-dozen different medical teams to provide care in a number of emergency situations,” Adams said.

Dr. Wendy Horton, chief operating officer of the medical center, said the child is recovering and that the unit’s care saved the child’s life. She said those staff members who have since been tested have been negative.

Adams said elective surgeries that might require a pediatric patient to recover in the intensive care unit have been postponed. Those children already in the unit, and any emergency patients that may transfer from other hospitals for a higher level of care at UVa, will continue to be served.

“We receive a lot of patients from around the region and provide care that’s not readily available in other areas,” Adams said. “Any patient whose care would not adversely affected by a delay will be postponed until this is resolved.”

The exposure is at least the second this month to hit a hospital unit. About a week ago, a patient in the cardiac care unit was diagnosed with COVID-19, requiring several caregivers to go on administrative leave for quarantine.

There was limited exposure in that case, officials said. The unit was not closed down and exposed staff were not asked to continue working.

“We were able to continue to function and take care of people who needed cardiac care, even with people going on [leave],” Adams said.

That unit is completely reopened and staff has returned, he said.

Considering how easily the virus is transmitted, officials said they feel fortunate there have been only a few cases of exposure.

“We’ve been fortunate in that we’ve had relatively few events, but we’ve had three or four exposures, all of them smaller [in number of staff exposed],” Adams said. “Most have been related to patients who have tested negative [on admission] and then test positive. There have been one or two where staff unknowingly were positive and where the epidemiologist, through contact tracing, figured out there were some potential exposure.”

Although officials say they are trying to limit the number unexpected COVID cases through testing and protocols, COVID-19 has a knack of showing up wherever there are people.

“Everybody expects that we’ll have some of these. Those no real way to avoid it, no matter how much testing you do or how careful you are,” he said. “We’re all human and it only takes one little slip or drop of the mask.”

So far, UVa’s record is good, Horton said, especially compared to some hotspots across the country.

“When you talk to our colleagues across the nation, I feel very fortunate we’ve had few inpatients [testing positive post admission] and few exposures among staff,” she said. “When we compare ourselves to El Paso, [Texas] or Madison, Wisconsin, we’re incredibly fortunate about how we’ve limited COVID.”

On Nov. 4, hospital administrators announced they would expand testing for all patients and any staff who are ‘worried, but well.’ On Nov. 6, the hospital increased to 100 the number of tests available to medical school and hospital faculty, employees and staff. The goal is to increase the number to 300 tests within a few weeks.

Tests will be limited to one per employee every 14 days. So far, the positivity rate for COVID-19 tests among the UVa Health staff has been less than 1% officials said.

Plans are in place to provide tests for patients admitted to the hospital through the emergency department, outside hospitals, clinics and other sources at the time of admission. Rapid testing will be used for symptomatic and high-risk patients, including those who live in nursing homes, care facilities and prisons or jails.

Beginning later this month, the hospital will also require patients needing intubation or other procedures that could produce aerosols to receive a negative COVID-19 test within five days of the procedure.

COVID-19 is easily transmitted by aerosols, tiny particles of moisture exhaled during conversation, singing or heavy breathing. Some research studies show that aerosols may be the most effective mode of transmission and that has led public health officials to push wearing face masks as a way to cut down the amount of airborne virus.

“Operationalizing and implementing this new testing regimen will take some time and tremendous work by our clinical and administrative teams,” hospital administrators said in a Nov. 4 message to staff. “This increase in testing will not in any way reduce our ability to continue our community testing.”

The administrators said the ability to increase testing frequency is due to the hospital’s medical laboratory team working “relentlessly since March to increase our testing capacity.”

Reid said despite the protocols and testing regimen, it’s likely that exposures will happen again.

“No matter how many policies and rules you put in place, it only takes a brief second to be exposed and tests are only as good as the day they were taken,” he said. “We’ve seen patients test negative and several days later it’s a positive.”

Horton said she is hopeful the procedures will make any future exposures limited in scope.

“We now have really good [personal protective equipment] and protocols in place but we need to reassess every day what we’re doing and where we’re at,” she said. “As we approach the holidays it’s really important to continue to be aware. People are feeling COVID-fatigue and we need to continue to do the right things.”


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