Nurses with COVID-19 Asked to Keep Working in ND: Is This Our New Normal?

Hospitalizations for COVID-19 are quickly rising across the country. On Tuesday, the number of people with the disease at U.S. hospitals topped 60,000 for the first time since the start of the pandemic. Instead of working to combat a few hotspots, the virus has spread to virtually every region of the country, making it that much harder to contain.

Healthcare workers are spreading themselves thin as they work to combat new outbreaks. With infections rising, having trained providers travel between states is no longer an option. Many nurses and doctors are staying put to focus on helping their local communities instead of going into a hotspot on the other side of the country.

Staff shortages are becoming the new normal as we enter another wave of infections. Health experts warn that we could see around a million new daily cases by the end of the year.

That’s why North Dakota recently announced that nurses will be permitted to keep working even if they have been infected with COVID-19. Other states may have to do the same. Find out what the CDC says about working with an infectious disease.

Dire Straits in North Dakota

Gov. Doug Burgum held a press conference on Monday telling residents that nurses with COVID-19 can continue working due to a “severe” shortage of healthcare workers, as long as they are asymptomatic. Those who have tested positive will only be allowed to work around coronavirus patients to reduce the risk of transmission. Burgum said that the state’s interim health officer, Dirk Wilke, had amended a state order to allow healthcare workers who test positive for COVID-19 to work. The governor is also calling for more emergency healthcare workers to run testing sites, so nurses can return to local hospitals.

The CDC says this “crisis” model should only be used as a last resort. In a worst-case scenario, federal guidelines say healthcare workers with COVID-19 can also treat patients who have not tested positive for the virus. This should only be employed by facilities with severe staffing shortages, considering having providers work while they are positive could lead to more infections.

North Dakota is experiencing the fastest spike in new cases in the country. Many hospitals are already at 100% capacity with elective procedures on hold. There is currently no state-wide mask mandate in place, however the governor has issued support for local mask mandates.

Commenting on the scene on the ground, emergency medicine physician Dr. Leana Wen said:

“The difference between what’s happening now versus what happened before is that the virus is everywhere now. But when the virus is so widespread, we could very well run out of health care workers, which means that patient care is going to suffer. And we will be at breaking point in our hospitals.”

Is It Safe?

When the news came down from North Dakota earlier this week, healthcare professionals across the country were less than thrilled.

Dr. Steffanie Strathdee, Associate Dean of Global Health at UC San Diego, wasn’t having it. She said, “I was aghast when I saw Governor Burgum announce that he was advocating for Covid+ nurses to continue to work at hospitals.  My first thought was: Is he crazy?”

She thinks the governor’s decision to keep nurses on the floor could lead to disaster. “It is precisely why we need a national mitigation plan for COVID-19, so we can prevent governors from enacting ill-informed deadly public policies that will worsen the epidemic instead of alleviating it.”

During the press conference, Gov. Burgum said nurses already wear PPE to prevent transmission of the virus, so there’s little reason to be worried that keeping them on the floor would lead to more infections. He also said other states have already used this policy to combat staff shortages, but that may or may not be exactly true.

Department of Health spokeswoman Nicole Peske and Sanford Bismarck spokesman Jon Berg both said they were unaware of any other states that have taken the extreme step.

Regardless of staff and patient safety, the policy will remain in effect as long as these facilities remain short-staffed. So far, 644 people in the state have died from the virus since March, with around half occurring in nursing homes. There are now more than 10,000 confirmed cases in North Dakota, which is more than this small rural state can handle.

“Surges in rural areas are especially concerning since many rural hospitals have less capacity to expand the ability to care for patients and fewer resources to fall back on,” said Nancy Foster, vice president of quality and patient safety policy for the American Hospital Association.

We could see more hospitals and states asking nurses and providers to stay on the job even if they have tested positive for COVID-19, especially in rural areas and those with fewer resources.