Minnesota nurses fear for safety as a possible COVID-19 case surge looms

Mary Turner grew tearful in legislative testimony Tuesday about the fellow nurse she treated for COVID-19 in intensive care and sad at the prospect of one day reporting the first death of a nurse who contracts the infectious disease on the job.

"That will be a day that wakes me up in nightmares," said Turner, a critical care nurse at North Memorial Health Hospital and president of the Minnesota Nurses Association.

Nurses with the union testified to a state House committee on Tuesday, and planned a protest march to the Capitol Wednesday night to highlight safety risks of using masks, gowns and other personal protective equipment (PPE) beyond their shelf lives and safety guidelines.

Health care workers constitute 1,949 of Minnesota's 17,029 lab-confirmed cases of COVID-19, a respiratory illness caused by a novel and highly infectious coronavirus. The latest data from the Minnesota Department of Health indicates 929 people were likely infected due to being health care staff, but it isn't clear how many were infected while providing direct care to other COVID-19 patients.

Monday's end of the statewide stay-at-home order, which had been in effect for 51 days to slow the spread of the virus, renewed nurses' concerns that a return to normal life and regular face-to-face contact will cause a surge of COVID-19 infections that will exhaust PPE supplies.

"We are approaching the surge point very fast," Turner said.

The latest COVID-19 numbers offer mixed signals about the status of the pandemic. Cases have doubled only in the last 13 days, a relatively slow rate that suggests measured growth.

On the other hand, hospitalizations jumped from 485 on Monday to 545 on Tuesday — with 229 patients needing intensive care due often to respiratory problems and the need for ventilators to maintain adequate oxygen intake.

Another 17 deaths reported Tuesday also brought the statewide toll to 748 — including 608 deaths among residents of long-term care and assisted-living facilities.

The state's PPE stockpile has stabilized with rising levels of supplies available for hospitals or other medical providers when they start to run out.

Supplies of gowns ran so short at one point last month that some local hospitals were down to three-day supplies and the state ordered rain ponchos as a backup.

"Under normal situations you probably wouldn't say that a rain poncho would make a very good gown, but according to the experts, a rain poncho actually protects employees pretty darned well," said Mary Krinkie, vice president of government relations for the Minnesota Hospital Association.

She also spoke Tuesday to the Minnesota House Select Committee on Minnesota's Pandemic Response and Rebuilding.

The state went from 122,000 gowns obtained and 1.1 million awaiting delivery on April 29 to 210,000 gowns obtained and 5.8 million awaiting delivery as of Tuesday, according to the state's COVID-19 preparedness website.

The concern for nurses is that the state and its hospitals aren't building up supplies based on the old one-time-use policies for masks and gowns that offer maximum protection, but on continued pandemic conservation policies.

Hennepin Healthcare nurse Sarah Simons discussed how her Minneapolis hospital reused N95s that technically expired in 2001 and 2002.

While the reuse met COVID-19 standards set by the CDC, Simon said the masks were re-threaded with straps that were at first way too loose to provide protection and then way too tight to fit.

"Even worse, the bands broke while a nurse provided care to a patient positive for COVID in the patient room, causing an exposure," she said.

Some hospitals have conserved gowns through reuse policies in which they are taken off in the rooms of COVID-19 patients and hung with the potentially contaminated sides facing the walls so nurses can put them back on again later.

That process is fraught with potential errors, said Kara Spike, a nurse at St. Joseph's Hospital in St. Paul, who remains nervous about bringing COVID-19 home and infecting her asthmatic grade-school daughter.

"It's like trying to fold a fitted sheet and do it perfectly every time," she said, "not to mention if we're in a hurry to get in and take care of a choking patient."

The nurses also worried about the accelerated use of the gowns since the state allowed hospitals to provide elective surgeries again.

Krinkie said that was a financial necessity for the hospitals, which lost $31 million a day delaying those procedures, but also a necessity for patients with overdue cancer screenings, heart checkups and other procedures.

"If we see the supplies of PPE dropping dangerously low ... we may need to go back to Gov. Walz and ask that the dials be turned back and that perhaps we have to go back to the previous executive orders regarding elective procedures" being delayed, she said.

While the trade groups for the state's nurses and hospitals had opposing views during much of Tuesday's testimony, they agreed on their mutual concern over irregular delivery of supplies to the state.

The delivery status is still listed on the state website as "unclear" for 1.5 million N95 masks ordered on March 29 — though its overall supply of these masks has improved.

Lawmakers offered support for the nurses and said they would be reviewing state grants and purchases to see if enough money has been earmarked for personal protective equipment.

"Loud and clear, we're hearing that you need more PPE," said House Minority Leader Kurt Daudt, R-Crown.

In a media briefing later Tuesday, state Health Commissioner Jan Malcolm acknowledged that nurses are being asked to use personal protective equipment in new ways that raise concerns.

On the other hand, new technologies — such as ultraviolet lighting systems to sanitize N95 masks — are making these different methods safer.

"It's a good thing," she said, "the technologies have been created to allow the sterilization and reuse of some of these things like N95 masks."