I May Have Unknowingly Exposed My Patients To COVID-19

As a nurse, the past few weeks have been terrifying. COVID-19 is sweeping the country. The first week that cases started to appear in the United States, my county, including the medical professionals, were mostly unfazed. This was the most dangerous reaction that any of us could have had. As more and more cases appeared, New York State slowly became the most dangerous place to be in the country; my upstate county was still woefully behind.

I work in two healthcare settings: long-term care and an outpatient office setting. As the news became more worrisome, I watched, unsure what to think given the location of our county. Some nurses and doctors were starting to become concerned. Many were researching how to prepare in the outpatient offices and in the long-term care facilities. Some upper management scoffed and turned down employees who requested to be measured for N-95 masks.

The mixed responses of those around us left us nurses in the middle, unable to prepare. Was COVID-19 something that was serious for us locally? Should I even worry about preparing, if some of the providers I worked for weren’t even mildly concerned? What should I do with regards to caring for my medically frail patients in long-term care? Should I wear gloves and a mask for something as simple as feeding them dinner or administering oral medications? Every single day in outpatient care the rules are changing: what personal protective equipment to wear, what questions to ask people, who can test patients, and what the parameters for testing are. It’s all changing so fast, most of us can’t keep up. We don’t know if what we’re doing is correct per our ever-changing company policies.

Then it happened: I was unknowingly symptomatic.

Last week, I had a follow up with my primary care provider. Although I was there for an unrelated issue, I informed my provider that I’d been having trouble with my asthma lately. Normally my asthma is pretty mild, but for about a week and a half, something as simple as walking up half a flight of stairs would leave me winded. My vitals revealed I had an elevated heart rate as well. My provider ran some tests for me.

On that day, I was working in my provider’s outpatient office. For most of my shift, I was working on patient phone calls (mostly sitting), and had minimal patient contact. Something as simple as talking too much left me short of breath. An hour before my shift was supposed to be over, my doctor gave me the results in his office. The test results could only confirm that I had some type of infection. It wasn’t influenza or any other respiratory illness on the respiratory panel that was run; a pulmonary embolism was also ruled out.

I was moved into an empty patient room. No one but my doctor came in; my isolation had officially begun. My provider made some calls in order to find out the process for getting me tested for COVID-19 within his network. I was left in the room alone. Through the door I could hear workers, who had nothing to do with my care, discussing me and my medical information.

I was trying my best to stay calm while I waited. However, I was overwhelmed; it all happened so fast. I was crying in an exam room, just trying to wrap my head around the possibility of what was going on. Outside of my fear for myself, my mind began to race to all of the people I had been in contact with in the past week.

There was a knock at the door, and my provider came back in. He was given three different answers by three different people, and the final conclusion was this: Despite the research behind the importance of widespread testing, in our county we are only testing patients in critical care that are being admitted to the hospital. I was told to self-quarantine at home, due to being symptomatic, starting immediately after having a chest x-ray taken. My doctor had already informed infection control for the medical group.

Before I got home, my phone had already rung several times. My supervisor within this system was trying to reassure me. During this same phone call, I learned that the office manager from my primary care provider’s office had broken HIPAA guidelines and used her position to share my information — at this point still an unsubstantiated diagnosis — with my supervisor, among others. At the time, I didn’t have room in my head to be angry about this, given the fear and panic that had set in.

When I got home, I got out a piece of paper and made a list of the people I would need to call due to physical contact that I had made just in the past week alone:

1. My supervisor in long-term care

2. Infection control for long-term care

3. My son’s sitter from Tuesday

4. My son’s sitter from Monday

5. My in-laws, who currently had my son

6. My therapist

7. Two friends to whom I had delivered crafting supplies over the weekend

These individuals were only the ones I knew how to contact. What about the grocery store I’d been to over the weekend? What about my husband’s work? Then came the thought that has haunted me since I was sent to the exam room for the second time: what about all the patients I’d come in contact with?

This crippling thought still makes me cry on and off every day. I was not a confirmed positive, which means they and their families are not being contacted. In one week, I have worked with many at-risk groups (patients with chronic respiratory conditions, patients with compromised immune systems, elderly patients) in addition to patients with no underlying concerns who should also be notified. There is nothing that I can do.

Between that night and the next morning, I had called everyone on my list, depending on who was available outside of business hours. The phone calls were mentally exhausting. I was asked questions that I didn’t have answers to. I was asked to provide direction on what to do, when I hadn’t been given much instruction myself. Human resources with my state-run, long-term care facility stated it would not grant me leave with pay unless I had documentation of a confirmed positive COVID-19 test.

Then my doctor called me personally. He asked for an update on how I was doing, and then asked my permission to allow him to continue to try to get me testing. Despite his efforts, another day went by, and I wasn’t tested. By this point, my husband and son were in quarantine with me.

Two days after my quarantine began, my symptoms got worse. I was actively coughing and had a fever. On this day, after multiple attempts, I finally spoke with the county health department. The woman I talked to informed me that based on my symptoms, the information from my provider, and who I’ve been in contact with, she believed I should be tested. However, she said, she didn’t know how to make that happen.

I spoke to my doctor again that afternoon. For about the tenth time in three days, the only person fighting for anything is defeatedly apologizing to me. I still will not be tested. Again, after this phone conversation, I broke into tears.

Since I’m in my early thirties, and because, aside from my asthma, I’m otherwise healthy, I will likely have a full recovery. But I’m terrified for my patients. I’m concerned for those I’ve cared for who might be at terrible medical risk. When the law states that notification only happens during a known contact of a positive COVID-19 test, I believe it is a breach of medical ethics not to test symptomatic health care professionals. Medical groups fail their patients when their own staff isn’t protected.

I’m past fear. I’m angry now.