Health-care workers struggle to get tested for COVID as they battle case surges and staff shortages
How big is the demand for COVID-19 tests? So big nurses working in the ICU can't get ahold of one when they feel sick.
When Marty Harrison started experiencing COVID-19 symptoms just before the new year, she told Temple University Hospital staff she’d been exposed to the virus and was feeling ill.
Protocol at the North Philadelphia hospital, where Harrison works as a nurse on a gastroenterology unit, is that anyone exposed or experiencing COVID symptoms should notify the hospital’s occupational health department and wait for further instruction.
But Harrison didn’t hear back from anyone until four days after her symptoms began. In the interim, unsure what else to do, she got a COVID test at a clinic unaffiliated with Temple. When hospital staff finally reached out to her on Jan. 2, an occupational health staffer wrote that she should return to work on Jan. 5, as long as her symptoms were resolving.
“We will not require nor offer PCR testing at this time,” the staffer wrote, “due to the overwhelming demand of testing overwhelming our lab and testing services team.” Besides, the staffer wrote, Harrison’s isolation period would be over before her results came back.
The day before she was supposed to return to work, Harrison got back results from the test she’d sought out on her own: positive.
Harrison, a vice president for the Temple chapter of the Pennsylvania Association of Nurses and Allied Professionals (PASNAP), said her experience has become a common one for nurses in the region as the highly transmissible omicron variant surges and COVID tests are increasingly scarce.
Frontline workers at several Philadelphia hospitals said they have struggled to get through to employee support hotlines and routinely wait days for an appointment to get tested. Unable to wait, they must fend for themselves to locate a test, and, if unsuccessful, go to work sick or stay home out of caution, leaving colleagues shorthanded.
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Local hospitals have been hit hard by the latest surge of the virus, with nearly full COVID-19 units run by a depleted staff, as many are out sick with omicron. As the city’s positivity rate creeps up toward 40% and new cases reach a record high, meeting demand for tests among patients and employees has become increasingly challenging.
Hospital administrators say they are doing their best to expand testing capabilities, but workers worry help will come too late to avoid dire workforce shortages at a time when the pandemic feels more unrelenting than ever.
‘Crisis staffing’
“When the whole world shut down, nurses did everything they asked. We left our families ... continued to work,” said Peggy Malone, a nurse at Crozer-Chester Medical Center in Delaware County. “These patients receive safe, quality care. Now the nurses are the patients.”
Malone tested positive for COVID-19 on Dec. 27, using an at-home antigen test that her daughter bought at a drugstore. Just four days later, she said, a Crozer administrator told her she could come back to work.
“He didn’t ask if I was symptomatic, if I had been tested again,” said Malone, vice president of the PASNAP local at Crozer. “He didn’t even ask if I was OK. He said that because of the crisis we’re in, we’re allowing nurses with minor symptoms to return to work.”
Malone still hasn’t returned to work and is using an already planned vacation to isolate instead. She said she’s worried about how to protect her patients.
“The lack of respect — now these nurses are sick, and they’re not being given the time to heal like everyone else,” Malone said. “I think it is truly the saddest thing in health care.”
Physician Gary Zimmer, chief medical officer for Crozer Health, said hundreds of employees are out sick, positive and asymptomatic, or immunocompromised and unable to safely work.
The CDC shortened its quarantine recommendations late last year, suggesting that members of the general public who contract COVID-19 should isolate for five days. Afterward, people who are asymptomatic or whose symptoms are improving should wear a mask around others for another five days.
But in health care, where staffing shortages can seriously impact patients, the CDC recommends that hospitals bring back COVID-positive employees after five days under a “contingency staffing plan.” That’s no longer an option at Crozer, Zimmer said. The hospital system is now following the CDC’s plan for “crisis staffing,” bringing staffers back to work earlier than normal.
“Crisis staffing mode means we just don’t have enough staff -- there are hundreds currently impacted by COVID,” he said.
Crozer-Chester Medical Center has on-demand testing for staffers, but only for those who are symptomatic and scheduled to work. Staffers who have only been exposed to COVID can’t get a test, Zimmer said: Between staffing shortages in the lab and the sheer number of tests to run -- all take between 15 and 60 minutes to get results -- “we simply don’t have the bandwidth.”
“It’s not been perfect in terms of timeliness of getting results -- we’re prioritizing when people can come back to work safely, and like everyone, we’re doing triple work just to be able to keep things running,” he said. For employees who are able to get tested, he said, the positivity rate has been over 50%.
Zimmer said he’s proud of frontline workers at Crozer Health. “We need to reinforce how much work has been done by the frontline workers -- and now during the surge, when we really had our numbers cut because of illness, it’s been all that much more impressive,” he said. He urged the public to only come to emergency rooms if they were experiencing a true emergency, saying all of the region’s ERs have been stressed by people worried they have COVID, but who can recover at home.
‘A brick wall’
At Einstein Medical Center Philadelphia, every patient admitted to the hospital is tested for COVID-19, regardless of whether they have symptoms, meanwhile tests aren’t readily available for the medical staff who want to know whether it is safe to come to work, said Peg Lawson, a nurse at Einstein and copresident of the PASNAP local chapter there.
When staff feel sick they’re supposed to call Einstein’s employee health office, which has a COVID-19 helpline. But most times they have to leave a message and wait for days for a call back to (hopefully) get scheduled for a test. Most workers can’t wait that long to get tested, so they try to find a test on their own at a pharmacy or local testing site, Lawson said.
“You can’t just assume a cough is a cold. You have to assume it’s COVID and get tested so you don’t sicken your patients and coworkers,” she said. “That’s as difficult for us as it is for everyone else.”
Lawson said she understands the hospital is strained and the employee health office isn’t set up to accommodate so many inquiries, and patients must be prioritized for testing.
Still, the situation is emblematic of the broader lack of support many nurses feel, she said.
“As caregivers we’re keenly aware of needing to take care of everyone’s problems, no matter what and not be biased or judgmental … but when you are met with such a high number of people, patients, visitors, family who are not cooperating with the recommendations and are not getting vaccinated and are not distancing, it makes it so, so hard to continue to just be able to do your job well,” Lawson said. “It’s just a brick wall.”
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In a statement, Einstein spokesperson Damien Woods said administrators at the hospital, now part of Jefferson Health, were “actively working to address the testing needs for the community and our staff.”
The hospital is increasing staffing for its employee health call center, expanding testing to seven days a week and establishing a prioritization process to test employees who support critical patient care areas.
At St. Christopher’s Hospital for Children, nurses and doctors aren’t able to get a COVID test at their own hospital — instead, finding tests is an employee’s responsibility, an increasingly arduous prospect, said Suzanne Swift, a St. Christopher’s nurse and head of the hospital’s PASNAP chapter.
Employees with vaccine exemptions do get regularly tested at the hospital. So do St. Christopher’s patients. Swift thinks the hospital should be regularly testing everyone.
Hospital administrators recently promised that an outside company will set up an on-campus testing site soon, Swift said, but it’s unclear when that will happen.
Tower Health, which owns St. Christopher’s, did not respond to a request for comment.
Temple Health employees who are exposed to the virus or experiencing COVID-like symptoms are supposed to contact the hospital’s internal response team to be evaluated. Employees are given an appointment for testing “when deemed clinically appropriate,” said Jeremy Walter, a Temple spokesperson. He declined to elaborate on what criteria an employee must meet in order to qualify for a test. He added that testing over the holidays was limited due to “overwhelming demand,” and that testing availability in the city has improved since.
Mary Adamson, Harrison’s colleague and the president of Temple’s PASNAP chapter, said she’s frustrated by the hoops she and her colleagues have had to jump through to keep themselves safe amid a historic surge in the pandemic.
“I don’t know what the rationale is — it can’t be costing [Temple] much money to throw another test in the lab,” she said. “Why would you not want your staff to be safe?”