- More frontline workers, such as police officers, firefighters, paramedics, and hospital employees, are becoming ill with COVID-19.
- Experts say the increase is due to a lack of personal protective equipment as well as the close contact these workers have with the virus.
- Staffing levels at hospitals, police stations, and ambulances are being affected.
- Experts say emergency agencies could contact staffing agencies to help fill the gaps.
- Doctors are using telehealth services more, and medical professionals like dermatologists could be called into action.
You’ve seen the videos of frontline workers vividly retelling what their tired eyes have seen as a result of the COVID-19 pandemic.
Healthcare workers and first responders, such as paramedics, police officers, and firefighters, are putting themselves at risk each day just by doing what they do for a living.
Many of them are now becoming ill.
In addition, the New York City Police Department (NYPD) reports that nearly 20 percent of its uniformed employees are out sick, and 12 of them have died from COVID-19.
As the COVID-19 pandemic continues, Healthline asked experts how quickly the virus will spread among these frontline groups and what will happen to our healthcare systems — hospitals, clinics, and doctors’ offices — as these workers fall ill.
Due to the nature of their jobs, first responders are at major risk for exposure, mainly because they may be dealing with people who have COVID-19.
Physical distancing is also difficult for team workers, such as firefighters.
“They often are living together for 24-hour shifts or more, and so they’re sharing a lot of close contact, even outside of their runs,” said Kathleen Winter, PhD, MPH, an assistant professor in the department of epidemiology at the College of Public Health at the University of Kentucky.
“If one person in that group gets infected, it can more easily be spread to the others if they are not able to be socially distant throughout their entire shift,” she said.
There are strategies to keep those individuals working with the same small group of people, so if someone contracts an infection, it stays within those eight and won’t spread to the entire workforce, Winter explains.
First responders know how to use personal protective equipment (PPE), but those are in short supply across the country.
“First of all, the healthcare workers are the number one need for PPE,” said Gregg Gonsalves, PhD, an assistant professor of epidemiology at the Yale School of Public Health in Connecticut. “The second ones are people who are forced to break social distancing by virtue of what they do every day, and that’s first responders, and so it’s not surprising to see EMS, fire, police come down with COVID-19 because their jobs don’t allow working from home.”
That’s the million-dollar question.
“I can’t tell you how many medical workers are likely to get COVID-19. I don’t think anyone can,” Maureen Miller, PhD, an infectious disease epidemiologist and adjunct associate professor at Columbia’s Mailman School of Public Health in New York, told Healthline.
“It will depend entirely on continued access to PPE, which is an urgent and ongoing problem, as well as on their own physical health that may be deteriorating due to long hours and high levels of stress,” she said.
Miller notes the NYPD have even less PPE than healthcare workers in New York, but they also don’t have the constant known exposure to COVID-19.
In some places, masks are being reused, shared, or used throughout a long shift.
“There should be a new mask with every patient. With multiple exposures in a shift, they might be running 10 or 12 cases, and 11 of those are going to be COVID-19 cases,” said James Farley, national executive vice president of the National Association of Government Employees, a union that supports police officers, firefighters, correctional officers, nurses, paramedics, and emergency medical technicians (EMTs).
“We’re at a point where the union is sourcing PPE for our members, and that’s not our function. We’re happy to do it, but it’s not right,” he said.
Gonsalves agrees that access to PPE is the central problem right now for all of these workers.
“We’re in a situation where precious real protective equipment is barely available in hospitals, and so of course we’re going to see this whole cohort of men and women working as EMTs, fire, police getting infected,” he said.
Preparedness for disasters is something that healthcare systems are always planning for, says Kristi Sanger, director of the Association of Healthcare Emergency Preparedness Professionals.
“Staffing is always an issue,” she told Healthline.
She adds that there are backup plans that can be put into play if workers get sick and more hands are needed.
“All of those things have been discussed in trainings and exercise,” she said.
Hospitals that have sick workers may turn to staffing agencies to fill the gaps. Workers in desk jobs may also get the call. In places like New York and Boston, medical students are graduating early so they can help.
“If they have to utilize someone like myself — I’ve not been a clinician for a while but I used to — so maybe they’ll be calling if they needed the help,” Sanger said. “They’re going to ask the university clinicians that are no longer clinicians if we can get back out there.”
Less hands on deck will translate to longer waiting times in hospitals, especially if your medical needs aren’t related to an emergency.
“If a healthcare facility can take 200 patients and there’s 500 patients that need help, of course we’re going to have to expect longer waits and it’s going to be more of a challenge,” Sanger said.
Police departments, says Justin Nix, an assistant professor of criminology and criminal justice at the University of Nebraska Omaha, may seek temporary coverage from their local sheriff’s department or may call on the National Guard.
“Folks who don’t normally go out on the road, at the end of the day they’re still cops, and they could go out and do that,” Nix told Healthline. “The high-ranking officers usually work from headquarters. Maybe they would then have to get out on the street.”
There was an EMT shortage before the pandemic, explains Philip Petit, national director of the International Association of EMTs and Paramedics (IAEP).
If more workers are needed in hot spots across the country, the Federal Emergency Management Agency (FEMA) could assist as they did in the New York region in March, when 250 ambulances and 500 EMTs were sent to help.
“I’ve heard in places where we’re getting high call volume that we’re starting to negotiate over how we can let other private companies pick up the slack for extra calls. We already do that. It’s called mutual aid,” Petit told Healthline.
“When mutual aid is overworked, I don’t want to scare you, but beyond FEMA and being able to shift resources around the country, we would need to really find a pool of certified individuals, retired individuals, folks to push out there,” he said.
“It’s just a very fragile system, and it’s not meant to operate in this fashion,” Farley added. “We’re at 20, 25 percent of folks out sick in New York. If that goes to 50, there isn’t a fail-safe for that.”
Michael Marasco, an IAEP national representative, saw a colleague battle the virus and recover.
“We just had a paramedic in Orlando who just walked out of the hospital yesterday after spending about 7 to 8 days on a ventilator,” Marasco told Healthline.
“It’s just one of those things you’re going to encounter. I hate to say it, but once the PPE is out, these people are not going to stop running in. Even if PPE is gone, they’re still going to be responding to calls,” he said.
Dr. Gary LeRoy, FAAFP, a family physician at the East Dayton Health Clinic in Ohio and president of the American Academy of Family Physicians (AAFP), is seeing about one-fourth of his regular patient flow right now.
He’s doing frequent telehealth calls with patients.
Telemedicine methods, which are currently being promoted on the AAFP’s website, require less staffing should workers get sick, LeRoy says.
“If they have symptoms of COVID-19 like a cough, or a fever, or shortness of breath, we don’t want them coming into the office and infecting our staff and the other patients. We would need to talk with them via telehealth technology to determine whether they should seek medical attention to get tested,” he explained. “A lot of communities are doing things like that.”
LeRoy’s parent hospital, Miami Valley Hospital in Dayton, sent memos to area physicians who might be willing to volunteer, if needed.
“If they had a surge and they were losing staff and such, would we be willing to go on a list to be called in on an emergency call-in list?” he said.
For LeRoy, the answer is yes.
Refresher seminars aimed at reintroducing physicians to ventilator management and intensive care management have also been sent out by medical academies, he says.
“If we’re called to duty, it’s like riding a bike. You just say, ‘OK, I’m a doctor of medicine, I know how to do that,’” LeRoy said. “It’s just refamiliarizing myself with the newer-fangled ventilators that they have now, that they didn’t have when I was a resident.”
It’s a team effort, he adds, and doctors of all genres could be called upon to help when healthcare systems are struggling.
“You may have dermatologists that are seeing one-fourth of their patients, so it’s like, ‘OK, can you come and start doing ICU work?’ Well, sure, if that’s what I have to do, that’s what I have to do,” LeRoy said.
But, he stresses, don’t let the idea of different types of physicians treating COVID-19 leave you nervous.
“You have to realize that anyone that has the initials behind their name — MD, medical doctor, doctor of osteopathic medicine, RN, registered nurse — we have a similar level of training, a basic level of understanding of medicine and human physiology and certain things,” LeRoy said. “Hospital systems would be going for individuals with credible credentials to do what needs to be done. They are not just grabbing anyone off the street.”
Sanger is hopeful that plans for the worst case staffing scenario won’t need to be implemented.
“I do think that a lot of our flattening of the curve and social distancing is helping so that we don’t hit that mark, so that we can’t care for these people,” she said. “As long as we continue to all do our best to social distance, we’re very hopeful that we’ll be able to meet the needs.”