Coronavirus has been in the news since January, but it wasn’t until March 11 — the day the World Health Organization declared it a pandemic — that some UPMC employees say they got their first official guidance on how the 40-hospital health system was preparing for the disease’s spread.
That guidance came in the form of a memo posted on facility bulletin boards that said, in part: “It remains our promise to you to be transparent and keep you updated in this evolving situation.”
Based on detailed interviews with seven UPMC employees at four hospitals and emails from several UPMC employees and employee family members, some of the healthcare giant’s workers feel that their employer has not been transparent, leaving them to guess as to plans regarding protective equipment and policies on calling off sick. Others are publicly questioning, in an open letter signed by nearly 300 practitioners, the health system’s decision to continue with non-emergency surgeries.
UPMC has, in public statements, emphasized its commitment to protecting its employees.
"UPMC is ready now, and it will be ready in the future, to protect our patients, our staff and our communities," Dr. Donald Yealy, UPMC's chair of emergency medicine, said at a press briefing Friday. He said the system's "goal is to make sure that we meet the needs of our patients, and that we keep our staff safe while that's happening. We have adequate protective equipment for all types of care."
Such statements didn’t assuage employee concerns, shared with PublicSource under the condition of anonymity. (Notably, the March 11 memo emphasized UPMC’s policy barring rank-and-file employees from talking with reporters, noting that “questions from media should be directed to UPMC Media Relations.”) Employees said they could be disciplined if they were identified in the press.
“There hasn’t really been a centralized form of communication,” said one UPMC employee, who is not a doctor or nurse but whose job involves direct contact with patients. “We received several emails that basically said, read Infonet,” the system’s online portal for employees, and “search for COVID-19 on Infonet.” The information found there, according to the employee, was focused on “what we were instructed to tell patients and families of patients, to emphasize UPMC’s commitment to cleanliness, to keeping people safe.”
A spokesman for rival Allegheny Health Network [AHN] wrote in response to questions that its first "all-employee communication" about the virus was a Jan. 26 email asking them to report any recent travel to China or any contact with people who had taken such trips. The health system indicated that it has sent out "more than 120 employee communications" about the pandemic. Unit leaders are also asked to share new information at the start of each shift.
While it did not address specific questions posed by PublicSource, UPMC issued a statement Monday afternoon saying that its leadership has "had extensive communication with employees to share what we know about COVID-19 and explain UPMC's preparedness. We've had several in-person and virtual chat sessions where our experts answer questions. We also have an email address where employees can ask non-urgent questions," plus a hotline for urgent questions about infection prevention.
Another UPMC employee, whose job entails contact with patients in two hospitals, told PublicSource: “I have a very high level of anxiety every day. It scares me. I’m jumpy now. Every time someone comes near me, I’m afraid.”
That anxious employee works in a unit that has been “very short” on face masks, the employee said. “Whenever we bring this to the attention of the supervisor, they say they’ll order more but we haven’t seen any yet.”
Another employee said: “I know where one box is that currently has three face masks in it.” That employee described the masks in the box as “the basic respiratory face masks that you could buy at CVS.”
A custodial employee reported that last week face masks became unavailable to workers in that role in one UPMC hospital.
And another employee — whose work entails more contact with visitors and other staff than with patients — wants a policy that “face masks are mandatory — you can’t work in whatever area without a face mask.”
UPMC has noted in its online communications that “disposable surgical face masks do not completely protect against infection, according to the Centers for Disease Control and Prevention,” and that the more effective N95 respirators “require a fit test, and wearers must check the seal when they put them on.”
In UPMC’s Friday media briefing, when asked about the availability to staff of protective equipment, Yealy said the system is “titrating back based on the facts as they exist here in Western Pennsylvania, and predictions about the future."
That seems to suggest that UPMC is adjusting its practices regarding the distribution of protective equipment, so that it has enough on hand if the novel coronavirus crisis hits the region harder. UPMC did not immediately address follow-up questions emailed Monday morning about its current practices regarding employees’ access to protective equipment.
AHN announced Sunday that it, along with Highmark Health, had secured a shipment of 65,000 N95 masks, "that will support the greater Pittsburgh region’s response" to the virus. The system's release said the masks would be distributed among local hospitals. AHN's spokesman wrote Tuesday that the network is following Centers for Disease Control and Prevention guidelines on the use of protective equipment.
A hard call
While some employers in general have, during the coronavirus crisis, told workers not to come to work if they feel at all sick, UPMC employees reported getting no new guidance on when to call off.
At the Friday press briefing, Graham Snyder, UPMC's medical director of infection prevention, said he had "no interest in having a healthcare worker being exposed to COVID-19 and I have no interest in not helping a healthcare worker recover if they're sick or exposed and doing the right thing to keep their friends and their family safe."
“If you feel sick, stay home — that’s been in place for years," said a UPMC employee whose work includes contact mostly with staff and visitors. That employee added, though, that UPMC requires a note from a doctor if you are off three days, and worried about the consequences of a potential two-week quarantine following any report of a cough and fever. “After 14 days, will I still have a job?”
Another reported “a culture that has been promoted where people are strongly discouraged from calling off,” which might become even more acute if coronavirus stretches the capacity of UPMC staff.
PublicSource on Monday morning asked UPMC and AHN whether staff have received any special guidance since the coronavirus crisis started on when to call off sick. UPMC did not provide details. AHN is telling employees with "flu-like" symptoms or a combination of fever, cough or shortness of breath to stay at home, according to a spokesman. Any such employee "would be screened and tested," as would employees exposed to someone with a confirmed case of COVID-19.
A custodial employee suggested that UPMC “should be testing their workers on a regular basis, No. 1. … We’re not tested, so we have no idea if we’re positive or not.”
Snyder said in the press briefing that such measures are not, at this time, needed. "Public health guidance does not say to test asymptomatic individuals, so we're not testing asymptomatic individuals,” he said. Shortages in testing supplies, he said, "are a potential threat to testing opportunities.”
He added: “We have said what we've always said to healthcare workers, which is, ‘Please don't come to work sick."
Electing to do electives
Nearly 300 medical professionals have issued an open letter to UPMC — with some signing on as recently as Friday — asking the hospital system to "cancel elective procedures and routine outpatient visits to prepare for and proactively protect patients, the community and staff from the expected spike of infections related to COVID-19." They warned of "the possibility of shortages of ventilators, oxygen, personal protective equipment" and other resources, and wrote that "surgical gowns and blue towels are now in limited supply."
"While we understand the financial implications inherent in keeping patients at home, the benefits clearly outweigh these risks in the context of a global pandemic," they wrote.
Dr. Yealy said in the Friday press briefing that the health system is "not yet broadly canceling care," noting that non-emergency procedures can include "important healthcare needs that can't always be safely delayed."
He said UPMC is relying on its clinicians and patients to "determine which care can be delayed without harm," and trying to "smartly identify" which care should be postponed.
On March 24, after this story was published, UPMC announced that it is closing ambulatory surgery centers and moving all “medically necessary” surgeries and procedures into hospitals, in order to protect staff and preserve protective equipment.
Both health systems have been public about some changes made in response to coronavirus. AHN on Thursday suspended all visits to patients at its facilities.
UPMC is not allowing any visitors to patients that are being tested for COVID-19 or have been diagnosed with the disease, and has reduced, but not entirely eliminated, visitor access to many other patients. It is canceling some, but not all, non-emergency surgeries.
The employees interviewed for this story said they were aware of those measures, but did not feel that they are in the loop.
“I feel that they should talk to us more — at the least, talk to us more. We as employees have a right to know what’s going on,” said one UPMC employee. “Every day, we’re risking our lives. … Everyone is risking their lives, working hard to keep UPMC running.”
Update (3/24/2020): This story was updated to include new information about changes to UPMC's practices regarding surgery. This story was later updated to include information on Allegheny Health Network's communications with employees, practices on protective equipment and guidance to workers regarding calling off sick.
PublicSource reporter Oliver Morrison contributed to this story.
This post will be intermittently updated when new information becomes available.
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