As hospitals in the state reach capacity and face dire staff shortages, North Dakota's governor announced this week that the state will allow healthcare workers who have tested positive for Covid-19 to continue working in coronavirus units.
The order applies only to those who have asymptomatic cases, and the Covid-positive nurses will only be allowed to treat other Covid-19 patients. Still, some nurses worry that the practice might not be safe, and some health administrators in North Dakota are warning of burnout among hospital staff.
"I think it's irresponsible,” Sarah Lothspeich, an ER nurse in Fargo, told NBC News.
"We have to think about the patients that don't have Covid, the staff that don't have Covid. The amount of times I've thought about this whenever somebody leaves my facility with Covid: ‘How many doorknobs have they touched to leave? Who's cleaning them? Who’s sterilizing the room?’ We are, but things could be missed," Lothspeich said.
"That might sound a little crazy to think about doorknobs, but I just think about the risk of exposure, somebody that has Covid-19, to somebody that does not. I think that risk is just too great to know the benefit isn't good enough."
Hospital administrators have asked for the extraordinary action to be taken, Gov. Doug Burgum said at a Monday press conference, and interim State Health Officer Dirk Wilke amended an order to allow the new measure to take effect.
The move comes as the state struggles to alleviate a healthcare system overwhelmed by the coronavirus, with record positive cases pushing hospitals to operate at 100% capacity.
“Our hospitals are under enormous pressure now,” Burgum said. “In the last few days, our hospitalizations due to Covid [rose] by another 10 percent. That’s 60 percent higher than just four weeks ago.”
Burgum has moved every county in the state to the “high-risk” category, asking residents to take the virus as seriously as they take “diabetes” or “heart disease.”
Allowing healthcare workers to work while Covid-positive follows the Centers for Disease and Control’s “crisis capacity strategies,” which permits healthcare personnel suspected or confirmed to be positive to return to work if there are persistent staffing shortages.
Concerns about spread
Burgum said this will not pose a significant risk for more spread, as only patients with the virus will be in contact with the COVID-positive healthcare workers.
But Tessa Johnson, the president of the North Dakota Nurses Association, told NBC News she isn’t so sure.
“What about the bathrooms and the break rooms and the elevators and all of those spaces? How are we going to keep those things clean? It’s not realistic,” she said.
Johnson, who's also the executive director at a senior long-term care facility, said staffing has been a constant challenge during the pandemic.
“People are exhausted. People are emotional. People are stressed," she said. "People can’t take much more physically, emotionally. We’re losing nurses."
“Nurses are saying: ‘If we get positive at this point, we want to take the break. It’s a welcome break," Johnson said. "We’re exhausted, we’re overworked, we need the rest. So, how can I get positive and come down with this disease and I still continue going at my best?’”
Johnson said that due to the risk and toll the job takes, some nurses would rather be on unemployment — and the new measure permitting nurses to work while sick “is only going to make things worse.”
When asked if she would personally raise her hand to continue working while sick with Covid-19, Lothspeich, the Fargo ER nurse, said “no”. Like many other nurses, she’s especially worried about the risk it poses to non-sick patients and staff.
“They’re very worried about common spaces,” Johnson said of the nurses she’s spoken with.
Sherri Miller, the North Dakota Nurses Association’s executive director, said it’s a “catch-22.”
"Having the Covid-positive, asymptomatic individuals working — there’s the risk of spread," Miller told NBC News.
Some nurses want to keep working
Some nurses, despite the risk, said they would continue working while Covid-positive and asymptomatic, and they welcome the new measure.
“I wish I could have came to work with the proper stuff on that I could continue day to day caregiving,” said Lindsey, a long-term care nurse in Stark County who had Covid-19 and asked that her last name not be used. She told NBC News that while she was sick and isolating it was “very difficult” not being in the hospital where she works.
Shelly Peterson, the president of the North Dakota Long Term Care Association, said nurses she’s been in contact with also wanted the measure to go into effect.
“We were one of the organizations that asked the governor to consider this,” Peterson said. “We came forward with requesting because staff themselves were requesting it because they wanted to help. And eight months ago, I would have never thought we would be asking that.”
Peterson said she even knows of one facility that’s already been doing this, prior to the governor’s announcement.
“We're having outbreaks everywhere,” she said. "There's just not enough staff.”
Frustration over lack of statewide coronavirus measures
Some nurses, including Sherri Miller and Tessa Johnson, say that a better solution would be for the state to initiate a mask mandate in order to reduce transmission. With fewer patients, they said, there’d be no need to have Covid-positive healthcare workers continue working.
“If we continue to have these patients, I honestly don’t know what other solution there is than asking positive nurses to take care of them,” said Johnson, who believes that without a statewide mask mandate, North Dakotans may not take the virus seriously.
When asked if she thinks that masks have been politicized in North Dakota, Johnson said, “We are a strong Republican state and a lot of the general public feel that way.”
Dr. Doug Griffin, the chief medical officer at Sanford Health, said he thinks the state "probably did deal with some Covid fatigue."
"As a state, we let our guard down during the summer, large gatherings for Fourth of July over the holidays," he said, adding, "We have variability on mask usage across the state, as you're probably well aware."
The governor's office did not immediately respond to an NBC News requests for comment.
Griffin said that despite the governor’s announcement Monday, his hospital will not be allowing Covid-positive nurses to stay on the job.
“We appreciate him taking this very seriously," Griffin said of the governor. “We are not to the point that we personally at Sanford Medical Center will be having nurses that are positive for Covid work and caring for patients.”
His colleague Dr. Rishi Seth said the hospital will consider the measure if their situation worsens and that it's “a tool in the arsenal.”
On Thursday, North Dakota broke the single-day case record with 2,019 coronavirus cases.