A coronavirus outbreak in a surgical unit at Harborview Medical Center has infected four patients, killing one. Ten Harborview staffers have tested positive for the virus, which causes COVID-19, and are isolating. Thirty more staffers are in quarantine after possible exposure.
The patient died in the intensive care unit, said Dr. John Lynch, medical director of infection prevention and control at Harborview Medical Center.
Lynch said the patients who contracted the virus all had been at Harborview for more than 14 days, indicating they likely contracted the virus at the hospital.
"This virus spreads among patients and staff because of gaps in adherence to the precautions we know are very effective," Lynch said.
Harborview is working to determine how the virus got into the surgical unit, Lynch said. Cases were first detected between September 29 and Oct. 2. The outbreak was reported to Public Health -- Seattle & King County on Oct. 4. One patient died Oct. 8.
Lynch said Harborview did not publicly disclose the outbreak until Friday because it took time to gather genomic sequencing data, perform surveillance testing and reconstruct staffers' schedules to understand the parameters of the outbreak.
The surgical unit stopped accepting new patients on Oct. 1. Lynch said the outbreak was contained to that unit. Susan Gregg, a Harborview spokesperson, said the hospital would not disclose the specific name of the unit out of concern for patient privacy.
All 10 workers who tested positive are "recovering at home" and haven't needed to be hospitalized, Lynch said.
The hospital is doing surveillance testing of patients and staff and has put additional restrictions on visiting hours, Lynch said.
Patrick Racioppo, a registered nurse on the unit who said he worked in a shared room that contained a patient later found to be infected, said he learned of the outbreak on Oct. 5.
"It's worrisome," Racioppo said, who questioned why it took that long for staffers to receive news of the outbreak from UW Medicine. He'd spent days prior to that with his wife.
"I decided to quarantine myself for five more days in my garage, separate, to try to keep her safe" in case he became infectious, Racioppo said. He received testing results Oct. 6, which did not detect the virus that causes COVID-19. He slept on an air mattress in the garage through Oct. 9.
He said it had been hard to hear about colleagues' positive tests.
Lynch said Harborview requires staffers wear masks at all times, wear eye protection when in close proximity to patients and stay home when feeling ill, but the virus "just preys upon any gap."
After many months of community transmission, Lynch said pandemic fatigue was grinding on staffers and visitors. He said visitors are required to wear masks, but sometimes remove them in family members' rooms.
"You remind them, you leave, and the masks are off again," Lynch said, adding that the hospital was moving toward a "no-strikes" policy on visitor masking.
Lynch said staffers are finding it more challenging to resist the urge to socialize and connect with colleagues.
In Harborview's cafeteria, "we literally had to bolt the tables to the ground so people wouldn't eat together," Lynch said. "You have to assume everyone has COVID and act that way."
Some staffers are now in quarantine because they did not wear required eye protection when they visited patients who became infected during the outbreak, Lynch said.
Racioppo said education, training and staffing levels play a role, too.
"There's gonna be breaks in the system and not just due to COVID fatigue," Racioppo said, adding that until recently his floor had small break rooms that did not foster distancing and that he would feel safer if issued a N-95 respirator.
Personal protective equipment is the last layer of protection for hospital staffers, said Julie Fischer, who studies ways to protect front-line health care workers at Georgetown University Medical Center.
Fischer said how a hospital's physical space is used, its engineering and its administrative procedures are key to infection control. Ventilation plays a big part.
Lynch said he feels confident the ventilation at Harborview is "excellent," but Harborview is an older facility with many double rooms, where patients are separated by only a curtain.
"We have a lot of shared spaces and a lot of very sick people in our facility," he said.
King County voters on this November's ballot will consider a $1.74 billion bond measure for upgrades at Harborview, in part for renovations and infection control updates.
The Washington state Department of Health (DOH), as of Oct. 10, has counted 321 outbreaks in health care settings, including hospitals. An additional 659 outbreaks were counted at long-term care facilities during that time period, according to a statewide COVID-19 outbreak report published Thursday.
In April, one patient at Harborview likely acquired the coronavirus from the medical center. This is Harborview's first incident involving multiple patients, Lynch said.
To be considered an outbreak, the DOH requires at least two individuals to record positive coronavirus tests, at least two cases in which symptoms began within 14 days of one another and plausible evidence of transmission at a shared location that is not a household.
The Seattle Times submitted a public-disclosure request to DOH earlier this month for reports and data about outbreaks in health care settings. The agency said it would provide records by July of next year.
Hospitals across the state have struggled with outbreaks.
At least 73 people tested positive for the novel coronavirus after an outbreak that began in August at St. Michael Medical Center in Bremerton, according to the Kitsap Public Health District.
Public Health -- Seattle & King County has recorded 27 outbreaks in acute care hospitals in King County since the pandemic began, said public health spokesperson Sharon Bogan in an email.
Most involve between two and four cases, Bogan said. Since June, two additional outbreaks have involved five or more people.
In mid-August, eight health care workers and one patient tested positive at Swedish Cherry Hill. Later that month, four employees and a patient tested positive at Virginia Mason Medical Center in Seattle.
Throughout the world, "health care workers are at higher risk for COVID-19 than almost any other group," Fischer said.
At the national level, no agency is tracking how many health care workers contract the new coronavirus, Fischer said.
The National Nurses Union published a report saying more than 1,700 health care workers had died from COVID-19 or its complication as of Sept. 16.
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