A month ago, when Lindsay Manning first asked whether she should steer clear of COVID-19 patients, her supervisor at Mercy Medical Center in Springfield tried to reassure her. It was primarily a respiratory virus. Pregnant women weren’t necessarily at greater risk.
But as more details about the course of the illness emerged, the pregnant ICU nurse worried about the unknowns. What about fever, which can be linked to preterm labor and fetal abnormalities? What about the breathing problems COVID-19 patients were suffering, forcing them onto ventilators? Manning was only six months pregnant. What would happen to her fetus if her oxygen levels dropped or she ended up sedated on a ventilator?
With her anxiety rising, the 30-year-old mother of a 3-year-old again asked if she could limit her exposure to coronavirus patients, but a manager made clear that a transfer was not guaranteed. A move would depend on staffing levels, Manning was told. The last day she worked, April 1, she tended to an array of patients, most of whom were being treated or tested for coronavirus.
Now, she has COVID-19 too. Two weeks after her positive test, she remains sick and sleepless, wracked with anxiety about what will become of her baby. Even now, the Catholic hospital where she works will not reassure her that if she recovers and returns to work, she will be reassigned.
“I just don’t know why they can’t just say, ‘hey — we’ll protect you,’ ” she said.
The unknown effects of the novel coronavirus are worrisome for all but particularly agonizing for pregnant women, who fear the ravages of a severe respiratory illness could harm the development of their fetuses. But those same uncertainties are being cited by some employers as a reason to maintain the status quo in the workplace.
While some hospitals — including Baystate Medical Center in Springfield and Massachusetts General Hospital in Boston — are giving pregnant health care workers the option of temporarily changing job responsibilities, Mercy Medical Center has made no such guarantees.
Mercy Medical administrators did not comment on the hospital policy. Neither Deb Solomon, executive director of human resources, nor Amy Ashford, director of marketing and communications, responded to repeated calls and e-mails from The Boston Globe over one week.
Mercy Medical, a 182-bed acute care hospital in Springfield, is part of Trinity Health Of New England Medical Group, which also runs Providence Behavioral Health Hospital in Holyoke. Based in Michigan, Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the country, according to its website.
“We’re supposed to be a Catholic hospital. You’re making these women bring their unborn children in," said Jaime Dorunda, a fellow ICU nurse at Mercy Medical who co-chairs the hospital’s chapter of the Massachusetts Nurses Association. "You wouldn’t make me bring my 12-year-old in.”
Each time Manning asked about her situation, she said, managers pointed her to a Trinity memo, citing the data currently available about the coronavirus.
The Centers for Disease Control and Prevention says that pregnant women do not appear to be at increased risk of the coronavirus, though they are known to have a higher risk of severe illness from influenza and other respiratory infections. But the virus raging around the world is so new that very little is known about how a fetus will weather a mother’s infection and the aggressive medical intervention that may be required to treat it.
“Are there any studies to show that it’s not a danger? That’s the whole point," said Dorunda. “This is a new virus. We don’t have studies yet."
The Trinity Health memo that Manning was provided, dated March 17, said there’s no data that suggest an increased risk of miscarriage or congenital effects on fetal development. But it also cites information from the Royal College of Obstetricians and Gynaecologists that, “infection with COVID-19 may pose some risks to a pregnant woman’s unborn baby: there is a possible risk of fetal growth restriction and a risk of premature birth for the health of the mother and baby, should the mother become seriously unwell.”
The Trinity memo says that pregnant health care workers can ask their supervisors to review assignments, but that “if staffing levels don’t permit reassignment,” they will have to rely on personal protective equipment.
It also cites guidance from the American College of Obstetricians and Gynecologists which does not recommend restricting the work of pregnant health care workers based solely on COVID-19. But it also notes ACOG’s conclusion that information is so limited that “facilities may want to consider limiting exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher-risk procedures, if feasible, based on staffing availability.”
Some hospitals have done so at the request of health care workers. Baystate Health, which operates Baystate Medical Center, also in Springfield, and other health care facilities, began offering an “accommodation request process” allowing employees who are at particular risk to seek changes in their roles to avoid potential exposure to COVID-19 patients.
“As a result, we have been excepting pregnant workers from caring for COVID-19 patients or those under investigation for the novel coronavirus, and redeploying them to different departments or positions altogether," Kristin Morales-Lemieux, a Baystate Health vice president, said in a statement. Pregnant nurses have been mobilized to staff employee hotlines, for instance, she noted.
“Our goal has been to keep pregnant workers in their core roles wherever possible, but allowing them not to participate in direct care of suspected or confirmed COVID-19 patients,” she said.
At MGH, employees over 37 weeks pregnant are being encouraged to avoid all in-person patient contact “to decrease the risk of inadvertent infection through unrecognized exposure,” according to Jovita Thomas-Williams, MGH’s senior vice president for human resources.
Until that stage of pregnancy, she said, they can discuss their specific medical needs with their managers while they request accommodations through human resources and Occupational Health.
Pregnant women across Massachusetts already have the right to request changes to their work conditions to accommodate their needs under the state’s Pregnant Workers’ Fairness Act, which took effect two years ago. That law — the same that made lactation rooms available in the workplace for breast-feeding mothers — made it illegal to deny a “reasonable accommodation” requested by a pregnant employee unless the employer can show it would impose an “undue hardship” on the business.
“It’s not just a nice thing for the employer to do,” said Dina Bakst, co-president of A Better Balance, a national legal advocacy organization that advocates for pregnant workers and caregivers. “It’s actually a law.”
Manning, meanwhile, remains home sick with COVID-19, at 28 weeks pregnant. So far, the baby seems fine, based on an ultrasound and her own medical tests. Manning’s symptoms — including a tight chest, an unremitting raging cough, and the need for an inhaler — have not required hospitalization, though her doctor has ordered a chest X-ray, steroids, and now, sleeping pills, which she would rather have avoided while pregnant.
But she’s still agonizing on how she can return to work when she’s better; Mercy has not offered her a different shift.
On Monday, after weeks of filling out paperwork and repeatedly sending doctors’ notes, she beseeched her chief nursing officer for help, saying, “I don’t know where else to turn and I’m desperate for your help."
“This is my Hail Mary,” she told the Globe. “I don’t want to return back to work without people understanding and accommodating me.”