I work in a long-term care facility/nursing home, in Pennsylvania as a certified nursing assistant. I informed my employer of the positive case in my home. I volunteered to stay home 14 days because I don’t want to risk infection to my residents I take care of, or fellow employees.

My employer says they want me to wear a mask and face shield and come to work, and make sure other employees are wearing a mask properly OR go get tested again. I do NOT want to put my residents at risk and I refuse to go through that painful test again.

They said they are my only two choices. Force me to work as a possible carrier or force me to test again, which I feel is against my rights. Can they give me this ultimatum? I’m assuming if I don’t follow through, they are going to fire me.

Trapped between working, quarantine and a test

Dear Trapped,

This isn’t about you, as much as it is about your patients. Quarantining and having a clearer idea if you have contracted coronavirus or not are the responsible courses of action. That applies to everyone, but it particularly applies to you. A nasal-swab may be uncomfortable for a moment, but a ventilator on one of your patients would be a hell of a lot more uncomfortable.

There are far worse things than a COVID-19 nasal swab. I’ve had one. It was not painful for me. Uncomfortable for a brief moment, perhaps, but it was a small price to pay. There are caveats: A nasal swab test is not 100% accurate, as the doctor or nurse who administers the test will tell you, and there’s nothing preventing you from being infected after you take the test.

However, focusing on that is only going to fuel your indignation and anger against your employer, and distract you from the main issue. This dilemma is about your patients, who are among the most vulnerable population. Nursing homes around the world have been hit hard by the coronavirus pandemic because COVID-19 was transmitted from workers and/or visitors.

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Unfortunately, not all nursing homes in the U.S. have been following the right protocols. The Centers for Medicare and Medicaid Services in Pennsylvania last week announced that it had imposed $15 million in fines and tripled the most severe type of citations to nursing homes during the first six months of the pandemic. Your employer could be next on that list.

More than 3,400 nursing homes in the U.S. have been cited for noncompliance with infection-control requirements and/or failure to report COVID-19 data, the Pennsylvania Health Care Association said. The U.S. has had the highest number of deaths in nursing homes in the world, and has one of the highest rates of COVID-related nursing-home deaths per capita.

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In Pennsylvania, nearly 70% of fatalities associated with COVID-19 have occurred within nursing homes or other long-term care settings, according to this letter from four senators to the U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services and Centers for Disease Control and Prevention.

This is all useful information to have when responding to your employer. In the meantime, you can also fill out this online form provided by the Pennsylvania Department of Health to report workplace violations. You should NOT go to work if you have been in contact with someone who has tested positive for COVID-19. Know your rights. Know the rules. And act upon them.

Coronavirus update: As of late Tuesday, COVID-19 has infected 25,587,737 people worldwide, which mostly does not account for asymptomatic cases, and killed 852,851. The U.S. still has the world’s highest number of COVID-19 cases (6,068,139), followed by Brazil (3,908,272), India (3,691,166) and Russia (997,072), according to data aggregated by Johns Hopkins University.

In the meantime, cases keep rising in the U.S. with California becoming the first state in the country to surpass 700,000 confirmed cases; infections there hit 712,475 as of Tuesday with 13,022 COVID-related deaths. New York has recorded 434,756 infections and the highest number of deaths in the U.S. (32,957). COVID has killed 184,450 people in the U.S.

AstraZeneca AZN, -1.10% , in combination with Oxford University; BioNTech SE BNTX, -5.61% and partner Pfizer PFE, -2.40% ; GlaxoSmithKline GSK, -1.61% ; Johnson & Johnson JNJ, -1.23% ; Merck & Co. MERK, -0.31% ; Moderna MRNA, -2.41% ; and Sanofi SAN, -1.34% are among those currently working toward COVID-19 vaccines.

The Dow Jones Industrial Index DJIA, +0.75%, the S&P 500 SPX, +0.75% and the Nasdaq Composite COMP, +1.39% all ended higher Tuesday. Over the past five months, the Dow’s advanced 30%, its biggest 5-month percent gain since July 2009, while the S&P 500 added over 35%, its best 5-month run since October 1938.