Apr 6, 2020 - Health

Special report: Health care workers vs. coronavirus

This illustration shows health care workers confronting the coronavirus

Photo Illustration: Sarah Grillo/Axios. Photos: Angela Weiss/AFP via Getty Images, Bruce Bennett/Getty Images, and Europa Press News/Europa Press via Getty Images

Health care workers are at an especially high risk of catching the coronavirus, because of their prolonged exposure to patients who have it. Making matters worse, the U.S. doesn't have enough of the protective equipment, like masks and gloves, that keeps them safe.

  • And yet these workers, with loved ones of their own, keep showing up at hospitals across the country, knowing that more Americans than they can possibly care for are depending on them.

Between the lines: The coronavirus is expected to create a demand for hospital care that far exceeds what the system was built to handle.

  • An overwhelmed health care system is not some abstract thing. It is a group of overwhelmed people — health care workers toiling around the clock with inadequate supplies, to treat patients with a highly infectious disease.
  • Thousands of health care workers in China and Italy have fallen sick from the coronavirus, a warning sign for the U.S.

Two nurses in New York City died earlier this month, the New York Times reported last week, and health care workers said they were afraid more would follow.

Shortages of masks, gloves, face shields and other protective equipment have led providers to reuse supplies and improvise with makeshift alternatives.

  • Some hospitals have threatened to fire workers who raise the alarm about these shortages, Bloomberg reports.

Beyond their own health, workers have to worry about spreading a highly contagious disease to their loved ones.

  • Some workers report physically distancing themselves from their immediate families — including spouses and children — by sleeping in separate rooms or living in different places altogether, per the NYT.

The bottom line: "Each morning, on the way to work, I wonder if I'll be healthy enough to return tomorrow," Dhruv Khullar, a doctor in New York City, writes in the New Yorker.

2. Health workers' jobs could get even harder

Paramedics transport a patient wearing a face mask to the emergency room entrance of the Wyckoff Heights Medical Center in Brooklyn, New York. Photo: Angela Weiss/AFP via Getty Images

The looming shortage of ventilators doesn't just impact the coronavirus patients who will need one to breathe. It also creates harrowing decisions for the health care workers who may have to decide which patients get them and which ones don't.

Between the lines: Today's doctors generally have no comparable experience to draw on for making these kinds of decisions, although accredited hospitals are supposed to have some mechanism for doing so, per NPR.

By the numbers: When the coronavirus is at its peak around the middle of the month, U.S. hospitals will be about 25,000 ventilators short of expected demand, according to one estimate, the Wall Street Journal reports.

  • Yes, but: Doctors and other health care workers are doing everything they can to stretch limited resources, including attaching more than one patient to a single ventilator and converting anesthesia machines to serve as ventilators.

The bottom line: If the numbers bear out, health care workers will still likely have to make horrible decisions about who receives a ventilator and who doesn't — decisions that mean life or death for patients.

  • In Italy, the situation deteriorated to the point where doctors were advised to prioritize younger, healthier patients, per Politico.

Case in point: NYU Langone Health told emergency room doctors last month that they have "sole discretion" to place patients on ventilators, and that the hospital supports withholding "futile intubations," WSJ writes.

What to watch: New York City could run out of ventilators by Tuesday or Wednesday, Mayor Bill de Blasio said Sunday, per WSJ.

3. The health care workers who are losing their jobs

Illustration: Aïda Amer/Axios

The health care system cut 42,500 jobs in March as the coronavirus epidemic forced providers to delay an array of non-urgent procedures and doctor visits, according to new data from the Bureau of Labor Statistics.

The big picture: Almost all of the lost jobs came in medical offices and other outpatient settings, but many people who are fighting the coronavirus in hospitals are seeing cutbacks, too, Axios' Bob Herman reports.

Driving the news: 96% of the axed health care jobs in March are on the outpatient side. Those are places like dentists' offices, physicians' clinics, speech therapy and vision centers. Hospitals did not net any job losses, according to BLS.

  • The federal government told health care providers to put off visits or procedures that weren't necessary — so it's logical that outpatient areas are the main source of job loss.

Yes, but: Hospital workers, including clinicians who could be treating coronavirus patients, have not been immune to furloughs and layoffs.

Go deeper: Health care's hiring boom may not help the coronavirus outbreak, since most new jobs are administrative.

4. The rapid push to expand the workforce

In response to the overwhelming demand for coronavirus care, the medical workforce has rapidly swelled and morphed to expand its critical care capacity as much as possible.

Details: Retired providers have jumped back into the workforce, medical students are preparing to help, and providers whose specialties are on pause are shifting into roles that are drastically different from those they're used to.

Yes, but: This redeployment isn't always voluntary, the New York Times reports.

  • Northwell Health, a New York health network, told its employees that they would either be reassigned to an area in need or furloughed without pay.
  • The redeployment also isn't limited to providers; administrative staff have also been reassigned.
  • And still, New York hospitals are pleading for doctors from other states to provide help.

What they're saying: The care of some coronavirus patients at NewYork-Presbyterian "was being provided by a redeployed cardiac anesthesiologist and a redeployed cardiac surgeon, both close colleagues of mine," wrote Craig Smith, chair of Columbia's Department of Surgery, in his daily update on Saturday.

  • "The cardiac surgeon was the first of my subspecialty partners to be felled by COVID-19. He recovered well and returned to the front lines last week."
  • "Adaptability, resolve, and self-sacrifice is how everyone is fighting back," Smith added.

Go deeper: Retired doctors and nurses may be needed in a coronavirus surge

5. Plight of health care's "forgotten" workers

A home care worker drives to her client in March. Photo: Lane Turner/Boston Globe via Getty Images

The coronavirus has made life even more difficult for the 5 million aides and workers who care for the frail populations living at home and in nursing homes, Axios' Bob Herman reports.

Why it matters: These low-paid workers face the conundrum of seeing patients and increasing risk of exposure and spread, or staying away at the expense of their income and patients who rely on that care.

By the numbers: Home health workers, nursing home assistants and other therapists and orderlies hover around poverty and are predominantly women and people of color, according to PHI, a research group that studies this group of care workers.

The big picture: It is almost impossible for workers to bathe, feed and otherwise care for their patients while social distancing, and a reliable source of masks or other protective gear for them is not guaranteed.

  • That makes their already-high-risk job even more high-risk for them, as well as their patients who are most likely to die from contracting COVID-19.
  • If they, their clients or the facilities decide to hold off on services, they lose what little income they have.

The bottom line: "There's no doubt that we're being sort of forgotten in all this, and I fear that mentality is going to eventually come back and punish us," Joe Russell, executive director of the Ohio Council for Home Care and Hospice, told the Washington Post.

6. Health care workers' child care crisis

State and local governments are working to help medical workers and emergency responders fighting against the coronavirus outbreak who no longer have child care and day care centers for their children, AP reports.

By the numbers: 4.6 million health care workers are parents of children under the age of 14, according to the Center for American Progress.

  • About 15% of health care workers have children but don't have another family member to provide child care when schools close, possibly keeping some from going to work, a separate analysis shows.

Some state governors have allowed some child care centers to stay open for essential workers like employees in health care, Axios' Marisa Fernandez writes.

  • The New York City schools chief called for staffers to volunteer at emergency child care centers, per AP.
  • In Washington, D.C., six emergency child care centers were opened in late March to help children of health care workers, the Washington Post reports.

Other institutions and fellow nurses and doctors have created networks to take care of their colleagues' children in states with no other options.

  • Hedge fund billionaire Ray Dalio pledged $3 million toward care for the children of hospital workers in Connecticut.
  • Students at universities created contact sheets of people willing to provide care for clinicians' children whose child care services were shut down by the coronavirus, The Atlantic reports.

7. Readers' stories from Axios Vitals

So many of you shared your personal stories about the health care workers you know. Thank you again.

A small sampling:

  • "Our daughter, Kaelan, is a pediatric ENT surgeon who lives in McLean, Virginia. Every day she is struggling with the conflict between treating her patients, any or all of whom could have COVID-19, and her responsibilities to her husband and two young daughters aged 5 and 3. She is deeply affected by the shortages of masks and gloves and is reusing product that she would normally discard."
  • "My wife, Kathleen, has been a nurse for nearly 40 years. We live in Huntingtown, Maryland. As a Nursing Administrator for a hospital in Silver Spring, Maryland, she, like her colleagues around the world, are overwhelmed daily. Despite the fact that she could retire at any time, because she feels a sense of ethical duty to her staff she bravely goes to work daily."
  • "Mitch is an ER RN at John Peter Smith Hospital in Fort Worth, Texas ... Mitch is a father of two children, one of which was born with a heart condition. Because of the obvious inherent risks to his child, his two children and wife have moved into her mother's house for the foreseeable future."
  • "My friend, Jacky, is a medical resident living in the Bronx who is working with COVID patients. She is selflessly helping others in a country she’s only been in for a year as she's from Argentina."
  • "My mom ... is a nurse (RN) working at two different hospitals on Long Island .... My mom's a hero because she's been dealing with that, showing up, and caring for people every day in the worst possible circumstances. When I shared your request with my mom this morning, she responded, 'Every healthcare worker who shows up for work is a hero. There's no one more heroic than the other. We're all in it.'"

To all the health care workers out there — thank you. We couldn't do this without you.

Reader note: This article first appeared as a special edition of Axios Vitals, our health care newsletter. Sign up here.

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