Good afternoon, and welcome to our latest Axios Deep Dive on the coronavirus pandemic and its impact on the nation.
🎂 Happy birthday to Florence Nightingale, who was born May 12, 1820; her birthday marks the end of annual National Nurses Week.
Illustration: Eniola Odetunde/Axios
In this special issue, my Axios colleagues dig into the trials and heroics of America's front-line health care workers.
I got the idea for this Deep Dive when I saw doctors and nurses — for the first time in any crisis — telling their own stories, in real time, with social posts, on cable TV, and even with essays, op-eds and online diaries.
I realized that front-line health care professionals usually escape our attention, and certainly our acclaim, until we have a forced personal encounter: a scary symptom ... a life-changing diagnosis ... an accident in the family. Doctors and nurses are suddenly the most important people in our life. We thank them, take them donuts, pray for them. And then, if we're lucky, we move on.
Why they matter ... Caitlin Owens, in a takeover issue last month of our health care newsletter, Axios Vitals, framed the medical professionals' valor:
MSNBC's Rachel Maddow has played a parade of videos of nurses just talking into their phones — often in their cars, before or after a shift — pleading with people to stay home and avoid becoming one of their patients.
My biggest fear — as I encourage my staff to come to work every day, and be compassionate and help people — ... is I'm going to lose one of them. And then I have to carry [that] on my shoulders, because I'm asking them to do a service that I realize is very hard...
I know they've got that pit in the middle of their stomach. And you get up and you come to work, and you think: "OK, is this the day?"
So please, work on the social distancing, please help people out, so the number of deaths that we have to endure are minimized as much as they can. That's my plea today. Thank you.
Thank YOU, Sharon — and all the Sharons across our sad land.
Sign up for Caitlin's Axios Vitals.
President Trump poses with nurse Amy Ford during a Rose Garden ceremony at the White House yesterday. Photo: Mandel Ngan/AFP via Getty Images
West Virginia nurse Amy Ford traveled to Brooklyn at the start of the pandemic to help treat coronavirus patients. She was honored yesterday at the White House.
I had to adapt to a new way of nursing — one where treatment was still unknown; one where families had to trust my word, and I had to prove that my word was trustworthy; one where I could only provide comfort by holding my patient's hand because I could no longer give comfort with numbers and statistics of success rates. Those were unavailable in the beginning.
I provided families comfort through FaceTime calls — holding my phone up to a patient's ear, hoping that, by hearing their loved one's voice, it would in turn give them comfort as well.
This experience has been one of the most emotionally challenging things that I've ever been through, but it has made me a better person in the end.
Illustration: Aïda Amer/Axios
In March and April, as the scope of the pandemic became known, there were dire warnings of a health care system crushed under the burden, driven by stories of overloaded hospitals in Italy as the pandemic peaked.
Why it matters: As states begin to experiment with reopening, there are chances virus hotspots could return, making it worthwhile to remember these past challenges.
Case in point: Projected shortages of ventilators had led health care workers and hospitals to plan for sharing ventilators, converting anesthesia machines, or even making in-the-moment decisions on which patients would get access to ventilators and which wouldn't.
The bottom line: Social distancing measures and stay-at-home orders helped avoid the worst in the initial phase of the outbreak.
Illustration: Aïda Amer/Axios
The coronavirus pandemic is a health care crisis, but health care still isn't immune from the rampant job losses the pandemic has wrought, Axios' Bob Herman reports.
By the numbers: The health care industry lost more than 1.4 million jobs in April.
The reason: These jobs have gone away because outpatient care has dried up, as providers postponed elective procedures.
What's next: Don't expect a quick return, even as elective procedures are able to come back online.
Go deeper: Health care's hiring boom may not help the coronavirus outbreak, since most new jobs are administrative.
Hashem Zikry had been working as a doctor for nine months.
Why it matters: At Elmhurst Dr. Zikry finds himself in the middle of a neighborhood with a large working-class population that was "hit earlier and harder by the pandemic than most of the rest of the city."
The tale vividly illustrates preparations for a deluge of patients, the struggles in treating patients who must be isolated from their families, and the relentless toll the virus can quickly exact.
When Zikry came on shift on the evening of March 21st, one of the COVID patients signed out to his team seemed not as sick as some of the others he’d seen. “He walked by the desk during sign-out,” Zikry told me. “He walked by again fifteen minutes later. Asked us where the bathroom was. He was walking — that’s a great sign. Talking — that’s a great sign. These are very reassuring things to a physician. I wrote down, ‘Ambulatory, Conversant.’”
A short time later, a hospital police officer approached Zikry to say that a man had collapsed in the bathroom. When Zikry reached him, the man had no pulse. He began chest compressions. “Nothing like this had ever happened to me,” Zikry said. “I had seen him walking minutes before.”
The man was taken on a stretcher to the critical-care area, where resuscitation equipment was on hand. Despite the efforts of Zikry and others, the patient died about fifteen minutes later. Zikry recalled turning back toward the rest of the E.R. He said, “We look back on this sea of, like, three hundred people that expected us to treat them immediately, to figure out what was wrong with them.” This was around 3:15 a.m.
Go deeper: A new doctor faces the coronavirus in Queens (The New Yorker has made all its coronavirus coverage free.)
Illustration: Sarah Grillo/Axios
It could be the pandemic's second curve in need of flattening — rising incidents of mental health issues or even post-traumatic stress disorder, among health care workers helping fight coronavirus.
Why it matters: Even before the pandemic, physicians had a rate of suicide twice as high as the general population.
Two examples of the toll in New York City:
Our thought bubble: Health care workers care and comfort us through this crisis, and in the long tail of its impact they'll likely need support, too.
Go deeper: The coming coronavirus mental health crisis
Illustration: Eniola Odetunde/Axios
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, Bob 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.
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.
The first panel of "The COVID-19 Playlist" comic. Courtesy of Dr. Grace Farris
Art made by health care workers offers a rare look — through very personal lenses — at how the fight against coronavirus is unfolding in hospitals.
Why it matters: These can be the best glimpses of what happens behind hospital doors because patient privacy issues make it difficult for journalists to capture what is happening on the front lines.
What they're saying: Dr. Grace Farris, a hospitalist at Mount Sinai and a cartoonist, published a comic on NPR's site showing how hospitals are using music to "sing patients home" when they were discharged.