"a high number of number of people who came in coding [receiving CPR] and died", "hospitals are already at or above capacity on a frequent basis", "moments that are quieter than I’ve ever seen", a lack of personal protective equipment, an emergency department nurse in Oregon, “This is the policy on masks: take one mask and use it all day”, HARD CRACKERS: Chronicles of Everyday Life, medical care for profit, Mental Health, neglected people, nosocomial infection
Source: HARD CRACKERS
“An Incredible Catch-22”: An Emergency Nurse Discusses the COVID-19 Crisis
HC Editor — April 4, 2020 Leave a Comment
HC: Tell us what you do for work.
I am an emergency department nurse in Oregon.
HC: What was your workplace like before the Coronavirus?
Nursing in an emergency department is partly mental health for people who are neglected in every other way. Although we don’t really have resources to help people who are dealing with addiction, homelessness, and mental health issues, we’re one of the only places in society that can’t say no to somebody when they come for help. So a big portion of it is dealing – very poorly – with homelessness, meth, mental health issues. A smaller portion is dealing with people who are very sick, have traumatic accidents, heart attacks, and are at risk of dying. On some days that portion is higher than others. We also take care of people who don’t have other access to a doctor. Even if they have Obamacare, Medicare, or Medicaid, since it’s not profitable enough, doctors won’t take their insurance. So a decent segment of our work is providing primary care.
HC: When did the Coronavirus show up in your workplace?
We know now that in late January, at least, there were cases showing up in the Northwest region, despite the fact that by all appearances the Center for Disease Control (CDC) went out of their way to cover it up. There was a lab in Washington that started digging up cases and was told to stop looking. Where I’m located it’s been a few weeks or a month, at least, we’ve been seeing a decent number of otherwise inexplicable viral pneumonias that are making people sicker than you would expect, including young people. However, our official counts have been very low, because in the beginning we didn’t have tests, and even now our testing capacity is incredibly low relative to the amount of cases. There’s stringent standards around who can get tested: if you’re not getting admitted to the Critical Care Unit for possible COVID, you don’t get tested. Even with the critical patients that have been admitted and tested, we have a low rate of positives, leaving us wondering if it’s not a very sensitive test, or if there’s another viral illness that happens to be coinciding with this one.
HC: Have you seen an uptick in cases recently?
When we began seeing cases the federal government was basically saying “this isn’t happening.” Our Democratic state government was hemming and hawing and acting like it wasn’t happening as well. And when the federal government finally stepped up and admitted it was happening, so did the state and local governments. The interesting thing is that since the “shelter in place” order has been imposed, the emergency department is still busy but has these moments that are quieter than I’ve ever seen them in my many years of doing this job. People aren’t coming in for small things. The other thing that’s creating is, the last day that I worked we had a high number of number of people who came in coding [receiving CPR] and died – a high number in a short period of time relative to normal. We don’t know – was it COVID? It very well could have been. The thing with COVID is when they head south, they head south very quickly. They could be sitting up talking with you and an hour later they could be intubated, fighting for their life. But we’re not testing dead people for COVID, because we don’t have enough tests. So they’re not COVID deaths, at least by the statistics. Or are they people who were terrified to come in because of COVID and had something wrong with them, but they waited and waited? We don’t know.
HC: Have any of your coworkers contracted COVID?
Well, we don’t know – one of the interesting things about the fact we still don’t have tests! We see plenty of patients who could, but if they’re not getting admitted to the hospital they’re not getting tested. Plenty of us have had some sort of viral illness over the past month. One coworker who took care of somebody with all the clinical indicators of Coronavirus got sick shortly after taking care of him. Management said: “It’s not work-related, and it’s not Coronavirus because you don’t have a positive test from another person to show us.” Despite the fact that she was sick enough that she had to come into the emergency unit and the doctors said: “We need to test you for Coronavirus,” but because of the state standards around who can get tested, because of the shortage of the tests, she couldn’t get tested. So there’s an incredible catch-22, where she doesn’t get paid for her time off, she has to use her sick leave because it’s not work related because it’s not COVID, and it’s not COVID because she can’t get tested to prove that it is COVID. It gets even better: when she asks our hospital “I’m feeling better but I still have symptoms, when should I come back to work?” They say: “We need you, come back to work because you don’t have COVID.” And that is in an environment where we do not have enough masks, either to protect patients from us or to protect ourselves from patients.
HC: Besides the tests, what else are you running short on?
Right now we have equipment: masks and gear. I think it’s likely that COVID is spread by droplets, so in most situations a surgical mask and a gown could be decent protection. However everywhere in Europe that’s being nailed by it, they’re using much more intensive precautions. They’re in full Tyvek suits and respirators. Here, with each week that goes by, the CDC has whittled back its recommendations for reasonable precautions. Now they’re saying: if it’s what you got, bring your own bandana from home.
HC: That’s coming from the CDC?
That’s actually coming from the CDC: if you don’t have anything else, bring your own scarf or bandana from home.
HC: Just mask up and come on in!
Yeah, which is funny because in our state just a month ago they were trying to outlaw wearing masks at political demonstrations. Now they’re telling healthcare workers and homeless people to wear bandanas when they go out!
Where I work we currently have surgical masks and a limited amount of respirators to use when we’re doing something with a high risk of contamination. For the moment it’s enough, but with the numbers we’re seeing, we’re projected to burn through the masks in a short period of time and nobody will tell us how many we have. There’s an awful dynamic, where we come in in the morning and somebody in management says “This is the policy on masks: take one mask and use it all day” – definitely not a good containment procedure but also what the CDC is recommending now. So that’s the policy we hear in the morning, but I was at the nurses station the other day and one of the high ranking officials was talking to nurses and said: “What are you doing? You can’t do that! We are not reusing masks.” This led to an entertaining back-and-forth between the nurses and the administrator that ended when the high-ranking administrator sulked away and said: “Let me go get your manager.”
HC: So he hadn’t gotten the memo about how things were being done on the floor?
Yeah, it’s the difference between somebody who sits in an office all day and counts pennies trying to figure out how to streamline and “lean” the hospital, and what’s happening in reality. So then the message becomes: if you think somebody is at risk of having this infectious and dangerous disease, wear a mask, don’t reuse it, we know that we’ll probably run out at some point, we’ll figure out what to do then, but don’t waste it with somebody who you think doesn’t have the illness.
The problem is we’ve implemented these strict lockdown policies across society to stop the rate of infection. Some of the data coming out is arguing a large number, if not the majority of cases is asymptomatic, and a large number, if not the majority of transmissions are asymptomatic. What this means is if you come in with a stubbed toe, I sit down and look at your toe, you breathe in my face, you cough, or you sneeze – turns out you have COVID, but you have no idea because you’re young, healthy, and asymptomatic. Now I have COVID, and I’m going to spend all day going into the rooms of healthy people spreading COVID because I don’t have protective equipment. During the H1N1 crisis years ago, the policy was every time you go into a room you wear a mask, because you don’t know who has it and you don’t want to spread it.
Now we have a situation where maybe the mitigation strategies will work and be helpful, however there’s a chance healthcare facilities will be a key focal point where it continues to spread. That’s where people are still coming together, you have a high concentration of the illness, and there isn’t the proper equipment to successfully mitigate that. So we have masks now, but we’re told we’re probably going to run out. But we get conflicting messages from leadership, depending on who you’re talking to. Those of us on the floor have differing ideas among us about what the best decisions will be, but we have good ideas about how to keep ourselves and the community safe, which differ from the policies being decided up above.
HC: And ultimately, it will be the folks trenches who will make those final decisions.
This is what we have to do. It’s not ideal. There’s a risk for contamination doing things like reusing masks, but we’re balancing it against the risk of what happens if we don’t.
HC: Right. We’ve seen a lot of folks, in places COVID hasn’t taken off yet, express skepticism about how serious the pandemic is. What do you have to say to those people?
What we’ve seen with the federal government’s response is a “pay now or pay later – with interest” situation. When we look at what’s happening in Europe, where they implemented drastic measures relatively soon and still far exceeded their capacity to care for people, it really doesn’t bode well. I’ve seen different models. Some are pretty optimistic, and say we won’t exceed capacity. But I regularly poll doctors and nurses I work with, and I would say the vast majority do not feel confident about those optimistic projections which say we could avoid a catastrophe on some scale.
HC: We realize you can’t see into the future, but what could that look like if a hospital like yours exceeds capacity?
It’s a common thing, without this massive emergency, that hospitals are already at or above capacity on a frequent basis. That’s not happening right now because they’ve shut down all non-essential procedures, elective surgeries and other procedures, and have done everything they can do to clear the hospitals out to be ready for this. But at some point the people who have been waiting to come in because they don’t want to get exposed, whether it’s COVID or some other disease, are going to get sick enough that they’ll have to come in and our numbers will rise. And the longer they wait, the more likely it’s critical. There’s a very real risk we’ll not have enough places for people. In the worst case scenario, we see people in Italy having to make a decision about who gets a ventilator, and that decision is based on survivability and how many years are left in your life. And if we reach that level of overload, and you come in with a heart attack, there will be less resources to help save your life as well. I don’t know what will happen, but even the better-case scenarios don’t look very good. It’s a question of how bad it’s going to be.
HC: A lot of folks are not comfortable staying inside and want to be out organizing, engaging in mutual aid, helping vulnerable people, and building ties of communal solidarity. How should people balance these activities with the need to maintain “social distancing” and not spread COVID further?
That’s a difficult question and I don’t think there are easy rights and wrongs. There are ways mutual aid can be done more responsibly, whether its meetings conducted electronically, or when possible, allowing supplies to age for three days, and when you have to get together, to wear masks, use hand sanitizer, and stay six feet apart. It is a distinct reality that the more social distancing is respected and employed, the better we’re going to do at flattening that curve. But another thing that needs to be considered is we’re entirely missing out on what they call suppression, where you do mass testing of the population, you track cases and their contacts, you isolate them and stop the spread that way. If you look at data from different countries, places that have done that effectively and early on have actually been able to keep their spread rates down without having to do as much of the shutdowns and social distancing. That’s not happening in the United States.
HC: This does not paint an optimistic picture for how COVID will play out in the US.
We’ll only know over time – maybe there are different factors, such as geographical dispersion. We have no idea what our seed rates were when we began to implement these measures because we had no testing. Maybe in some regions we’ll get lucky. What optimism I have of that is cautious, and I think more than anything, just wanting it to be true.
HC: Is there anything you’d like to emphasize to the folks reading this?
I hope that this manages to offer some clarity on what happens with a political and economic system that’s organized around profits and money when the shit hits the fan, and that that it creates openings for the legitimacy and validity of other ways to organize ourselves. This is a moment when the bankruptcy of official institutions is really clear. And when those institutions are failing to respond and don’t have a plan, everyday people begin to devise their own solutions, and often those solutions are better than the ones that come from the top. I was talking to a coworker who also works at another hospital where they were shutting down all their elective surgeries and non-essential procedures. There was a whole unit of nurses, anesthetists, and other staff who suddenly didn’t have work to do, and were looking at being laid off. So they came to management and said: “Between us, we have people who have critical care experience, and we have one ventilator in this unit. We’re ready to go out on the emergency department floor and start training now, so we’re ready when it hits.” To me that’s a great example. Of course, the response from leadership was: “We’re working on a plan, that’s not the plan right now, we’ll let you know.”
Over the next days and weeks we hope to continue publishing stories about daily life amid the Coronavirus. We are looking for testimonials from everyday people about workplace safety, unemployment and housing issues, struggles with paying bills and taking care of their loved ones as well as any acts of solidarity and collective action in these very difficult times. We want to hear from you! If you have a story that you want to share with us, please email the editor at firstname.lastname@example.org.