Early in the pandemic outbreak, a nurse at a New Orleans-area hospital witnessed the surge — “an explosion of cases” that seemed to overwhelm the emergency room — and then she witnessed something else. Hospital staff were getting sick.
The nurse has been instructed by her employer not to speak to the media, so she’s not being named to protect her identity.
She herself fell ill with COVID-like symptoms — shortness of breath and a high fever — but eventually tested negative. At one point, she estimates, 25 percent of her unit was out with COVID-19 symptoms. Not all have survived.
“We have lost a co-worker, and several co-workers have been extremely ill and out of work for several weeks with positive infections,” she said.
There have been reports of other deaths, including a nurse named Larrice Anderson who worked at the New Orleans East Hospital.
Months into the pandemic, exactly how many Louisiana health care workers have been made ill or have died from COVID-19 remains unknown. That’s because the Department of Health isn’t tracking that data and health care facilities in the state are declining to make the information routinely public. At the nurse’s hospital, not even staff have been told how many of their colleagues are ill.
“Health care providers are dying because of their exposure to this disease,” she said. “So absolutely this information is important, to know how we're doing, how we're responding, how effective we are in managing this pandemic.”
Nationally, there have been reports of doctors writing their wills. Health care workers have been fired for raising the alarm about conditions in their workplaces, and one nurse has filed a whistleblower lawsuit.
There have been glimpses of the coronavirus’s spread at Louisiana hospitals. In late March, more than 300 employees of Ochsner Health Systems across the state were in quarantine, 50 of whom had tested positive for COVID-19. In early April, the U.S. Department of Veterans Affairs said 82 staff at its hospital in New Orleans tested positive — more than double the number at the VA hospital with the next highest number of cases.
Experts say the data is critical, but not all governments are tracking it.
It’s not clear why this kind of information isn’t being collected in Louisiana. Neither the health department nor Ochsner, Tulane or LCMC Health explained that decision for this reporting.
But other states have released such information, including Ohio, where in early April, one in five positive coronavirus cases were in a health care worker. Internationally, health care workers were 14 percent of cases in Spain. And in mid-April, the Centers for Disease Control and Prevention found more than 9,200 health care workers have been infected. That figure was likely an undercount, the CDC said, given that more than 80 percent of the records it surveyed did not indicate if the person was a health care worker.
Health experts, including at the CDC, have noted that it is critical to understand the impact on health care workers, not only for their own safety, but in order to ensure our ability to keep fighting this virus.
It could even provide context for why COVID-19 is infecting and killing more black people than any other group. Tanjala Purnell, an assistant professor of epidemiology at John Hopkins University and an associate director of the Center for Health Equity, said safety-net hospitals — those mandated to care for patients who are poor or uninsured — often lack the resources of other facilities in normal times.
“A lot of the health care workers at many of these types of facilities are often also reflective of the communities that they serve. So for example, a given safety-net hospital may have a disproportionate number of African American providers or other providers who are members of these same communities that are hardest hit by COVID-19,” she said.
Hospital employees such as certified nurse assistants and house-keeping and janitorial staff are often disproportionately people of color, she added.
Personal protective equipment supplies remain a big problem.
For the nurse, the question of why healthcare workers are getting sick has an obvious answer: They just don’t have enough of the right protective gear.
“Once the N95 respirator is used in a room where there is an infection, the belief prior to the pandemic was that mask is now infected and needs to be disposed of,” she said.
But standards have changed in the middle of the pandemic.
“We’re being asked to reuse the N95 respirator mask repeatedly for several days, among different patients, from room to room. And place them in a paper bag with our name on it, so that we can go back and get it another day or another time for another use.”
Personal protective equipment — including masks, gowns, bonnets and face shields — has been in dramatically short supply across the U.S. As a result, the CDC released guidelines designed to “stretch” their use.
“It is shocking, and it's very concerning because if we're not safe, patients aren't safe,” the nurse said.
In early April, Thea Ducrow, the executive director for the Louisiana State Nurses Association, sent out a survey to nurses to find out what they might need in a care package — maybe lotion or energy drinks, she thought.
“I was completely surprised,” she said.
The number one thing nurses wanted was more PPE.
“It was people that couldn't feel safe and they were worried,” she said. “They were worried about going home to their family. And they're worried about passing it on to their family. They're worried about it going from patient to patient.”
She ended up sending out 50,000 surgical masks, and 1,600 face shields across the state. Nurses are also worried that as the state begins to reopen in mid-May, the demand for PPE will only go up, she added.
For Dr. Richard Oberhelman, the chair of the Department of Global Community Health and Behavioral Sciences at the Tulane School of Public Health and Tropical Medicine, the completely new use of PPE is part of an unprecedented new public health crisis.
“I don't think we know the full impact,” he said.
It’s also uncharted territory for infection control. Hospital infection control units are designed to track infections and bacteria predominantly among patients, he said, not to protect the entire population in a hospital from a highly communicable disease.
Oberhelman said he hasn’t been a part of decisions about whether to release data on staff infection rates, but “it seems like something that be we should be tracking,” something that “really speaks to the point of the need for a good test for exposure and immunity.”
Testing, too, has been lacking.
Hospitals in Louisiana say they’ve been testing their staff since the start of the outbreak. At the Tulane Health System, staff are now being given rapid tests that provide results in minutes and are being monitored remotely by colleagues to check symptoms and temperatures. Ochsner has begun to provide antibody testing for all its staff, at the rate of about 3,000 tests a day.
The antibody test doesn’t predict immunity, but it does indicate who’s had the virus — a key metric as we begin to understand the vast numbers of people who may have contracted coronavirus but were asymptomatic.
At the nurse’s hospital, staff are only getting one coronavirus test.
“If you are tested once for COVID, that's it. That's all you get,” she said. “So you're either positive or negative. If you later have become symptomatic, again, they're not going to provide you with the second test.”
Staff that have no fever for 72 hours, regardless of whether they were positive or negative, are expected to return to work, she added.
“We didn’t sign up to die.”
Hospitals say they’ve been doing everything they can to boost their supplies of protective equipment. But the nurse working at a New Orleans hospital said the current situation just isn’t good enough.
In normal times, she’d go to a supply closet to get what she needs. But protective equipment is being held in a manager's office, where she can see it, but can’t get it without asking permission.
“So what are we saving it for?” she said. “There is no more urgent time than right Now, there is no more important nurse than the nurse who's going to work today to care for a patient in a hospital because of this pandemic.”
The pandemic has spurred an outpouring of gratitude for nurses, doctors and others staffing our hospitals. In March, Governor John Bel Edwards sent health care workers a special video message in which he praised their efforts and compared them to heros.
“My mother was a nurse, and through her I learned that not all heroes wear capes,” the governor said. “Some wear scrubs and lab coats just like you.”
But the nurse said praise can’t take the place of actually feeling safe at work.
“I love hearing that people think we're heroes, but we're basically doing the job that we're expected to do. We’re not soldiers,” she said. “We didn’t sign up to die.”
National nursing groups are calling for health care worker infection data to be released. Zenei Cortez, president of California Nurses Association and of National Nurses United, called it “the measure of success or failure of a response to this pandemic.”
Without it, she said, there will be no way to hold employers and governments accountable for the price paid by frontline workers tasked with saving the rest of us.
Correction: Due to a transcription error, an earlier version of this story contained an incorrect spelling of Tanjala Purnell's name. It has been corrected.
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