The Health 202: Here are the stories of medical professionals being upended by coronavirus fight

THE PROGNOSIS

We asked, and you responded. Today, we’re sharing thoughts from medical professionals around the country caring for patients with — and without — the disease covid-19. 

The doctors, nurses and specialists we spoke to described mask shortages, the postponing of all sorts of medical procedures and the constant pressure to keep all except the most seriously ill patients out of overburdened emergency departments. Here’s what they told us.

Joan Chartier, a respiratory therapist in Minneapolis (above right in a picture she provided us)

Chartier says WestHealth, the urgent-care clinic where she works, is seeing about one covid-19 patient per shift. She’s most concerned about the rationing of protective masks and a lack of training among nurses in using ventilators.

How many covid-19 patients have you cared for so far?

“There have probably been four since last Thursday that have gotten transferred to the main hospital we’re affiliated with. They’ve all been male, all overweight, all have diabetes, all have been smokers.”

What have you observed about these patients?

“They tend to crash quickly. They’ll walk in, we’ll get them back to a room, put them on oxygen and they tend to decompensate pretty quickly.”

How often do you change your N95 face mask?

“Apparently people were going through them too quickly to suit management. All the N95s got moved into the manager’s office and locked up.

“Sometimes after several days they fall apart, they’re not sealing well, or the elastic straps have broken and we’ve been told to staple them back on. The charge nurse has a notebook and writes down who got one, the date and the reason, like we’re 12 years old.”

Who are you testing for the coronavirus?

“We’re only testing people that are in congregant facilities like nursing homes or health-care workers or if they’re sick enough to be transferred to the hospital. It was up to provider discretion before, maybe a week or two ago. We just don’t have enough tests. One of the nurses at work told me she’d been tested 14 days ago and hadn’t received a result.”

Is there anything you want readers to know?

“Everyone is talking about ventilators. Nurses don’t know how to run ventilators. Every time I work, the manager will say go show the nurses again how to run this. If I’m not there for some reason and we’re not fully staffed with respiratory therapists, they kind of have to fend for themselves.

“You can have as many ventilators as you need, but if you don’t have people who know how to run them, you’re sunk.”

Are you worried about contracting the virus while at work?

“I’m over 60, so that’s not good. I’ve had breast cancer in the past, so that’s a little ding there. I really try not to worry about it, although I would say the anxiety is a lot higher than normal.”

George Diaz, specialist in Infectious Diseases in Everett, Wash.

Diaz treated the first covid-19 patient in the U.S., who was admitted to Providence Regional Medical Center on Jan. 20.

Are cases still rising at your hospital?

“We’ve probably over the past 10 days now have had a fairly flat number of folks in the hospital with covid-19, around 50 or so. It hasn’t declined yet but it hasn’t risen.”

How are your supplies of PPE and ventilators?

“Thankfully, we’re part of a large health system and the PPE is generally acquired at a system level and distributed to those that have the most need. My hospital used more PPE in the first two months of this outbreak than the entire health system used in the prior year.”

“At this point the ventilator supply seems to be okay. Of all the ventilators in the hospital, about half are currently in use.”

How often do you change your mask?

“It sort of depends on what you’re doing. One of the things we’re doing is trying to really limit the number of people who enter the room of a patient with covid. Sometimes physicians can do the patient history from outside the room. All the rooms have windows and telephones so they can connect with the patient remotely. That reduces exposure and need for PPE.”

How many hours are you working a week?

“I would imagine probably 70 hours a week. It was probably 50-55 hours before covid. When I’m working clinically, patient care is about 16 hours a day and the days I’m not working clinically I have mostly administrative meetings related on covid stuff, like clinical trials.”

Are covid-19 patients different than other influenza patients?

“When we had the swine flu epidemic 10 years ago, we weren’t seeing the volume of patients coming into the hospital with severe infections like we see now. We don’t typically see people under 60 becoming really ill and requiring a ventilators and it’s much more common with covid than we see with seasonal flu.”

Devyani Chowdhury, an independently practicing pediatric cardiologist in Lancaster, Pa.

Chowdhury, who is conducting most appointments via telehealth, says she is urging parents of her patients to schedule important heart surgeries as soon as possible, because she fears it will soon be difficult once area hospitals are caring for more covid-19 patients.

How have things changed at your practice since the pandemic?

“I have converted all my appointments to telehealth, pretty much, but I see any concerns, I bring the patients into the office. I saw a couple post-op patients, a couple babies yesterday. Two of my patients need open-heart surgery, and we are juggling that as pediatric specialists because everything is about covid-19 right now, but these children need to be taken care of.”

How do hospitals decide which surgeries to do and which to delay?

“The thing is for our medical community this is new criteria: who are we going to operate on? Right now, we are kind of going with the directive that any child who is symptomatic from their heart problems should be operated on, and any babies with heart problems.”

“Right now we are expecting this big peak to hit PA, so I’m actually pushing my patients who need surgery right now to go in and get it done. You have a window right now. If you get caught in that [peak] you are not going to be given that same priority.”

Do you have PPE?

“I don’t; my regular vendors don’t have anything. I have approached all the local legislators in my area, I was just on the phone with [Rep.] Scott Perry’s office, I have filed out the form that goes to FEMA; pretty much it’s been a closed door everywhere.

“I happen to be doing a call with one of my telehealth patients whose father is a pastor. In the call it came through that he was given a box of N95s through some distribution center in Harrisburg, so he met me at the office and gave them to me the night before I had to see these babies. There is some divine-intervention-type stuff happening here.”

Have you been affected financially?

“My appointments are down; I can’t do echocardiograms … I’m only doing urgent testing, which needs to be done. Right this minute I’m getting reimbursements from last month, but in two weeks I won’t have that revenue.”

Charles Gebhardt, a general practitioner in Albany, Ga.

Gebhardt works in Dougherty County, a rural community of 90,000 people that has become Georgia’s hot spot for coronavirus infections and deaths. When a telehealth visit doesn’t suffice, he and his colleagues have started conducting exams and treatments while patients stay in their cars.

What’s it like there?

“The problem we have our community is very high proportion are people who are infected or in contact with people infected. Probably 80 percent of our patients are in one of those categories, so we can’t really let them into the office. We’re trying to do everything over the phone or over the Internet, except for when people need to come in to have blood draws or blood pressure checks.”

Do you have any stories from your practice to share?

“Let me give you a story of a patient who went to one of the local funerals and was in contact with someone sick. She then went to work, then needed to go to the court system to apply for a license. Then she went to a local church that weekend for services, and she went to a party. She went to visit someone in a nursing home, and when she got home she started to feel sick.

“She went to the emergency room and she died in the hospital that evening. She tested positive for covid-19. She had exposed probably 500 other people. That’s why all of a sudden just about the entire population of Albany has been exposed.”

Has your practice’s income dropped?

“Our reimbursement is down by 75 percent or more. All the services we’re providing right now are either unreimbursed or minimally reimbursed. Half our staff is on the phone constantly talking to someone relative to the coronavirus anxieties or how to get the services they need despite the lack of availability. All that is unreimbursed, almost all of it.”

How is all this affecting care for non-covid patients?

“Say a patient calls with abdominal pain. I can’t safely bring that patient into the office and examine their abdomen. I don’t feel like I can safely send them to the ER unless I’m convinced it’s a really serious problem. So it’s that kind of problem, multiplied by 50, for all kinds of conditions.”

The vast majority of Americans are now taking seriously the pleas from public health officials to limit interactions with others.

— Ninety-two percent of Americans say they’re now practicing some form of social distancing, such as canceling travel plans and avoiding large gatherings, according to new polling from the Kaiser Family Foundation. That’s up from 59 percent two weeks ago. 

— And 75 percent say they are staying home instead of going to work, school, or other regular activities — roughly triple the share who said that two weeks ago. Eighty-two percent of Americans said they’re sheltering in place, not leaving their homes except to buy food or receive medical care.

The poll also illustrates the catastrophic economic and mental health effects reaching into virtually every corner of society.

— Four in 10 said they’ve lost a job or income because of the crisis. That includes 54 percent of part-time workers and 45 percent of workers paid hourly or by the job.

— One-third said they’ve been unable to get needed care for medical conditions other than covid-19. Nearly a quarter said they’ve been unable to get prescription medications.

— Forty-five percent said the pandemic has impacted their mental health, and 19 percent say there’s been a “major impact.” Mental health experts say that’s normal in a situation like this, our colleague Joel Achenbach reports.

AHH, OOF and OUCH

AHH: The Trump administration is poised to call on Americans to wear masks in public. 

The White House coronavirus task force has been weighing a recommendation that people wear DIY cloth masks to prevent the spread of the virus, in part because of growing evidence people who are infected but don’t have symptoms can spread the virus, our colleagues Lena H. Sun and Josh Dawsey report. 

The masks are meant to prevent transmission by those out buying groceries, or out for a walk, and who may not realize they are infected because they are asymptomatic. It protects others from the person wearing the mask but is not meant to protect the wearer. 

New guidance provided to the White House and obtained by our colleagues notes the face covers should not be used by children under the age of 2 or by anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the cover without assistance.

— At yesterday’s task force briefing, White House coronavirus response coordinator Deborah Birx cautioned against allowing face coverings to provide a false sense of security. 

She said the “most important thing is the social distancing and washing your hands.” 

“Her words came as some state and local leaders have begun to issue their own guidance on face coverings — urging their use while grocery shopping, for example — while warning similarly against a false sense of security or taking much-needed medical-grade masks from health-care workers,” Lena, Josh and Hannah Knowles report. 

For example, California Gov. Gavin Newsom (D) said at a news conference: “If individuals want to have face coverings that is a good thing and a preferable thing in addition to the physical distancing.” 

— Not the crafty type but need to make your own mask? The Los Angeles Times’s Lisa Boone has instructions here on how to make your own face mask, including a no-sew option, with tips from doctors and craft stores. 

— In a private meeting in March, executives of manufacturing giant 3M told Vice President Pence they were concerned that allowing medical workers to use its industrial masks could put the company at risk for lawsuits. 

Chief executive Michael Roman said the “lack of a liability waiver from Congress — a protection the industry has sought for years — would hinder full distribution of the gear,” The Post’s Jeanne Whalen, Rosalind S. Helderman and Tom Hamburger report. 

“The liability issue, which set off a scramble by Pence’s aides, was one of a number of roadblocks that delayed the distribution of a basic protective item desperately needed to stem the spread of the virus,” they write. “The confluence of a slow initial response by the Trump administration, its wariness of compelling the industry to produce gear and a long-running debate about granting manufacturers legal protection in a health emergency contributed to a critical shortage of masks to front-line workers, according to an examination by The Washington Post of the early weeks of the crisis.”

The lack of masks for medical workers in the United States, even after the public health crisis spread abroad, has become a symbol of the broader failure in the country to properly prepare for when the coronavirus hit.

— Trump yesterday said he would invoke the Defense Production Act to force 3M to provide more N95 masks for use by medical workers. “We just signed an element of the act against 3M, and hopefully they’ll be able to do what they are supposed to do,” Trump said.

— More than a million masks were on their way to New York hospitals yesterday thanks to help from New England Patriots owner Robert Kraft, who helped arrange the use of the team’s plane. “The initial shipment of approximately 1.2 million masks is scheduled to arrive Thursday afternoon in Boston from China and is being carried by the Patriots’ team plane,” our colleague Mark Maske reports, adding that more than 1.7 million total masks will be delivered. 

“… The Kraft family is paying $2 million of the approximately $4 million cost of the masks. Kraft and his son, Patriots executive Jonathan Kraft, teamed with the state to purchase 1.4 million masks for Massachusetts. Robert Kraft also purchased 300,000 masks for New York.”

— New York and New Jersey will also get deliveries of hundreds of thousands of medical supplies that were seized by the government by anyone hoarding products

“The FBI located the supplies on March 30, as part of its work under the department’s Covid-19 hoarding and price gouging task force, which was announced last week,” Politico’s Myah Ward reports. “… Along with the N95 respirator masks, the FBI also discovered 598,000 medical gloves, 130,000 surgical masks and other supplies like gowns, disinfectant towels, hand sanitizers and disinfectant sprays, materials the Justice Department said are being distributed to states.” 

OOF: What is like to be a garbage collector, a doula, an unemployment call taker or a carpenter for 24 hours in the District of Columbia during this global pandemic? 

A team of 21 of our Post reporter and photographer colleagues chronicled the days of numerous people whose lives have been upended by the coronavirus crisis. 

At 6 a.m. one morning, a group of men and women who collect trash in Washington met sprawled across a parking lot. They learned one of the members of their ranks had tested positive for the coronavirus. One man exclaimed that hours earlier, he learned that his only child had died of the coronavirus in a Detroit hospital. 

A couple ready to give birth at George Washington University Hospital texted their doula, who was awake an hour away, sending updates. 

Those who work at the District’s Department of Employment Services call center say they’re getting more than 500 calls an hour. Corrine Jones said she reminded her employees to take a deep breath before picking up the phone again. In one day, 5,336 people had filed new claims. 

OUCH: House Speaker Nancy Pelosi (D-Calif.) announced the creation of new House select committee with subpoena powers to assess the Trump administration’s response to the pandemic. 

“Pelosi’s announcement comes amid growing clashes between congressional Democrats and the Trump administration about oversight of the new rescue legislation and a $500 billion fund controlled by the Treasury Department,” our Post colleagues Erica Werner and Paul Kane report. “President Trump has to appoint a new inspector general to oversee that fund but has already signaled opposition to the scope of that person’s mandate.”

The select committee will be chaired by Rep. James E. Clyburn (D-S.C.). 

“Where there’s money, there’s also frequently mischief,” Pelosi (D-Calif.) said as she announced the panel. 

— Democrats have officially delayed their presidential nominating convention that was supposed to be in July. 

The party’s convention is now set for the week of Aug. 17 in an attempt to still hold it as an in-person gathering, our Post colleagues Michael Scherer and Annie Linskey report. 

Still, the Republican convention in Charlotte that’s set for Aug. 24 is reportedly still going forward. 

“Trump said last week that there was ‘no way’ his convention would be canceled, and [Republican National Committee Chairwoman Ronna McDaniel] said that planning for a ‘full seated’ convention was moving ‘full steam ahead,’ ” they write. 

— The still-operating Bernie Sanders campaign is grappling with how to proceed in this new reality. 

“Now though, as the novel coronavirus ravages the country, Sanders’s staffers and organizers have found themselves stuck in their homes, unable to hold the sunshine-splashed, concertlike events that have become a staple of the campaign,” our Post colleague Chelsea Janes reports. “Instead, they’re reduced to connecting to people over Zoom, erasing a major advantage they had over former vice president Joe Biden — an ability to fill communities with volunteers and have thousands of conversations about their candidate.”

— Other news to know: 

The Trump administration’s response: 

  • The White House announced Trump took a second coronavirus test and again tested negative. “This was the new rapid test that is administered in about a minute and produces the results in about 15 minutes,” The Post’s Colby Itkowitz reports. “It wasn’t clear exactly why Trump took the test; he suggested there wasn’t immediate concern, but that he took it just to try it out.”
  • Vice President Pence announced the administration is considering using some of the $100 billion allocated for hospitals in the coronavirus stimulus measure to cover coronavirus treatment costs for the uninsured, The Post’s Samantha Pell writes.“We don’t want any American to worry about the cost of getting a test or the cost of getting treatment,” Pence said. “We’ve expanded coverage through Medicaid, we’ve expanded coverage through Medicare.”

On the front lines: 

  • The Navy hospital ship USNS Comfort was supposed to help New York deal with its crisis with its 1,000 beds. But only 20 patients have been transferred to the vessel, the New York Times’s Michael Schwirtz reports. And Michael Dowling, the head of Northwell Health, New York’s largest hospital system, said: “If I’m blunt about it, it’s a joke.”
  • Researchers at the University of Pittsburgh School of Medicine report initial success in animal trials for a coronavirus vaccine, CNHI News Service’s Eric Poole reports.

In the states: 

  • A Washington state nursing home tied to dozens of covid-19 deaths faces a $611,000 fine if it does not address numerous deficiencies that led to he nation’s first major coronavirus outbreak, The Post’s Maria Sachetti and Jon Swaine report.
  • Georgia Gov. Brian Kemp (R) issued a stay-at-home order and said it was in part because he had just learned the virus can be transmitted by those who are asymptomatic, The Post’s Aaron Blake reports.
  • While a growing number of states and cities are restricting movement and issuing such orders, some “government and private-sector leaders across a large swath of the country remain defiant that the devastation unfolding in New York and other seemingly faraway cities should not curtail life in their own communities,” our Post colleagues Chelsea and Isaac Stanley-Becker report.

The hardest hit: 

  • Poorer communities in New York have been more affected, even while wealthy cities have had more coronavirus cases, The Post’s Philip Bump reports.
  • Numerous lawmakers, led by Rep. Ayanna Pressley (D-Mass.) and Sen. Elizabeth Warren (D-Mass.), are calling on the government to change how it’s collecting data about coronavirus patients, worried there’s not enough information showing how people of color and those from low-income communities could be disproportionately harmed by the pandemic, our colleague Eugene Scott reports.

SUGAR RUSH

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