New Orleans is the most severely affected U.S. city, per capita, by the Covid-19 pandemic. The disease has killed approximately 400 people in the metro area. Nurses there — like their counterparts across the United States and in many other countries — must treat coronavirus patients with inadequate personal protective equipment (PPE). In March, while working long shifts treating the surge of COVID patients, a nurse in New Orleans developed a fever. While she was placed on quarantine, her employer did not provide her with testing. In this interview, she talks about worsening conditions for her colleagues and for patients. To protect her from potential retaliation at her workplace, we are not publishing her name.
Tell us about what happened in New Orleans in March.
I work in the acute care hospital. At first we got some patients with flu-like symptoms. They’d get sent home on Tamiflu whether they were positive or negative on the flu test. But then we saw a lot of cases of pneumonia — a kind that we know now is pretty definitive with Covid. We started to discover that we had cases of the coronavirus here. But this was very difficult to identify because there were no tests in the United States at first. Our first few cases took over a week from swab to results. Swabs were sent to the Mayo Clinic [in Minnesota], and then they were overwhelmed, so they were sent to the University of Washington [in Seattle]. They’d be overwhelmed and send them back. We had a huge backlog of tests. But as we had to wait up to eight days for tests and keep those patients isolated, PPE was seriously wasted. Every negative test involved one week, 24 hours a day, of someone going in and out using PPE. It went from a few cases on each floor to Covid patients quickly filling up whole wards. There is no separate unit, like nurses in other cities have told me about. All of our floors in all of our hospitals are mostly Covid patients.
How has your hospital gotten enough employees on the floor to treat the sudden influx of people with Covid-19?
I think comparatively my hospital has handled it to the best of their ability. In the first days they announced if you picked up extra shifts, they would give you a bonus. Then it was an hourly bonus for your regular shifts too. Some hospitals here have zero incentive to work overtime, zero hazard pay. It was a great incentive for us, but the workload greatly increased overnight when we started seeing Covid. For the first week it meant the nurses were assigned to do the work of four or five different groups of staff. Even doctors spoke with patients through the door or over telehealth computers. One hundred percent of the risk was given to the nurses.
One New Orleans nurse who spoke to the press reported that staffing at their hospital was as low as one nurse for every six patients with Covid-19.
We have always been 6:1 with one or more discharges and admission, so seven or eight patients a day total. Five to one was a good day pre-coronavirus. The supposed national “ideal” is 4:1 in acute care and 2:1 in ICU. But California is the only state with a ratio set by law. Having the same ratio before this pandemic and during the pandemic when we had to take on huge additional work and get into sterile gowns before entering each patient room essentially means our workload was doubled.
The understaffing and overwork is the main problem in hospitals. And it’s why I have decided to leave the bedside in acute care, because it was too much to handle during the day, with everything they expect us to do. Health care is so task oriented. Medications scattered three, four, five times per shift for six patients. Full head-to-toe assessments for each one. Hourly rounding. Care plans. Trying to actually read the chart and see the overall picture of the hospital course. Every day is full throttle from the moment you walk into the door to the moment you leave, and that’s if nothing goes wrong. I don’t know how nurses keep up this pace day in and day out.
Many nurses do this for decades, working back-to-back shifts five or six days a week. They are awe inspiring to me, but I wonder what is the physical and mental cost? A good portion of my chronic back pain patients are health care workers. Health care workers are more prone to depression and substance abuse. It’s not a coincidence. It’s the job — the culture. Setting aside your personal needs is a common mind-set. It’s Stockholm syndrome in scrubs.
What PPE do health care workers need to be as protected as possible, and what do you have?
Well, we need the same thing the CDC wears during their drive-through tests. I’ve seen photos where they wear the full white suits with the hoods, N95 masks underneath, and so on at their drive-through testing sites. Why do other people get those things and we don’t? Government guidelines of what is safe PPE are now given based on the availability of supply, not fact. Of course, it’s not a priority for the people in charge who aren’t going into the room.
When did you realize you were getting sick?
I started to have headaches and dizziness, which I chalked up to having to wear full PPE 12 hours a day and stress or anxiety. It can be very restricting and hot, causes nausea, makes it difficult to see through the face shields. But one day I showed up and had an elevated temperature at the entrance check. I wanted to cry thinking of the extra workload my coworkers were going to have with me out. I only had a fever for one day but missed almost two weeks of work due to quarantine policy and the delay in my testing. Because it was not provided to me for days by my hospital, I went and got the test (eventually returned negative) on my own at another provider.
Massive travel and crowds for Mardi Gras on February 25 presumably contributed to the explosion of the virus in New Orleans. The mayor has claimed she would have canceled Mardi Gras if the federal government had warned her about the danger. Two days later, on February 27, the head of the Senate Intelligence Committee, Richard Burr, spoke to a closed meeting of businessmen from his home state. He told them the coronavirus was “much more aggressive in its transmission than anything we have seen in recent history. It is probably more akin to the 1918 pandemic [that killed tens of millions of people].” Burr sold around $1 million worth of stocks on February 13 before their value crashed. But he did not warn the public of the imminent danger. Earlier, on February 7 he had published an op-ed saying, “Thankfully the United States today is better prepared than ever to face emerging public health threats like the coronavirus.”
I’m tired of these brazen lies. “Better prepared than ever?” How can this man still be a senator today when he learned how dangerous the disease was and did nothing except sell his stock? Nurses are getting fired for bringing their own PPE or speaking out to the media about how unprepared we are but this hypocrite still has a job. He should be in jail.
I don’t know if the mayor would have canceled Mardi Gras if she knew about the seriousness of the pandemic. I highly doubt it. A person was fatally run over by a float during Mardi Gras. Despite the pleas of her father, nothing was done after this to keep spectators separated from the floats, and another person was actually killed the same way a few days later. This is how our government operates.
The federal government learned about this disease in January and they chose to do nothing. They could have taken immediate measures to hold back the spread.
What have other nurses at your hospital said about the crisis?
Nurses are warriors. We stick together. We work as a team. We do what needs to be done as safely as possible. It really angers us when people sitting in offices, who have never touched a patient, are making decisions that may endanger our lives or the lives of our families. We have lost faith in the official public health authorities — the CDC tells us that if we run out of PPE, we can wear scarves or bandanas to treat Covid patients, and the FDA tells us to keep the same gloves on between multiple patients not diagnosed with an infectious disease.
What are the structural problems in the healthcare system?
Health care should not be a for-profit business. They rationalize that by saying that our hospitals are “not for profit,” but profit is still being made, and those dollars are distributed in the system by people who know nothing about health care. That needs to end now. These people who are threatening to fire us for speaking out about working conditions? They need to go. Health care should not be a commodity. Everything is such a business in this country, but the “commodities” here are people. I spend 12 hours a day with patients, seeing them at their most trying times. The barriers to their health in the system are really disturbing.
Is management knowingly allowing nurses to continue working while infected but undiagnosed?
Knowingly? No. They’re checking for fevers every day. If you have one or you have a positive test, you’re required to stay home for a certain number of days. But we’re starting to see positive tests come back on people with no or low symptoms. At one of my jobs there are employees who actually have positive tests and are still working because they have zero symptoms and there is literally no staff who can replace them.
What is the pandemic doing to people in the city? What is happening to people who are quarantined, laid off, or caring for sick family members?
There was already a lot of poverty in New Orleans. It’s a huge reason why the disease is so bad, because a lot of people are uninsured or underinsured. They don’t have jobs with health benefits to help prevent underlying illnesses that are making the disease worse.
Many jobs here are service industry or gig jobs. Those workers don’t get paid sick time or group health plans. Seventeen million people in the United States have now filed for unemployment. A lot of them are in New Orleans. People’s rents came due for April. There’s no way to make money come out of thin air. And this disaster was not their fault. Nor was it their fault they were living paycheck to paycheck. The need for this extent of quarantine was the direct result of the federal government’s poor response. If we were a court of law, they ought to be found at fault and ordered to pay the damages. It’s time for the people in charge to pay up for their errors. And not just to corporations but to working people.
Do you believe that people working in hospitals are getting adequate hazard pay?
Absolutely not. How much money equals a probable chance of catching a disease like this? It’s hard to put a number on that. But the number they offered was not good enough for me, and I’m leaving acute care for my other jobs.
Do you believe that other essential workers, such as grocery store employees, transportation workers, and others should be getting hazard pay?
Absolutely. Anyone that’s considered essential enough to be at their work instead of a mandated quarantine deserves to be compensated for the risk they are forced into taking. The only people left standing right now supposedly don’t even deserve to make $15 an hour and are paid wages you can’t live comfortably on. But when something like this happens, they’re the only ones keeping us fed, keeping the lights on, shipping products, keeping pharmacies open. Those are the heroes, as well, not just doctors and nurses.
In the hospital, the underrecognized people are equally as essential as we are. The janitors who sterilize and clean the whole hospital during a pandemic? Not paid enough. Nursing assistants are the only reason I can do my job. They help patients get through life in the hospital, and they’re not paid enough either. These are all considered menial jobs. But they are keeping our country running right now. They are keeping people alive. And the profits of these industries, we’re not seeing the money, none of these people are — so where is it? I would like to know where it’s going.
What do you believe are structural solutions for health care?
The health care system and the government need to be ready for pandemics. We should have had more equipment. We should have responded quickly to manufacture more PPE and implemented travel restrictions and stay-at-home instructions sooner to restrict the spread.
What’s really hurting people, especially in this area, is the underlying medical conditions and socioeconomic problems that people have. We’re essentially slapping Band-Aids on huge wounds. We spend the most out of any country in the world on health care, yet we have some of the worst outcomes. We really need to take a step back and look at how this money is used. We really need to focus on primary care and prevention, and access to health care for everyone. People who are unwell are very susceptible to a disease like Covid.
How many people could have been kept out of the hospital in the last few weeks if they had their underlying illnesses under control? A lot of patients in the clinic tell me they can’t afford basic medications that cost $10, $4, that they don’t have insurance so they avoid going to the hospital, that they can’t get insurance through their job, or their copays and deductibles are outrageous.
A correlation with people we have placed on ventilators with Covid is that a great majority of them have diabetes, hypertension, heart disease. These are preventable diseases. We have technology, medicine, and money. So why is this happening? This is why I am leaving acute care and starting to focus on becoming a primary care provider. I’m sick of fishing people out of the river and risking my life to do so, day after day. I want to walk upriver and see — why are people falling in? Our health care system does not promote prevention that can save suffering and much of the need for future treatment.
On March 30, 1,000 workers walked out of a meatpacking factory in Colorado, because the company admitted that 10 of the employees in the cramped plant had already tested positive for Covid-19.
The people who are sitting at home who get the profits — all their wealth depends on our labor. And that’s what they’re scared of! That’s why they want to have everyone go back to work! If people realized — they withhold that, they have a lot of power. The Amazon people, who walked out, good for them. That worker who led it was fired. That’s outrageous.
In Italy there was a huge strike of factory and logistics workers to close workplaces. A large number of hospital workers declared they supported the strike and symbolically stopped work for one minute while it was happening.
That makes me want to cry. That’s so cool. I hope shit like that happens over here, because we’ve — enough is enough. The people in charge take advantage of nurses by trying to cash in on our altruism and our personality where we put other people in front of ourselves. So some nurses will say, “They’re giving us this bonus, that’s so nice, and they’re bringing us lunch, and they’re emailing us about how much we’re heroes.” And I’m like, “Do you know how much money the hospital is going to get from the government?”
The $2 trillion federal bailout at the end of March is going to give $100 billion to hospitals. This is over $100,000 for every regular hospital bed in the United States. But the question is — who in the hospital will it go to? The patients who were not and are not protected? Doctors? Nurses? Nursing assistants and other low-paid medical staff? Janitors? Or is it going to flow to top executives, insurance companies, private hospital shareholders? How about pharmaceutical and medical supply corporations and low-wage outsourcing companies? The flow of money is why the health care system isn’t really set up to fight for people’s health.