•   
  •   
  •   

US What the Nurses See: Bronx Hospital Reels as Coronavirus Swamps New York

20:40  01 april  2020
20:40  01 april  2020 Source:   online.wsj.com

NYC coronavirus: Hospitals could run out of needed supplies by next week, De Blasio says

  NYC coronavirus: Hospitals could run out of needed supplies by next week, De Blasio says New York City hospitals will only be able to get through this week before they get "to a point where people can't be saved" because of equipment shortages, New York City Mayor Bill de Blasio tells CNN.New York City hospitals will only be able to get through this week before they start getting "to a point where people can't be saved" because of equipment shortages, New York City Mayor Bill de Blasio told CNN on Monday.

Slideshow by photo services

Christina Norstein was hoarse, her nose swollen by mask marks. She wasn’t sleeping much, and woke up crying one morning after a day at work. “I feel like we’re being sent to slaughter,” she said.

Ms. Norstein is an intensive-care nurse at Montefiore Medical Center’s Moses campus in the Bronx, one of the hospitals inundated with Covid-19 patients.

In hospitals across New York City and elsewhere in the country, nurses and doctors are complaining about a lack of safety equipment, insufficient staffing, murky policies and other challenges. New York City accounts for the largest number of Covid-19 cases in the U.S. On Tuesday morning, the city reported 40,900 cases and 932 deaths.

Get news and analysis on politics, policy, national security and more, delivered right to your inbox

In the last few weeks, the 57-year-old Ms. Norstein and other nurses say they have seen freezer trucks out back for dead bodies; four to five patients dying every emergency-room shift; the loudspeaker frequently booming out “codes” for patients whose hearts or breathing stopped. Colleagues who were healthy one day fell critically ill the next.

Despite multiple alarms raised by workers in the past two months, she and other nurses say the hospital system stumbled in creating protocols to prevent the disease’s spread and is sending its workers out to the battlefield underprepared. Staffers say the hospital is running out of critical supplies—ventilators, dialysis machines, sedation medication, feeding pumps. Ms. Norstein said a doctor told her that physicians are discussing how they would decide who lives as ventilator supplies dwindle.

Fractured caregivers' vehicles to steal masks: "It's incomprehensible"

 Fractured caregivers' vehicles to steal masks: © LOIC VENANCE / AFP Doctors, nurses and even pharmacists report fractured vehicles and theft of equipment, as well as buttons affixed to the windscreen breeze with the symbol of the caduceus. Ghislaine had to remove hers on the advice of the police. We applaud them every evening at 8 p.m. And yet caregivers are more and more victims of robberies . Across France, doctors, nurses, pharmacists are reporting broken vehicles.

News to stay informed. Advice to stay safe.
Click here for complete coronavirus coverage from Microsoft News

Many nurses and doctors have symptoms, like dry coughs, but are being denied tests and remain working, Ms. Norstein and other Montefiore health-care workers said colleagues have told them.

Friday night, she asked herself: Should she even come back home after her next shift? She feared she would infect her family. One of her daughters has lupus and other autoimmune conditions, putting her at risk. It has been a long time since she has hugged them—it’s against her own rules.

“I feel overwhelmed with sadness,” said Ms. Norstein, who lives in Pawling, N.Y., with her husband and two of her four children. “It is not just sadness for the patients, it is for their families, for my family. It is for the possibility that I may very well get this.”

a person in a car © Kevin Hagen for The Wall Street Journal

Among New York City’s boroughs, the Bronx has the most reported Covid-19 deaths per capita. It has high rates of asthma, heart disease and diabetes—conditions that make people more vulnerable to becoming severely ill from the virus and ending up in the ICU. Montefiore is a major hospital system there.

As of Monday, more than 800 patients in the Montefiore system, which includes multiple campuses in New York state, had tested positive and of that number, 381 were at the Bronx’s Moses campus, hospital administrators said on a conference call, according to nurses who listened.

In Montefiore’s Moses campus, the 48 beds in the four ICU units are filled with coronavirus patients and the hospital is expanding critical care into other areas, Ms. Norstein and two other nurses said. A surprising number of patients in critical condition are younger, between the ages of 20 and 50, she said. Another ICU nurse in her 50s, she said, caught the illness and later “coded” into respiratory arrest earlier in March; she remains in critical condition.

For weeks, Montefiore declined to disclose to nurses the number of infected employees, nurses said. On Monday, Montefiore CEO Philip Ozuah went on the conference call with employees and said 311 workers had been confirmed positive for Covid-19 and more than 1,000 were quarantined.

A Montefiore spokesman in a statement said: “These claims are gross misrepresentations of the facts. Montefiore is working at the direction of the Governor and following CDC and Department of Health protocols to protect our workforce and treat our patients.” He declined to make Dr. Ozuah available for an interview.

Doctors should realize that it is wartime and supplies always will run short, said Evan Garfein, a Montefiore plastic and reconstructive surgeon who reported for his first emergency room overnight shift in a long time last week. “Let’s do what we can to build supplies as quickly as we can, but now let’s go fight the battle,” he said. “I don’t think Montefiore is different” in its preparedness, he added. “All hospitals have struggled with how to communicate.”

As a critical-care nurse, Ms. Norstein is used to dealing with dying. What scares her is the speed of the virus, the havoc it wreaks across all the body’s systems and what she sees as a make-it-up-as-you-go response. “It’s very science fiction,” she said. “It is being made up by the second, and it is so frickin’ scary.”

On her Saturday shift, she said, her attending physician told her to start lowering sedation levels for patients on ventilators; the hospital pharmacy’s supply of both sedatives and drugs for paralysis, which are essential for proper intubation, was shrinking.

When she tried in the morning to get a patient a feeding pump—a key device for nutrition that usually arrives within an hour—she couldn’t get one until 6 p.m. Ms. Norstein and other nurses said intensive-care nurses at the hospital are taking on three to four times their normal patient loads. In tents outside the ER, patients wait to get tested and often leave without one, ER nurses and doctors said.

These days, when she gets to work at 7 a.m. for her 12½-hour shift, Ms. Norstein puts on dark-blue paper scrubs over her normal ones, covers her head with an operating-room cap and tapes two head covers to her shoes. (They are out of foot protectors.) The possibility of infection looms over every interaction. On a recent day, she found a nurse crying quietly at her computer. “She couldn’t even speak to me,” she said.

“It’s sort of like the Hunger Games. You don’t know where your enemy is,” said Judy Sheridan-Gonzalez, a Montefiore nurse who is also president of the New York State Nurses Association, a union. “Will I be the last one standing?”

Many workers in the Montefiore system said they are angry that supervisors didn’t take seriously alarm bells rung by health-care employees, and the hospital hasn’t done enough to protect workers and patients against transmission of the virus, according to interviews with more than a dozen Montefiore health-care workers and email records The Wall Street Journal reviewed.

The Moses ER on East 210th Street often functions as a de facto primary-care clinic for low-income patients. The first suspected Covid-19 case many medical workers had seen arrived Feb. 3, according to emails that ER nurses sent their supervisors. That day, the ER was warned that a patient, who had recently traveled to China and had virus symptoms, was on the way, according to an email and several nurses, including Samantha Castillo, an ER nurse who was there.

The patient was brought in the main ER space, potentially exposing more than 100 patients and staff, emails show and the nurses said. “Everybody was shocked,” said Benny Mathew, an ER nurse who heard of the incident from other people who were there. “We could have all gotten exposed.”

The next day, Mr. Mathew and another emergency-room nurse sent the emails to supervisors expressing their anger about the handling of the suspected Covid-19 case. Mr. Mathew asked for strict “guidelines and staff education,” and said the arrival of the virus in New York City now “seems inevitable,” according to a Feb. 4 email. He said a supervisor told him that the hospital was following government health guidelines.

There were no publicly disclosed Covid-19 cases in New York City at that time. And in these early days, the U.S. as a whole wasn’t taking exceptional precautions.

Dr. Ozuah, Montefiore’s CEO, was quoted in the local Norwood News publication’s Feb. 13 issue saying the hospital system had an elaborate contingency plan for Covid-19 with “space-age” airtight transportation systems and decontamination rooms. Montefiore nurses and doctors said such a plan wasn’t put in place.

One patient with confirmed coronavirus stayed in the Moses ER for over 14 hours and used the same bathroom as other patients, Mr. Mathew wrote in a March 14 email to the hospital epidemiologist and an environmental health and safety director. He said he received no response.

The emergency department “mimics a petri dish for transmission of the virus,” read a petition circulated around the weekend of March 20 by Montefiore health-care workers to the hospital administration.

Mr. Mathew said he is now sick with Covid-19, holed up in his daughter’s Bronx bedroom and trying to avoid contact with his wife and two children. He received positive test results Thursday, he said, and was told he could return to work Sunday. Previously, the hospital had been telling workers to quarantine for 14 days even if they had just had a high-risk exposure.

Many nurses say they are terrified of passing on the disease inadvertently to loved ones; several nurses’ family members have tested positive. It is unclear whether the nurses were carriers of the virus and difficult for them to find out.

Mr. Mathew’s biggest fear: “I suspect we are now vectors.”

A doctor at Einstein, another Montefiore location in the Bronx, told nurses on March 19 they couldn’t wear special “N95” masks to check on patients because they were in limited supply, said Jungoui Hwang, a nurse there. “If you cannot follow the new policy, you gotta leave,” the doctor said, according to Ms. Hwang.

N95 masks filter out small particles to help guard against the virus, but U.S. hospitals have reported dwindling inventory as the surge in global demand for protective equipment enters another week.

Ms. Hwang said she raised exposure concerns but was told to “just be careful.” The hospital later said in an email that a notice of “significant punitive actions” for using an N95 mask was “sent in error.” Late last week, the Montefiore system told staff in an email they would receive a fresh N95 mask twice a week regardless of the number of patients they saw. On Monday, after the Journal contacted Montefiore, the hospital told the nurse’s union it would distribute N95 masks daily.

Ms. Hwang, who lives alone in the Bronx, said she felt weak about a week ago with a headache, fever and body aches. Her parents in South Korea have been calling and begging her to quit. She called her hospital’s occupational health services, she said, and it declined to give her a test. She is using sick days to stay home, afraid of infecting others, she said: “We are so scared.”

One of the most frightening things for Ms. Norstein is how ill people get so fast. She was caring for a man in his 40s with a kidney disease that he had discovered only when he tested positive for coronavirus. That morning, he was able to talk to his wife and family by phone, but later he was listless.

“Leave it, I don’t want to talk to anybody,” he told Ms. Norstein when the phone rang. She offered to switch on the television or play music. He said he didn’t want anything. “He was closing his eyes,” Ms. Norstein said. “I guess he was contemplating his death.”

When she returned to work days later, he was on a ventilator. He had mittens on his hands so he couldn’t pull out his tube.

Before the coronavirus upended her life, Ms. Norstein would arrive at work and first visit each of her patients. Now she strategizes: How should she take blood samples and give medicines with the least visits to save precious safety gear? She has been keeping IVs and other machines outside patient rooms. “Normally you would never have IV tubing that people could trip on,” Ms. Norstein said. It is against policy, but with the sheer number of times they need to change the medicine, “it is not a choice.”

The long hours are a blur of surprising new turns. Ms. Norstein plunged a syringe full of a viscous experimental drug into the abdomen of the coronavirus patient in his 40s—and was shocked at his screams. Every shift, she said, she helps wrap intubated coronavirus patients “pastry-like” into bedsheets and flip them periodically in a choreographed procedure with the help of six other nurses and a respiratory therapist, to improve drainage of their lungs.

Among nurses, there is gallows humor but also “teamwork like I’ve never experienced,” Ms. Norstein said. A nurse who sings in a choir suddenly burst into a devotional song on one shift.

Ms. Norstein worries about the vanishing supplies of little things: plastic thermometer covers, the “stickies” used to hook up the EKG to patients’ bodies, chlorhexidine wipes to sterilize gear. When the wipes run out—each shift gets only one box these days—she washes her mask with hand sanitizer before shoving it back into a paper bag to wear again. She eats lunch and breakfast cramped in her mini-SUV, scared of break-room germs.

Last week, a doctor told her that colleagues were discussing the ventilator shortage. Among questions: Between a 75-year-old with a history of medical issues and a morbidly obese 42-year-old with asthma, who would you put on a ventilator? They had differing opinions. One doctor told Ms. Norstein, “I just hope two weeks from now when I need a ventilator that I get it.”

Like many hospitals, Montefiore is desperately short-staffed, nurses in the system said. Montefiore told the union in recent days that it would soon require many nurses on the hospital floors to take care of 10 patients each, Ms. Sheridan-Gonzalez said; a 6 to 1 ratio is considered extreme.

Late last week, a clerical nurse who hasn’t done bedside nursing for 17 years was sent in to start working in the Moses ICU, Ms. Norstein said. Ms. Norstein’s son, also a nurse, recently tested negative for the virus. When Montefiore asked him to come work per diem, Ms. Norstein told him to “stay the hell away.”

At 7:30 p.m., Ms. Norstein leaves the hospital exhausted. She can’t stop examining every tickle in her throat. She used to turn on the music while driving home, sometimes breaking loudly into song. Not anymore. “How could I be happy when all these people are suffering?”

Last week, her husband, Warren Norstein, who owns a local barbecue restaurant, said he asked his wife to stop working. She said, “This is what I do.” He can’t fully understand, he said: “I wish she were a coward and we could all just cower together and hang out and wait till the storm passes.”

On her two days off late last week, she grasped at moments of normalcy ahead of her Saturday shift. She vacuumed. Did laundry. Watched “Marriage Story” on Netflix with her daughters—they sat across the room.

Then everything changed.

On Friday at 10:30 p.m., a group text with her other ICU nurses began to blow up her phone. One had tested positive, and two others were having symptoms and awaiting test results.

She told her girls she needed to leave to keep them safe. Tears rolled down their faces. Her older daughter Olivia said she would go stay at her uncle’s instead, but Ms. Norstein refused. “I just want a hug,” Olivia said. Ms. Norstein’s heart broke: She could only offer an “air-hug.”

When her husband awoke at 5 a.m. Saturday, Ms. Norstein broke the news: She was moving out for her family’s sake. He was quiet, then said he understood. He asked: If he got sick, would she come back? “Of course,” she replied, then broke her rules and hugged his back.

She packed three days’ clothing, not knowing where she would end up that night. During her lunch break, her 26-year-old called to tell her she had found a hotel in Yonkers. Ms. Norstein drove there after work as the sky darkened.

Back at work Sunday, she heard of nine deaths in the ER. Sweaty and overworked, she was running around as she was assigned to care for three patients at once for the first time. The makeshift ICU on one of the hospital floors was already full, and workers were converting an old auditorium into another.

A co-worker told Ms. Norstein on Sunday that they are no longer to do chest compressions to resuscitate Covid-19 patients because it uses lots of protective gear and puts workers at greater risk than chemical resuscitations. Ms. Sheridan-Gonzalez, the union president, said she heard from other nurses who corroborated that it has become an “unspoken rule.”

“The situation is disgusting,” she said. Nurses and doctors said they want to provide all the care but find themselves hobbled by the lack of gear.

Ms. Norstein’s unit had become unrecognizably messy. Paper bags hung on walls with nurses’ names on them, holding their reused masks. IV poles and bedside tables, piled with gauze pads and syringes, cluttered the hallway, moved outside patients’ rooms so they wouldn’t be contaminated.

Floors were often unmopped, and sometimes the garbage wasn’t taken out, because cleaning staff were scared of going into Covid-19 patients’ rooms without protection, she said: “My biggest concern is that the patients are not going to get the quality of care that I would like to have if I get this disease.”

On Monday, her day off, she received a sliver of good news: Montefiore told her it would pay for a hotel stay through the pandemic. She went shopping at Costco with her husband—they used separate shopping carts and held their breaths as people passed by—and went home to gather her things.

She will say another goodbye to her family and check into the hotel Wednesday for the long haul. At least they’ll be safe from her, she said: “This is everybody’s worst nightmare.”

Write to Shalini Ramachandran at shalini.ramachandran@wsj.com and Khadeeja Safdar at khadeeja.safdar@wsj.com

Fractured caregivers' vehicles to steal masks: "It's incomprehensible" .
© LOIC VENANCE / AFP Doctors, nurses and even pharmacists report fractured vehicles and theft of equipment, as well as buttons affixed to the windscreen breeze with the symbol of the caduceus. Ghislaine had to remove hers on the advice of the police. We applaud them every evening at 8 p.m. And yet caregivers are more and more victims of robberies . Across France, doctors, nurses, pharmacists are reporting broken vehicles.

—   Share news in the SOC. Networks
usr: 28
This is interesting!