with Paulina Firozi
Paul Kwak believes he was infected with the virus while inserting tubing into a covid-19 patient’s neck.
Kwak, an otolaryngologist at NYU Langone hospital, was wearing an N95 mask, a face shield and a full-length gown as he performed a tracheostomy — a procedure in which a tube is placed through a small incision into a severely ill patient’s windpipe to help them breathe.
But those personal protections, while helpful, are no guarantee. Days after the procedure, on March 30, Kwak started feeling feverish. He tested positive for the coronavirus and spent the next 10 days fighting what he describes as a relatively mild version of the illness.
“You’re literally face-to-face with a patient’s throat and airway and even in the most controlled situation there are secretions and droplets going everywhere,” the 38-year-old doctor told me. “Providers who are part of that team are inevitably high-risk.”
Health-care workers may constitute between 1 and 2 of every 10 coronavirus cases in the United States.
As of one week ago, 9,282 medical workers had tested positive for the virus and 27 had died, according to a Centers for Disease Control and Prevention report. That’s 19 percent of the 49,370 reported cases in which data was included about whether the patient was a health worker. In a dozen states that did a better job reporting the information, about 11 percent of cases were medical workers.
“These numbers are believed to be a gross undercount of infections due to the continuing lack of available tests in many areas,” my colleague Ariana Eunjung Cha writes. “Some regions and institutions are no longer testing health-care workers, reserving kits for the sickest patients.”
The Guardian and Kaiser Health News have launched a project to document the lives of medical workers in the United States who die of covid-19, the disease caused by the novel coronavirus.
There was particularly grim news out of Ohio this week, where health officials reported more than 1,300 medical workers had tested positive. That’s about 1 in 5 of all known infections in the state.
The highly infectious disease has struck health-care workers around the globe. Nearly 13,000 health-care workers in Italy had been infected as of April 7, according to the country’s National Institute of Health. Ninety-four doctors and 26 nurses had died. In Spain, nearly 14 percent of infected individuals in March were medical workers. China’s National Health Commission has said more than 3,300 workers have been infected and at least 13 have died.
Medical workers are committed to their jobs, but some worry about repeated exposure to such a risky disease.
Officials have stressed that the risks to the medical community and the need to prevent hospitals from getting overloaded should inspire people to keep appropriate social distance and stop the spread. And they’re urging Americans to construct homemade face masks to preserve the supply for hospitals facing shortages.
But even having sufficient protective gear – which is not a guarantee in every hospital – doesn’t erase the fear medical workers can feel amid repeated daily encounters with severely ill patients.
“Some residents have expressed strong reservations about participating in covid care,” Kwak told me. “I was very much like, guys, this is what I signed up for; we took an oath and this is our time.”
Kwak said he went “to a pretty dark place” when he started getting sick because of the stories he had read about young, healthy people succumbing to the virus. He said he was particularly nervous around the seventh day, because patients with covid-19 often see their symptoms subside after a few days, only for them to return more aggressively than before. He didn’t even tell his parents he had contracted the virus until the 14th day after getting sick.
But now that he has returned to work, he feels less frightened. “Those of us who have had it, we feel a little bit more comfortable being in the wards,” Kwak said. “It’s not like we’re trying to be reckless, but … there’s less fear, which has been liberating, I suppose.”
Workers don’t always know how many patients have the coronavirus and in what units they are being treated.
My colleagues Rachel Chason, Jenna Portnoy and Kyle Swenson found that 11 hospitals in D.C., Maryland and Virginia take dramatically different approaches on how they share information about infected patients and employees.
“Interviews with health-care workers showed many feel kept in the dark by leaders at their organizations and fear a lack of information could hurt their families, or their patients,” they write. “Staff in some medical centers and hospitals said that in addition to wanting more notice when a fellow employee tests positive, they would like to see more information provided about the number and condition of covid-19 patients being seen in their facilities.”
And the demand for personal protective gear has been a point of contention in some health care centers. Some nurses and aides say they have been asked to reuse face masks far beyond their intended use, prompting pushback from unions who say their members are being forced to put their own health at risk.
States are prioritizing medical workers for testing.
Cognizant of the risks, many state health officials have placed medical workers in a class of people considered top priority for getting tested for having the virus. New York Gov. Andrew Cuomo (D) says medical workers in his state will also be prioritized for getting antibody tests, which show whether someone has already had the virus and is therefore considered to have some level of immunity to it.
New York State will prioritize antibody testing for healthcare workers, first responders and essential workers.
— Andrew Cuomo (@NYGovCuomo) April 15, 2020
Some medical workers used little protective gear before they fully understood how contagious the virus is.
The Los Angeles Times tells the story of Ryan Padgett, an emergency room doctor in the Seattle area, who nearly died after contracting the virus and had to be placed on a ventilator in his own hospital. At first, he and his colleagues used only surgical masks and gloves before adding respirators and other gear.
“To worry about myself, as a 44-year-old healthy man, didn’t even cross my mind,” Padgett told the Times.
Similarly, workers didn’t use special protective gear while interacting with a patient with respiratory issues who arrived Feb. 15 at a hospital in Solano County, Calif. These doctors and nurses, whose cases were detailed in the CDC report, interacted with the patient and performed multiple aerosol-generating procedures without special protection.
“Eleven days later, they discovered the patient had covid-19, and 121 staff had been exposed to the virus,” Ariana writes.
“Of the 43 staffers who subsequently experienced flu-like symptoms and were tested with nasal swabs, three had confirmed infections — making them among the first known cases of occupational transmission in a hospital,” she adds. “While two of those three workers were involved in higher-risk procedures that tend to kick the virus into the air, the third was not.”
Note to readers: Health 202 is on an abbreviated schedule this week and won’t publish tomorrow. Thanks for reading and get some rest this weekend, if you can. We’ll be back in your inbox on Monday.
Ahh, oof and ouch
AHH: We know the coronavirus can destroy the lungs. But it can also damage your kidneys and heart.
There’s a growing body of evidence that points to ways the virus may affect other organs. It may cause heart inflammation, acute kidney disease, neurological malfunction, blood clots, intestinal damage and liver problems.
This new evidence clinicians are seeing has complicated the treatment of the most severe cases of covid-19, our colleagues Lenny Bernstein, Carolyn Y. Johnson, Sarah Kaplan and Laurie McGinley report.
“Almost half the people hospitalized because of covid-19 have blood or protein in their urine, indicating early damage to their kidneys, said Alan Kliger, a nephrologist at the Yale School of Medicine who co-chairs a task force assisting dialysis patients who have covid-19,” they write.
Even more alarming: Kliger pointed to early data showing 14 to 30 percent of intensive care patients in New York and Wuhan, China — the birthplace of the pandemic — losing kidney function and requiring dialysis, or its in-hospital cousin, continuous renal replacement therapy. New York intensive care units are treating so much kidney failure, he said, they need more personnel who can perform dialysis and have issued an urgent call for volunteers from other parts of the country.
“The question is, is it kind of behaving like a hybrid of different viruses?” Brennan Spiegel, co-editor in chief of the American Journal of Gastroenterology, told our colleagues. “What we’re learning is, it seems anyway, that this virus homes in on more than one organ system.”
OOF: The search for a coronavirus treatment in the United States has been disorganized and decentralized.
“In a desperate bid to find treatments for people sickened by the coronavirus, doctors and drug companies have launched more than 100 human experiments in the United States, investigating experimental drugs, a decades-old malaria medicine and cutting-edge therapies that have worked for other conditions such as HIV and rheumatoid arthritis,” Carolyn reports.
“Some large trials designed to be definitive have launched,” she adds. “But with more than 500 human clinical trials worldwide, the lack of coordination puts the world at risk of ending up with a raft of inconclusive and conflicting studies and little idea of what interventions work for the next wave of illness.
Francis Collins, head of the National Institutes of Health, acknowledged researchers’ frustration but said he’s working on a public-private partnership to address the problems.
“He said the framework involves top pharmaceutical companies such as Pfizer and Johnson & Johnson, domestic and international government agencies including the European Medicines Agency, and academic research centers,” Carolyn writes.
“Collins said the month-long discussions have been kept under wraps to ensure buy-in for an approach likely to require sacrifices of personal recognition, scientific credit and profit — a centralized decision, for example, not to proceed with tests of one company’s drug in order to move faster on a competitor’s.”
OUCH: Documents show Chinese health officials kept the pandemic secret for six days.
In a secret teleconference on Jan. 14, top health officials in China made a grim assessment of the coronavirus outbreak, determining the “epidemic situation is still severe and complex, the most severe challenge since SARS in 2003, and is likely to develop into a major public health event” It wasn’t until Jan. 20 – six days later — that President Xi Jinping told the public about it, the Associated Press reports based on internal documents.
In that six days, millions traveled as they prepared for Lunar New Year festivities. There was a mass banquet for tens of thousands in the outbreak epicenter of Wuhan.
By the time the public was warned of the coronavirus, more than 3,000 had been infected.
“That delay from Jan. 14 to Jan. 20 was neither the first mistake made by Chinese officials at all levels in confronting the outbreak, nor the longest lag, as governments around the world have dragged their feet for weeks and even months in addressing the virus,” per the AP. “But the delay by the first country to face the new coronavirus came at a critical time — the beginning of the outbreak. China’s attempt to walk a line between alerting the public and avoiding panic set the stage for a pandemic that has infected more than 2 million people and taken more than 128,000 lives.”
After the teleconference, the CDC in Beijing initiated the highest-level emergency response internally and the National Health Commission distributed 63 pages of instructions provincial health officials. But in public, officials continued to downplay the threat.
White House coronavirus response
Trump isn’t the only one critical of the World Health Organization.
“Criticism of how the WHO handled China is resonating well beyond the White House,” our Post colleague Emily Rauhala writes
“In the early days of the crisis, the WHO amplified Chinese claims and figures without signaling that they could be inaccurate,” she writes. “The organization was slow to address the risk of human-to-human transmission, slow to declare a public health emergency and slow to use the term ‘pandemic.’”
“Yet it was quick to praise Beijing,” she adds. “As evidence mounted that China had silenced whistleblowers and undercounted cases, Tedros Adhanom Ghebreyesus, the WHO’s director general, continued to heap compliments on Beijing and dodged questions about worrying problems with the Chinese response.”
Some congressional Democrats are calling Trump’s WHO funding freeze illegal.
The move sparked a gush of criticism from Democrats and international health experts who said Trump is “trying to deflect blame from his own mishandling of the situation while weakening the principal international organization leading the response to the pandemic,” our Post colleague Erica Werner reports.
House Speaker Nancy Pelosi (D-Calif.) called the freeze “senseless.”
“We can only be successful in defeating this global pandemic through a coordinated international response with respect for science and data,” she said in a statement. “This decision is dangerous, illegal and will be swiftly challenged.”
Meanwhile, some congressional Republicans expressed support for Trump, including Sen. Lindsey O. Graham (R-S.C.), who said “cutting off funding at this time is the right move.”
A White House team secured thousands of face masks from Taiwan for its senior staff.
In the middle of March, a National Security Council official turned to Taiwan to secure surgical masks as it worried about the lack of the supplies hindering the government’s function amid the pandemic.
Of the hundreds of thousands of masks the foreign government donated, 3,600 were set aside for White House officials and staff, our Post colleagues Carol D. Leonnig, Elizabeth Dwoskin and John Hudson report, while the rest went into the Strategic National Stockpile.
At the time, the U.S. government was discouraging the public from wearing masks themselves. Instead, the government urged that masks be saved for front-line health-care workers most at risk, and insisted that other healthy people did not need them.
The “urgent appeal to Taiwan on March 14 highlights a stark conflict between the Trump administration’s stance then on the use of masks and the race behind the scenes to obtain them for key White House personnel,” our colleagues write.
The campaign continues
Elizabeth Warren has thrown her support behind Joe Biden.
The senator from Massachusetts is the latest of Biden’s former primary opponents to formally endorse the former vice president, now the presumptive Democratic nominee.
Might she be his VP pick? Warren has spoken to Biden several times since exiting the race, The Post’s Annie Linskey reports.
“Allies who have spoken to her since she left the race have touted her as a potential partner for presumptive nominee Joe Biden, who has pledged that a woman will be his running mate,” Annie writes. “Failing that, they envision her securing a leading role in his administration should he win in November — potentially as the country’s first female treasury secretary or running the Consumer Financial Protection Bureau, which she helped create.”
Here are other headlines and developments to catch up on this morning.
By the numbers:
- The United States has thrown more than $6 trillion at addressing the coronavirus crisis, but it may not be enough to hold the economy together, our Post colleague Andrew Van Dam reports.
- The number of confirmed coronavirus infections around the world has surpassed 2 million, Brady Dennis writes.
On the front lines:
- Grocery delivery services were meant to be lifelines, but some are falling short as demand outpaces supply, Abha Bhattarai reports. And delivery workers are feeling the pressure.
The hardest hit:
- Many immigrants who work in jobs that can’t be done remotely — those working in grocery stores, making deliveries or cleaning hospitals and other essential businesses — are at higher risk for exposure. But many are afraid to get care because they fear deportation, Stat News’s Usha Lee McFarling reports.
- Some small businesses, worried about what the future holds, are choosing to close their doors rather than apply for government help, the Wall Street Journal’s Ruth Simon reports.
In the states:
- Cuomo ordered all New York residents to wear face coverings in public — such as in stores, on crowded sidewalks or on buses — when social distancing isn’t possible, the New York Times’s Luis Ferré-Sadurní and Maria Cramer report.
The Trump administration’s response:
- The White House is placing Trump campaign veteran Michael Caputo in the Department of Health and Human Services’ top communications role, Politico’s Dan Diamond and Daniel Lippman report. The decision is meant to “assert more White House control over Health and Human Services Secretary Alex Azar, who officials believe has been behind recent critical reports about President Donald Trump’s handling of the coronavirus pandemic,” they add.
- The administration is paying a premium to third-party vendors in the push to acquire N95 respirator masks, Isaac Stanley-Becker, Desmond Butler and Nick Miroff report.
- The president denied that he wanted his signature on stimulus checks sent to millions of Americans. But the administration was already secretly working on a plan to make it happen, Toluse Olorunnipa and Lisa Rein report.
- Business executives are telling Trump that testing must be ramped up before the public will feel confident enough to go back to work, or even to go out to retail shops or to eat, the Wall Street Journal’s Michael C. Bender and Andrew Restuccia report.
The Daily Social Distancing Show with Trevor Noah: