In the face of COVID-19, healthcare workers have been both heroically working around the clock in dangerous conditions to treat coronavirus victims and organizing for higher safety standards and more resources. Nurses unions in particular, which have led the fight for years for single-payer healthcare, have played a vital role in recent days in exposing the truth behind the Trump administration’s rosy claims about its preparedness for this pandemic.
Offering dire warnings both of the current situation in New York City hospitals and what it may soon become, Sean Petty, a pediatric emergency room nurse at Jacobi Medical Center in the Bronx and the southern regional director for the New York State Nurses Association, spoke to The Indypendent’s Danny Katch. He notes that medical centers have been stripped bare by budget cuts in the lead up to this moment and that current safety measures are woefully inefficient to prevent the spread of coronavirus.
The chaos and casualty count of the pandemic have been exacerbated by the extreme short-term thinking and anti-human priorities characteristic of American capitalism. Between the immediate incompetence of the Trump White House and the permanent crisis of our privatized healthcare system, Petty tells an underreported story of dangerous cuts to already insufficient medical infrastructure that were pushed for by leaders of both parties and are now pushing us to the brink.
What’s been the view of this pandemic from a New York City hospital so far? How do you expect the situation to change?
The situation is dire. We are already days and weeks behind the measures Italy has implemented in terms of preventing spread and they have a better-prepared healthcare system that is massively overwhelmed. Healthcare workers in Italy are having to make decisions of who should get a live-saving ventilator and who shouldn’t. In New York State, we are only testing symptomatic people and the test takes two to three days to get results. South Korea has had the most success containing the virus and they have tested almost 300,000 people compared to the U.S.’s 25,000. We have fewer doctors and hospital beds per person than Italy. We should expect the worst.
As you can imagine, the situation is evolving rapidly. Preparations are being made, but in a woefully uneven and sluggish way that is exposing the profound weaknesses of our healthcare system.
Protocols for treating patients are changing daily, communication is spotty from the administration, equipment is short, and people who don’t directly take care of patients are making decisions that don’t make sense and are putting people in danger.
We are probably less than a week from a mass surge in patients needing ICU beds, regular beds, and emergency treatment. We currently don’t have a plan for increased staffing, increased ventilators, and increased supplies. There are rumors of increasing some of our bed capacity, such as the opening of a unit closed a year ago, but nothing has been communicated.
On Monday, we finally opened up a COVID-19 clinic so the public can get tested and people with minor issues can get treated in a separate part of the hospital. At White Plains Hospital, a private hospital in Westchester County, the National Guard helped them construct a tent outside of their facility to screen COVID 19 patients and ease emergency room overcrowding. We should have one of these at all major hospitals in New York City, especially at the 11 major public hospitals.
We already know we are going to be short on ventilators, ICU beds, and all beds with oxygen ports. We need to create makeshift beds with portable oxygen in every part of the hospital and possibly in public schools and colleges to handle this surge. The scaling up of this is not happening anywhere near the extent necessary.
Workplace safety for healthcare workers during a pandemic is critical, first, for your own safety and, secondly, because if you are infected you can be a major vector in spreading the disease. You’re an active member of the New York State Nurses Association. Can you explain why unions like NYSNA and National Nurses United have been very critical of the Trump administration’s treatment of nurse safety?
First and foremost, the federal government has known about the inevitability of this crisis hitting the United States for at least a month. Immediately, they could have developed the capacity for widespread rapid testing, ramped up domestic N95 mask production, increased bed capacity, and possibly even produced more ventilators. We could have made plans to shift healthcare workers where they might be needed most. They could have instructed local governments with clear protocols for closing schools and other public institutions and restricting gatherings. None of this happened in time.
The most pressing issue right now is the N95 mask shortage. The shortage has led the Centers for Disease Control to roll back guidelines for treating potential and actual COVID-19 patients. Prior to a week ago, the CDC guidelines stated that all patients with suspected COVID-19 were to be on airborne precautions. This means that healthcare workers need an N95 mask, a face shield, two pairs of gloves and a surgical gown. After the change, they are saying these patients should only be on Droplet Precautions, which means a surgical mask, a face shield, and a less protective gown. Surgical masks are in better supply than N95s but do not protect you against airborne particles.
There is a lot that we don’t know about COVID-19 transmission other than that it is transmitted very easily, even among asymptomatic people. Studies have shown that COVID-19 can survive on aerosolized particles. Healthcare workers are one of the most precious resources in this epidemic, putting them at greater risk is criminal and will help spread the disease. It is unclear why but we know healthcare workers, regardless of age and underlying conditions, are at a greater risk of becoming critically ill from COVID-19. It also doesn’t help that hospitals have been backing Trump’s CDC decisions that are putting us frontline workers at risk.
It will be up to us to organize and protect ourselves and our patients. If we can change the protocols, there will be more pressure on the government to procure enough masks.
The second biggest danger for healthcare workers is how they are treated when they do get exposed. And here, it’s not just Trump that is failing us. The lack of rapid testing means that nurses should be taken out of commission when they are exposed until they test negative or for 14-days. But Mayor Bill de Blasio and Governor Andrew Cuomo have not ensured that this is happening across the board.
In the public system where I work, nurses with known exposures to COVID-19 patients are being asked to come back to work unless they have a fever. This, of course, significantly increases the chances that they are asymptomatically and unknowingly spreading this virus among their coworkers and patients. Until Monday of this week, they also weren’t being tested. And even now — the test takes two to three days to come back, remember — people are still working with known exposure.
I’m running out of words to express how dangerous and scary all of this is.
When Hurricane Maria hit Puerto Rico, part of its vast devastation was due to the crisis of debt and austerity that weakened the island’s infrastructure and ability to withstand the disaster. I’m afraid there may be a parallel situation with coronavirus and the New York City public hospital system. Can you talk about the austerity budget of NYC Health + Hospitals and the impact it’s had on the system’s ability to handle this crisis?
To answer this, I think it’s worth discussing briefly how healthcare funding works in the public system. We rely on funding from Medicaid, Medicare and subsidies from the city, state, and federal government. We have a very small amount of patients with private insurance. Medicaid does not reimburse enough to take care of patients. Medicare does. And private insurance more than covers the cost, so that’s why private hospitals have extra money to expand their services.
We have lots of uninsured patients also so we are set up to “lose” money. That’s why we need subsidies. In the last decade, Gov. Cuomo has made increased cuts to Medicaid. The Affordable Care Act decreased Medicare funding and some subsidies to safety-net hospitals. Currently — and outrageously — Cuomo is proposing another $2.5 billion dollars in Medicaid cuts during the COVID-19 epidemic, which also means losing another $2.5 billion in federal matching funds. This has forced New York City’s public hospital system to drastically reduce staff. In the last seven years, we have lost over 1,000 nurses in the public system.
One bright spot was a change in leadership in our system, which shifted gears to trying to expand services and increase staff in order to increase revenue. We have recovered some of our nurses through this strategy but have not nearly caught up to previous levels as we wade into this pandemic. The city has also increased subsidies to make up for the shortfall but this has not been enough.
Staffing losses, and bed capacity lost due to it, is the number one way in which our public health system is going to be overwhelmed in this crisis. During the previous financial crisis, they privatized dialysis. NYSNA actually led a successful campaign to reverse this but plenty of privatization and consolidation of services happened that didn’t get reversed. In December, our system decided to close its inpatient detox units. All of these decisions weakened our extra capacity to respond to this crisis.
I would also add that these cuts didn’t just affect the public system. There are other private, nonprofit safety-net hospitals and rural hospitals that suffered from these cuts. They either closed down entirely or drastically reduced their services. Since 2000, New York State has lost over 21 hospitals, which could been a huge asset in this crisis. The utter failure of politicians in both parties to prioritize people over profits is being revealed in a massive way.
How is this part of a national context of the “lean model” pushed by the Affordable Care Act?
Lean healthcare was already being practiced prior to the ACA but it was massively incentivized through various funding mechanisms within the bill. For those who don’t know, the lean model was developed in the auto industry to increase productivity and efficiency by decreasing “waste.” In the auto industry, this meant workers’ rest. In healthcare, it means anything that can’t be proven on a computer. So holding a patient’s hand and all the non-tangibles nurses do is considered waste. In the public system in New York City, we all had to attend lean classes and were encouraged to join teams to come up with ideas to increase efficiency.
This is all an attempt at “just-in-time” healthcare delivery, which means that patients in hospital beds are flipped as quickly as possible, bottlenecks in the emergency room are considered good because there is a constant stream of patients occupying those beds, and supplies and the number of nurses are stripped to the bare bones. In a pandemic, this makes our system as brittle as a cracker.
I work in a pediatric emergency room. When our staffing started to get cut, we complained that we needed a set amount of staff to make sure we were prepared for an influx of patients that can come at any given time. We were told explicitly by management that we can longer staff based on a “what if” scenario. Well, of course, an emergency room is one giant “what if” scenario in normal times, but then “what if” a pandemic comes? Unfortunately, we now know, and it’s going to be really, really bad.
What can readers do to support public health workers’ response to this crisis?
Even though everyone should absolutely be taking the advice of health officials in terms of social distancing and sheltering in place, there are still ways we can fight. Healthcare workers are the people that will be in the most significant collective spaces during this crisis so we can still organize among our co-workers. Even if from afar, readers should support any actions that healthcare workers take — petitions, press conferences, possibly even rallies and job actions. These will need massive public support.
From my vantage the point, the priorities are:
- Get more N95 masks to healthcare workers.
- Better prepare the hospitals: increase the number of beds, increase testing, increase screening, increase supplies, increase staffing. We should join Spain and nationalize the hospitals to make all of this happen.
- Fight Cuomo’s Medicaid cuts, force Trump to increase hospital resources and win paid pandemic time off for all workers.
- Fight for the future — we need Medicare For All!
You can make phone calls and send emails to your community organizations, churches, politicians and to other groups and institutions to support and implement the demands of healthcare workers. For the next month or longer we are all going to be physically separated, so all of our organizations should find better ways to communicate and make decisions that can then mutually support each other.
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Originally posted by Truth Out on 2020-03-20 09:50:02