As the COVID-19 pandemic continues to escalate in the United States, health care workers and first responders find themselves facing shortages of personal protective equipment (PPE) but also the possibility that they will have to make harrowing choices, both personal and professional. We know from the reported experiences of female physicians and nurses in China, where the SARS-CoV-2 virus first hit, that the pandemic has affected women in specific ways. Nurses in China reportedly took birth control to suspend their periods, shaved their heads, and wore adult diapers so that their work would be minimally disrupted. Young mothers have been separated from their children by work, quarantine, and varying degrees of illness. With the number of U.S. COVID-19 patients who require hospitalization increasing daily — in some cities, exponentially — are female health care workers in the United States facing similar scenarios? Will they soon? And how is this impacting them?
Here, seven women in different cities and roles share their experiences so far, from huge ethical dilemmas to quotidian aspects of their lives, relationships, and jobs that have already changed in ways unfathomable a month ago. None are authorized to speak for their employers, and some say they risk being fired if they do. Several participants requested anonymity for that reason.
"We're like, 'I hope this works.'"
The Nurse Anesthetist Ready To Intubate In A Bandana
Sandra Choi, 39
Because there are not enough elective surgeries happening, we nurse anesthetists have formed something called a COVID response intubation team at my hospital.
Within our own WhatsApp groups, we've been circulating a lot of information that's coming out. We're desperate to learn from other people's innovations as well as other people's mistakes. When we passed around that video [about how] an intubation team was really successful in Wuhan, China, we [thought], we should do this.
We had heard a few stories about some botched up intubations with COVID-positive patients. Nurses were off hiding and crying, and there [were] too many people in the room, and people were not following proper protocols. You need people who know how to do this, who can calm the room down and say, "This is what we're doing."
We're a specific team now that gets called to intubate the COVID-positive or COVID-suspected patients in the hospital. It's people who have advanced airway skills, those of us that know how to intubate patients really well, mostly [certified registered nurse anesthetists (CRNAs)] and attending anesthesiologists. I'm sure other hospitals are going to try to form these types of teams, too, because it makes sense.
"All of a sudden my older sister who doesn't ever cry is sobbing on FaceTime."
The whole key to this is to go in there and get it in one shot because the longer you take to intubate someone, the more exposed everyone's going to be to this patient who's COVID-positive. I'm sure you've seen stories: People who are intubating are at the highest risk of exposure because we're in the [patient's] mouth. You're getting thrown into this room with all this PPE, if you have it, and you want to get that tube in as quickly as possible to get out as quickly as possible.
I did my first shift for the COVID response team yesterday for 12 hours. It wasn't that busy yet. I think it's still early. We're getting a lot of COVID-positive patients, [but] I don't think they're in the stage yet where they're going to complete respiratory failure. I think that's going to start happening this week and next week.
We did one true intubation yesterday. When I left, we were eyeballing three to four patients that were probably going to go down. We're trying to intervene before it becomes an emergency where patients are freaking out, but we also don't want to intubate these people unless we absolutely have to because A, there's exposure [for us] and B, we're worried that the outcome won't be that great. Once we put the breathing tube in, you may never be able to be extubated and breathe on your own again. We're trying to give people a chance to fight it before we intervene.
I wasn't worried about my own safety so much until I spoke to my sisters. Neither one of them are in health care, but they watch the news, and they hear how dire it is. Then they're talking to me, and I'm confirming yeah, we're having a really hard time getting masks and supplies. All of a sudden my older sister, who doesn't ever cry, is sobbing on FaceTime.
"We're pissed off at the CDC because we know that they're loosening the guidelines because of the situation we're in, not because it's proven to be safer, and they want us to keep working."
Health care providers don't often think about our own safety, but when we start thinking about how it's going to affect our family members, that's when it starts to get upsetting for us. A lot of us are afraid to come back home to our own family members that we've been isolating with, especially in New York City because everyone lives in a small one bedroom or studio apartment. We’re terrified of infecting someone in our own home, especially because we don't have the proper protective equipment and we're at a high level of exposure.
I have to say, yesterday when we were doing our COVID intubation, the other anesthesia person and I that went in, we were scared, even though we'd done this a thousand times. It was really important for us to help each other out with the equipment, how we were putting it on and taking it off. A lot of times if you're not careful, you can infect yourself during the stage of taking off the PPE. So we just went real slow and real methodical, and if we went out of order, like took off the gown before we took off the headgear, we had this moment of, OK, just change your gloves that you're wearing, take it slow, and move it away from your face.
The worst part is then I'm taking it from him, and I'm bleaching it because we have to reuse it. That's terrifying to me, because in the past you could just throw it in the garbage. Now I have to bleach it for you, let it dry, and then we're going to have to reuse it in a few hours. And we're like, "I hope this works."
"How can we be considered this first-world country, and we can't get masks?"
We never thought we would be in a situation where our PPE wouldn't be supplied to us. And it's always been: Never re-use. Never, ever reuse a mask. Take it off. Throw it in the garbage. That's it. So this is a whole new world for all of us. We're like, but isn't this thing contaminated now? That's why we're wearing an outer mask over our N95s, with the hope that the outside of the outside mask would get thrown out. But we're running out of regular masks, too. Eventually I don't know how we're going to protect the outside of the N95 masks that we're reusing.
That's why we're so pissed off at the CDC because we know that they're loosening the guidelines because of the situation we're in, not because it's proven to be safer, and they want us to keep working.
It's funny, it's like going through stages of grief. None of us are angry about taking care of patients. We consider it a privilege to take care of people. We're angry at the lack of PPE, but we don't know who exactly to be angry at. How can we be considered this first-world country, and we can't get masks?
"I think [it] could get to that point of scarves and bandanas. Are we still going to go in? Yeah."
I feel like skill-set-wise and mentality-wise, we're prepared to do whatever it takes. We've already discussed it amongst ourselves. Our [hospital administration] has said no one goes in the room without PPE, but I think [it] could get to that point of scarves and bandanas. Are we still going to go in to intubate a patient that needs it? Yeah. I mean, I think we're going to get creative with things that we've seen on the internet and things out of China. But I don't think any of us are going to be able to stand by and just let someone go without trying to help them. I don't think we're cut like that. It was totally voluntary [to join the COVID response team], and I would say almost all CRNAs have volunteered to do it at our institution, despite the PPE shortage.
My boyfriend is really worried about me. He knows I'm high risk. I have asthma. People that have other pulmonary issues or other comorbidities are at higher risk for not having such a smooth recovery.
I realized the best thing I could do to reassure my family members and my loved ones is to say over and over again, "I'm being really, really careful. I promise I'm being careful." That seems to make them feel better.
The ER Doctor + Wellness Influencer Waiting For The Wave
Cassie Majestic, 33
Orange County, California
The community emergency department is very busy in Orange County, so we see between two to three patients an hour. In the past week I have seen fewer people, which is great because we want patients to stay home to avoid exposure unless they are really, really sick. The majority of patients I'm seeing now are respiratory, which could [or] could not be coronavirus.
I don't feel fearful. I ask myself sometimes if that's normal, if I should have more fear. But I'm in a field where I know there's risk with everything that I do, including getting in my car. I think my brain has been trained to turn fear into solution and reassurance: We'll do the best that we can with the situation at hand.
"I don't feel fearful. I ask myself sometimes if that's normal."
I feel frustration for other health care providers. I have a large community on social media, [and] it's really upsetting when you hear that they want you to keep working and carry out the goal of saving people and ending this pandemic, but that they're not putting health care providers first. I've spoken to many providers over on the East Coast who have said they don't have access to testing, and that's not how it is for me. If I get sick, I've been told that I'm able to be tested quickly so that I know if I can go back to work or not so that I can continue to help others.
I try not to be angry because the emergency department is an angering environment regardless of the times, but it is disconcerting when you start to see health care workers dying but you're not seeing any real change in the [PPE] supply or in the ability to be tested early on.
The Oncology Nurse With A 3-Month-Old
Quite a way to be welcomed back from maternity leave, with a pandemic. I'm breastfeeding and trying to pump, which is stressful as a nurse because you're constantly available. I often do not have time to have lunch, or I stay late, so I was already anxious about making time to pump. Now I'm even more so because of everything that's happening.
My first day [back on the floor], they wanted me to go to the COVID-positive unit. I told staffing that I couldn't take care of those patients right now because I'm breastfeeding. We're not overrun with COVID patients yet. There's still plenty of oncology patients, which is what I do. I said I would rather wait before taking COVID patients, because as soon as I do, I have to wear a mask with my baby every time I interact with her.
Also, when a nurse enters that COVID-positive unit, they put on surgical scrubs, they get in the bunny suit, and they have the N95 masks, the goggles, a headpiece, and they stay in that gear the entire shift. The only thing they change is their gloves between patients. With me pumping every three hours or so, I would be wasting a lot of PPE, and we don't have that luxury.
"As soon as I take COVID patients, I have to wear a mask with my baby every time I interact with her."
I know I will take those patients. I've actually been in a lot of emotional distress about it. I cry often. I accept what's going on, and then I freak out about it. There's this sense of fear in the hospital that's ever-present. I've talked to my husband about if I am exposed, he and my baby would move out with his parents for the seven to 14 days to see if I'm going to have symptoms.
I'm very cautious when I come home. After a shift, I go into the locker room, I change my clothes into clean clothes, I leave. When I get to my house, I go into my garage, I strip all my clothes down, I put on a robe and different shoes. All of my clothes that I had worn into the hospital and home from the hospital, including those clean clothes that I changed, I put them all in a bag, I disinfect everything — my watch, my wedding ring, my ID badge, my keys, with Clorox wipes. I come in, I put my clothes in the laundry and then I go immediately upstairs and shower. Everything else, my purse that I bring to the hospital, my shoes that I wear to the hospital stays in the garage. I think I'm taking every precaution that I can.
[Our hospital] ran out of N95 masks, and they're being very stringent with the surgical masks. We've even had patients steal them. They used to just be in drawers outside of patient rooms. Now in order for us to get masks, we have to page, and they bring down one or two boxes, to protect the supply.
"This weekend we had trash just piling out of the containers in these patients' rooms. The environmental service didn't want to come up and collect the trash because they're scared. I don't blame them."
This weekend we had trash just piling out of the containers in these patients' rooms. The environmental service didn't want to come up and collect the trash because they're scared. I don't blame them.
I hate all the work-from-home jokes. I would love to work from home. I want to be with my daughter, but instead I'm risking my health. I'm going to have to work overtime and extra shifts and be away from her and somehow try to pump. When I was there on Sunday, I barely drank or ate, because the moment I took my mask off, it was garbage, and I didn't want to waste the mask.
It’s just so surreal. How is this real?
The Nurse At A Rural Hospital Teaching Everyone Else How To "Doff"
In our hospital, I'm the expert on what PPE the staff needs, how they should wear it, what they do when they go in a room. I worked almost 12 days straight when we first got our first COVID case. In nursing school, you learn about pandemics, but you don't ever think that it's going to hit us.
My job right now feels like I'm putting fires out throughout the day. There might be a doctor that doesn't know how to put their face shields on. We have masks that are called cappers — it's just a cap with air pressure reversal, so that way we're not breathing in the particles — so a lot of our staff need help getting them on. Everyone is scared right now, so sometimes the nurses know what they're doing, but they need that support: “You're doing it right. You're OK.”
"Everyone is scared right now, so sometimes the nurses know what they're doing, but they need that support: 'You're doing it right. You're OK.'"
It's the taking it off that is really concerning everyone. There is a technique. It's called doffing. You have to doff in the appropriate fashion so that you don't expose yourself. Because the coronavirus right now is airborne and possibly droplet, you could have droplet particles on your PPE. So if I touched my gown and then I went and touched my face, I could now have just put a particle on my face where I could potentially breathe it in.
I'm following proper PPE guidelines, but I am not really putting myself in direct line [to contract the virus at the hospital]. I haven't felt like I am in any harm at work. At the same time, I could catch this at the grocery store or the gas station, or my husband could bring it home, so I'm scared. I don't think that I'm invincible to getting it.
The First-Year ER Resident Fighting With Her Boyfriend Over What She's Touched
Jenny Tsai, 27
New Haven, Connecticut
Right now our volume is much lower in the emergency department (ED). I think people are staying home, which is great and eerie on its own. We're all aware that in the next week or two, things are going to get really wild.
My life is: I go to the hospital, I come back home, I go to the hospital, I come back home. There are no breaks, and when I’m home, should I see my roommates? Is it irresponsible for me to do that? Should I not be hanging out with them, even in the kitchen?
I had to talk very seriously with my partner. It was brought up that we shouldn't stay together. I think it is a cruel thing to make people face the prospect that somebody they love is getting up each morning to run toward danger. For now, he's decided that that's a risk that he wants to, or is willing, to take.
"The other day, I wanted to swing on a swing set. I think I just wanted three minutes to be a kid."
To be honest, it's made us fight over stupid things. We try to take a walk once a day, and the other day, I wanted to swing on a swing set. I think I just wanted three minutes to be a kid. Immediately he's like, “No, it's dirty. We can't clean it. Don't do it,” and that was a fight. We saw a dog, and I wanted to pet the dog, and I pet the dog, and then later on he was like, "Maybe you shouldn't have pet the dog." It is heightened anxiety, and it's part of how he cares, but I'm going to pet the dog. Right now, we're still staying [over at each other’s apartments], but I think we've gotten to a point where if I or he develops symptoms, we would probably not continue doing that. Hopefully we won't have to face that.
It's not fun to be nervous. It's not fun to not know if we will have PPE next week or next month. That is a real and concrete fear for us. We're at a very well-stocked and wealthy hospital in a big hospital system, but we're rationing our masks, and we're cleaning them after every use. I go into work each day, and I am given one [N95] mask that’s under lock and key. I keep my mask with me and reuse it throughout the day. That's not something that I've ever seen or done. At the end of our shifts right now, we dispose of them in a very specific way that [gives us] the impression that they will have to be sterilized to be reused.
I have colleagues, people that I lived with, went to college with, and are my dear friends, who are being told, "You get one mask, and if it breaks, you staple it back together." These aren't stories that I see on Twitter. The CDC is putting out these information blurbs about how you can use bandanas and vacuum bags. My partner is asking me, "Should we buy vacuum bags? Should we make some for you?"
"I had this moment where I realized if I were hospitalized, I probably would not tell my parents."
The fear of getting sick myself surges once in a while. I tell myself, “I'm 27. I'm probably healthy. I don't have a medical history that puts me at risk. I'll probably be OK. I need to be most concerned that I'm spreading it.” But also you read these reports of young docs and health care workers getting really, really ill. The young people who are critical are usually health care workers with high exposure.
I had this moment where I realized if I were hospitalized, I probably would not tell my parents, because they cannot come see me. They are in their 60s, would have to fly, have medical issues, and I think it would cause them great stress and anxiety. So I don't think I would tell them.
I have a job to do. I know that, and I signed up for it, and I'm going to do it. That has not wavered. Especially in an emergency, [when] somebody may or may not be perishing in front of you, it's hard to turn away.
What I don't want to see is the erosion of humanism and humanity. I don't want to have to make decisions that we see reports of in Italy, where they're not coding — performing heroic measures or CPR on — patients older than 70. That seems like an insult, honestly, to what I was trained to do. To walk around an ED and say, "We have a new set of triage expectations to not code somebody who's 70, just because they're 70 because we don't have the resources to care for them further."
"I have a job to do. I know that, and I signed up for it, and I'm going to do it. That has not wavered."
It is part of our board [certification] that we have some training around standard triage for mass casualty situations like an airplane crash or, I don't know, anything that Grey's Anatomy has featured. But I cannot recall in medical school ever being prepared for this.
The EMT With A Message For Celebrities
Carla Orta, 45
Ambulance and hospital volume is actually down right now because people are staying home, as opposed to calling 911 for things. My husband is a police detective, and they told him, "Work from home, we'll call you if there's a murder." I have to go to work, and it can be a little frustrating. Everybody thinks they have COVID; they sneeze and they think they have COVID.
The ambulance protocol for COVID is the same protocol for the flu. If someone calls 911 and they have any flu-like symptoms, we always put a mask on them, put a mask on ourselves, gloves, and call it in as flu-like symptoms to the hospital. I would say the only difference for COVID is that the dispatchers ask, “Can that patient physically go outside the ambulance?” If the answer is yes, people are meeting us curbside, which hasn't happened in the past. Then we don't have to go into someone's house. The state has also said anyone with COVID-19 symptoms is not to get on the stretcher, if possible, and to sit in one of the bench seats in the ambulance, so that they have the least amount of contamination possible.
In Massachusetts, we have a shortage of personal protective equipment especially for women, because most of us wear small masks and small gloves. Most of the supply is large [or] extra large for the men, so there's not only a shortage of PPE, but there's a real shortage of smalls.
"We have such a shortage of personal protective equipment especially for women, because most of us wear small masks and small gloves. Most of the supply is large [or] extra large for the men."
A month ago, these N95 respirator masks were one-time use only. Now, they've given me one small N95 respirator mask. They said, "Put your name on it, and this is what you're using. That’s it. You're getting one."
I've kind of taken a break from social media. We don't have enough PPE, the hospitals don't, ambulances don't, and you see celebrities, they've got their masks on, they've got their gloves, and they're like, "Look at me, I'm so cute right now." It's frustrating for health care workers. You're a celebrity. Go in your mansion and stay there.
"You see celebrities, they've got their masks on, and they're like, 'Look at me, I'm so cute right now.' It's frustrating for health care workers. You're a celebrity. Go in your mansion and stay there."
The Internist Already Making Hard Choices
When this started, I had just returned from a vacation. My first day [back] was the day we heard that there was a patient in New Orleans who had COVID-19. We learned pretty quickly that it was spread via community spread, and we realized that if it's already community spread, we're in a bad situation, and it's about to get worse.
You have a lot of patients who come in with COVID or suspected COVID who are doing OK, and a lot of patients that pretty rapidly deteriorate. Sometimes we're admitting them because they're elderly, or they're immunocompromised, or they have other factors that make us think that they're at high risk for decompensating. A lot of them do fine. We monitor them for 48 hours, then we discharge them back to their homes to self-quarantine.
"Every consult or imaging test I request potentially places other health care workers at risk, and this patient does qualify for hospice, so it's weighing risk [versus] benefit."
The main concern with that is what if they just came in too early? There's some data showing that the second week is really when they decompensate, and it's just so hard to know when they're first coming in. The first few weeks I was calling all my patients every day after I discharged them, but I can't do that on my own and take care of all these new patients. Luckily we were able to get a group of medical students to call all of our discharged patients on a daily basis to follow up with their symptoms, which has been a huge relief.
Other patients rapidly decompensate. It's tough. Sometimes they come in, and they're intubated so quickly, you don't have a lot of time to make sure they know how sick they are or had that communication with their families.
I have one woman who was walking, talking, completely independent, and now two weeks later is very weak. A physical therapist could try to build her strength back, but I haven’t done it yet. Every consult or imaging test I request potentially places other health care workers at risk, and this patient does qualify for hospice, so it's weighing risk [versus] benefit. That's a different ethical challenge than I'm used to.
I have moved one patient to ICU. I don't know what happened. They were pretty young, one of the youngest, and a health care worker. So you've always got that in the back of your head.
When I get free time to think about it, sure, it's scary. A lot of data that have come out saying that health care workers are at an increased risk of infection. I think a lot about this rationing of the PPE. I am trying to use caution in how I put it on, how I take it off. I limit how much time I'm in the patient's room. I’m going in there to do physical exams, see the patient, but then calling them on the phone to have a lengthy discussion outside of the room to try to reduce how long I'm at risk.
"I have moved one patient to ICU. I don't know what happened. They were pretty young, one of the youngest, and a health care worker."
The hardest part for me is not my health, but feeling like I need to protect those I supervise and make sure they have the safest working conditions possible. If this keeps up, we will run out of PPE, which is really terrifying. We can't function without staff, and it is really tough to provide reassurance to them. They're adult doctors, so they are going to know if you're laying it on too hard. I'm trying to be real with them. We have daily emails that go out with all the updates, providing them mental health resources, but I think everyone's a little burned out on email. It's hard to know if they even have time to read.
There’s obviously that fear of am I bringing it home? Am I infecting my fiancé? I try not to think about [it]. I probably have already been exposed. Honestly I think most of New Orleans has been. Unfortunately, there's no way to test. I think there is a good chance I will get it if I haven’t already had it. I'm very lucky I don't have any comorbidities.
I'm just planning on being in the 80% of people who do fine. The hope is to be in that 80%.
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