At one New York City hospital, a doctor's used mask tore as she performed CPR on her infected patient.
In Seattle, a nurse compares walking into her intensive care unit to bathing in COVID-19.
And in St. Louis, a nurse slips her used N95 mask into a paper bag at the end of her shift and prays that it's disinfected properly.
These are scenes playing out in hospitals across the country, based on interviews with more than a dozen residents, doctors and nurses who go into work every day feeling unprotected from the disease they're supposed to treat.
Nearly a month into the declared pandemic, some health care workers say they're exhausted and burning out from the stress of treating a stream of critically ill patients in an increasingly overstretched health care system. Many are questioning how long they can risk their own health. Some are falling sick themselves, and even dying. In many hospitals, the pandemic has transformed emergency rooms and upended protocols and precautions that workers previously took for granted.
"It's like walking into Chernobyl without any gear," said Jacklyn, an ER doctor at a New York City hospital who asked to go by her middle name for fear of being fired over speaking out.
At her hospital 90% of patients have COVID-19, but health care workers get only one N95 mask every five days.
"We're constantly breathing in everything that's aerosolized because of all of the procedures that we're doing," the New York City doctor said.
Coronavirus can spread easily through droplets during close interactions such as coughing and talking. It can also stay on some surfaces for days in some cases. During certain procedures, the virus becomes aerosolized and can linger in a room for longer periods of time. In such cases, health care workers are directed to take "airborne precautions" and wear N95 masks or another kind of respirator.
She said she's baffled by how unprepared the government and hospitals are for this moment.
The day Jacklyn shows up to the hospital and there are no N95 masks, she'll refuse to work, she said.
"I'm not on a suicide mission here. I'm not going to do anything that puts my life at risk. What is my daughter going to do without me? What would my husband do without me?" she said.
With a nationwide shortage of protective equipment, many hospitals are limiting how often nurses and doctors can get new masks and devising ways to stretch supplies.
"Whoever is disinfecting these masks, are they trained to do this? Is someone supervising? Where are they doing it and how?" wondered Sophia Rago, an ER nurse based in St. Louis, about her hospital's policy.
Rago said she gets only one surgical mask and one N95 mask for three shifts in a row. Afterward, she places it in a brown paper bag and writes her name on it.
"You give it to somebody and they are supposed to be disinfecting it between your shifts," she said. "Do I trust that? No!"
"It can be disheartening to have that feeling of uncertainty that you are not going to be protected," she said.
Much of the anxiety felt by front-line health care workers stems from the ever-shifting federal guidance that in some cases later turned out to be wrong.
For example, in the early days of the pandemic, the Centers for Disease Control and Prevention had narrow criteria for screening suspected coronavirus cases that was later broadened as the virus spread in the U.S.
The CDC still recommends, in cases where N95s aren't readily available, that a simple surgical mask will suffice for health care workers unless they're doing procedures that cause aerosol spray from the patients, such as intubating someone. It was only last week that the agency changed its guidelines and told all Americans to cover their faces with masks or cloth when in public.
It makes health care workers distrustful of the recommendations, which many said appear to err on the side of less than what they need. They point to the CDC's recommendation to use a bandanna or scarf as a last resort if masks run out.
"I don't care what the CDC guidelines say. If your nurses feel uncomfortable in a certain area, you should give them what they need," said Ramona Moll, a nurse who works at UC Davis Medical Center in Sacramento.
Moll said she contracted COVID-19 in mid-March after treating a patient suspected of having coronavirus. She believes the exposure happened when the older patient with dementia became combative and tried to bite her.
At the time, she was wearing a surgical mask, goggles, gloves and a gown, but no N95 mask. It was in line with CDC guidelines.
"The hospitals need to take responsibility for the fact that they did not take care of their nurses. They did not have N95s available," she said.
Her hospital disputes her account. Spokesman Edwin Garcia said there were no COVID-19 patients at the hospital at the time and that it has "dedicated, full-time teams that are committed to infection prevention and keeping our employees safe."
Grueling shifts, stress and bruised faces
The lack of protective gear is one piece of a mosaic of stress that comes with caring for COVID-19 patients.
There are the 12- and 13-hour shifts in uncomfortable masks, the many unknowns of the disease and difficulties screening for it, the fear of getting infected or accidentally infecting another patient and the sadness of watching people die alone.
At an under-resourced community hospital in Los Angeles, a nurse practitioner, Marie, has a plastic bag in her car where she stashes her used N95 masks for the day her hospital may run out.
"I'll spend the majority of my shift trying not to have a panic attack and then come home and fear going back to work," she said. "If this goes on for weeks and weeks and things only get worse I just don't know how I'm going to be able to handle it.
She asked to use her middle name because her hospital has warned employees not to speak publicly; some workers have been reprimanded for critical social media posts.
Marie has lost three pounds in a week. Once she puts her mask on during a shift, she won't take it off, not even to eat. The bridge of her nose is cut open from wearing it on her face for hours at a time. The lack of preparation has her considering leaving nursing after the pandemic passes.
"I have dedicated my life to treating other people," she said. "And yet when I'm in need, I'm not provided with what I need. It's like an abusive relationship."
Health care workers across the country and the globe are sharing selfies of their bruised faces from wearing N95 masks.
"It is a long six hours to be in all that gear," said Amanda Adams, a travel nurse who works at an ER in the New York City suburbs. "I try to put aside my emotions and cheer up the patients. Meanwhile, I am thinking which one is going to give it to me and am I going to get sick?"
Many items are in short supply after weeks of seriously ill COVID-19 patients streaming into the hospital. Perhaps, the most scarce resource is time.
"You are finding yourself starting to work on one patient and then rushing to the next room," she said.
Other nurses tell her it's like a war. "I don't really see the light at the end of the tunnel," she said.
Once infected, who takes care of the health care worker?
Already front-line workers are falling ill and feel they have to choose whether or not to risk their lives to save others.
At least 30 U.S. health care workers in the U.S. have died of COVID-19, according to Medscape. Some of them were young and early in their careers.
"That also increases the fear. That it's hitting young people," said Roy Akarakian, an ER resident at Henry Ford Hospital in Detroit. "I'm worried and afraid about the overall situation. This is something we've never seen before."
Akarakian has already survived the virus — one of more than 730 employees of the Henry Ford Health System who have tested positive since tracking began on March 12.
In Seattle, Edward, an ICU nurse, said he developed flu-like symptoms and shortness of breath last month after treating COVID-19 patients.
He decided to stay at home out of caution while he waited for his test results. Seven days passed before he learned he was positive.
"It was just really hard and nerve-wracking," said Edward, who works at Swedish Medical Center.
Edward is using just his first name because he's afraid of losing his job for speaking publicly.
While in isolation and recovering, he was required to use his own vacation and sick time. After learning he had COVID-19, he said his employer "tried to pin those results on something outside the hospital." Probably, Edward said, because the hospital provides fully paid emergency administrative leave only if you can prove you caught it on the job.
"I did not feel supported at all," he said. "Their main concern was trying to explain away my positive results as community-acquired."
In a statement, Swedish spokeswoman Tiffany Moss said the hospital is "grateful for our caregivers' unwavering commitment to our patients and the selflessness they bring to work every day to ensure our patients and community are safe."
A spokesperson also noted that Swedish provides 80 hours of full-paid emergency time off for workers affected by COVID-19 — no matter where they were exposed to the virus — but only after infected employees exhaust vacation and sick time.
When Edward got the green light to go back to work, his co-workers seemed afraid to be near him.
"When I would tell people, they would physically back away from me. They would question whether I should be at work," he said. "It was hard to go home at night and deal with those emotions."
Increasingly, nurses are having to use sick or vacation time while in quarantine with COVID-19, according to National Nurses United, which represents more than 150,000 workers. Some hospitals are providing emergency leave for health care workers regardless of where they caught the virus.
The risk of infection is higher for hospital workers than the general public,so many take extreme precautions.
One ER resident in Chicago has a plastic curtain that comes down to the floor at the front entrance of his apartment. There he strips out of his scrubs puts them in a backpack, leaves his shoes outside and beelines to the shower before touching anything in his home.
Arash Hosseini, a nurse from Bothell, Wash., said he was "obsessive" about wearing proper personal protective equipment. Still, his wife came down with many of the "classic symptoms" of COVID-19, but she wasn't sick enough to get tested.
Hosseini started with protecting his kids. He moved his two children, one has an autoimmune condition, to his mother's house. He started sleeping in his car. But last week, the symptoms started.
"It is just a difficult situation with all of us separated from each other," he said.
He is still sleeping in the garage.
Sarah Prybylski, a travel nurse, came down with COVID-19 symptoms after a stint at a Seattle hospital last month. She returned to her home in Arizona with a dry cough, fever and fatigue.
Weeks later, Prybylski started feeling better but was torn about whether to accept a new contract at a hospital in California.
"I feel like I am abandoning nurses, if I don't go," Prybylski said. "But it gives me anxiety to know, if I go out there, I am going to be at risk every single day."
Health care workers defy gag orders
With all the risks health care workers face, many hospitals are also admonishing them when they share their stories. Supervisors and administrators have sent out emails at various hospitals reminding health care workers not to speak to the press or post on social media.
An ER doctor in Bellingham, Wash., was even fired for posting on social media and speaking publicly about what he saw as lack of protections at his hospital.
"Those on the front line are being silenced," the Washington State Nurses Association said in response to the doctor's firing. "Nurses and other health care workers are being muzzled in an attempt by hospitals to preserve their image."
Some are ignoring the gag orders and going public. Others are getting creative with personal and anonymous social media accounts, like the Twitter account @Covid19Docs.
In ER, the doctors are getting surgical scrubs and N95s. The nurses are left with surgical masks.
— Take Medicine Back (@TakeMedBack) April 3, 2020
“In ICU, residents get 1 surgical mask, no n95. Nurses lock away masks. Nurses have access code but residents don’t.”
— Take Medicine Back (@TakeMedBack) April 3, 2020
Olabunmi Agboola, a Washington, D.C.-based doctor, is organizing. She started National Physicians United about two weeks ago. Already it has more than 21,000 members in a closed Facebook group.
"I don't want this to ever happen again," she said. "So this group will not only get aid to physicians in the current crisis, but then also look to fix the things that are wrong with health care, that are blocked, that led us to this type of fallout."
The group is creating informal supply chains for physicians and task forces that provide emotional, legal or financial support.
"We also have a reporting tool for physicians who are experiencing mistreatment and abuse. So this way their stories are documented," Agboola said. "This should have never happened."
This story is part of NPR's reporting partnership with Kaiser Health News.
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