The first call in early April was from the test center, informing the nurse that she was positive for Covid-19 and would need a two-week quarantine.
The second call, less than 20 minutes later, was from her employer because the hospital informed her that she could return to her job within two days.
“I slept 20 hours a day,” said the nurse, who works at a hospital in New Jersey’s Hackensack Meridian health system and spoke on condition of anonymity because she is afraid of revenge against her employer. Although she did not have a fever, she coughed and had other Covid-19 symptoms such as vomiting, diarrhea and nausea.
“You tell me, because I do not have a fever, that you think it is safe for me to care for patients?” said the nurse. “And they told me yes.”
Guidance from public health experts has evolved as they have learned more about the coronavirus, but one message has remained consistent: if you feel sick, stay home.
However, hospitals, clinics and other health care facilities have flown that guidance pressuring workers who contract Covid-19 to go back sooner than public health standards suggest is safe. Some employers have failed to provide adequate paid leave, as one, so employees felt they had to return to work – even if they may have been contagious.
Many hospitals with a seizure of patients have staffed themselves briefly. That need depends on a familiar culture in medicine of ‘presenteeism’. Frontline health care workers in particular follow a brutal ethos of being hard enough to work, even when they are sick, because they reason that other “people are sick”, said Andra Blomkalns, the department’s chairman for Emergency Medicine from Stanford University.
In a survey of nearly 1,200 members, the Union of Health Care Professionals and Allied Workers found roughly a third of those who said they had gotten sick reported returning to work with symptoms.
Hospital staff are not only forced to choose between their pay and their health, they also return to work knowing they can infect patients as colleagues. A study by KHN and the Guardian has identified at least 922 frontline health workers who died from Covid-19, most likely exposed to the virus at work.
The dilemma strains health professionals’ sense of professional responsibility, knowing that they can become vectors that spread disseminating diseases to the patients they are meant to cure.
A database of Covid-related complaints made to the Occupational Safety and Health Administration this spring hints at the extent of the problem. It includes a respiratory clinic in North Carolina, where Covid-positive employees were told they would be fired if they stayed home, and a veteran hospital in Massachusetts, where employees returned sick to work because they would not otherwise paid values.
“What we learned in this pandemic was staff feel disposable,” said Debbie White, a registered nurse and president of the Union for Health Care and Allied Staff. “The employers did not protect them, and they felt like a commodity.”
The nurse from Hackensack Meridian, the largest hospital chain in New Jersey, told the hospital that a doctor had instructed her to stay home. Her supervisors are threatening not to burn her, she said.
But in the daily conversations of the work, she was reminded that her colleagues were short staff and “suffering”.
She also discovered that her employer in March carried out what it called a “pay adjustment”, saying goodbye to many of her employees without explaining her calculations. (A spokesman for the hospital said the adjustment corrected a technical problem, adding that workers were informed of the changes and denied that anyone was “shorting any PTO they rightfully deserved”.)
The health system followed CDC’s recommendations when removing workers who contracted Covid-19 to return to work, it said.
Federal officials recognize that shortages of staff may require sick health care workers to return to work before recovering.
If all other options are exhausted, says the CDC website, workers who are suspected or confirmed to have Covid-19 (and “who are good enough to work”) may be allowed to treat patients who are not ill immunocompromised – first those who were also confirmed to have Covid-19, then those with suspected cases.
“As a last resort,” the website says, Covid-positive workers can provide care to patients who do not have the virus.
Meanwhile, immunocompromised workers are at high risk of getting the virus with difficult choices, said Liz Stokes, director of the American Nurses Association’s Center for Ethics and Human Rights.
She recounted the experience of a surgical nurse with Crohn’s disease, who took leave on the recommendation of her doctor but was pressured by her boss and colleagues to return.
“She showed really hard guilt because she felt she was abandoning her duties as a nurse,” she said. “She felt like her colleagues, her patients abandoned.”
Money pressure is also a factor. Shenetta White-Ballard carried an oxygen tube in a backpack at work. A nurse at Legacy Nursing and Rehabilitation of Port Allen in Louisiana, she needed help to recover from a serious respiratory infection.
When Covid-19 appeared, she showed up at work. Her husband, Eddie Ballard, said his Walmart salary was not enough to support her family.
“She kept stopping, she had to pay the bills,” he said.
She died May 1 at the age of 44.
Legacy Nursing and Rehabilitation did not respond to requests for comment.
Residents, like doctors in training, are one of the most vulnerable, working on flexible, tightly packed schedules that often care for dozens of patients every day.
Not long after New York Presbyterian Hospital admitted one of the city’s first confirmed Covid-19 patients, Lauren Schleimer, a first-year surgical resident, reported a sore throat and a cough. Because she was not exposed to this patient, she was told she could continue working and wear a mask if she coughed.
Her symptoms dropped. But weeks later, her symptoms returned, worse than before. The hospital instructed her to stay home for seven days. She was never tested.
A spokeswoman for the hospital said it provides urgent state and federal guidance to protect frontline workers.
Schleimer returned to work asymptomatic at the end of her quarantine, caring for patients battling the same virus she suspected she had. While she never felt so sick, she made sure she could infect someone else.
“This was not the kind of thing I would stay at home,” Schleimer said. “But I certainly had some symptoms, and I was just trying to do the right thing.”
KHN is a non-profit news service that deals with health issues. It is an editorially independent program of KFF (Kaiser Family Foundation) which is not affiliated with Kaiser Permanente.
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