The P-III BLAZE-2 COVID-19 prevention trial involves assessing bamlanivimab (4,200mg) vs PBO in residents and staff at skilled nursing and assisted living facilities. The 965 &132 COVID-19 negative & positive participants were included in the analysis of 1EPS & 2EPs for assessing prevention & in exploratory analyses respectively
The results demonstrated an 80% reduction in risk of contracting COVID-19 in residents. Results for all 2EPs also reached statistical significance in both the overall and resident populations
Results from the exploratory analyses showed viral load is consistent with the previous studies
Click here to read full press release/ article | Ref: Lilly | Image: Reuters
The effort to vaccinate some of the country’s most vulnerable residents against covid-19 has been slowed by a federal program that sends retail pharmacists into nursing homes — accompanied by layers of bureaucracy and logistical snafus.
As of Thursday, more than 4.7 million doses of the Pfizer-BioNTech and Moderna covid vaccines had been allocated to the federal pharmacy partnership, which has deputized pharmacy teams from Walgreens and CVS to vaccinate nursing home residents and workers. Since the program started in some states on Dec. 21, however, they have administered about one-quarter of the doses, according to the Centers for Disease Control and Prevention.
Across the country, some nursing home directors and health care officials say the partnership is actually hampering the vaccination process by imposing paperwork and cumbersome corporate policies on facilities that are thinly staffed and reeling from the devastating effects of the coronavirus. They argue that nursing homes are unique medical facilities that would be better served by medical workers who already understand how they operate.
Mississippi’s state health officer, Dr. Thomas Dobbs, said the partnership “has been a fiasco.”
The state has committed 90,000 vaccine doses to the effort, but the pharmacies had administered only 5% of those shots as of Thursday, Dobbs said. Pharmacy officials told him they’re having trouble finding enough people to staff the program.
Dobbs pointed to neighboring Alabama and Louisiana, which he says are vaccinating long-term care residents at four times the rate of Mississippi.
“We’re getting a lot of angry people because it’s going so slowly, and we’re unhappy too,” he said.
Many of the nursing homes that have successfully vaccinated willing residents and staff members are doing so without federal help.
For instance, Los Angeles Jewish Home, with roughly 1,650 staff members and 1,100 residents on four campuses, started vaccinating Dec. 30. By Jan. 11, the home’s medical staff had administered its 1,640th dose. Even the facility’s chief medical director, Noah Marco, helped vaccinate.
The home is in Los Angeles County, which declined to participate in the CVS/Walgreens program. Instead, it has tasked nursing homes with administering vaccines themselves, and is using only Moderna’s easier-to-handle product, which doesn’t need to be stored at ultracold temperatures, like the Pfizer vaccine. (Both vaccines require two doses to offer full protection, spaced 21 to 28 days apart.)
By contrast, Mariner Health Central, which operates 20 nursing homes in California, is relying on the federal partnership for its homes outside of L.A. County. One of them won’t be getting its first doses until next week.
“It’s been so much worse than anybody expected,” said the chain’s chief medical officer, Dr. Karl Steinberg. “That light at the end of the tunnel is dim.”
Nursing homes have experienced some of the worst outbreaks of the pandemic. Though they house less than 1% of the nation’s population, nursing homes have accounted for 37% of deaths, according to the COVID Tracking Project.
Facilities participating in the federal partnership typically schedule three vaccine clinics over the course of nine to 12 weeks. Ideally, those who are eligible and want a vaccine will get the first dose at the first clinic and the second dose three to four weeks later. The third clinic is considered a makeup day for anyone who missed the others. Before administering the vaccines, the pharmacies require the nursing homes to obtain consent from residents and staffers.
Despite the complaints of a slow rollout, CVS and Walgreens said they’re on track to finish giving the first doses by Jan. 25, as promised.
“Everything has gone as planned, save for a few instances where we’ve been challenged or had difficulties making contact with long-term care facilities to schedule clinics,” said Joe Goode, a spokesperson for CVS Health.
Dr. Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, acknowledged some delays through the partnership, but said that’s to be expected because this kind of effort has never before been attempted.
“There’s a feeling they’ll get up to speed with it and it will be helpful, as health departments are pretty overstretched,” Plescia said.
But any delay puts lives at risk, said Dr. Michael Wasserman, the immediate past president of the California Association of Long Term Care Medicine.
“I’m about to go nuclear on this,” he said. “There should never be an excuse about people not getting vaccinated. There’s no excuse for delays.”
Bringing in Vaccinators
Nursing homes are equipped with resources that could have helped the vaccination effort — but often aren’t being used.
Most already work with specialized pharmacists who understand the needs of nursing homes and administer medications and yearly vaccinations. These pharmacists know the patients and their medical histories, and are familiar with the apparatus of nursing homes, said Linda Taetz, chief compliance officer for Mariner Health Central.
“It’s not that they aren’t capable,” Taetz said of the retail pharmacists. “They just aren’t embedded in our buildings.”
If a facility participates in the federal program, it can’t use these or any other pharmacists or staffers to vaccinate, said Nicole Howell, executive director for Ombudsman Services of Contra Costa, Solano and Alameda counties.
But many nursing homes would like the flexibility to do so because they believe it would speed the process, help build trust and get more people to say yes to the vaccine, she said.
Howell pointed to West Virginia, which relied primarily on local, independent pharmacies instead of the federal program to vaccinate its nursing home residents.
The state opted against the partnership largely because CVS/Walgreens would have taken weeks to begin shots and Republican Gov. Jim Justice wanted them to start immediately, said Marty Wright, CEO of the West Virginia Health Care Association, which represents the state’s long-term care facilities.
The bulk of the work is being done by more than 60 pharmacies, giving the state greater control over how the doses were distributed, Wright said. The pharmacies were joined by Walgreens in the second week, he said, though not as part of the federal partnership.
“We had more interest from local pharmacies than facilities we could partner them up with,” Wright said. Preliminary estimates show that more than 80% of residents and 60% of staffers in more than 200 homes got a first dose by the end of December, he said.
Goode from CVS said his company’s participation in the program is being led by its long-term care division, which has deep experience with nursing homes. He noted that tens of thousands of nursing homes — about 85% nationally, according to the CDC — have found that reassuring enough to participate.
“That underscores the trust the long-term care community has in CVS and Walgreens,” he said.
Vaccine recipients don’t pay anything out-of-pocket for the shots. The costs of purchasing and administering them are covered by the federal government and health insurance, which means CVS and Walgreens stand to make a lot of money: Medicare is reimbursing $16.94 for the first shot and $28.39 for the second.
Technically, federal law doesn’t require nursing homes to obtain written consent for vaccinations.
But CVS and Walgreens require them to get verbal or written consent from residents or family members, which must be documented on forms supplied by the pharmacies.
Goode said consent hasn’t been an impediment so far, but many people on the ground disagree. The requirements have slowed the process as nursing homes collect paper forms and Medicare numbers from residents, said Tracy Greene Mintz, a social worker who owns Senior Care Training, which trains and deploys social workers in more than 100 facilities around California.
In some cases, social workers have mailed paper consent forms to families and waited to get them back, she said.
“The facilities are busy trying to keep residents alive,” Greene Mintz said. “If you want to get paid from Medicare, do your own paperwork,” she suggested to CVS and Walgreens.
Scheduling has also been a challenge for some nursing homes, partly because people who are actively sick with covid shouldn’t be vaccinated, the CDC advises.
“If something comes up — say, an entire building becomes covid-positive — you don’t want the pharmacists coming because nobody is going to get the vaccine,” said Taetz of Mariner Health.
Both pharmacy companies say they work with facilities to reschedule when necessary. That happened at Windsor Chico Creek Care and Rehabilitation in Chico, California, where a clinic was pushed back a day because the facility was awaiting covid test results for residents. Melissa Cabrera, who manages the facility’s infection control, described the process as streamlined and professional.
In Illinois, about 12,000 of the state’s roughly 55,000 nursing home residents had received their first dose by Sunday, mostly through the CVS/Walgreens partnership, said Matt Hartman, executive director of the Illinois Health Care Association.
While Hartman hopes the pharmacies will finish administering the first round by the end of the month, he noted that there’s a lot of “headache” around scheduling the clinics, especially when homes have outbreaks.
“Are we happy that we haven’t gotten through round one and West Virginia is done?” he asked. “Absolutely not.”
KHN correspondent Rachana Pradhan contributed to this report.
A new variant of SARS-Cov-2 thought to be more transmissible was discovered in Colorado’s eastern plains and San Diego, California. At the same time, federal vaccination rates are lagging far behind projections.
A new variant of SARS-Cov-2 thought to be more transmissible was discovered in Colorado’s eastern plains and San Diego, California. At the same time, federal vaccination rates are lagging far behind projections.
CVS and Walgreens began administering the first doses of Covid-19 vaccines across long-term care facilities last week. But many questions still remain about how it will be administered to the general public.
More than 2,900 U.S. health care workers have died in the COVID-19 pandemic since March, a far higher number than that reported by the government, according to a new analysis by KHN and The Guardian.
Fatalities from the coronavirus have skewed young, with the majority of victims under age 60 in the cases for which there is age data. People of color have been disproportionately affected, accounting for about 65% of deaths in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of around 300 victims, KHN and The Guardian learned that one-third of the fatalities involved concerns over inadequate personal protective equipment.
Many of the deaths — about 680 — occurred in New York and New Jersey, which were hit hard early in the pandemic. Significant numbers also died in Southern and Western states in the ensuing months.
The findings are part of “Lost on the Frontline,” a nine-month data and investigative project by KHN and The Guardian to track every health care worker who dies of COVID-19.
One of those lost, Vincent DeJesus, 39, told his brother Neil that he’d be in deep trouble if he spent much time with a COVID-positive patient while wearing the surgical mask provided to him by the Las Vegas hospital where he worked. DeJesus died on Aug. 15.
Another fatality was Sue Williams-Ward, a 68-year-old home health aide who earned $13 an hour in Indianapolis, and bathed, dressed and fed clients without wearing any PPE, her husband said. She was intubated for six weeks before she died May 2.
“Lost on the Frontline” is prompting new government action to explore the root cause of health care worker deaths and take steps to track them better. Officials at the Department of Health and Human Services recently asked the National Academy of Sciences for a “rapid expert consultation” on why so many health care workers are dying in the U.S., citing the count of fallen workers by The Guardian and KHN.
“The question is, where are they becoming infected?” asked Michael Osterholm, a member of President-elect Joe Biden’s COVID-19 advisory team and director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “That is clearly a critical issue we need to answer and we don’t have that.”
The Dec. 10 report by the national academies suggests a new federal tracking system and specially trained contact tracers who would take PPE policies and availability into consideration.
Doing so would add critical knowledge that could inform generations to come and give meaning to the lives lost.
“Those [health care workers] are people who walked into places of work every day because they cared about patients, putting food on the table for families, and every single one of those lives matter,” said Sue Anne Bell, a University of Michigan assistant professor of nursing and co-author of the national academies report.
The recommendations come at a fraught moment for health care workers, as some are getting the COVID-19 vaccine while others are fighting for their lives amid the highest levels of infection the nation has seen.
The toll continues to mount. In Indianapolis, for example, 41-year-old nurse practitioner Kindra Irons died Dec. 1. She saw seven or eight home health patients per week while wearing full PPE, including an N95 mask and a face shield, according to her husband, Marcus Irons.
The virus destroyed her lungs so badly that six weeks on the most aggressive life support equipment, ECMO, couldn’t save her, he said.
Marcus Irons said he is now struggling financially to support their two youngest children, ages 12 and 15. “Nobody should have to go through what we’re going through,” he said.
In Massachusetts, 43-year-old Mike “Flynnie” Flynn oversaw transportation and laundry services at North Shore Medical Center, a hospital in Salem, Massachusetts. He and his wife were also raising young children, ages 8, 10 and 11.
Flynn, who shone at father-daughter dances, fell ill in late November and died Dec. 8. He had a heart attack at home on the couch, according to his father, Paul Flynn. A hospital spokesperson said he had full access to PPE and free testing on-site.
Since the first months of the pandemic, more than 70 reporters at The Guardian and KHN have scrutinized numerous governmental and public data sources, interviewed the bereaved and spoken with health care experts to build a count.
The total number includes fatalities identified by labor unions, obituaries and news outlets and in online postings by the bereaved, as well as by relatives of the deceased. The previous total announced by The Guardian and KHN was approximately 1,450 health care worker deaths. The new number reflects the inclusion of data reported by nursing homes and health facilities to the federal and state governments. These deaths include the facility names but not worker names. Reporters cross-checked each record to ensure fatalities did not appear in the database twice.
The tally has been widely cited by other media as well as by members of Congress.
Rep. Norma Torres (D-Calif.) referenced the data citing the need for a pending bill that would provide compensation to the families of health care workers who died or sustained long-term disabilities from COVID-19.
Sen. Ron Wyden (D-Ore.) mentioned the tally in a Senate Finance Committee hearing about the medical supply chain. “The fact is,” he said, “the shortages of PPE have put our doctors and nurses and caregivers in grave danger.”
This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.
Workers at Garfield Medical Center in suburban Los Angeles were on edge as the pandemic ramped up in March and April. Staffers in a 30-patient unit were rationing a single tub of sanitizing wipes all day. A May memo from the CEO said N95 masks could be cleaned up to 20 times before replacement.
Patients showed up COVID-negative but some still developed symptoms a few days later. Contact tracing took the form of texts and whispers about exposures.
By summer, frustration gave way to fear. At least 60 staff members at the 210-bed community hospital caught COVID-19, according to records obtained by KHN and interviews with eight staff members and others familiar with hospital operations.
The first to die was Dawei Liang, 60, a quiet radiology technician who never said no when a colleague needed help. A cardiology technician became infected and changed his final wishes — agreeing to intubation — hoping for more years to dote on his grandchildren.
Few felt safe.
Ten months into the pandemic, it has become far clearer why tens of thousands of health care workers have been infected by the virus and why so many have died: dire PPE shortages. Limited COVID tests. Sparse tracking of viral spread. Layers of flawed policies handed down by health care executives and politicians, and lax enforcement by government regulators.
All of those breakdowns, across cities and states, have contributed to the deaths of more than 2,900 health care workers, a nine-month investigation by over 70 reporters at KHN and The Guardian has found. This number is far higher than that reported by the U.S. government, which does not have a comprehensive national count of health care workers who’ve died of COVID-19.
The fatalities have skewed young, with the majority of victims under age 60 in the cases for which there is age data. People of color have been disproportionately affected, accounting for about 65% of deaths in cases in which there is race and ethnicity data. After conducting interviews with relatives and friends of around 300 victims, KHN and The Guardian learned that one-third of the fatalities involved concerns over inadequate personal protective equipment.
Many of the deaths occurred in New York and New Jersey, and significant numbers also died in Southern and Western states as the pandemic wore on.
Workers at well-funded academic medical centers — hubs of policymaking clout and prestigious research — were largely spared. Those who died tended to work in less prestigious community hospitals like Garfield, nursing homes and other health centers in roles in which access to critical information was low and patient contact was high.
Garfield Medical Center and its parent company, AHMC Healthcare, did not respond to multiple calls or emails regarding workers’ concerns and circumstances leading to the worker deaths.
So as 2020 draws to a close, we ask: Did so many of the nation’s health care workers have to die?
New York’s Warning for the Nation
The seeds of the crisis can be found in New York and the surrounding cities and suburbs. It was the region where the profound risks facing medical staff became clear. And it was here where the most died.
As the pandemic began its U.S. surge, city paramedics were out in force, their sirens cutting through eerily empty streets as they rushed patients to hospitals. Carlos Lizcano, a blunt Queens native who had been with the New York City Fire Department (FDNY) for two decades, was one of them.
He was answering four to five cardiac arrest calls every shift. Normally he would have fielded that many in a month. He remembered being stretched so thin he had to enlist a dying man’s son to help with CPR. On another call, he did chest compressions on a 33-year-old woman as her two small children stood in the doorway of a small apartment.
“I just have this memory of those kids looking at us like, ‘What’s going on?’”
After the young woman died, Lizcano went outside and punched the ambulance in frustration and grief.
The personal risks paramedics faced were also grave.
More than 40% of emergency medical service workers in the FDNY went on leave for confirmed or suspected coronavirus during the first three months of the pandemic, according to a study by the department’s chief medical officer and others.
In fact, health care workers were three times more likely than the general public to get COVID-19, other researchers found. And the risks were not equally spread among medical professions. Initially, CDC guidelines were written to afford the highest protection to workers in a hospital’s COVID-19 unit.
Yet months later, it was clear that the doctors initially thought to be at most risk — anesthesiologists and those working in the intensive care unit — were among the least likely to die. This could be due to better personal protective equipment or patients being less infectious by the time they reach the ICU.
Instead, scientists discovered that “front door” health workers like paramedics and those in acute-care “receiving” roles — such as in the emergency room — were twice as likely as other health care workers to be hospitalized with COVID-19.
For FDNY’s first responders, part of the problem was having to ration and reuse masks. Workers were blind to an invisible threat that would be recognized months later: The virus spread rapidly from pre-symptomatic people and among those with no symptoms at all.
In mid-March, Lizcano was one of thousands of FDNY first responders infected with COVID-19.
At least four of them died, city records show. They were among the 679 health care workers who have died in New York and New Jersey to date, most at the height of the terrible first wave of the virus.
“Initially, we didn’t think it was this bad,” Lizcano said, recalling the confusion and chaos of the early pandemic. “This city wasn’t prepared.”
Neither was the rest of the country.
An Elusive Enemy
The virus continued to spread like a ghost through the nation and proved deadly to workers who were among the first to encounter sick patients in their hospital or nursing home. One government agency had a unique vantage point into the problem but did little to use its power to cite employers — or speak out about the hazards.
Health employers had a mandate to report worker deaths and hospitalizations to the Occupational Safety and Health Administration.
When they did so, the report went to an agency headed by Eugene Scalia, son of conservative Supreme Court Justice Antonin Scalia who died in 2016. The younger Scalia had spent part of his career as a corporate lawyer fighting the very agency he was charged with leading.
Its inspectors have documented instances in which some of the most vulnerable workers — those with low information and high patient contact — faced incredible hazards, but OSHA’s staff did little to hold employers to account.
Beaumont, Texas, a town near the Louisiana border, was largely untouched by the pandemic in early April.
That’s when a 56-year-old physical therapy assistant at Christus Health’s St. Elizabeth Hospital named Danny Marks called in sick with a fever and body aches, federal OSHA records show.
He told a human resources employee that he’d been in the room of a patient who was receiving a breathing treatment — the type known as the most hazardous to health workers. The CDC advises that N95 respirators be used by all in the room for the so-called aerosol-generating procedures. (A facility spokesperson said the patient was not known or suspected to have COVID at the time Marks entered the room.)
Marks went home to self-isolate. By April 17, he was dead.
The patient whose room Marks entered later tested positive for COVID-19. And an OSHA investigation into Marks’ death found there was no sign on the door to warn him that a potentially infected patient was inside, nor was there a cart outside the room where he could grab protective gear.
The facility did not have a universal masking policy in effect when Marks went in the room, and it was more than likely that he was not wearing any respiratory protection, according to a copy of the report obtained through a public records request. Twenty-one more employees contracted COVID by the time he died.
“He was a beloved gentleman and friend and he is missed very much,” Katy Kiser, Christus’ public relations director, told KHN.
OSHA did not issue a citation to the facility, instead recommending safety changes.
The agency logged nearly 8,700 complaints from health care workers in 2020. Yet Harvard researchers found that some of those desperate pleas for help, often decrying shortages of PPE, did little to forestall harm. In fact, they concluded that surges in those complaints preceded increases in deaths among working-age adults 16 days later.
One report author, Peg Seminario, blasted OSHA for failing to use its power to get employers’ attention about the danger facing health workers. She said issuing big fines in high-profile cases can have a broad impact — except OSHA has not done so.
“There’s no accountability for failing to protect workers from exposure to this deadly virus,” said Seminario, a former union health and safety official.
More ‘Lost on the Frontline’ Stories
Desperate for Safety Gear
There was little outward sign this summer that Garfield Medical Center was struggling to contain COVID-19. While Medicare has forced nursing homes to report staff infections and deaths, no such requirement applies to hospitals.
Yet as the focus of the pandemic moved from the East Coast in the spring to Southern and Western states, health care worker deaths climbed. And behind the scenes at Garfield, workers were dealing with a lack of equipment meant to keep them safe.
Complaints to state worker-safety officials filed in March and April said Garfield Medical Center workers were asked to reuse the same N95 respirator for a week. Another complaint said workers ran out of medical gowns and were directed to use less-protective gowns typically provided to patients.
Staffers were shaken by the death of Dawei Liang. And only after his death and a rash of infections did Garfield provide N95 masks to more workers and put up plastic tarps to block a COVID unit from an adjacent ward. Yet this may have been too late.
The coronavirus can easily spread to every corner of a hospital. Researchers in South Africa traced a single ER patient to 119 cases in a hospital — 80 among staff members. Those included 62 nurses from neurology, surgical and general medical units that typically would not have housed COVID patients.
By late July, Garfield cardiac and respiratory technician Thong Nguyen, 73, learned he was COVID-positive days after he collapsed at work. Nguyen loved his job and was typically not one to complain, said his youngest daughter, Dinh Kozuki. A 34-year veteran at the hospital, he was known for conducting medical tests in multiple languages. His colleagues teased him, saying he was never going to retire.
Kozuki said her father spoke up in March about the rationing of protective gear, but his concerns were not allayed.
The PPE problems at Garfield were a symptom of a broader problem. As the virus spread around the nation, chronic shortages of protective gear left many workers in community-based settings fatally exposed. Nearly 1 in 3 family members or friends of around 300 health care workers interviewed by KHN or The Guardian expressed concerns about a fallen workers’ PPE.
Health care workers’ labor unions asked for the more-protective N95 respirators when the pandemic began. But Centers for Disease Control and Prevention guidelines said the unfitted surgical masks worn by workers who feed, bathe and lift COVID patients were adequate amid supply shortages.
Mary Turner, an ICU nurse and president of the Minnesota Nurses Association, said she protested alongside nurses all summer demanding better protective gear, which she said was often kept from workers because of supply-chain shortages and the lack of political will to address them.
“It shouldn’t have to be that way,” Turner said. “We shouldn’t have to beg on the streets for protection during a pandemic.”
At Garfield, it was even hard to get tested. Critical care technician Tony Ramirez said he started feeling ill on July 12. He had an idea of how he might have been exposed: He’d cleaned up urine and feces of a patient suspected of having COVID-19 and worked alongside two staffers who also turned out to be COVID-positive. At the time, he’d been wearing a surgical mask and was worried it didn’t protect him.
Yet he was denied a free test at the hospital, and went on his own time to Dodger Stadium to get one. His positive result came back a few days later.
As Ramirez rested at home, he texted Alex Palomo, 44, a Garfield medical secretary who was also at home with COVID-19, to see how he was doing. Palomo was the kind of man who came to many family parties but would often slip away unseen. A cousin finally asked him about it: Palomo said he just hated to say goodbye.
Palomo would wear only a surgical mask when he would go into the rooms of patients with flashing call lights, chat with them and maybe bring them a refill of water, Ramirez said.
Ramirez said Palomo had no access to patient charts, so he would not have known which patients had COVID-19: “In essence, he was helping blindly.”
Palomo never answered the text. He died of COVID-19 on Aug. 14.
And Thong Nguyen had fared no better. His daughter, a hospital pharmacist in Fresno, had pressed him to go on a ventilator after seeing other patients survive with the treatment. It might mean he could retire and watch his grandkids grow up. But it made no difference.
“He definitely should not have passed [away],” Kozuki said.
Nursing Homes Devastated
During the summer, as nursing homes recovered from their spring surge, Heather Pagano got a new assignment. The Doctors Without Borders adviser on humanitarianism had been working in cholera clinics in Nigeria. In May, she arrived in southeastern Michigan to train nursing home staffers on optimal infection-control techniques.
Federal officials required worker death reports from nursing homes, which by December tallied more than 1,100 fatalities. Researchers in Minnesota found particular hazards for these health workers, concluding they were the ones most at risk of getting COVID-19.
Pagano learned that staffers were repurposing trash bin liners and going to the local Sherwin-Williams store for painting coveralls to backfill shortages of medical gowns. The least-trained clinical workers — nursing assistants — were doing the most hazardous jobs, turning and cleaning patients, and brushing their teeth.
She said nursing home leaders were shuffling reams of federal, state and local guidelines yet had little understanding of how to stop the virus from spreading.
“No one sent trainers to show people what to do, practically speaking,” she said.
As the pandemic wore on, nursing homes reported staff shortages getting worse by the week: Few wanted to put their lives on the line for $13 an hour, the wage for nursing assistants in many parts of the U.S.
The organization GetusPPE, formed by doctors to address shortages, saw almost all requests for help were coming from nursing homes, doctors’ offices and other non-hospital facilities. Only 12% of the requests could be fulfilled, its October report said.
And a pandemic-weary and science-wary public has fueled the virus’s spread. In fact, whether or not a nursing home was properly staffed played only a small role in determining its susceptibility to a lethal outbreak, University of Chicago public health professor Tamara Konetzka found. The crucial factor was whether there was widespread viral transmission in the surrounding community.
“In the end, the story has pretty much stayed the same,” Konetzka said. “Nursing homes in virus hot spots are at high risk and there’s very little they can do to keep the virus out.”
The Vaccine Arrives
From March through November, 40 complaints were filed about the Garfield Medical Center with the California Department of Public Health, nearly three times the statewide average for the time. State officials substantiated 11 complaints and said they are part of an ongoing inspection.
For Thanksgiving, AHMC Healthcare Chairman Jonathan Wu sent hospital staffers a letter thanking “frontline healthcare workers who continue to serve, selflessly exposing themselves to the virus so that others may cope, recover and survive.”
The letter made no mention of the workers who had died. “A lot of people were upset by that,” said critical care technician Melissa Ennis. “I was upset.”
By December, all workers were required to wear an N95 respirator in every corner of the hospital, she said. Ennis said she felt unnerved taking it off. She took breaks to eat and drink in her car.
Garfield said on its website that it is screening patients for the virus and will “implement infection prevention and control practices to protect our patients, visitors, and staff.”
On Dec. 9, Ennis received notice that the vaccine was on its way to Garfield. Nationwide, the vaccine brought health workers relief from months of tension. Nurses and doctors posted photos of themselves weeping and holding their small children.
At the same time, it proved too late for some. A new surge of deaths drove the toll among health workers to more than 2,900.
And before Ennis could get the shot, she learned she would have to wait at least a few more days, until she could get a COVID test.
She found out she’d been exposed to the virus by a colleague.
Shoshana Dubnow and Anna Sirianni contributed to this report.Video by Hannah NormanWeb production by Lydia Zuraw
This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.
One tray of COVID-19 vaccine from pharmaceutical giant Pfizer contains 975 doses — way too many for a rural hospital in Arkansas.
But with the logistical gymnastics required to safely get the Pfizer vaccine to rural health care workers, splitting the trays into smaller shipments has its own dangers. Once out of the freezer that keeps it at 94 degrees below zero, the vaccine lasts only five days and must be refrigerated in transit.
In Arkansas — where over 40% of its counties are rural and COVID infections are climbing — solving this distribution puzzle is urgently critical, said Dr. Jennifer Dillaha, the state’s epidemiologist.
“If their providers come down with COVID-19,” Dillaha said, “there’s no one there to take care of the patients.”
Such quandaries resonate with officials in Georgia, Kentucky, Utah, Indiana, Wisconsin and Colorado. The first push of the nation’s mass COVID vaccination effort has been chaotic, marked by a lack of guidance and miscommunication from the federal level.
With Washington punting most vaccination decisions, each state and county is left to weigh where to send vaccines first and which of two vaccines authorized by the Food and Drug Administration for emergency use makes the most sense for each nursing home, hospital, local health department and even school. And after warning for months that they lacked the resources to distribute vaccines, state officials are only now set to receive a major bump in funding — $8.75 billion in Congress’ latest relief bill, which lawmakers are likely to pass this week.
The feat facing public health officials has “absolutely no comparison” in recent history, said Claire Hannan, executive director of the Association of Immunization Managers.
Officials who thought the H1N1 swine flu shot in 2009 was a logistical nightmare say it now looks simple in comparison. “It was a flu vaccine. It was one dose. It came at refrigerator-stable temperatures,” Hannan said. “It was nothing like this.”
Within just a few days, the logistical barriers of the vaccine made by Pfizer and BioNTech were laid bare. Many officials now hang their hopes on Moderna, whose vaccine comes in containers of 100 doses, doesn’t require deep freezing and is good for 30 days from the time it’s shipped.
The federal government had divvied up nearly 8 million doses of Pfizer and Moderna’s vaccines to distribute this week, on top of roughly 3 million Pfizer shots that were sent last week, said Army Gen. Gustave Perna, chief operating officer of the Trump administration’s Operation Warp Speed effort.
Perna said he took “personal responsibility” for overstating how many Pfizer doses states would receive.
Federal delays have led to confusion, Dillaha said: “Sometimes we don’t have information from CDC or Operation Warp Speed until right before a decision needs to be made.”
Officials in other states painted a mixed picture of the rollout.
Georgia’s Coastal Health District, which oversees public health for eight counties and has offices in Savannah and Brunswick, spent more than $27,000 on two ultra-cold freezers for the Pfizer vaccine, which it’s treating “like gold,” said Dr. Lawton Davis, its health director. Health care workers are being asked to travel, some up to 40 minutes, to get their vaccinations, because shipping them would risk wasting doses, he said. Vaccination uptake has been lower than Davis would like to see. “It’s sort of a jigsaw puzzle and balancing act,” he said. “We’re kind of learning as we go.”
In Utah, sites to vaccinate teachers and first responders starting in January had no capability to store the Pfizer vaccine, although officials are trying to secure some ultra-cold storage, a state department of health spokesperson said. Very few of Kentucky’s local health offices could store the Pfizer shots, because of refrigeration requirements and the size of shipments, said Sara Jo Best, public health director of the Lincoln Trail District. Indiana’s state health department had to identify alternative cold storage options for 17 hospitals following changes in guidance for the vaccine thermal shippers.
And in New Hampshire, where the National Guard will help administer vaccines, officials last week were still finalizing details for 13 community-based sites where first responders and health care workers are due to get vaccinated later this month. Jake Leon, a state Health and Human Services spokesperson, said that while the sites will be able to administer both companies’ vaccines, most likely they’ll get Moderna’s because of its easier transport. Even as the earliest vaccines are injected, much remains up in the air.
“It’s day to day and even then hour by hour or minute by minute — what we know and how we plan for it,” Leon said Friday. “We’re building the plane while flying it.”
In all, the Trump administration has bought 900 million COVID vaccine doses from six companies, but most of the vaccines are still in clinical studies. Even the front-runners whose shots have received FDA emergency authorization— Pfizer and BioNTech on Dec. 11, Moderna on Dec. 18 — will require months to manufacture at that scale. The Trump administration plans to distribute 20 million vaccine doses to states by early January, Perna said Saturday.
By spring, officials hope to stage broader vaccine deployment beyond top-priority populations of health care workers, nursing home residents and staff, as well as first responders.
During the effort to vaccinate Americans against H1N1, Dillaha said, health departments set up mass vaccination clinics in their counties and delivered doses to schools. But hospitals are taking charge of parts of the initial COVID immunization campaign, both because health care workers are at highest risk of illness or death from COVID-19, and to pick up the slack from health departments overwhelmed by case investigations and contact tracing from an unending stream of new infections.
Best said her workforce is struggling to keep up with COVID infections alone, much less flu season and upcoming COVID vaccinations. Public health department personnel in Kentucky shrank by 49% from 2009 to 2019, according to state data she supplied. Across the country, 38,000 state and local health positions have disappeared since the 2008 recession. Per capita spending for local health departments has dropped by 18% since 2010.
Nationally, Pfizer and Moderna have signed contracts with the federal government to each provide 100 million vaccine doses by the end of March; Moderna is set to deliver a second tranche of 100 million doses by June. States were playing it safe last week, directing Pfizer vials mainly to facilities with ultra-cold freezers, Hannan said.
“A lot of that vaccine is destined for institutional facilities,” Sean Dickson, director of health policy for West Health Policy Center, said of the Pfizer shots. The center, with the University of Pittsburgh School of Pharmacy, found that 35% of counties have two or fewer facilities to administer COVID vaccines.
The analysis found tremendous variation in how far people would need to drive for the vaccine. Residents of North Dakota, South Dakota, Montana, Wyoming, Nebraska and Kansas face the longest drives, with more than 10% living more than 10 miles from the closest facility that could administer a shot.
Counties with long driving distances between sites and a low number of sites overall “are going to be the hardest ones to reach,” said Inmaculada Hernandez, an assistant professor at the University of Pittsburgh School of Pharmacy and lead author of the analysis.
Certain vaccines could be better suited for such places, including Johnson & Johnson’s potential offering, which is a single shot, and health departments could distribute in rural areas through mobile units, she said. The company is expected to apply for FDA emergency authorization in February, Operation Warp Speed chief scientific adviser Moncef Slaoui said this month.
Until then, Pfizer and Moderna are the companies supplying doses for the country, and they’re not considered equal even though each is more than 90% effective at reducing disease.
In Wisconsin, the Moderna vaccine “gives us many more options” and “allows for us to get doses to those smaller clinics, more-rural clinics, in a way that reduces the number of logistics” needed for ultra-cold storage, Dr. Stephanie Schauer, the state’s immunization program manager, told reporters Wednesday.
Alan Morgan, head of the National Rural Health Association, echoed that the Moderna vaccine is being looked to as a “rural solution.” But he said states including Kansas have shown that a Pfizer rural rollout can be done.
“It’s where these states put a priority — either they prioritize rural or they don’t,” he said. “It’s a cautionary tale of what we may see this spring, of rural populations perhaps being second-tier when it comes to vaccination.”
Virginia, too, has a plan for getting the Pfizer vaccine to far-flung places. It’s shipping the vaccines to 18 health facilities with ultra-cold freezers across the state. The hubs are distributed widely enough so vaccinators can bring shots from there to health workers even in thinly populated areas before they spoil, said Brookie Crawford, spokesperson for the Virginia Department of Health’s central region.
Washington, on the other hand, allows hospitals without ultra-cold freezers to temporarily store Pfizer vaccines in the thermal boxes they arrive in, said Franji Mayes, spokesperson for the state’s health department. That means a box needs to be used quickly, before doses expire. “We are also working on a policy that will allow hospitals who don’t expect to vaccinate 975 people to transfer extra vaccine to other enrolled facilities,” she said. “This will reduce wasted vaccine.”
– White house coronavirus task force doubles down on rapid testing strategy to fight the coronavirus as some states say they don’t have the supplies to comply with the federal government’s advice.
– This article was originally published by the Center for Public Integrity, a nonprofit investigative news organization based in Washington, D.C.
The White House coronavirus task force is doubling down on part of its strategy for halting the spread of the virus: widespread use of rapid tests.
As COVID-19 cases and hospitalizations reached record highs, the task force last week issued advice to a number of governors: Begin using rapid tests on all young people, even those without COVID-19 symptoms, in counties with exploding numbers of cases.
The guidance came as state officials and some scientists express doubt about rapid testing strategies. The rapid tests, known as antigen tests, give results faster but are more likely to return false negatives than lab-based polymerase chain reaction (PCR) tests, and the Food and Drug Administration has not yet approved the rapid tests for use in patients who show no symptoms.
But the nation’s testing czar, Adm. Brett Giroir, who also sits on the task force, gave a robust defense of the strategy in emailed responses to questions from the Center for Public Integrity.
“The testing of asymptomatic individuals with rapid antigen tests is vital,” Giroir wrote. “The data are really to a point that those who argue against asymptomatic testing … are more influenced by politics, financial self-interest of their industry, or lack of knowledge, than they are by the evidence of how to support control of the pandemic.”
The task force previously urged states to use the rapid tests to screen certain groups, such as teachers or health-care workers. The federal government is distributing to states 150 million antigen tests made by Abbott Laboratories.
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In his email Giroir pushed back on comments from another member of the task force, Dr. Scott Atlas, who told The New York Times last month that testing asymptomatic people would amount to “destroying the workforce.” Atlas, a favorite adviser of President Donald Trump, holds views repudiated by many scientists studying the pandemic and has been the source of rifts within the task force.
“No credible public health expert would suggest that it is good practice to allow an infectious person — whether symptomatic or asymptomatic — into the community or workforce,” Giroir wrote. “The best way to keep America working and Americans in school and employed is to control the spread of the virus.”
But it’s not clear that states can keep up with the federal advice to deploy rapid tests more broadly.
Of the 16 states that responded to questions from Public Integrity, 11 said they were using rapid tests to screen special populations, such as nursing-home residents or health-care workers, but only four indicated plans to use them on broader populations. Several said they didn’t have enough tests to screen the general public.
“We do not have enough supplies to use for general population testing,” said Taylor Gage, spokesman for Nebraska Gov. Pete Ricketts. “The state is using all the tests — we do not have a reserve or backlog on hand.”
Manpower is another dilemma. Some states don’t have enough school nurses to deploy antigen test screening in schools, let alone the general population, said Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials.
“Nobody’s against that but some of it is just pure logistics. If you want us to do that, where are the tests?” Plescia said. “It’s just there are sort of on-the-ground challenges to rolling some of the stuff out with the speed that the administration would like.”
Another hurdle to testing 18-40-year-olds: the millennials themselves. Young people so far have not responded well to efforts such as contact tracing, said Lori Tremmel Freeman, CEO of the National Association of County and City Health Officials.
“Getting them to test frequently, if this is the population we’re targeting, will require more than just putting the tests out there,” she said. “It requires, really, a campaign to change public sentiment around the disease.”Preview mode is not supported for related articles. Please change to Edit mode by clicking the pencil icon in the toolbar above.
That’s something the White House has not done. The president lately has been mostly silent about coronavirus testing, after weeks of falsely blaming high case counts on increased testing. And the task force’s recent endorsements of antigen testing are contained in reports to governors that the White House does not make public.
“We’re hearing some of the right words, the right public health tactics, the right strategies emerging from the White House task force behind the scenes, but we really have to turn that internal to an external, public-facing messaging campaign,” Tremmel Freeman said. “Nobody really knows what the strategy is or why it’s important.”
In addition to concerns about “how,” some states are hung up on whether they should use rapid tests on asymptomatic people when the FDA has not approved them for that use.
Several states still have official health guidance that contradicts the White House view of rapid tests — Virginia policy, for example, says PCR testing should be used whenever possible. At least three states have discouraged the antigen tests’ use in nursing homes. The federal government has shipped more than 13 million rapid tests to nursing homes, but a Kaiser Health News investigation found that roughly 38% of the nation’s nursing homes have yet to use them.
“There’s quite a bit of uncertainty and things we’re sorting out that have caused most of us to move forward with some caution,” Plescia said. The health officials in his organization “just have some anxieties around the accuracy of the test.”
But several scientists who spoke to Public Integrity said the administration’s push to test more asymptomatic young people using antigen tests is a good idea.
“We have to do more to break these chains of transmission,” said Gigi Gronvall, an immunologist at the Johns Hopkins Center for Health Security. “You could be saving somebody by testing them and getting them to isolate.”
Some cautioned that jurisdictions who deploy the tests more broadly need to have clear plans to ensure positive people isolate — which may be a challenge for those who need to show up to jobs or risk losing them.
“Advocating for [antigen tests’] use really broadly without a plan for what to do with the results is going to create problems,” said Susan Butler-Wu, an associate professor of clinical pathology at the University of Southern California’s medical school. “You have to have a plan for what to do when it’s positive, and you have to have a lot of education around what to do if it’s negative.”
Giroir said states must figure out how exactly to test wide swaths of their populations, though he said weekly testing at universities has shown the best results.
“States and counties need to employ strategies specific to their populations including education and resources,” he wrote.
In the middle of the night, Stefania Silvestri lies in bed remembering her elderly patients’ cries.
“Please don’t leave me.”
“I need my family.”
Months of caring for older adults in a Rhode Island nursing home ravaged by COVID-19 have taken a steep toll on Silvestri, 37, a registered nurse.
She can’t sleep, as she replays memories of residents who became ill and died. She’s gained 45 pounds. “I have anxiety. Some days I don’t want to get out of bed,” she said.
Now, as the coronavirus surges around the country, Silvestri and hundreds of thousands of workers in nursing homes and assisted living centers are watching cases rise in long-term care facilities with a sense of dread.
Many of these workers struggle with grief over the suffering they’ve witnessed, both at work and in their communities. Some, like Silvestri, have been infected with the coronavirus and recovered physically — but not emotionally.
Since the start of the pandemic, more than 616,000 residents and employees at long-term care facilities have been struck by COVID-19, according to the latest data from KFF. Just over 91,000 have died as the coronavirus has invaded nearly 23,000 facilities. (KHN is an editorially independent program of KFF.)
At least 1,000 of those deaths represent certified nursing assistants, nurses and other people who work in institutions that care for older adults, according to a recent analysis of government data by Harold Pollack, a professor at the School of Social Service Administration at the University of Chicago. This is almost certainly an undercount, he said, because of incomplete data reporting.
How are long-term care workers affected by the losses they’re experiencing, including the deaths of colleagues and residents they’ve cared for, often for many years?
Edwina Gobewoe, a certified nursing assistant who has worked at Charlesgate Nursing Center in Providence, Rhode Island, for nearly 20 years, acknowledged “it’s been overwhelming for me, personally.”
At least 15 residents died of COVID-19 at Charlesgate from April to June, many of them suddenly. “One day, we hear our resident has breathing problems, needs oxygen, and then a few days later they pass,” she said. “Families couldn’t come in. We were the only people with them, holding their hands. It made me very, very sad.”
Every morning, Gobewoe would pray with a close friend at work. “We asked the Lord to give us strength so we could take care of these people who needed us so much.” When that colleague was struck by COVID-19 in the spring, Gobewoe prayed for her recovery and was glad when she returned to work several weeks later.
But sorrow followed in early September: Gobewoe’s friend collapsed and died at home while complaining of unusual chest pain. Gobewoe was told that her death was caused by blood clots, which can be a dangerous complication of COVID-19.
She would “do anything for any resident,” Gobewoe remembered, sobbing. “It’s too much, something you can’t even talk about,” describing her grief.
I first spoke to Kim Sangrey, 52, of Lancaster, Pennsylvania, in July. She was distraught over the deaths of 36 residents in March and April at the nursing home where she’s worked for several decades — most of them due to COVID-19 and related complications. Sangrey, a recreational therapist, asked me not to name the home, where she continues to be employed.
“You know residents like family — their likes and dislikes, the food they prefer, their families, their grandchildren,” she explained. “They depend on us for everything.”
When COVID-19 hit, “it was horrible,” she said. “You’d go into residents’ rooms and they couldn’t breathe. Their families wanted to see them, and we’d set up Zoom wearing full gear, head to toe. Tears are flowing under your mask as you watch this person that you loved dying — and the family mourning their death through a tablet.”
“It was completely devastating. It runs through your memory — you think about it all the time.”
Mostly, Sangrey said, she felt empty and exhausted. “You feel like this is never going to end — you feel defeated. But you have to continue moving forward,” she told me.
Three months later, when we spoke again, COVID-19 cases were rising in Pennsylvania but Sangrey sounded resolute. She’d had six sessions with a grief counselor and said it had become clear that “my purpose at this point is to take every ounce of strength I have and move through this second wave of COVID.”
“As human beings, it is our duty to be there for each other,” she continued. “You say to yourself, OK, I got through this last time, I can get through it again.”
That doesn’t mean that fear is absent. “All of us know COVID-19 is coming. Every day we say, ‘Is today the day it will come back? Is today the day I’ll find out I have it?’ It never leaves you.”
To this day, Silvestri feels horrified when she thinks about the end of March and early April at Greenville Center in Rhode Island, where up to 79 residents became ill with COVID-19 and at least 20 have died.
The coronavirus moved through the facility like wildfire. “You’re putting one patient on oxygen and the patient in the next room is on the floor but you can’t go to them yet,” Silvestri remembered. “And the patient down the hall has a fever of 103 and they’re screaming, ‘Help me, help me.’ But you can’t go to him either.”
“I left work every day crying. It was heartbreaking — and I felt I couldn’t do enough to save them.”
Then, there were the body bags. “You put this person who feels like family in a plastic body bag and wheel them out on a frame with wheels through the facility, by other residents’ rooms,” said Silvestri, who can’t smell certain kinds of plastic without reliving these memories. “Thinking back on it makes me feel physically ill.”
Silvestri, who has three children, developed a relatively mild case of COVID-19 in late April and returned to work several weeks later. Her husband, Michael, also became ill and lost his job as a truck driver. After several months of being unemployed, he’s now working at a construction site.
Since July 1, the family has gone without health insurance, “so I’m not able to get counseling to deal with the emotional side of what’s happened,” Silvestri said.
Although her nursing home set up a hotline number that employees could call, that doesn’t appeal to her. “Being on the phone with someone you don’t know, that doesn’t do it for me,” she said. “We definitely need more emotional support for health care workers.”
What does help is family. “I’ve leaned on my husband a lot and he’s been there for me,” Silvestri said. “And the children are OK. I’m grateful for what I have — but I’m really worried about what lies ahead.”
Join Judith Graham for a Facebook Live event on grief and bereavement during the coronavirus pandemic on Monday, Nov. 16, at 1 p.m. ET. You can watch the conversation here and submit questions in advance here.
We’re eager to hear from readers about questions you’d like answered, problems you’ve been having with your care and advice you need in dealing with the health care system. Visit khn.org/columnists to submit your requests or tips.
Nursing homes are still taking days to get back COVID-19 test results as many shun the Trump administration’s central strategy to limit the spread of the virus among old and sick Americans.
In late summer, federal officials began distributing to nursing homes millions of point-of-care antigen tests, which can be given on-site and report the presence or absence of the virus within minutes. By January, the Department of Health and Human Services is slated to send roughly 23 million rapid tests.
But as of Oct. 25, 38% of the nation’s roughly 15,000 nursing homes have yet to use a point-of-care test, a KHN analysis of nursing home records shows.
The numbers suggest a basic disagreement among the Trump administration, state health officials and nursing home administrators over the best way to test this population and how to strike the right balance between speed and accuracy. Many nursing homes still primarily send samples out to laboratories, using a type of test that’s considered more reliable but can take days to deliver results.
As a result, in 29% of the approximately 13,000 facilities that provided their testing speed to the government, results for residents took an average of three days or more, the analysis found. Just 17% of nursing homes reported their average turnaround time was less than a day, and the remainder tended to get results in one or two days. Wait times for test results of staff members were similar.
Those lags could have devastating consequences, because even one undetected infection can quietly but rapidly trigger a broad outbreak. It’s especially concerning as winter sets in and the pandemic notches daily records of infections.
In the meantime, the coronavirus continues its march through institutions. Nursing homes have reported more than 262,000 infections and 59,000 deaths since the government began collecting the information in May. Even without estimating how many residents died from COVID-19 before then, reported nursing home deaths amount to more than a quarter of all COVID-19 fatalities in the U.S. so far.
During the week ending Oct. 25, the most recent period for which data is available, a third of skilled nursing facilities reported a new suspected or confirmed coronavirus infection of a resident or staff member.
Many state public health authorities and nursing homes have ongoing reservations about the rapid tests. They are considered less accurate than the more expensive ones sent out to laboratories, which are known as polymerase chain reaction, or PCR, tests and identify the virus’s genetic material but often take days to complete. And their manufacturers say the rapid tests are designed for people with symptoms — not for screening a general population.
In early November, the Food and Drug Administration warned of false positive results — where someone is told incorrectly they are infected — associated with one type of rapid COVID test, and urged providers to follow Centers for Disease Control and Prevention recommendations for using them in nursing homes. False negatives are also a concern because people who don’t know they are infected can unwittingly spread the virus.
HHS bought millions of rapid tests to distribute to nursing homes as the federal government imposed new mandates for the facilities to test staffers at least once a month. Routine staff testing increases to as often as twice a week for homes in areas with the highest infection rates. The Centers for Medicare & Medicaid Services, which is part of HHS, does not recommend testing asymptomatic residents unless a new outbreak occurs or a resident routinely goes outside the facility.
Leaders in multiple states, including Nevada, Vermont and Illinois, have moved to ban antigen tests in nursing homes or limit their use.
“I thought the hard part was getting the testing to the different facilities,” said David Grabowski, a health care policy professor at Harvard Medical School. Instead, he said, “The major barriers to the use of rapid testing seem to be a lack of guidance on when and how to use the tests, coupled with concerns about their accuracy.”
Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine, said the national effort has been chaotic and inadequate.
The federal government “just hands stuff off to nursing homes and then says, ‘Hey, it’s yours; go use it,’” he said. “And then when things fall apart, ‘We’re not to blame.’”
Nursing homes that don’t trust the rapid tests are having to shoulder the higher cost of lab tests. It costs Stuart Almer, president and CEO of Gurwin Jewish Nursing & Rehabilitation Center on New York’s Long Island, $125,000 a week to conduct lab tests on up to 1,500 residents and staff members.
“We embrace the testing,” Almer said. “But how are we supposed to continue operating and paying for this?”
Goodwin House in Virginia, which includes skilled nursing and assisted living facilities, had performed more than 9,500 tests for COVID-19 as of late October, said Joshua Bagley, an administrator. Only 100 of them were antigen tests. “The majority of our focus is still toward the PCR testing,” Bagley said.
The concerns of state health officials were perhaps most evident in Nevada, where in early October the state banned antigen testing in nursing homes. HHS said the order was illegal, and it was revoked within days.
“There is no such thing as a perfect test,” Adm. Brett Giroir, a senior HHS official who leads the Trump administration’s COVID testing efforts, said on a call with reporters Nov. 9. For example, Giroir said, a risk of PCR tests is that they could provide a positive diagnosis when a person is no longer “actually infectious.”
Although there have been widespread accuracy concerns over antigen tests, certain tests the administration is distributing nationwide have comparable accuracy to lab-based tests, he said.
Other state responses have not been as aggressive as Nevada’s but nonetheless demonstrated unease over how best to use the devices, if at all.
Vermont recommends the use of antigen tests after a known COVID exposure but says they should not be used to diagnose asymptomatic people.
Ohio was initially reluctant to deploy them after Republican Gov. Mike DeWine’s false positive result from an antigen device, although the tests have since been adopted, said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents some skilled nursing facilities in the state.
Some nursing homes say relying on antigen tests has made a monumental difference. In Hutchinson, Kansas, Wesley Towers Retirement Community has used both types of tests, but it was Abbott’s BinaxNOW antigen test that detected its first two asymptomatic people with COVID-19, said Gretchen Sapp, Wesley Towers’ vice president of health services.
“We have more confidence that our staff are indeed COVID free or that they are out and not exposing residents. And that is incredibly helpful,” Sapp said. “The biggest challenge is I need more tests.”
A total of 1,150 homes told the federal government they did not have enough supplies for point-of-care tests for all workers, the KHN analysis found. Nursing homes can go through millions of tests quickly when testing monthly or more often, depending on the level of COVID-19 in the area.
White House spokesperson Michael Bars said the administration is working “hand-in-hand with our state and local partners” and “doing more than ever to protect the health and safety of high-risk age groups most susceptible to the virus.”
Janet Snipes, executive director of Holly Heights Care Center in Denver, said antigen tests have been useful to screen staff members despite a few false-positive results. One test was used on a clergy member a resident had summoned.
“We wouldn’t have been able to allow him in, but we were able to do the antigen testing,” she said. “With the vulnerable residents we serve, we’re hoping for more antigen testing, more testing period, more testing of any type.”
Higher-quality nursing homes, as measured by inspection ratings, have substantially lower COVID-19 mortality. Quality does not predict the ability to prevent any COVID-19 resident or staff cases, but higher-quality establishments prevent the spread of resident infections conditional on having one. Preventing COVID-19 cases and deaths may come at some cost, as high-quality homes have substantially higher non-COVID deaths, a result consistent with high excess non-COVID mortality among the elderly since March.
Recent positive news of a potential COVID-19 vaccine is welcome news. However, will people actually take it if the vaccine proves safe and effective? The answer likely depends if your proximate peers are pro-vax or anti-vax. A paper by Estep and Greenberg (2020) argues that:
…residential and school selection processes create “pockets of homogeneity” attracting parents inclined to opt out of vaccines. Structural features of these enclaves reduce the likelihood of harsh criticism for vaccine refusal and foster a false sense of protection from disease, making the choice to opt out seem both safe and socially acceptable. Examination of quantitative data on personal belief exemptions (PBEs) from school-based vaccination requirements in California schools and districts, as well as findings from parent interviews, provide empirical support for the theory.
David Joel Perea called from Maine, Vermont, Minnesota and, ultimately, Nevada, always with the same request: “Mom, can you send tamales?” Dominga Perea would ship them overnight.
That’s how she knew where her 35-year-old son was.
The traveling nurse had “a tremendous work ethic,” routinely putting in 80 hours a week, said his brother, Daniel.
But when Perea took a job at Lakeside Health & Wellness Suites — a Reno nursing home that has received dozens of safety citations since 2017 from the Centers for Medicare & Medicaid Services — Dominga was “scared silly.”
During Perea’s stint, nearly one-fifth of Lakeside’s residents were infected with COVID-19, according to state health records. Lakeside’s “top priority is the safety of those who live and work in our facility,” a spokesperson said.
When her son didn’t respond to her text on April 6, Dominga knew something was wrong. Perea had COVID-19. He died days later.
As COVID-19 surges across the country, health care systems continue to suffer critical shortages, especially among non-physician staff such as nurses, X-ray technicians and respiratory therapists.
To replenish their ranks, facilities have relied on “travelers” like Perea. Staff agencies have deployed tens of thousands nationally since March outbreaks in the Northeast.
Rural hospitals have relied largely on traveling nurses to fill staffing shortages that existed even before the pandemic, said Tim Blasl, president of the North Dakota Hospital Association. “They find staff for you, but it’s really expensive labor,” he said. “Our hospitals are willing to invest so the people of North Dakota get care.”
The arrangement presents risks for travelers and their patients. Personnel ping-ponging between overwhelmed cities and underserved towns could introduce infections. As contractors, travelers sometimes feel tensions their full-time colleagues do not. Frequently employed by staffing agencies based thousands of miles away, they can find themselves working in crisis without advocates or adequate safety equipment.
In 2020, the upsides of their jobs — freedom and flexibility — have been dwarfed by treacherous conditions. Now the ranks of travelers are thinning: The work is exhausting, bruising and dangerous. Thousands of front-line health workers have gotten the virus and hundreds have died, according to reporting by KHN and The Guardian.
On April 17, Lois Twum, a 23-year-old traveling nurse from New Orleans, was one of four passengers on a flight to New York’s John F. Kennedy Airport.
When the self-described “adventure-seeking adrenaline junkie” arrived for her first shift at Columbia University’s Irving Medical Center, she said, she was assigned four patients on a COVID-19 unit. (Intensive care nurses typically care for two or three patients.) As these “constantly crashing” patients required resuscitations and intubations, “there was practically no one to help,” Twum said, because “everyone’s patient was critical.” The hospital did not respond to requests for comment on the workplace conditions and treatment of travelers.
Meanwhile, as hospital employees got sick, quit or were furloughed amid budget cuts, travelers picked up the slack. They were redeployed, Twum said, assigned more patients as well as the sickest ones.
“It was like we were airdropped into Iraq,” Twum said. “Travelers, we got the worst of it.”
On social media and in email groups, recruiters for travelers circulate photos of sun-splashed skylines or coastlines emblazoned with dollar signs, boasting salaries two or three times those of staff nurses. They promise signing bonuses, relocation bonuses and referral bonuses. They make small talk, ask about travelers’ families and suggest restaurants in new cities.
But when it comes to navigating workplace issues, “these people can just disappear on you,” said Anna Skinner, a respiratory therapist who has traveled for over a decade. “They are not your friends.”
Caught between the hospitals where they report for duty and remote staffing agencies, their worker protections are blurred.
For instance, under the Occupational Safety and Health Act, providing protective equipment is the agency’s responsibility — but the travelers who spoke with KHN said agencies rarely distribute any.
Perea’s family said they believe David did not have adequate PPE. His employer said it was the nursing home’s responsibility to provide it. “It is up to each of our clients to provide PPE to our staff while they are working assignments through MAS,” said Sara Moore, a spokesperson for Perea’s agency, MAS Medical Staffing.
Sometimes travelers are assigned to emergency rooms or intensive care units with which they have little experience. Skinner, a pediatric specialist, said she landed in adult ICUs when deployed to the University of Miami Health System in April. She received an hour of orientation, she said, but “nothing could have prepared me for what I had to deal with.”
Over five weeks, she said, she intubated one patient after another; suctioned the blood pouring into patients’ lungs and out of their noses and mouths; and dealt with families who were aghast, angry and afraid. Under the stress, Skinner said, she couldn’t sleep and lost weight. The hospital did not respond to requests for comment on workplace conditions for travelers.
Travelers often face “incredibly onerous” hurdles to the overtime, sick leave or workers’ compensation they are entitled to under the Fair Labor Standards Act, said Nathan Piller, a lawyer at Schneider Wallace Cottrell Konecky, an employment and business litigation firm.
Even the number of hours they can count on working is out of their control, Skinner said. Contracts reviewed by KHN authorize travelers to work a set number of hours, but only a fraction of those hours are guaranteed, and must be approved by on-site managers. The guaranteed hours may be compensated at rates hovering around minimum wage, and may require working holidays, which are not uniformly recognized.
The terms can be “modified from time to time during employment,” according to the contracts.
In 2018, AMN Healthcare, one of the country’s largest travel nursing agencies, agreed to a $20 million settlement for wage violations involving nearly 9,000 travelers. Violations “appear fairly commonplace across the industry,” said Piller, who worked on the settlement.
Travelers, Skinner said, are left to advocate for themselves to managers they might have just met — and “complaining just isn’t an option.”
KHN reviewed travel nursing contracts issued by Aya Healthcare, a large staffing agency, and found that any disputes — wrongful termination claims; claims of discrimination, harassment or retaliation; wage claims; and claims for violation of federal, state or other laws or regulations — must be settled out of court, in arbitration.
Officials at the Service Employees International Union, the American Nurses Association and National Nurses United said their constituents have been suspended or fired from traveling worker agencies for speaking to the news media, posting on social media or otherwise voicing concerns about unfair practices.
Matthew Wall, a longtime traveling nurse, knows this all too well. In July, two days into his assignment at Piedmont Henry Hospital in Stockbridge, Georgia, Wall said, he reported to hospital administrators “undeniably unsafe” conditions for himself and patients, including inadequate PPE, long hours and high patient-to-staff ratios.
Instead of addressing his concerns, Wall said, the hospital — which is under investigation by the federal government for workplace safety issues after another traveling nurse died of COVID-19 in mid-March — canceled his contract. “Travelers are treated like dog chow,” Wall said. “The second you become a liability, they dispose of you.”
“We continue to closely follow Centers for Disease Control and Prevention guidelines paired with our best practices in patient care and safety for all,” said John Manasso, a hospital spokesperson, who declined to comment on Wall’s case.
Some see an impossible choice. “We all know, if not for us, these patients would have no one,” Twum said, “but watching each other get sick left and right, it makes you wonder, is this worth my life?”
Skinner, for her part, took a job as a staff nurse in Aspen, Colorado. After his current contract in New Orleans ends, Wall is planning a break from nursing.
It was like we were airdropped into Iraq.
Dominga Perea finally received a text back the night of April 6: “Don’t panic, Mama, I have the COVID.
“Pray for me.”
She saw David over FaceTime on Easter. “He struggled even eating mashed potatoes” she said, “because he couldn’t breathe.” The next morning he went on a ventilator and never woke up.
Months later, Lakeside hadn’t filled Perea’s position. “Ideal candidate must be a caring individual dedicated to providing high quality care,” the job listing read, and “able to react to emergency situations appropriately when required.”
KHN Mountain States editor Matt Volz contributed to this report.
With its share price falling from more than $66 to less than $24, September was a tumultuous month for Nanox.
On August 25th, the medical imaging start-up closed its initial public offering, having raised $190m from the sale of 10,555,556 ordinary shares at a price of $18 each. Money poured in as investors were sold on Nanox’s cold cathode x-ray source and the subsequent reduction in costs that it would enable, as well as the vendor’s pay-per-scan pricing model that would let the company access new, untapped markets.
A week later the shares were being traded for almost double their opening amount, and by the 11th of September, they had reached a peak of $66.67. This meteoric rise soon came to an end though, as activist short-seller Andrew Left of Citron Research published a report comparing the Israeli start-up to disgraced medical testing firm Theranos and asserted that the company’s shares were worthless.
Other commentators added to Left’s criticism, causing investors to abandon the stock. Class action lawsuits followed, with legal firms hoping to defend shareholders against the imaging company’s alleged fabrication of commercial agreements and of misleading investors.
Nanox defended itself against the Citron attack, insisting that the allegations in the report are ‘completely without merit’, but the extra scrutiny and threat of legal repercussions have left the share price continuing to plummet, falling to $23.52 at month’s end.
– New business and payment models could capture demand from new customers in untapped and emerging markets
– Vendors should be reactive. A successful launch of Nanox’s X-ray system could channel more focus and resources on the portfolio of low-end X-ray systems
– Once established, recurring services are hard to displace
– However, brand loyalty and hard-earned reputations aren’t easily forgotten
– Potential for disruptive technology to expand access to medical imaging and provide affordable X-ray digital solutions, delivering a significant and rapid overall market expansion
– New customer bases could have less expertise and a lack of trained professionals – ease of use becomes a critical feature
– Where X-ray system price is a battleground, and a fundamental factor driving purchasing decisions, Nanox’s proposed ecosystem offers revenue-generating opportunities
The Signify View
Assessing the viability and long-term potential of any business is a dangerous game, doubly so if it depends on a closely guarded game-changing technological innovation as is the case with Nanox. Fortunes are won and lost on a daily basis by investors, speculators, and gamblers trying to get in on the ground floor of the next ground-breaking company after being convinced by slick presentations and thorough prospectuses.
There is likely merit in some of the arguments being put forward by those on either side of the Nanox debate. For example, the lack of peer-reviewed journal articles about new technology is questionable. But, the skepticism around the feasibility of Nanox’s technology seems to ignore that research into cold-cathode x-ray generation, the cornerstone of Nanox’s offering has been ongoing for numerous years, and isn’t as out of the blue as the naysayers may suggest.
Regardless of these and other specifics in the ongoing fracas between short-sellers, Nanox, investors, and lawyers, all of whom have their own agendas, the voracity with which the stocks were initially purchased shows the keen appetite investors have for a company that would bring disruption to the X-ray systems market.
When delving into Signify Research’s data on this market, it is easy to see why. Across many developed and mature regions, the market has become relatively stable. It is one of replacement and renewal rather than selling to new customers and increasing the accessibility of X-ray imaging. Developed markets do continue to drive growth for X-ray manufacturers to some extent, particularly as a result of digitalization and favored reimbursement for digital X-ray imaging. However, by and large, the market remains broadly flat, with a CAGR of just 2.7% forecast for the period 2018-2023.
Figure 1: While there are some growth areas, the X-ray market as a whole is very stable
Nanox has strong ambitions to outperform this underwhelming outlook by utilizing its unique and more affordable technology to offer a relatively feature-rich system, dubbed the Arc, at a far lower price than existing digital X-ray systems. Competing on price is only one part of the equation, however.
After all, there are countries where, despite their economies of scale, the multi-national market leaders in medical imaging are unable to compete with domestic manufacturers, which are able to produce X-ray systems locally, with lower overheads, and no importation costs. Globally, there are also a large number of smaller imaging vendors, which have limited, yet low-cost offerings at the value end of the market, with this increased competition driving down average selling prices.
To differentiate itself further, Nanox also plans to launch with a completely new business model. Instead of traditional transactional sales, which see providers simply purchase and pay the full cost of the imaging system in one installment, use the system for the entire shelf life of the product and then replace with an equivalent model, Nanox plans to retain ownership of its machines, but charge providers to use them on a pay-per-scan basis.
There are some regions and some situations where legislation and other factors make this model unfeasible, so Nanox will also make its products available to purchase outright, as well as licensing its technology to other firms. However, the start-up’s focus is on offering medical imaging as a service.
The company says that this shift from a CapEx to a managed service approach means that instead of competing with established vendors over market share, it will be able to expand the total market, enabling access to imaging systems in settings where they have been hitherto absent, with urgent care units, outpatient clinics, and nursing homes being suggested as targets.
According to the Nanox investor’s prospectus, current contracts already secured (although the legitimacy of these deals is one of the issues raised by the short-sellers) feature a $40 per scan cost, of which Nanox receives $14 – although the exact figure varies depending on regional economics. The contracts feature a minimum service fee equivalent to seven scans a day, although the target is somewhat higher, with each machine expected to be used to produce 20 scans a day, for 23 days a month.
If Nanox’s order book is as valid as the company insists, and it already has deals for 5,150 units in place, each system will consequently be bringing in a minimum of $27,048 dollars per year for a minimum total revenue of $139m. If the systems are used 20 times a day as Nanox hopes, that means almost $400m in sticky recurring revenues annually. To put that in perspective, one of the market leaders for X-ray imaging systems in 2018 was Siemens Healthineers, which turned over almost $2.8bn across its general radiography, fluoroscopy, mammography, mobile, angiography, and CT imaging divisions.
With an order book that is, on the face of it, this healthy, there have been questions as to why Nanox went public at all, but the listing may be required for this business model to work. The Israeli vendor says that the vast majority of the investment will be sunk into producing the Nanox scanners, and the associated manufacturing capacity. This is necessary because unlike other imaging companies selling systems on a CapEx basis, Nanox will receive nothing for delivering scanners to customers. Revenue is generated later as the systems are used.
This means that the company is effectively fronting the initial cost of the systems, so needs to get as many units installed and being used as quickly as possible to recoup its initial costs. Unlike other vendors, it cannot rely on sales of a first tranche to fund the second and so on, in its new managed service model, it is better to mass produce everything at once.
Open to exposure
There is, however, nothing to stop other, established players from switching to a similar model. This should be of concern to Nanox, after all, Siemens Healthineers or GE Healthcare already have the manufacturing capacity and capital ready to offer products in a similar way.
And of course, Nanox, shouldn’t underestimate the difficulty of disrupting a long-established market. Despite ample funding and solid products, other companies are still struggling to make an impact in other markets. For example, Butterfly Network, a vendor offering an affordable handheld ultrasound solution, has a valuation of over $1 billion and has received more than $350m in funding.
In 2019, the company turned over $28m, enough to make it the market leader in the nascent handheld category, but in a global ultrasound market worth almost $7bn, at present, it is little more than a drop in the ocean.
Nanox hopes that its own new business model would be disruptive by opening up the market to a far greater range of customers than are currently served. A nursing home, for example, might not be able or willing to allocate the cost of a CT machine from a single year’s budget, but spreading that cost as the scanner is used, and particularly if that cost is passed on to patients at a time of use, on-site imaging suddenly becomes a far more feasible proposition.
What’s more, if a company was able to increase its product’s user base there is a strong possibility for upselling additional services, software, and tools. These could be things like AI modules that increase workflow efficiency, or, especially pertinent given the pricing model could allow machines to be installed in new settings that lack on-site expertise, tools that aid clinical decision making.
Beyond that, there is also ample scope for an imaging vendor to entice a customer into its ecosystem with a scanner that has no cost at the point of delivery, before getting it to commit to its own PACS and other IT systems. Being able to fully exploit these new customers relies, in the first instance, on being able to get a foot in the door. That is why an imaging service model could be so beneficial, even if the returns on the scans themselves aren’t especially lucrative.
While adopting a new business model and securing revenue from add-ons and upselling would help established vendors countenance the price differential Nanox proposes, if we are to take the start-up at its word, addressing its feature set might be another matter entirely.
As well as just providing imaging hardware, Nanox is offering a service that, at face value, is more complete. The Arc automatically uploads all imaging data to its cloud SaaS platform. This platform would initially use AI systems to ‘provide first response and decision assistive information’ before radiologists could provide final diagnoses that could then be shared with hospitals in real-time.
Figure 2: With teleradiology read volumes increasing, it makes sense that the necessary hardware comes baked into the Arc
There is currently limited information available about the exact nature of the so-called Nanox.CLOUD and its integration with the Arc, although several assumptions can be made:
– Firstly, although built-in connectivity is being touted as a feature with clinical benefits, its inclusion is as likely to be a necessity as a design choice, given that Nanox presumably needs to be able to communicate with the systems in order to find out scan volumes and bill accordingly. Or, more drastically, render the system inoperable if people don’t keep up with payments.
– Another assumption that can be made is that the full suite of tools wouldn’t be included in the basic pay-per-scan fee. Signify’s Teleradiology World – 2020 report found that in 2020, the average revenue per read for a teleradiology platform is, in North America for example, $24.40. As such, teleradiology services would only be able to be offered at an additional cost, creating another revenue stream for Nanox.
– Another sticking point could also be Nanox’s promise to enable the integration of its cloud into existing medical systems, via APIs. While well and good in theory, the competitiveness, complexity, and proprietary nature of many medical imaging workflows, combined with the fact that many vendors have absolutely no incentive to make integration easy for the newcomer, mean that in practice, it is likely to either be a prohibitively expensive, or frustratingly limited offering. This is one area where established vendors, which already offer comprehensive medical imaging packages, have a distinct advantage.
Back down to Earth
The short positions promoted by commentators including Citron Research and Muddy Waters Research postulate that the Nanox.ARC scanner isn’t real. There are some legitimate questions, but running through their papers is also an attitude that Nanox’s claims are simply implausible, whether that is because it has an R&D budget a fraction of the size of GE, or because anonymous radiologists unrelated to the company haven’t seen anything like it before.
It is worth remembering, though, that these short sellers will benefit financially if Nanox slumps. Nanox conversely, is obviously financially incentivized to promote its technology and its potential, and it wouldn’t be the first company, to promote the limited fruits of its start-up labor in a flattering light.
As so often happens in these he said, she said situations, the truth could well lie somewhere between the two extremes. Even in this instance, even if Nanox fails to deliver on some of its more impressive promises, the fact is, it has suggested bringing a whole new customer base into play and laid out a strategy for selling to them.
With that being the case, for a big vendor the issue of whether Nanox is legitimate almost becomes moot, their focus should be what these other customers require, how to get these customers into their product ecosystems, and what add-on products, and additional services they can feasibly sell them at a later date.
If nothing else, the entire Nanox furor shows that to achieve growth in mature markets, a vendor’s innovation needs to extend beyond its products.
About Alan Stoddart
Alan Stoddart is the Editor at Signify Research, a UK-based market research firm focusing on health IT, digital health, and medical imaging. Alan joined Signify Research in 2020, using his editorial expertise to lead on the company’s insight and analysis services.
To make ends meet, Martha Tapia works 64 hours a week at two Orange County, California, nursing homes. She is one of thousands of certified nursing assistants who perform the intimate and physical work of bathing, dressing and feeding the nation’s fragile elderly.
“We do everything for them. Everything you do for yourself, you have to do for the residents,” Tapia said.
In March, when the coronavirus began racing through nursing homes, the federal government banned visitors. (That guidance has since been updated.) But even with the ban, infections kept spreading. A team of researchers from UCLA and Yale University decided to examine the people who continued to enter nursing homes during that time: the employees.
Keith Chen, a behavioral economist and UCLA professor, said the key question is this: “The people who, we can infer, work in this nursing home — what other nursing homes do they work at?”
Using location data from 30 million smartphones when the visitor ban was in place helped the scientists “see” the movements of people going into and out of nursing homes. The data showed a lot of nursing home workers are — like Tapia — working at more than one facility. Chen said the findings suggest that staffers who work in multiple nursing homes are one source of the spread of infections.
“When you learn that over 20 of your workers are also spending time in other nursing homes, that should be a real red flag,” Chen said.
The Toll on Patients and Beyond
More than 84,000 residents and staff members of nursing homes and other long-term care facilities have died of COVID-19 across the U.S., representing 40% of all coronavirus fatalities in the country, according to KFF’s most recent analysis. (KHN is an editorially independent program of KFF.)
In California, the analogous toll is more than 5,700 deaths, making up 35% of all coronavirus fatalities in the state.
The UCLA team created maps of movement and found that on average each nursing home is connected to seven others through staff movement. Limiting nursing home employees to one facility could mean fewer COVID-19 infections — but that would hurt the workforce of people who say they work multiple jobs because of low wages.
After each of her shifts, Tapia worries she’ll bring the coronavirus home to her granddaughter. She tries to take precautions, including buying N95 masks from nurses. She knows it’s not just patients who are at risk. Nursing home workers such as Tapia are also contracting COVID-19 — in California alone, 153 of them have died since the pandemic began.
At the nursing home where she works in the morning, Tapia gets an N95 mask that she must only use — and reuse — in that facility. At her other nursing home job, in the afternoons, she gets a blue surgical mask to wear.
“They say they cannot give us N95 [masks],” she said, because she works in the “general area” where residents haven’t tested positive for the coronavirus.
She doesn’t want to work at multiple nursing homes, but her rent in Orange County is $2,200 a month, and her low pay and limited hours at each nursing home make multiple jobs a necessity.
“I don’t want to get sick. But we need to work. We need to eat, we need to pay rent. That’s just how it is,” Tapia said.
Staff Connections Equal Infections
The UCLA study also found that some areas of the country have a much higher overlap in nursing home staffing than others.
“There are some facilities in Florida, in New Jersey, where they’re sharing upwards of 50 to 100 workers,” said UCLA associate professor Elisa Long, who, along with her colleagues, examined data during the federal visitor ban from March to May. “This is over an 11-week time period, but that’s a huge number of individuals that are moving between these facilities; all of these are potential sources of COVID transmission.”
They also found the more shared workers a nursing home has, the more COVID-19 infections among the residents.
“Not only does it matter how connected your nursing home is, but what really matters is how connected your connections are,” Long said.
The researchers say they’ve informally dubbed these highly connected nursing homes as each state’s “Kevin Bacon of nursing homes,” after the Six Degrees of Kevin Bacon parlor game.
“We found that if you’re going to see a nursing home outbreak anywhere, it’s likely to spread to the Kevin Bacon of nursing homes in each state,” Chen said.
The team hopes that local health departments could use similar cellphone data methods as an early warning system. Using the test results from the “Kevin Bacon of nursing homes” as an indicator would be the first step.
“As soon as you detect an outbreak in one nursing home, you can immediately prioritize those other nursing homes that you know are at increased risk,” Chen said.
Prioritize Masks and Hand-Washing
The California Association of Health Facilities represents most nursing homes in the Golden State. In response to the study, the group said its members can’t prevent workers such as Tapia from taking jobs elsewhere, and they can’t pay them more, because California doesn’t pay them enough through Medicaid reimbursements.
Mike Dark, an attorney with the California Advocates for Nursing Home Reform, doesn’t buy that argument. He said the state already tried paying nursing homes more in 2006 — and that made them more profitable but not more safe and efficient. He said he’s skeptical that extra funding to pay staff would reach those workers.
“We know from past experience that money tends to go into the pockets of the executives and administrators who run these places,” Dark said.
He agreed that health workers such as Tapia should be paid more but cautioned against one idea being floated in some policy circles: limiting workers to one nursing home.
“Then you can wind up depriving some of the crucial health caregivers that we have in these facilities of their livelihoods, which can’t be a good solution,” he said.
Instead, he said, regulators need to focus on the basics, especially in the 100 California nursing homes with ongoing outbreaks, since it’s been shown that infection control measures work.
“Right now there’s poor access to [personal protective equipment]. There’s still erratic compliance with things like hand-washing requirements,” he said. “If we spent more time addressing those key issues, there would be much less concern about spread between facilities.”
Jackie Fortiér is health reporter for KPCC and LAist.com. This story is part of a partnership that includes KPCC, NPR and Kaiser Health News.
Nursing homes, small physician offices and rural clinics are being left behind in the rush for N95 masks and other protective gear, exposing some of the country’s most vulnerable populations and their caregivers to COVID-19 while larger, wealthier health care facilities build equipment stockpiles.
Take Rhonda Bergeron, who owns three health clinics in rural southern Louisiana. She said she’s been desperate for personal protective equipment since her clinics became COVID testing sites. Her plight didn’t impress national suppliers puzzled by her lack of buying history when she asked for 500 gowns. And one supply company allows her only one box of 200 gloves per 30 days for her three clinics. Right now, she doesn’t have any large gloves on-site.
“So in the midst of the whole world shutting down, you can’t get PPE to cover your own employees,” she said. “They’re refilling stuff to larger corporations when realistically we are truly the front line here.”
More than eight months into the pandemic, health care leaders are again calling for a coordinated national strategy to distribute personal protective equipment to protect health care workers and their patients as a new wave of disease wells up across most of the country. The demand for such gear, especially in hot spots, can be more than 10 times the pre-pandemic levels. While supply chains have adjusted, and the availability of PPE has improved dramatically since the mayhem of the spring, limited factories and quantities of raw materials still constrain supply amid the ongoing high demand.
In this free-market scramble, larger hospitals and other providers are stockpiling what they can even while others struggle. Some facilities are scooping up supplies to prepare for a feared wave of COVID-19 hospitalizations; others are following new stockpiling laws and orders in states such as California, New York and Connecticut.
“They’re putting additional strain on what’s still a fragile hospital supply chain,” said Soumi Saha, vice president of advocacy for Premier Inc., a group-purchasing organization that procures supplies for over 4,000 U.S. hospitals and health systems of various sizes. “We want available product to go to front-line health care workers and not go into a warehouse right now.”
Over a quarter of nursing homes in the country reported a shortage of items such as N95 masks, gloves or gowns from Aug. 24 through Sept. 20. A recent survey from the American Medical Association found 36% of physician offices reported having a difficult time securing PPE. And about 90% of nonprofit Get Us PPE’s recent requests for help with protective gear have come from non-hospital facilities, such as nursing homes, group homes and homeless shelters.
“I can completely understand that large health systems don’t want to find themselves short on PPE,” said Dr. Ali Raja, co-founder of Get Us PPE and executive vice chairman of emergency medicine at Massachusetts General Hospital. “Smaller places simply not only can’t stockpile but also can’t get enough for their day-to-day usage.”
But the fight for PPE is becoming even more challenging as states, such as California, pass stockpiling requirements, Saha said. Premier asked California Gov. Gavin Newsom to veto a bill that requires hospitals, starting in April, to have stockpiles of three months’ worth of PPE, or face $25,000 fines. However, Newsom signed the bill into law in September, and Saha worries it could become model legislation for other states.
For an average hospital, a 90-day supply is $2 million worth of equipment filling about 14 truckloads, said Chaun Powell, Premier’s group vice president of strategic supplier engagement — or about a football field and a half of warehouse space.
Traditional supply chains were ill equipped to handle the onslaught of demand caused by the pandemic, which has led to the frantic search for PPE. When distributors face such shortages, they rely on past orders to allocate who gets what share of their existing products, so no single buyer buys up everything. Nursing homes and clinics never used this much protective gear in the past, so they lack an ordering history and get put at the back of the line. That has forced many of them to rely on lower-grade masks like KN95s and other workarounds, Saha said.
In Kirksville, a college town in northern Missouri, Twin Pines Adult Care Center Administrator Jim Richardson said his nursing home is running low on gowns. It also is reusing N95s after staffers treat them with UV light. Although major medical supplier Medline Industries has supplied him with extra products at times, he’s still had to turn to eBay.
“I’m a little-bitty facility and I’m bidding against a Life Care nationwide,” he said. “Guess who Medline is going to take care of?”
COVID-19 cases are rising in Kirksville following the students’ return to campus, Richardson said. Visitors are starting to return to the nursing home, and flu season is beginning.
Dr. Michael Wasserman, immediate past president of the California Association of Long Term Care Medicine, said the lack of supplies for smaller providers like nursing homes speaks to the nation’s priorities when it comes to caring for older adults.
“Here we are in October, and the fact that there is not an abundance of PPE for every nursing home in the country is a literal abomination,” he said. “Without PPE, you lose to this virus.”
Stuart Almer, president and CEO of Gurwin Jewish Nursing & Rehabilitation Center, has managed to scavenge the 60-day stockpile required by New York state law for his facility on Long Island, but it’s come at a great financial cost. And he worries that as long as hot spots and stockpiling persist, massive price fluctuations and delivery concerns will continue.
He learned early on no one was coming to save him. Even deliveries from the Federal Emergency Management Agency, which he appreciated, were too small in quantity and not always easy to use. The heavy floor-length gowns it provided needed to be trimmed.
“Really, we’re on our own,” he said.
American Medical Association President Dr. Susan Bailey said in an emailed statement that federal officials need to step in: “We urge the administration to pull every lever to ramp up PPE production — for N95 masks, gowns, and testing supplies — and coordinate distribution.”
Get Us PPE’s Raja argued for a more fair, robust, centralized and transparent allocation process that doesn’t rely on donations to fill gaps. What good does it do a community to have a hospital stockpile, he asked, when the nursing home down the street has no PPE?
RALEIGH, N.C. — Each time Beverly Tucker visited a nursing home or long-term care facility this fall, she brought along a rolling tote bag packed with supplies from the Durham County Board of Elections.
Boxes of face masks and face shields. Latex gloves and cleaning wipes. Hand sanitizer from Mystic Farm & Distillery, a local facility that was among the first to switch from producing liquor to hand sanitizer in the early days of the pandemic. And most important — even if they were dwarfed by the cleaning supplies — the absentee ballots and ballot request forms that Tucker would help residents complete in time for the election.
“The equipment is clearly different this year,” Tucker said. “But I’m doing whatever is possible to help people vote.”
Seniors in such facilities across the country have struggled to find safe ways to vote amid the pandemic. In North Carolina, it’s a particular challenge. The state is one of two (the other being Louisiana) where facility staffers are prohibited by law from assisting residents with voting. A 2013 voter ID law makes it a felony for staff to even sign as the witness on an absentee ballot.
That’s where community members like Tucker come in. The 66-year-old Durham resident is a member of the county’s multipartisan assistance team, often called a MAT, which helps residents in nursing homes, assisted living and other facilities complete mail-in or absentee ballots. The teams are appointed by the county board of elections and must include at least two people who have different political party affiliations or are unaffiliated. Some counties pay the teams, while others ask members to volunteer.
This year, the convergence of coronavirus concerns and the election has unexpectedly thrust team members to the front lines. They are entering some of the state’s hardest-hit sites, with nursing home residents accounting for about 40% of North Carolina’s COVID deaths, as cases continue to rise. The added risk has disrupted this crucial system in some areas. At least one county was unable to recruit a team, and members in another county have been unwilling to visit facilities with documented COVID cases.
But those who do venture inside say the risk is worth it to help people vote.
Kevin Marr, 66, has been volunteering with the voting assistance team in Wake County since 2017. He recognizes many of the residents now, even behind their masks. Although the visits are different this year, he said the residents’ enthusiasm to vote and receive their “I Voted” stickers is not. That’s what keeps him going, visiting about two facilities a day in recent weeks.
Tucker, of neighboring Durham County, has worked in public health for decades, including during the AIDS epidemic. She understood it was safer to go to residents in nursing homes and long-term care facilities than to risk them coming to polling sites with more people.
Still, when she first thought about holding voters’ hands to help them grasp a pen or sign a ballot, “I was instinctively reluctant to touch them,” she said. At the first nursing home Tucker visited, she felt anxious as a resident approached her without a mask.
But her concerns have eased over time, she said, and she simply focuses on ways to protect herself and her team. They conduct most of the visits outdoors, in the parking lot or front lawn. They put up plexiglass barriers between themselves and the voters, passing papers through an opening at the bottom. And they now carry masks for residents who may not have one.
It’s difficult to maintain social distancing when one team member is working with a resident to mark a ballot and the other is observing to ensure accuracy, but they do their best.
Foreseeing these challenges, the North Carolina Board of Elections asked the state legislature and courts earlier this year to temporarily suspend restrictions on facility staff assisting with voting. But neither request was fulfilled. A recent lawsuit contesting the restriction won accommodations for the plaintiff, who was a nursing home resident, but left the broader law intact.
At Brian Center Health and Rehabilitation in Goldsboro, administrator Julia Batts worried that MAT members would not be allowed to visit, since the facility has a designated COVID-positive unit with about a dozen residents. But when statewide visitation regulations eased in September, she eagerly reached out to them.
The plan was careful and clinical. Have the team set up in the dining hall of the COVID-free building and bring in any residents who had tested negative to meet with them, two at a time, in alphabetical order.
But on the day the team arrived, it felt more like a celebration. Several women asked the staff to do their hair, and many residents “began wheeling themselves or taking their walkers to go vote,” Batts said. “They were almost racing.”
By the end of the day, the team helped about 20 residents vote. They’ll return next week to assist more residents, including new entrants who finished their two-week quarantine and those who have recovered from COVID, Batts said.
For Linda Williamson in Durham County, seeing the enthusiasm of voters reminds her of her grandparents. They took her along when they cast their first ballot in the 1960s, after African Americans won the right to vote. The then-9-year-old Williamson dressed in her Sunday best: hair ribbons and patent-leather shoes. As she watched her grandparents disappear behind the voting curtain, she couldn’t wait for it to be her turn someday.
This year, she couldn’t bear to think that nursing home and assisted-living residents — many of whom likely fought for their right to vote just like her grandparents — would be robbed of that opportunity.
So Williamson, 64, put her apprehension about COVID aside, donned her face mask and gloves, and visited five facilities this fall.
To each resident she’d say, “Gosh, you picked a great day to vote.”
The convergence of the coronavirus pandemic and election season has complicated this year’s voting for residents of nursing homes, assisted living facilities and other long-term care centers.
Many seniors who need help to get or fill out their ballots may be stymied by shifting rules about family visits. Voting procedures — whether in person or by mail — are under increased scrutiny, adding to the confusion. Facilities that used to host voting precincts likely won’t do so this year because of concerns about the spread of COVID-19.
“We’re basically not allowed to go out into the public right now, we’re more vulnerable, and our immune systems are compromised anyway,” said Janice Phillips, a 14-year resident of Village Square Healthcare Center, a skilled nursing facility in San Marcos, California. “We’re basically locked in.”
Phillips, 75, who has rheumatoid arthritis, has voted by absentee ballot for years without problems. This year she is encouraging her fellow residents to vote by mail as well. She works with the facility’s activities staff, going resident by resident, to make sure folks are registered. As president of the resident council, Phillips has also raised the issue at community meetings.
Older Americans are a consistent voting bloc courted by both parties.
According to AARP, 71% of Americans 65 and older voted in the 2016 presidential election, compared with 46% of people 18-29. “For many older adults, it’s a point of pride for them that they’ve voted in every election since they were 18,” said Leza Coleman, the executive director of California’s Long-Term Care Ombudsman Association.
But hardly anyone has been allowed inside skilled nursing facilities since the start of the pandemic, except for staff members and the occasional state health official, or family members in certain circumstances. In California and beyond, facilities are beginning to open up in counties with low transmission rates, since federal rules changed in September to allow for more lenient visiting policies.
At the same time, outbreaks continue to plague some senior facilities, despite improved testing of staff and other safety measures. On Wednesday, Santa Cruz County health officials reported a major outbreak at the Watsonville Post-Acute Center, which has infected 46 residents, killing nine of them, and infecting 15 staff members.
California officials are pressing nursing homes and senior centers to give residents who want to vote the opportunity. The Department of Public Health on Oct. 5 sent a letter to all those facilities, explaining they have an obligation to inform and assist residents with voting, including what actions are permissible for staffers to undertake in helping voters. It also includes advice about maintaining a safe environment through the election by limiting nonessential visitors, properly using protective gear such as gloves and handling ballots as little as possible.
In years past, civic groups such as the League of Women Voters would stop by to give presentations on what’s on the ballot. Candidates for local office would hit nursing homes to make pitches. “In the context of a pandemic, we just can’t do it this year,” said Michelle Bishop, voter access and engagement manager with the National Disability Rights Network.
Before the pandemic, nursing homes and assisted living facilities also often served as polling places. Residents could easily access voting booths, often set up in a lobby or community room. That was especially important because nursing homes are likely to be accessible to people with mobility problems, Bishop said.
Otherwise, facilities would often organize bus trips and outings to polling places.
In California, the last day to register to vote online or by mail is Oct. 19, though voters can register in person up to and including Election Day. All registered voters will receive a ballot in the mail, and those postmarked by Nov. 3 will still be counted in California for 17 days after the election. Advocates say it’s important for newer residents at skilled nursing facilities to make sure they’ve registered at their new address or have plans to get their ballot delivered to them from their former homes.
Other states are also sending ballots to all registered voters by mail this year on various time frames. All states permit seniors or people who have trouble reaching polling stations to request an absentee ballot.
Once they have a ballot in hand, some older adults need help from family or staff at their facilities to complete it correctly and send it back to election officials. The federal directive to relax visiting rules could ease some of that pressure, but the situation varies by facility. For people whose relatives cannot help them, it may fall to staff members to set up calls and video chats between residents and their families, or provide the assistance to residents themselves.
Some states don’t allow nursing home staffers to help with ballots to avoid influencing votes. Even if they can assist, employees may be stretched too thin to help. In a year when nursing home staff members are spending an extra hour each day putting on protective gear, there isn’t always extra time to make sure every resident is registered and voting, said Dr. Karl Steinberg, chief medical officer for Mariner Health Central, a nursing home management company in California.
“There’s a perennial workforce shortage in nursing homes and it’s been exacerbated by this” pandemic, Steinberg said. “This year with all the chaos, there may be less staff time available to help people with voting.”
Tracy Greene Mintz, whose business, Senior Care Training, trains senior care workers, is responsible for staffing at 100 nursing homes in California. She said she started ringing alarm bells about voting rights in August.
“Elected officials do not care about nursing homes, period,” Greene Mintz said. “They assume residents don’t vote and don’t make contributions.”
She asked the California Department of Public Health, which surveys skilled nursing facilities every six weeks about COVID-19 infection control, to add a question on how facilities were planning for elections. The department declined.
So she set up webinars with facility administrators and the Los Angeles County Registrar-Recorder/County Clerk to go over information on how to submit and track absentee ballots.
She has also urged state officials to provide a statewide plan that facilities could use as a blueprint. She wrote one herself that was emailed out by a trade group, the California Association of Health Facilities.
Still, California is in better shape than some other states, said Raúl Macías, a lawyer with the Democracy Program at the Brennan Center for Justice, a law and public policy institute. Elsewhere, residents may have to apply for an absentee ballot, and sometimes must provide a reason they can’t vote in person.
California also has the Voter Bill of Rights, which allows individuals to designate someone to help them fill out and drop off their ballot. In some states, such as North Carolina, assistance can come only from designated bipartisan voting assistance teams, which may be harder to recruit during a pandemic, Macías said.
No matter the state, state and county elections officials and facility administrators should draft voting plans, said Bishop, of the Disabilities Rights Network. It will help staff know the proper way to assist residents without influencing their votes, and residents know their voting rights.
“There is a bit of a gray area on whose responsibility this is,” Bishop said. “It’s one of the years when we start asking ‘Whose responsibility is it?’ Who cares? We have to get it done.”
If they can’t get access to ballots or need help, California residents can contact the state’s long-term care ombudsman program, which can investigate complaints, help them resolve the issue and take the problem to the Department of Public Health if it can’t be fixed.
On the first night of the Democratic National Convention, New York Gov. Andrew Cuomo was among the first in a weeklong parade of speakers to issue scathing critiques of the Trump administration’s coronavirus response.
Cuomo’s criticisms drew a quick reply in a tweet from Michael Caputo, an assistant secretary for public affairs at the Department of Health and Human Services.
“Does the #DemConvention know @NYGovCuomo forced nursing homes across NY to take in COVID positive patients and planted the seeds of infection that killed thousands of grandmothers and grandfathers?” he wrote.
It was an easy jab: Cuomo has been dogged by criticism for months over his March advisory directing nursing homes in the state to accept patients who had or were suspected of having COVID-19. As long as they were medically stable, the notice said, it was appropriate to move patients in. Further, nursing homes were prohibited from requiring that medically stable prospective residents be tested for the virus before they arrived.
Between March 25 and May 8, approximately 6,326 COVID-positive patients were admitted to nursing homes, according to a state health department report.
While experts say this policy was flawed, is it fair to say that the governor’s directive “forced” nursing homes to take patients who were sick with COVID-19? And to what extent did that strategy sow the seeds of disease and death? When we examined the evidence, we found it was less clear-cut than the statement makes it seem. The policy likely had an effect, but epidemiologists identified additional factors that fed the problem. What’s more, the policy did not “force” nursing homes to accept COVID-positive patients. Nursing homes interpreted it this way.
We checked with HHS to find the basis for Caputo’s comment but got no response.
The Back Story
As the virus tore through nursing homes, killing dozens at some of them, Cuomo came under withering censure. His administration’s policy, implemented with an eye toward freeing up hospital beds for an onslaught of COVID patients, seemed to disregard the risks to frail and elderly nursing home residents who were especially vulnerable to the disease.
According to the COVID Tracking Project, 6,624 people have died of COVID-19 in nursing homes and other long-term care facilities in New York, accounting for 26% of the state’s 25,275 COVID deaths. Some say the true number of deaths is much higher because, unlike many states, New York does not count the deaths of former nursing home residents who are transferred to hospitals and die there as nursing home deaths.
Cuomo’s explanation for the policy — that he was simply following guidance from the federal Centers for Disease Control and Prevention — didn’t cut it. A recent PolitiFact piece examining his claim rated it “Mostly False.”
In May, the governor amended the March order, prohibiting hospitals from discharging patients to nursing homes unless they tested negative for COVID-19.
A Misguided Approach
In the early days of the COVID-19 pandemic, when New York was the epicenter and more than a thousand people were being hospitalized daily, there was a genuine fear that hospitals would not be able to accommodate the influx of desperately ill patients.
Moving people out of the hospitals and into nursing homes was one strategy to help hospitals meet these needs.
According to the CDC guidance cited in the earlier PolitiFact story, there were two factors to consider when deciding whether to discharge a patient with COVID-19 to a long-term care facility: whether the patient was medically ready, and whether the facility could implement the recommended infection-control procedures to safely care for a patient recovering from the virus.
A document from the federal Centers for Medicare & Medicaid Services said nursing homes should accept only patients they were able to care for.
Long-standing state guidance is based on the same condition.
Still, nursing homes didn’t believe turning away patients with COVID-19 was an option.
“On its face, it looked like a requirement,” said Christopher Laxton, executive director of the Society for Post-Acute and Long-Term Care Medicine, which represents medical professionals in nursing homes and other long-term care facilities. “The nursing homes we spoke to felt it was a mandate, and a number of them felt they had no choice but to take COVID patients.”
While the overarching guidance not to take patients in unless they could be safely cared for may have been clear, nursing homes’ experience was often different, said.
Richard Mollot, executive director of the Long-Term Care Community Coalition, an advocacy group for elderly and disabled people. “There was little reason for nursing homes to think they should only take in patients if they have the ability to do so safely because those rules are not generally enforced on a regular basis.”
Bottom line: State and federal rules didn’t force nursing homes to accept COVID-positive patients, but many of them believed they had no other choice.
A Lethal Result?
How much of the blame for the deaths of thousands of people in nursing homes from COVID-19 can be attributed to Cuomo’s March advisory?
That is the 6,000-person question.
In a July analysis of COVID-19 nursing home deaths, the state concluded that the deadly virus was introduced by nursing home staff members rather than sick patients.
It noted that peak nursing home resident mortality from COVID-19 on April 8 preceded the peak influx of COVID patients on April 14. In addition, it found that nearly 1 in 4 nursing home workers — 37,500 people — were infected with the virus between March and early June.
Based on these and other factors, the report concluded that the state admissions policy could not have been a driver of nursing home infections or fatalities.
Epidemiologists and nursing home advocates beg to differ.
“To say that introducing patients [to nursing homes] who had COVID did not cause problems is ridiculous,” said Laxton.
Calling the study’s approach “pretty flawed,” Denis Nash, an epidemiologist at City University of New York School of Public Health, said he didn’t agree with the report’s conclusion that the policy had nothing to do with deaths.
Others had the same view. “I didn’t think they showed data to say [the policy] is not a ‘driver,’” said Rupak Shivakoti, an assistant professor of epidemiology at the Mailman School of Public Health at Columbia University.
But Gary Holmes, assistant commissioner at the New York State Department of Health, had a different take. Critics of the report, he said, must be deliberately ignoring the rising death tolls in nursing homes in hot spots across the country.
“Public health officials in those states are experiencing (and acknowledging) what NY’s report indicated weeks ago: these facilities are microcosms of the community and transmission is occurring unknowingly by asymptomatic spread among staff members,” Holmes said, in an email.
While public health experts quibbled with the report’s self-serving claim that the governor’s policy wasn’t a factor in COVID-19 nursing home deaths, they nevertheless agreed with the report’s broader conclusion that nursing home staffers as well as visitors, before they were banned, were likely the main drivers of COVID-19 infection and death in nursing homes.
“Based on the timeline of the policy and deaths in the city, it is very unlikely that policy contributed to thousands of deaths,” said Shivakoti.
Infection control is a long-standing problem at nursing homes, Nash said, and the COVID deaths were a basic failure of infection control. That said, “it’s unclear how many of the deaths the policy might have caused.”
Also unclear: how many of the dead were grandmothers and grandfathers.
In a tweet, the HHS assistant secretary for public affairs said that New York Gov. Andrew Cuomo “forced” nursing homes across the state to admit COVID-positive patients and that this policy fueled the spread of COVID-19 that led to thousands of deaths in the nursing home population.
Although nursing homes felt pressure to accept COVID-positive patients, they were not actually forced to do so. State regulations require nursing homes to accept patients only if they can care for them, and they could have refused them on those grounds.
In addition, it’s unclear the extent to which the governor’s policy was responsible for nursing home COVID-19 deaths. Infection control is a long-standing problem in nursing homes, predating the pandemic, and a report showed peak numbers of nursing home deaths came prior to the peak influx of patients as a result of Cuomo’s advisory. While the introduction of COVID-19 positive patients into nursing homes no doubt had an effect on infection spread, Caputo’s statement suggests it was solely responsible. That’s not what the evidence shows.
The Trump administration’s latest effort to use COVID-19 rapid tests — touted by one senior official as a “turning point” in arresting the coronavirus’s spread within nursing homes — is running into roadblocks likely to limit how widely they’ll be used.
Federal officials are distributing point-of-care antigen tests — which are cheaper and faster than tests that must be run by a lab — to 14,000 nursing homes to increase routine screening of residents and staff. The initial distribution targets nursing homes in hot spots and those with at least three COVID-19 cases, senior Trump administration officials said in July, hailing it as a tool that could root out asymptomatic carriers who might still infect others.
But there’s a hitch: Two manufacturers that have received Food and Drug Administration authorization and whose instruments are being delivered — Becton, Dickinson and Co., known as BD, and Quidel — say their antigen tests are intended for patients with symptoms, calling into question how valuable the tests would be for broad screening purposes. The Centers for Disease Control and Prevention estimates 40% of infected people may be asymptomatic.
“It’s important always to use a diagnostic in the way that it has been designed to be used,” said Elizabeth Talbot, New Hampshire’s deputy state epidemiologist. “We simply don’t know how [the tests] will perform in persons who are asymptomatic.”
Perhaps the highest-profile example of the problem occurred in Ohio this month, when Gov. Mike DeWine had no symptoms and tested positive for COVID-19 with Quidel’s antigen test. Within hours, the Republican governor’s diagnosis was reversed after he got a PCR test.
“People should not take away from my experience that testing is not reliable or doesn’t work,” DeWine said on CNN after his false-positive diagnosis. “The antigen tests are fairly new,” he said. “We’re going to be very careful in how we use it.”
The bigger problem is false-negative results, which show someone isn’t infected when they actually are. BD’s false-negative rate — how often a test incorrectly says someone isn’t infected — is about 15%; Quidel’s is 3%.
Quidel and BD say their tests are intended to be used for people within the first five days of showing symptoms. A spokesperson for BD said its test should not be used on asymptomatic individuals. Quidel through a spokesperson deferred to FDA guidelines, which allow asymptomatic testing in certain scenarios.
“For routine surveillance, this is a great tool and these are our best tools that we have available,” said Adm. Brett Giroir, assistant secretary for health at the Department of Health and Human Services, on a July call with nursing home officials, according to a recording obtained by KHN. Seema Verma, the administrator of the federal Centers for Medicare & Medicaid Services, on the call referred to the effort as a “turning point” in the fight against the virus.
A month after the initial announcement, the Trump administration invoked the Defense Production Act to bump its contracts with the two companies to the front of the line and expedite shipments. BD will send roughly 11,000 devices and 3.75 million tests to nursing homes; Quidel and HHS declined to answer questions about its volume.
As states and the federal government move to mandate COVID testing inside nursing homes, whose patients are deemed highly vulnerable to infection and severe complications, several industry officials have said they hoped to use the tests on asymptomatic people. But many states restrict the use of antigen tests or still require lab-based testing because of accuracy concerns.
If a person with a negative test result has to default to getting a more accurate PCR test, “then we simply have just added time and cost,” Talbot said. “That’s a problem.”
Officials said the antigen test announcement caught them by surprise, underscoring the administration’s chaotic testing strategy. Separate from the federal effort, 10 states have banded together through the Rockefeller Foundation to secure 5 million tests from the two companies in hopes of curbing the virus’s spread this fall.
After nursing homes receive an initial batch of tests — each facility gets between 150 and 900 — they would have to buy future supplies. Medicare will cover the costs of diagnostic tests but not expenses for routine surveillance.
“I just have a lot of skepticism,” said Brendan Williams, president of the New Hampshire Health Care Association, which represents nursing homes and assisted living facilities in the state. “Basically you’re giving some lousy tests for nursing homes and you’re making them pay for them. I don’t see that as a win; I see that as a risk.”
Public health experts have become increasingly vocal that frequent rapid testing is the best tool for stopping the virus — which has killed more than 174,000 Americans including tens of thousands in nursing care — rather than relying on more accurate lab-based tests that have been plagued by delays and shortages. In a call this month with the industry, Verma estimated that half of the country’s nursing homes have experienced cases.
“I don’t see an avenue where these will not help to stop transmission chains, and I don’t see another option on the table for us,” said Dr. Michael Mina, an assistant professor of epidemiology at the Harvard T.H. Chan School of Public Health and a proponent of rapid tests. “It is what we need to be doing right now.”
“This is better for the folks in our buildings, without a doubt,” added Jason Belden, director of emergency preparedness and physical plant services for the California Association of Health Facilities.
In theory, antigen tests can serve dual purposes — diagnosing a person with a suspected infection or screening a group of people to more quickly identify sick individuals. The tests by Quidel and BD, under their FDA authorizations, can be used on certain asymptomatic individuals, including those suspected of having COVID-19 after exposure to an infected person. The companies would need additional FDA authorization to screen any asymptomatic person regardless of whether they’re suspected of being sick, according to agency guidelines.
The CDC has suggested antigen tests could be useful in high-risk settings if performed repeatedly. It said there was limited data to guide using them to screen asymptomatic people.
Nonetheless, HHS recommends universal screening of nursing home residents at least once and regular screening of staff regardless of symptoms, said agency spokesperson Mia Heck, citing the fact that COVID-19 viral loads are similar between patients with and without symptoms. “Only one test in the U.S. is authorized for asymptomatic individuals,” she said, referring to a PCR test from LabCorp, “yet the overwhelming majority of testing is being done on asymptomatic individuals.”
“If the world were ideal we’d say, ‘Oh, we want the more accurate test.’ But the more accurate test takes forever to get the results back,” said Peter Van Runkle, executive director of the Ohio Health Care Association, which represents the state’s nursing homes.
All targeted nursing homes will receive tests by the end of September, according to federal officials, who recently announced that facilities in states with a positivity rate of at least 5% must test staff each week.
“I don’t see this as a federal strategy so much as a stopgap method to bring a little relief to nursing homes,” said Katie Smith Sloan, president of LeadingAge, which represents nonprofit nursing homes. “It’s really tragic that we are where we are right now.”
Boosted by $71 million in federal funds for Quidel and $24.3 million for BD, Quidel plans to produce 1.8 million tests weekly by September; BD will produce similar volumes by October.
“The situation is much too urgent to wait a few months so we can put bows and lipstick on the program. So we’re going to build this plane a little bit while we’re flying it,” Giroir told nursing homes in July. “Just work with us. We want to get you what you need. And then in September, October you can get what you want.”
States take different approaches in deploying antigen tests in nursing homes; in at least seven — including California, Illinois and Maryland — officials say PCR tests should still be used to confirm results or to screen patients without symptoms. In Massachusetts, nursing homes must use PCR tests to meet surveillance requirements.
In Maryland, “our goal is to screen out staff who are positive as quickly as possible, particularly asymptomatic folks,” said Dennis Schrader, chief operating officer of the health department.
Maryland nursing homes can use antigen tests for weekly staff testing if there isn’t an outbreak. But if at least one person tests positive for the coronavirus, all staff and residents must be tested with PCR tests.
The U.S. Department of Health and
Human Services (HHS) today issued a Notice of Funding Opportunity to expand and
accelerate innovative uses of electronic health information via health information exchanges (HIEs)
to support state and local public health agencies.
Strengthening health data exchange and use between HIEs and state and local public health agencies will
help communities to better prevent, respond to, and recover from public health emergencies,
including disasters and pandemics such as COVID-19.
Build innovative HIE
services that benefit public health agencies.
Applicants must propose activities that would benefit public health agencies.
This requirement is included in the NOFO because of the unique opportunity that
HIEs present with regard to supporting public health agencies. The outcome of
achieving this objective will be that public health agencies are more capable
of responding to public health events, including pandemics such as COVID-19.
Improve the HIE services
available to support communities disproportionately impacted by the COVID-19
Applicants must describe how they would deploy services or functionalities to
enable, enhance, or increase the use of health information exchange among
relevant entities, including providers who care for vulnerable or at-risk
populations. Applicants must describe how their activities under the
cooperative agreement address communities disproportionately impacted by the
COVID-19 pandemic, including as it relates to the stratifying factors of age,
race, ethnicity, disability, and sex. The outcome of achieving this objective
will be to increase public health understanding of how COVID-19 has
disproportionately impacted various communities and increase the capability of
public health agencies and the health care system to respond to that impact.
STAR HIE Program Award Recipient Requirements
Award recipients will focus on improving HIE
services (such as last-mile connectivity and data services) in support of state and local public health agencies.
The STAR HIE Program aims to strengthen existing state and local HIE
infrastructure so that public health agencies are able to
better access, share, and use health information as well
as support communities that have been disproportionately impacted by
the COVID-19 pandemic.
Award recipients will be required to deploy
services that can enable, enhance, or increase the use of health information exchange
at the state and local levels among relevant entities, and
be inclusive of a diverse set of participating providers, including those who
care for vulnerable or at-risk populations. They also will be required to
engage in activities that address communities disproportionately impacted by
the COVID-19 pandemic, considering factors such as age, race, ethnicity,
disability, and sex.
Why It Matters
“State and local HIEs play a unique role in their communities by uniting health information from many different sites of service, including providers, hospitals, nursing homes, clinical laboratories, and public health departments, making them a natural fit to deliver innovative, local ‘last mile’ approaches to strengthen our overall public health response,” said Don Rucker, M.D., national coordinator for health information technology. “The funding opportunity we announced today will invest in infrastructure and data services for HIEs that provide critical real-time information to communities at the frontlines of responding to the COVID-19 pandemic.”
Every day, the nation is reminded of COVID-19’s ongoing impact as new death counts are published. What is not well documented is the toll on family members.
New research suggests the damage is enormous. For every person who dies of COVID-19, nine close family members are affected, researchers estimate based on complex demographic calculations and data about the coronavirus.
Many survivors will be shaken by the circumstances under which loved ones pass away — rapid declines, sudden deaths and an inability to be there at the end — and worrisome ripple effects may linger for years, researchers warn.
If 190,000 Americans die from COVID complications by the end of August, as some models suggest, 1.7 million Americans will be grieving close family members, according to the study. Most likely to perish are grandparents, followed by parents, siblings, spouses and children.
“There’s a narrative out there that COVID-19 affects mostly older adults,” said Ashton Verdery, a co-author of the study and a professor of sociology and demography at Pennsylvania State University. “Our results highlight that these are not completely socially isolated people that no one cares about. They are integrally connected with their families, and their deaths will have a broad reach.”
Because of family structures, Black families will lose slightly more close family members than white families, aggravating the pandemic’s disproportionate impact on African American communities. (Verdery’s previous research modeled kinship structures for the U.S. population, dating to 1880 and extending to 2060.)
The potential consequences of these losses are deeply concerning, with many families losing important sources of financial, social and caregiving support. “The vast scale of COVID-19 bereavement has the potential to lower educational achievement among youth, disrupt marriages, and lead to poorer physical and mental health across all age groups,” Verdery and his co-authors observe in their paper.
Holly Prigerson, co-director of the Center for Research on End-of-Life Care at Weill Cornell Medicine in New York City, sounds a similar alarm, especially about the psychological impact of the pandemic, in a new paper on bereavement.
“Bereaved individuals have become the secondary victims of COVID-19, reporting severe symptoms of traumatic stress, including helplessness, horror, anxiety, sadness, anger, guilt, and regret, all of which magnify their grief,” she and co-authors from Memorial Sloan Kettering Cancer Center in New York noted.
In a phone conversation, Prigerson predicted that people experiencing bereavement will suffer worse outcomes because of lockdowns and social isolation during the pandemic. She warned that older adults are especially vulnerable.
“Not being there in a loved one’s time of need, not being able to communicate with family members in a natural way, not being able to say goodbye, not participating in normal rituals — all this makes bereavement more difficult and prolonged grief disorder and post-traumatic stress more likely,” she noted.
Organizations that offer bereavement care are seeing this unfold as they expand services to meet escalating needs.
Typically, 5% to 10% of bereaved family members have a “trauma response,” but that has “increased exponentially — approaching the 40% range — because we’re living in a crisis,” said Yelena Zatulovsky, vice president of patient experience at Seasons Hospice & Palliative Care, the nation’s fifth-largest hospice provider.
Since March, Seasons has doubled the number of grief support groups it offers to 29, hosted on virtual platforms, most of them weekly. All are free and open to community members, not just families whose loved ones received care from Seasons. (To find a virtual group in your time zone, call 1-855-812-1136, Season’s 24/7 call center.)
“We’re noticing that grief reactions are far more intense and challenging,” Zatulovsky said, noting that requests for individual and family counseling have also risen.
Medicare requires hospices to offer bereavement services to family members for up to 13 months after a client’s death. Many hospices expanded these services to community members before the pandemic, and Edo Banach, president and CEO of the National Hospice and Palliative Care Organization, hopes that trend continues.
“It’s not just the people who die on hospice and their families who need bereavement support at this time; it’s entire communities,” he said. “We have a responsibility to do even more than what we normally do.”
In New York City, the center of the pandemic in its early months, the Jewish Board is training school administrators, teachers, counselors and other clinicians to recognize signs of grief and bereavement and provide assistance. The health and human services organization serves New Yorkers regardless of religious affiliation.
“There is a collective grief experience that we are all experiencing, and we’re seeing the need go through the roof,” said Marilyn Jacob, a senior director who oversees the organization’s bereavement services, which now includes two support groups for people who have lost someone to COVID-19.
“There’s so much loss now, on so many different levels, that even very seasoned therapists are saying, ‘I don’t really know how to do this,’” Jacob said. In addition to losing family members, people are losing jobs, friends, routines, social interactions and a sense of normalcy and safety.
For many people, these losses are sudden and unexpected, which can complicate grief, said Patti Anewalt, director of Pathways Center for Grief & Loss in Lancaster, Pennsylvania, affiliated with the state’s largest not-for-profit hospice. The center recently created a four-week group on sudden loss to address its unique challenges.
The day before Julie Cheng’s 88-year-old mother was rushed to the hospital in early July, she had been singing songs with Cheng’s sister over the phone at her Irvine, California, nursing home. The next morning, a nurse reported that the older woman had a fever and was wheezing badly. At the hospital, COVID-19 was diagnosed and convalescent plasma therapy tried. Within two weeks, after suffering a series of strokes, Cheng’s mother died.
Since then, Cheng has mentally replayed the family’s decision not to take her mother out of the nursing home and to refuse mechanical ventilation at the hospital — something she was sure her mother would not have wanted.
“There have been a lot of ‘what ifs?’ and some anger: Someone or something needs to be blamed for what happened,” she said, describing mixed emotions that followed her mother’s death.
But acceptance has sprung from religious conviction. “Mostly, because of our faith in Jesus, we believe that God was ready to take her and she’s in a much better place now.”
Coping with grief, especially when it is complicated by social isolation and trauma, takes time. If you are looking for help, call a local hospice’s bereavement department and ask what kind of services it provides to people in the community. Funeral directors should also have a list of counselors and grief support programs. One option is GriefShare, offered by churches across the country.
Many experts believe the need for these kinds of services will expand exponentially as more family members emerge from pandemic-inspired shock and denial.
“I firmly believe we’re still at the tip of the iceberg, in terms of the help people need, and we won’t understand the full scope of that for another six to nine months,” said Diane Snyder-Cowan, leader of the bereavement professionals steering committee of the National Council of Hospice and Palliative Professionals.
Journalists from KHN and the Guardian have identified more than 900 workers who reportedly died of complications from COVID-19 they contracted on the job. Reporters are working to confirm the cause of death and workplace conditions in each case. They are also writing about the people behind the statistics — their personalities, passions and quirks — and telling the story of every life lost.
In the late 1940s, the United Kingdom was busily reassembling country and what remained of the empire in the aftermath of World War II. Among many revelations, the war had convinced Britain’s leaders of the need to provide healthcare for all in the event of calamity upending the basic functions of a civilized society. With that, the UK’s National Health Service (NHS) was born.
In 2020, all perspectives about quality and the time it takes to see a provider aside, the NHS remains quite popular among UK citizens and is an enduring source of national pride.
With the United States in the midst of its own upheaval, it’s for a related question: Might the current COVID-19 situation give rise to significant changes to the American healthcare system?
Virtually no one thinks the correct answer is ‘No.’ Things will change. The question is how and to what extent. The healthcare system in place in the United States now is dramatically more complex than that in use by Britons after WW II. There are so many moving parts, so many things that can break.
So, in which aspects of the current American healthcare system are we likely to see changes after COVID-19 is dealt with?
Telehealth: Someone always benefits in a catastrophe. In this case, that someone may be Zoom shareholders.
From 10 million daily users in December, Zoom rocketed to 200 million in March and nearly 300 million a month later. Much of that was healthcare related.
Of course, Zoom is not the only direct beneficiary of coronavirus as venerable meeting platforms like WebEx and Skype, among others, have also experienced dramatic growth.
Hospitals and health systems were incrementally implementing telehealth services prior to the coronavirus outbreak, but there was no sense of urgency that accompanies a rapidly spreading virus. Since then, the federal government, states and insurance companies have allocated funds and rewritten regulation to expand the use of telehealth.
But there are more telehealth related-issues to address, some of which have thorns. Service and payment parity across insurance companies is an issue. If telehealth is going to be a regular component of healthcare, technology gaps will have to be addressed, especially in rural areas.
This is something the federal government recognizes. The White House recently drafted an executive order oriented around improving rural health by expanding technology access, developing new payment models and reducing regulatory burdens. The EO tasks the secretaries of health and human services and agriculture to work with the Federal Communications Commission to “develop and implement a strategy to improve rural health by improving the physical and communications healthcare infrastructure available to rural Americans.” But until Congress gets involved and provides funding for something like this, it will probably never get out of the proposal phase.
In fact, there are enough concerns—parity, technology gaps, added costs—associated with telehealth to wonder if it will endure after coronavirus is in the rear view. Enough about telehealth benefits both providers and patients for it to stick and proliferate, but that could also be said about any number of healthcare initiatives that seem to languish for lack of coordination and political will.
Health Insurance: This is where the NHS analogy is the most relevant. Many millions of workers are furloughed or simply laid off with the impact of COVID-19 on frontline jobs like restaurant worker, massage therapist and barista. Those who had insurance through work may not have it anymore, leaving them doubly vulnerable—no coverage, no income—to illness or accident.
Mass unemployment episodes reveal, each time, the weakness in the patchwork employment-based healthcare insurance system we’ve sort of made peace with for decades. Sure, Medicaid exists to fill the gaps, but it may make sense to render Medicaid unnecessary, especially since its value is questionable in particular states.
“You notice the number of band-aids that Congress is having to apply to help people who have lost their jobs,” said former CMS Administrator Don Berwick, MD. “What we have now is a whole series of band-aids and special measures. What if instead, we just had universal health insurance?”
What if, indeed. Will COVID-19 be the straw that burns the bridge of employer-based health insurance, to mangle a metaphor? That may depend on how long the pandemic lasts, who is president sometime after November 3 and how much damage is done to the national fabric before economy and society start a process of repair.
Payment Models: For years now, hospitals have been in the middle of slow shift from fee-for-service care to value-based care and alternative payment models. That transition didn’t happen quickly enough to prevent most hospitals from falling into a financial chasm. If elective procedures are a big part of revenue, it follows that revenue will fall if those procedures disappear.
To be fair, the hit to hospital finances has been catastrophic enough—more than $200 billion in losses over four months, according to the American Hospital Association—that federal government support would have been necessary even if a full pay-for-quality model had been in place.
But the pandemic spotlights the downside of treating essential services like healthcare as though they are mere services one selects or rejects. And it exposes the folly of not making sure everyone has insurance coverage (a payer) when the individual costs for COVID-19-related hospital admission can range from $20,000 to $88,000.
End-of-Life Care: According to one analysis, 42 percent of COVID-19 deaths have occurred in nursing homes or assisted living facilities. The families of those unfortunate souls who’ve died while in a facility have generally endured the agony of saying goodbye outside a window or over a video link. It’s hard to believe, after COVID-19, that the assisted living industry will continue as before.
“The crisis surely will lead nursing home administrators to reconsider the way patients are cared for,” says Modern Healthcare. “Among the ideas Harvard’s [Professor David] Grabowski believes will get a longer look in the wake of the pandemic are using telemedicine services, creating specialized Medicare Advantage plans for the homes and pursuing smaller settings.”
Perhaps. And perhaps a son or daughter that remembers coronavirus will simply choose not to risk everything by putting their parent in a home. Could enough of them make such a decision that the industry contracts? Is forced to take quality care more seriously? Attracts more serious federal regulation?
As the deaths mount, it’s hard not to give every option serious consideration.
Supply Chain: These days we’re bickering in public and on social media (looking at you, maskless Karen throwing food in Trader Joes) about whether or not masks should be mandated. Look back with me to February, however, and you’ll fondly recall concerns about there being enough masks at all.
Back then we learned that the United States had exactly one mask manufacturer, and that all other masks are sourced from overseas. That it takes longer to get stuff from China than from Amarillo creates obvious potential problems when a crisis hits, but it also pits hospitals and government entities against one another and guarantees that the winner will pay more for supplies than they would in less-critical times.
It also creates weird, unnecessary scenarios that could be avoided using coordination and leadership. The governor of Maryland, for example, used his wife’s connections to South Korea (her country of birth) to secure 500,000 coronavirus tests, which he then put in an undisclosed location and protected using national guard troops.
What’s the remedy?
Modern Healthcare has called for a national supply chain czar, which in other times may have just been the head of FEMA. The suggestion, however, highlights the need for a coordinated central clearing house where supplies can be ordered, managed and dispersed based on need.
Individual hospitals, clinics and health systems can also help themselves by using a robust supply chain software system that keeps track in real time of available supplies, covers all ordering systems and methodologies, and reacts swiftly to certain thresholds.
The uniquely unfortunate aspect of the American political system among western democracies is that, for the most part, it responds to the demands of special interests. Think about your local representative. Chances are good the shouts of specific business interests are ringing in his or her hears so loudly that little else is audible.
As such, there is a significant danger that the American healthcare system will return, post-COVID-19, to the same dynamic it had when the virus arrived, which will be unfortunate. What we need post-pandemic is not necessarily specific changes to hospitals, clinics, insurance companies, etc., though they could be part of an overall solution. What will be necessary is an examination of where every aspect of the healthcare system overall, inasmuch as there is one, didn’t do its job.
Disasters are social sodium pentothal that, while active, force groups of people to take an honest look at their failures. Once the disaster is passed, however, there is a danger that Upton Sinclair’s maxim—“It is difficult to get a man to understand something when his salary depends upon his not understanding it”—will rule the day.
No one hopes for more dramatic damage to the American economy and social fabric, but the irony is that necessary change sometimes only comes when reality is undeniable, as in a shellshocked Britain instituting the NHS. If COVID-19 doesn’t shock us sufficiently into making substantial changes to the healthcare system, it’s a pretty safe bet the same disaster will occur again.
America’s health care workers are dying. In some states, medical personnel account for as many as 20% of known coronavirus cases. They tend to patients in hospitals, treating them, serving them food and cleaning their rooms. Others at risk work in nursing homes or are employed as home health aides.
“Lost on the Frontline,” a collaboration between KHN and The Guardian, has identified 782 such workers who likely died of COVID-19 after helping patients during the pandemic.
We have published profiles for 139 workers whose deaths have been confirmed by our reporters.
Some cases are shrouded in secrecy. Our team contacts family members, employers and medical examiners to independently confirm each death. Many hospitals have been overwhelmed and workers sometimes have lacked protective equipment or suffer from underlying health conditions that make them vulnerable to the highly infectious virus. In the chaos, COVID casualties might otherwise get overlooked.
This project aims to document the lives of U.S. health workers who die of COVID-19, and to understand why so many are falling victim to the pandemic.
RN Nourished Souls As Well As Bodies
(Courtesy of the Abellera family and the Angelus Funeral Home)
Milagros D. Abellera
Age: 65 Occupation: Registered nurse Place of Work: Baptist Medical Center and Kindred Hospital in San Antonio Date of Death: May 13, 2020
Milagros Abellera cooked Philippine feasts for her husband, Roberto, six children and grandchildren. Sometimes they’d host nearly 100 people. No one ever left hungry.
A devout Catholic, Milagros also nourished souls wherever she went. “She would always bring people back to their faith,” said daughter Kristine Abellera.
Milagros earned her degree in the Philippines and worked as a nurse for 46 years. She landed in Texas in the early ’90s.
“She was a mother hen to our young nurses,” said Kyle Sinclair, CEO of Kindred Hospital San Antonio Central.
She would speak up with other nurses and doctors if she felt there was a better way to treat patients, Kristine said.
Milagros’ low-grade fever escalated in late March. She got tested for COVID-19 and went into home isolation once additional symptoms came on, but finally went to the hospital.
“She wanted to work it off like she does everything else,” Kristine said.
On the day of her death, an American flag was flown in her honor at the Texas Capitol. It was given to her family.
— Eriech Tapia, University of Oklahoma | Published July 10, 2020
Age: 22 Occupation: Emergency medical technician Place of Work: Vital Care EMS in Greenville, South Carolina Date of Death: May 26, 2020
John Paul Granger was used to working on the front lines. He aided federal hurricane disaster relief efforts in Texas and Florida. John Paul “was dedicated … to the profession of being a first responder,” Vital Care wrote in a statement published by the Greenville News.
JP, as he was also known, started washing ambulance trucks after high school and worked his way up to driver and EMT. He enjoyed boating, flying lessons and throwing the ball with his rescue dog, Shadow. He aspired to be a chef.
“He was one of the happiest people I’d ever met,” said Patrick Hahne, a friend and former Vital Care driver. No matter your race, sexual orientation or religious belief, “he would treat you like a brother or sister.”
John Paul was the only child of Laura and Paul Granger, who said he had “a smile that would light up any room.”
One of South Carolina’s youngest COVID victims, he died after a month in the hospital, his mother by his side.
Hahne said he and JP “frequently expressed how inadequate the PPE and precautions” were. Initially, he added, the only protection they typically had when transporting patients to dialysis clinics, for example, was surgical masks. Hahne said they started wearing N95 masks a few days before JP fell ill.
Vital Care did not respond to requests for comment.
Nurse’s Assistant Was A Perfectionist Who Doted On Patients
(Courtesy of Mike Graveline)
Age: 52 Occupation: Certified nursing assistant Place of Work: Lawrence + Memorial Hospital in New London, Connecticut Date of Death: May 19, 2020
Elva Graveline took small, graceful steps down the hospital corridors.
“You could see her smile coming,” said Connie Fields, her local union president.
A perfectionist at work, Elva arrived over an hour early for her 6:45 a.m. shift, according to her husband, Mike Graveline. She doted on her patients with shampoo and razors that she brought from home.
“She just wanted them smelling good,” Mike said.
Elva, born in Texas to Mexican American parents, adored her two daughters and three granddaughters. The third was born in April, but she never got to hold the baby because she was exposed to COVID-19 at work. Elva worked on a COVID floor, caring for as many as 12 patients a day, Mike said.
Fields said she believes Elva got sick from reusing protective gear: In March, Elva and others wore the same N95 respirator masks for two weeks, Fields said, though by early May they had new N95s each day.
Hospital spokesperson Fiona Phelan replied that “we value and respect [staff members] too much to not provide the protective gear needed in this battle.”
Elva tested positive for COVID-19 on May 12 and died a week later of cardiac arrest.
“This should never have happened,” Mike recalled telling his wife. “I just wish this was me.”
ICU Nurse Who Treated The First U.S. COVID Cases Dies Of The Virus
(Courtesy of Kathy Julian)
Age: 63 Occupation: Intensive care nurse Place of Work: EvergreenHealth Medical Center in Kirkland, Washington Date of Death: May 29, 2020
After the first U.S. surge of COVID-19 patients slammed his hospital in late February, Kurt Julian tended to its victims for weeks.
Then after three nights of caring for a COVID patient, Julian contracted the coronavirus.
“It was almost surreal, trying to think about this crazy new infection,” said his wife, Kathy Julian, an ICU nurse at a Seattle hospital. Her husband had ample protective gear and was careful in its use. Hospital officials said they were grateful for the compassionate care Julian provided.
When his symptoms began, Julian’s biggest concern was infecting his family, including four children ages 12 to 17.
In April, Julian was taken by ambulance to his own ICU and, later, placed on a ventilator by colleagues. In May, doctors at a trauma center used ECMO — extracorporeal membrane oxygenation — in a last-ditch effort to save him.
Kathy and their oldest son were present as nurses withdrew life support. The world lost a diligent nurse as well as a witty, creative soul who loved working with wood and stained glass at the family’s rural 5-acre property.
“I want people to get that this is real,” Kathy said. “Real people are dying.”
Age: 32 Occupation: Medical social worker Place of Work: Emergency Department, Kaiser Permanente San Francisco Medical Center in San Francisco Date of Death: May 30, 2020
Sarah Roncskevitz was larger than life, a vibrant, kind, generous and sometimes vexing bundle of superlatives: “a pillar of strength,” “a force of nature,” “a warrior mom,” friends wrote on Facebook.
“She exuded so much light,” said G. Allen Ratliff, her social work teacher at the University of California-Berkeley. In class, she stood out as always prepared, seated up front and eager to dig into issues.
She also had her troubles in the past, including addiction and domestic violence. That experience, Ratliff said, was the backbone of her work. “She had been very frustrated with social workers in her life,” he said. She was drawn to the profession, in a sense, to right those wrongs.
Kaiser San Francisco’s chaotic Emergency Department was exactly where she wanted to be. Yet she became increasingly concerned the hospital was unprepared for the pandemic. Her mom, Tami Leal-Roncskevitz, said in an email that Sarah was scolded in March for wearing a surgical mask, accused of contributing to the mask shortage and making patients fearful.
In an emailed statement, a Kaiser spokesperson wrote that the hospital was “devastated by [her] tragic death,” adding that the hospital followed all CDC precautions and that her complaint about mask-wearing “does not accurately reflect our policy.”
She became ill in mid-May but tested negative. On May 26, she collapsed at home. Hospitalized, she retested as positive and never regained consciousness.
ICU Nurse Found His Passion Caring For Children, Burn Patients
(Courtesy of Melvin Tam)
J. Aleksandr Vollmann
Age: 57 Occupation: ICU nurse, pediatric and burn units Place of Work: Harborview Medical Center in Seattle Date of Death: May 19, 2020
J. Aleksandr Vollmann, known as Aleks to friends and family, honed his caregiving skills as an Army medic and his discipline as an honor guard at the Tomb of the Unknown Soldier.
But the 57-year-old intensive care nurse in Seattle found his true passion at the bedsides of sick children and burn patients.
“He would tell me he would never leave here,” said Melvin Tam, who worked with Vollmann for more than a decade. “He found a home.”
In April, Vollmann contracted COVID-19, possibly from a patient. He was hospitalized twice with the virus and recovered. He was ready to return to work when he collapsed during an errand at Costco, days before his 58th birthday. He died of a probable heart attack complicated by blood clots related to COVID-19, records show.
“The COVID compromised him,” said his older sister, Jackie Martin. “People that recover, they don’t recover completely, and he didn’t.”
More than 100 people attended Vollmann’s memorial service at the hospital. He was remembered as a talented chef, the devoted owner of two cats, Azi and Kaali — and an exceptional nurse. Hospital officials issued a statement mourning his loss.
“There was so much love,” Martin said. “That really was his family.”
Haitian Immigrant’s 4 Children Followed Her Into Health Care Field
(Courtesy of Paul da Costa)
Age: 61 Occupation: Nursing aide Place of Work: New Jersey Veterans Memorial Home at Menlo Park in Edison, New Jersey Date of Death: May 11, 2020
Each day for lunch, Monemise Romelus and her fellow Haitian co-workers would heat up bowl after bowl of traditional cuisine: fried turkey, rice and peas, griot. They shared with all, said Shirley Lewis, her union president.
Romelus, who worked on a floor with COVID patients, was a quiet woman with many friends, Lewis said. Romelus beamed when talking about her four children, all of whom work in health care.
When the pandemic began, workers initially were told not to wear masks so they wouldn’t scare patients, said Paul da Costa, a lawyer representing Romelus’ family. She worked without adequate protective gear, contracted COVID-19 and died, he said.
More than 100 workers at the veterans home have tested positive for COVID-19; 62 residents have died, state data shows. Facility spokesperson Kryn Westhoven declined to comment on Romelus’ death but said workers “are directed to wear PPE in accordance with CDC guidelines.”
Management never acknowledged Romelus’ death, Lewis said. When the police killing of George Floyd ignited protests nationwide, staffers and supervisors gathered for eight minutes of silence. Lewis said she insisted they hold a moment of silence for Romelus, too.
Age: 53 Occupation: Registered nurse Place of Work: FutureCare Old Court nursing home in Randallstown, Maryland Date of Death: April 10, 2020
Quen Ako was known to wear stylish, bright clothing and break out in song and dance. Posting to an online memorial, friends, family and co-workers described a lively, compassionate woman.
“My memory of you is that of a warm person, one that will break out in songs of joy,” one friend wrote. Another described laughing at an inside joke with Ako just weeks before her death. “Did I for one second think that I would never hear that resounding, hearty laughter again?”
Born in Cameroon, Ako worked as a guidance counselor and teacher before coming to the U.S., where she earned her nursing degree. She worked for a chain of nursing homes and rehabilitation centers that saw massive COVID-19 outbreaks.
Ako’s family declined to be interviewed for this article but told a local news station that she had died of COVID-19. The Guardian independently verified Ako’s cause of death with one of her former co-workers. Ako’s employer did not respond to requests for comment about her death.
Age: 49 Occupation: Firefighter and emergency medical technician Place of Work: Chicago Fire Department Truck Company 25 Date of Death: April 7, 2020
Despite fighting fires and treating the injured for nearly 20 years, Mario Araujo remained goofy and light.
He had an uncanny ability to pry open roofs and pop open doors, said Richard Whitehead, a fellow firefighter. But he also loved playing virtual slot machines and cracking jokes.
“He was always kidding around. You could never take him serious,” Whitehead said. “But when it came time to go to work, he was just always ready to go.”
He was the first Chicago firefighter to die from the coronavirus, the department confirmed. Chicago Mayor Lori Lightfoot honored him on Twitter: “Mario selflessly dedicated his life to protecting our communities.”
Araujo approached his relationship with his girlfriend, Rosa Castillo, 48, and her son, Leo, 7, with the same zeal. He was attentive, picking up Leo from school and giving him a tablet computer so they could speak when he traveled.
“He taught my son a lot, even if they didn’t share the same blood,” Castillo said.
Castillo told Leo that God took Araujo to ease his suffering. She said her child believes he is an angel: “He hugs me and says, ‘Mom, I can feel Daddy with us.’”
Ghanaian Nurse Made ‘A Deep Impact Across The Planet’
(Courtesy of Kojoh Atta)
Age: 61 Occupation: Registered nurse Place of Work: Correctional Reception Center in Orient, Ohio Date of Death: May 17, 2020
In December 2019, Kojoh Atta returned to his father’s hometown in Offinso, Ghana. Kojoh arrived alone, but everybody knew his father, Bernard Atta.
As a nurse in Ohio’s prison system, Bernard worked overtime so he could afford to ship “drums of clothes” across the Atlantic to the Takoradi port. Inside were sneakers, sandals and Ralph Lauren polos for cousins. “Always with stripes,” Kojoh said, “so the boys knew they were special.”
The regard for his father made Kojoh realize “there are countless unsung heroes making a deep impact across the planet.”
In New York last summer, the two visited the United Nations to pay respects to a portrait of their hero, Kofi Annan, a former U.N. secretary-general from Ghana. They cried. “Look at this man, and look at us,” Bernard told his son. “We came from nothing, but we are here. We are making it.”
As COVID-19 ravaged Ohio, Kojoh urged his father to leave work, worried about inadequate protective gear. Bernard refused, citing “his duty,” Kojoh said. “PPE was, and continues to be available to staff,” a prison spokesperson said.
Bernard showed symptoms and tested positive for COVID-19, but he remained home, fearing the hospital bills. Awakened by a flurry of WhatsApp messages, Kojoh learned his father died, leaving behind his wife, three other children and grandchildren.
“He never could live for himself,” Kojoh said, “but he’s finally on vacation, in eternal paradise.”
Age: 65 Occupation: Registered nurse Place of Work: Clara Maass Medical Center in Belleville, New Jersey Date of Death: April 15, 2020
Barbara Birchenough consistently mailed cards to her family and friends, for birthdays, holidays or just as a pleasant surprise. Her youngest son, Matthew Birchenough, said it reflected her personality: quiet, thoughtful and kind.
Birchenough began training as a nurse right after high school and worked for 46 years. Her retirement was planned for April 4, with a big party to follow.
On March 24, she came home from work and told Matthew that four floors of the hospital had been taken over with COVID patients.
The next day, she began to cough. In text messages with her oldest daughter that morning, she conveyed that protective gear was lacking at the hospital. “The ICU nurses were making gowns out of garbage bags,” Barbara texted. “Dad is going to pick up large garbage bags for me just in case.”
When Birchenough returned to the hospital, though, it was as a patient. Her eldest daughter, Kristin Carbone, said she tested positive for COVID shortly before she died.
A Clara Maass spokesperson said the hospital has been compliant with state and CDC guidelines for protective gear.
First COVID Casualty Among Staff At His Hospital, Nurse ‘Had No Enemies’
Patrick cain and his wife, Kate (Courtesy of Kelly Indish)
Age: 52 Occupation: Registered nurse Place of Work: McLaren Flint Hospital in Flint, Michigan Date of Death: April 4, 2020
Patrick Cain was a dedicated nurse, always “close to his patients,” said Teresa Ciesielski, a nurse and former colleague. “The guy had no enemies.”
Cain was from Canada — a heritage he was especially proud of, Ciesielski recalled. He met his wife, Kate, in 1994, when they both worked in Texas. They had a son.
“He was an amazing father,” Ciesiekski said. “He was always talking about his kid.”
Cain’s ICU work meant caring for patients awaiting COVID test results. Some days, he worked outside the room where “suspected COVID” patients were being treated. The hospital hadn’t provided protective gear, despite his requests, according to Kelly Indish, president of the American Federation of State, County and Municipal Employees Local 875, his union.
On March 26, he texted Indish. He was worried he had been exposed to the virus the week before, and he hadn’t had a mask. “McLaren screwed us,” he wrote.
A hospital spokesperson said employees received appropriate gear based on government guidelines. But those rules didn’t mandate N95s — known to block viruses — for workers who, like Cain, were providing care but weren’t performing aerosolizing treatments, which can release virus particles into the air.
COVID-19 came with a fever, loss of appetite, dry cough, nausea. Cain was the hospital’s first employee known to die of the illness.
Grateful Immigrant Who Loved Thanksgiving Catered To Chinese Community
(Courtesy of the Hsu family)
Age: 67 Occupation: Internal medicine physician Place of Work: Hsu & Loy Medical Group in Margate, Florida Date of Death: March 24, 2020
Alex Hsu loved Thanksgiving.
Sitting down with his family for the holiday feast, Hsu always spoke for at least 10 minutes about how grateful he was to be in America. Hsu “didn’t really come from much,” said Zach Hsu, his son.
Hsu fled Communist China, first immigrating to Hong Kong and then to Hawaii, where he attended medical school. He served his residency in Kentucky and, eventually, landed in Broward County, Florida, where he practiced for decades.
As one of the few Chinese-speaking internal medicine doctors in the area, Hsu would see “a crazy amount of patients, and he never complained about it,” Zach said. As Hsu aged, he turned to Buddhism and meditation and wrote loving notes to his children as they left for college.
It is not clear how Hsu contracted COVID-19. He had traveled to New York weeks before falling ill but also was seeing patients who could have been carrying the virus.
Hsu worked in a private practice with privileges at Northwest Medical Center. His staff did not return requests for comment. Hsu died at the same hospital where he had cared for patients.
Hospital Supply Manager Lacked Protective Gear For Himself
(Courtesy of Bill Sohmer)
Age: 64 Occupation: Supply manager Place of Work: McLaren Flint hospital in Flint, Michigan Date of Death: April 10, 2020
Roger Liddell was a family man. One of nine siblings, he frequently visited his extended family back in Mississippi. He was involved in his church and loved cooking, Westerns and the Chicago Bears.
After high school, Liddell joined the Marine Corps. Upon finishing his service, he moved to Chicago, working for the U.S. Postal Service. Finally, he settled down in Michigan, working at McLaren Flint for almost 20 years.
His job took him all over the hospital. And as COVID cases climbed, he was worried.
Liddell requested protective gear from his hospital, said Bill Sohmer, president of AFSCME Local 2650, which represents non-technical employees at the hospital. Since he didn’t treat patients, he was denied — even though his work took him to floors with COVID-positive patients.
In an email, a hospital spokesperson said McLaren Flint had followed government guidelines to ensure employees received sufficient protective gear.
On March 30, Liddell posted to Facebook: He had worked the previous week in the ICU and critical care unit, without PPE. “Pray for me God is still in control,” he wrote.
Liddell tested positive for COVID-19. He was put on a ventilator but died, leaving behind his wife, four children, two stepchildren and 11 grandchildren.
Big-Hearted Nurse Feared For The Safety Of Those Who Cared For Her
(Courtesy of Lori Rodriguez)
Age: 53 Occupation: Registered nurse Place of Work: Kaiser Permanente Fresno Medical Center in Fresno, California Date of Death: May 25, 2020
Sandra Oldfield had a big heart and couldn’t say no to anyone, her sister Lori Rodriguez said. She had no children of her own but loved to spoil and care for her nieces and nephews.
She was a nurse who would listen to others’ problems. And she could amplify those concerns for management without losing her composure, Rodriguez said.
Oldfield had concerns of her own in mid-March while caring for critically ill patients in the telemetry unit. She was upset that she was given a surgical mask — not nearly as protective as an N95 respirator — to treat patients as COVID-19 was spreading.
Her concern was on point: She cared for a patient whose initial symptoms didn’t meet the well-known COVID profile, but who tested positive for the virus.
“I feel if she had an N95, she would be here today,” Rodriguez said. “I don’t want to see anyone else lose their life like my sister did.”
Kaiser Fresno said it has followed state and federal guidelines on protective gear. (KHN is not affiliated with Kaiser Permanente.)
Rodriguez said her sister resisted going to the hospital as her symptoms worsened, reluctant to expose paramedics or hospital staffers to the virus. When Oldfield agreed that an ambulance should be called, she wanted the paramedics to be advised to take every precaution.
Age: 62 Occupation: Registered nurse Place of Work: Huntington Hospital in Huntington, New York Date of Death: April 2, 2020
Long Island is where John Abruzzo was born, raised, worked and died. The second of 14 children, he was the “life of the party,” said his daughter, Christina Ravanes. He loved poker and fishing. He had a son as well, and three grandchildren.
Abruzzo developed strong friendships with patients, said Susan Knoepffler, the hospital’s chief nursing officer. “He had a winning smile. He was kind of a teddy bear,” she said.
He tested positive for COVID-19 in late March and died five days later. “I went from seeing my dad at a wedding,” Ravanes said, “to the next time I see him, it’s ashes.”
John’s wife, Mary Abruzzo, died eight days later, on her birthday, Ravanes said, likely from complications related to Type 1 diabetes (she had not been exposed to John when he was infected).
As of June 18, no other nurses at Huntington hospital had died of COVID-19, Knoepffler said, adding that the facility was well prepared and never ran out of supplies. What’s missing, she said, is Abruzzo.
— James Faris, James Madison University | Published June 26, 2020
Age: 65 Occupation: Licensed practical nurse Place of Work: Greenwood Leflore Hospital in Greenwood, Mississippi Date of Death: April 3, 2020
Dorothy Boles had two callings: one as a healer and the other as an ordained minister.
“Mama Boles,” as she was known, was a counselor and caretaker, said longtime friend and colleague Glory Boyd. Boles mentored aspiring ministers at First Chosen Tabernacle Church and welcomed recovering patients into her home.
“She went over, above and beyond,” said Boyd, the hospital’s chief nursing officer. “She cared for other people before she cared for herself.”
When patients leaving the hospital didn’t have the means to recover on their own, Boles opened her home to them, her son Marcus Banks told a local newspaper. Most stayed a few days. One young man stayed five years.
“Once she nursed him back to health, he just hung around,” Banks told the paper. “She just felt that nobody could take care of him like she could.”
Boles was admitted March 22 to the hospital where she had worked for 42 years. She was among the first four people to die of COVID-19 in Leflore County.
The hospital renamed the nurses’ station in her memory.
Pediatric Nurse Wore ‘Minions’ Scrubs And Connected With Children
(Courtesy of Carlos Dominguez)
Age: 33 Occupation: Registered nurse Place of Work: Providence Children’s Hospital in El Paso, Texas Date of Death: April 19, 2020
Karla Dominguez’s medical “practicing” began at a young age, with a doctor’s bag she got one Christmas. “Every time I came home, she’d say, ‘Let me listen to your heart; let me see how you’re doing,’” recalled her father, Carlos Dominguez.
She dreamed of becoming a pediatric neurosurgeon. Hurdles getting into medical school dampened her spirits. Then she pursued nursing, a field in which she blossomed.
“She was so full of joy, so happy with her work,” said Dominguez, a doctor. She wore scrubs with cartoon Minions and managed to connect with even the most challenging patients, her father said. A few years into her nursing career, she considered reapplying to medical school, but ultimately decided to stick with nursing because it allowed for more interaction with patients.
In early April, she began experiencing excruciating headaches — symptoms that have since been associated with COVID-19. She visited urgent care and the emergency room and was twice denied a coronavirus test. She was eventually hospitalized. Tests revealed she had the virus and CT scans showed brain hemorrhaging.
Dominguez doesn’t know how his daughter contracted the virus but suspects she may have contracted it at work. Providence did not respond to a request for comment.
Passionate EMT And Volunteer Firefighter Was ‘Constantly On Call’
(Courtesy of Shana Konek)
Age: 40 Occupation: Emergency medical technician Place of Work: Lehigh Valley Health Network MedEvac in Center Valley, Pennsylvania Date of Death: May 21, 2020
Jeremy Emerich and his girlfriend, Shana Konek, made a pact: Home is home. Work is work.
They set aside time to do things they loved, like watching “The Big Bang Theory” or walking their two beagle-mix puppies. “Unless we scheduled it in, it wasn’t happening,” Konek said.
An Army veteran who served in Iraq, Emerich “was passionate and loved a challenge,” Konek said. When he wasn’t taking emergency shifts, he volunteered for the Exeter Township Fire Department. “He was constantly on call, always lending a helping hand,” said Konek, an emergency medical services dispatcher.
If families of patients were in shock, he’d comfort them — sometimes in Spanish, to his colleagues’ surprise. Emerich worked long shifts caring for COVID-19 patients across the Lehigh Valley, for which he was equipped with adequate protective gear, Konek said. His employer could not be reached for comment.
On April 25, Emerich’s appetite began to wane and he complained of “a little fever.” Konek took his temperature: 104 degrees. A week later, he was in the ICU.
On May 8, Emerich told Konek he was signing some paperwork and would call her back.
Age: 61 Occupation: Food services coordinator Place of Work: Oregon Health & Science University (OHSU) in Portland, Oregon Date of Death: May 12, 2020
When Paul Odighizuwa left Nigeria in 1987, he enrolled at Portland State University to study visual arts and began a decades-long career at OHSU, a large teaching hospital. He became a pillar of the area’s close-knit Nigerian community.
“Paul was such a go-to guy,” said Ezekiel Ette, a friend. “If you needed something done, Paul would do it, and do it graciously.”
As a student, he helped paint a prominent mural depicting African and African American heroes — it stood for decades in Portland’s King neighborhood.
Odighizuwa, who worked in the hospital’s food services department, cooked traditional Nigerian dishes at home — as well as American-style pancakes with “crispy edges,” his daughter, Diana, said.
In mid-March, his union complained that management in Odighizuwa’s department was not allowing proper social distancing. Eleven people in the department became ill, and Odighizuwa died.
She Answered A Calling And Helped Fellow Native Americans
(Courtesy of Charmayne Bedonie)
Age: 56 Occupation: Certified medication aide Place of Work: Cedar Ridge Inn in Farmington, New Mexico Date of Death: May 16, 2020
Barbara Bedonie was happily raising three children when she realized she wanted to do more. She enrolled to become a certified nursing assistant, which turned out to be a calling.
“She was truly happy working,” her daughter Charmayne Bedonie said. “I’ve been hearing so many stories from families she’s helped.”
For 17 years, Barbara worked at a nursing home and received awards for perfect attendance. Management admired her work ethic enough to pay for her to become a certified medication aide. She was Navajo and could speak to residents at the home in their Indigenous tongue.
“I know she helped a lot of people just by speaking the language,” Charmayne said.
The home had reported a number of COVID cases. Bedonie tested negative for the virus repeatedly, but, overwhelmed by fatigue, she knew something was wrong. She was hospitalized and finally a test confirmed she had the coronavirus, Charmayne said.
Charmayne expressed praise for the hospital and the nursing home. Her employer did not respond to questions about protective gear and said only, “Cedar Ridge Inn misses our beloved colleague very much.”
Charmayne said families have been sharing stories about her mother. “They say she was a beautiful soul, inside and out,” she said.
Denny Gilliam and his wife, Amanda Marr Gilliam (Courtesy of Amanda Marr Gilliam)
Age: 53 Occupation: Travel nurse Place of Work: NewYork-Presbyterian Brooklyn Methodist Hospital in Brooklyn, New York, via Trustaff Date of Death: May 7, 2020
Amanda Marr Gilliam was on a cigarette break when Denny Gilliam threw that first glance. “Those blue eyes caught me,” she said. “The very next day, we started dating.”
Gilliam treasured family time, like movie nights, when the kids would pile into the couple’s king-size bed with chips and French onion dip.
“A country boy at heart,” Gilliam loved the outdoors, Amanda said. He took the family hunting for ginseng, digging for frogs and camping throughout the Appalachian Mountains near their home in Pelham, Tennessee. He and Amanda liked to fish in Lake Chickamauga for crappie and bluegill.
Gilliam was a committed nurse — it was his second career, after serving in the military. In April, when he learned New York hospitals were short-staffed in the pandemic, he felt obliged to serve.
In early May, when Amanda didn’t hear from him for “what felt like eternity,” she called 35 hotels near the hospital before finding where he’d checked in. A private investigator confirmed: He had died days earlier of COVID-19.
Age: 42 Occupation: Mason Place of Work: Lenox Hill Hospital in New York City Date of Death: April 22, 2020
Decades ago, two girls asked Gianmarco Bertolotti to the senior prom. Even as a teenager, Bertolotti was “such a sweet soul,” said Monique Bertolotti, his sister. Instead of rejecting either one, he skipped prom.
As a child visiting grandparents in Rapallo, Italy, Bertolotti would invariably return from town with “focaccia, espresso and stories of the friends he’d made.” As an adult, the man known as “G-Funk” had “a special way about him,” Monique said, “forg[ing] a lasting bond with everyone he met.”
An avid traveler, he’d visited New Orleans and Japan in recent years. “He explored life without restrictions,” Monique said.
A mason, Bertolotti took the subway from his home in Queens every morning to help repair the hospital’s ceilings, floors, soap dispensers and sharps collectors. But on April 13, he called his sister because he was coughing up blood after carrying a case of seltzer up three flights of stairs.
The next morning, he went to the emergency room. A week later, he was dead.
“Protecting our employees … has been our priority from day one,” the hospital said in a statement.
Age: 73 Occupation: Registered nurse Place of Work: Wellpath at Hudson County Correctional Center in Kearny, New Jersey Date of Death: April 5, 2020
Edwin Montanano went to the U.S. Open every year. He loved Broadway shows, especially “Miss Saigon,” but also “Les Misérables,” “The Phantom of the Opera” and “Cats.” He liked candy — Symphony bars and M&M’s. And he and his wife, Annabella, relished hosting guests.
“My parents always had an open-door policy, and [growing up] it was always a very busy house,” said Michelle Helminski, his daughter. “When relatives or friends would come to visit, my dad would take them to New York — he was an expert tour guide.”
In more recent years, his four young grandchildren became a focal point in his life.
Montanano, who studied nursing in his native Philippines, worked at St. Michael’s Medical Center in New Jersey for 30 years alongside Annabella; Michelle and her brother, Matthew, were born at the hospital. After retiring, Edwin returned to work as a nurse at a nearby prison.
Helminski said she does not know whether her father contracted the virus at work, but as of May, at least three other workers at the prison had died of COVID-19. A representative from Wellpath, Montanano’s employer, wrote that, “Our clinical personnel have ongoing access to masks, gowns, and other PPE, as well as the training to use it effectively.”
Montanano developed COVID-19 symptoms in late March and died at St. Michael’s.
A Former Marine Whose Altruism Shined In The Operating Room
(Courtesy of Valerie Alford)
Age: 60 Occupation: Licensed practical nurse Place of Work: DCH Regional Medical Center in Tuscaloosa, Alabama Date of Death: April 22, 2020
Jerry Alford brought the same meticulous care to nursing he’d learned as a reconnaissance Marine. He was a stickler for maintaining a sterile workspace and never passed on the chance to lighten a co-worker’s load.
Jerry dedicated 32 years to nursing and spent 27 of them married to Valerie, a trauma ICU nurse. Together they raised three sons and had three grandchildren.
When the pandemic hit, Jerry transferred to the emergency room, where Valerie believes he contracted COVID-19, despite access to personal protective equipment. Jerry’s employer did not respond to questions about whether he may have contracted the virus at work.
Jerry had celebrated his 60th birthday in January with a blowout surprise party. His wife and sons invited family he hadn’t seen in years. “Not knowing that was going to be his last birthday,” said Valerie, “that’s the best thing I could have done for him.”
— Suzannah Cavanaugh, City University of New York | Published June 17, 2020
Age: 62 Occupation: Urgent care physician Place of Work: Independent Physician Association of Nassau/Suffolk counties in Smithtown, New York Date of Death: April 30, 2020
When Arthur Friedman did not get into medical school in the United States, he enrolled in a school in Tampico, Mexico, teaching himself Spanish. “He was willing to do whatever it took,” said Eric Friedman, his son.
Arthur went on to open his own urgent care facility in Commack, New York. Though he was best known for his decades of work there, he was working at a clinic in Smithtown over the past year.
Arthur loved boating, the outdoors and hoped to retire soon in Florida, to be near his children. When COVID-19 hit, he put those plans aside.
“He seemed like a superhero to us. Nothing fazed him,” said Nikki Friedman, his daughter. Arthur began to experience symptoms on April 10 and tested positive shortly after. (His employer did not respond to requests for comment.)
He died on April 30 and was buried next to his youngest son, Greg, who died in 2014.
Scores of Arthur’s former patients reached out to his children after his death to express their love and gratitude for him.
— Madeleine Kornfeld, City University of New York | Published June 17, 2020
A Former Foster Child Who Was Charting Her Own Path
(Courtesy of the Fuqua family)
Age: 28 Occupation: Receptionist Place of Work: Pineville Children’s Clinic in Pineville, Louisiana Date of Death: April 2, 2020
Clair Fuqua was figuring out her path in life.
On her phone, she saved pictures of wedding dresses and venues, anticipating a proposal from her boyfriend of over two years, according to her parents, Curt and Claudia Fuqua. With an infectious smile, Clair welcomed young patients to the clinic, but she was looking forward to other roles in life.
“She was finally going to decide what she was going to do,” Curt said.
Her parents, who adopted Clair and two of her younger siblings when she was 10, hoped she would follow her passion for adoption and foster care into a career. Clair valued the love and stability of her forever family; before their adoption, Clair and her siblings had lived in six different foster homes.
When the coronavirus surfaced in Louisiana, Clair was already fighting bronchitis. At work, she wore a mask to keep her cough to herself. Days after a colleague was diagnosed with COVID-19, Clair developed a fever.
Clair’s employer declined to confirm how many staff members had become sick with COVID-19 or to comment for this story.
Clair was hospitalized on March 22.
“Everyone thought she would pull through,” Curt said.
In Clair’s honor, friends have donated Bibles and more than $2,100 to a local charity that supports children in the foster care system.
A Loving Mother And Nurse Who ‘Always Looked Tremendous’
(Courtesy of Scott Papetti)
Age: 65 Occupation: Registered nurse Place of Work: CareOne at Livingston Assisted Living in Livingston, New Jersey Date of Death: March 24, 2020
Marybeth Papetti cared for beautiful things. She planted a garden filled with “a thousand different colors” of flowers, according to her son, Scott Papetti. Her nails, hair and makeup were always done, whether hanging out with girlfriends or dining out with her husband. “She always looked tremendous,” said Scott.
“You wouldn’t have thought she had any health issues,” said Scott, referring to her pulmonary fibrosis, a condition where lung tissue is scarred and blocks oxygen from passing through freely.
Scott does not know where his mother contracted the novel coronavirus, or whether she had adequate PPE at work. Marybeth worked as the director of nurses at an assisted living facility in New Jersey, which, as of June 11, had reported 39 cases of COVID-19 among residents and staff and 15 deaths. But she also attended parties and continued regular appointments with a pulmonologist.
Papetti went to the hospital on March 12 with a fever and shortness of breath. She stayed there for two weeks before she died.
Almost everyone who sent messages after Marybeth passed talked about how well put together she was, according to Scott. “She would have been a wreck with not getting her hair done,” he joked.
Pitching In After Retirement, Traveling Nurse Was An Adventurer
(Courtesy of Tiffany Olega)
Rosary Celaya Castro-Olega
Age: 63 Occupation: Traveling registered nurse Place of Work: Various hospitals in Los Angeles County Date of Death: March 29, 2020
Rosary Celaya Castro-Olega wasn’t what you’d call shy. At her daughter’s basketball games, she was the loudest voice in the bleachers. She dressed head-to-toe in purple: purse, glasses, phone, scrubs. She was Kobe Bryant’s No. 1 fan. And she loved sharing stories with patients.
Her oldest daughter, Tiffany Olega, recalled meeting her mother’s patients.
“They’d say, ‘Your mom has told me all about you!’” she recounted. “She didn’t just do her rounds and disappear.”
Even after retiring in 2017 from Cedars-Sinai Medical Center, she couldn’t stay away. She filled in at hospitals that were shorthanded. In between, she traveled the globe. In 2019, she visited Germany, Japan and China.
She had a cruise planned in March. When it was canceled because of the coronavirus, she took shifts at various hospitals in Los Angeles County, hoping to help out. Olega doesn’t know if her mom cared for COVID patients. But Castro-Olega and her twin daughters — Olega’s younger sisters — developed symptoms in mid-March. All three wound up hospitalized. Castro-Olega never came home.
Los Angeles Mayor Eric Garcetti honored her as the first health care worker to die of COVID-19 in L.A. County.
Jess Fajardo (Left) and her friend Maria Hernandez (Courtesy of Maria Hernandez)
Jessica ‘Jess’ Fajardo
Age: 30 Occupation: Phlebotomist Place of Work: Center for Hypertension and Internal Medicine in Odessa, Texas Date of Death: April 12, 2020
Jessica “Jess” Fajardo had the same best friend for 28 of her 30 years: Maria Hernandez. They hung out in school and after school. They got jobs at a restaurant and, later, a video arcade. They rented an apartment.
Even when Hernandez married, moved away and had children, they talked or texted daily. “She would take care of anybody she could,” Hernandez said.
In phlebotomy, Fajardo found a career she loved. Patients loved her, too — even though her job was sticking them with needles. More than one commented on her sense of humor, her skill, her bubbly cheer.
In late March, Fajardo started coughing, but with no identified coronavirus cases in the county, she was diagnosed with asthmatic bronchitis. It got worse. When a colleague was hospitalized with COVID-19, Fajardo went for a test. Days later, she sought emergency care.
Dr. Madhu Pamganamamula, who runs the clinic where Fajardo worked, said precautions had been in place since mid-March. Ultimately, six employees tested positive for the virus; four others tested positive for the antibodies.
Hospitalized and intubated, Fajardo’s condition appeared to be improving. But she died after doctors removed her ventilator. Said Hernandez, “she was an amazing friend.”
A ‘Protective’ Presence, He Drove Seniors To Medical Appointments
(Courtesy of Rebecca Garrett)
Age: 45 Occupation: Van driver for patients Place of Work: Columbine Health Systems in Fort Collins, Colorado Date of Death: March 31, 2020
Brian Garrett had classic COVID-19 symptoms: cough, fatigue, fever, nausea, vomiting, breathing difficulty and loss of taste. But he fell ill early in the pandemic’s U.S. spread, his wife, Rebecca, said, and the health clinic he visited said it was probably the flu.
By March 23, the otherwise vigorous, nearly 6-foot-5 father of four (ages three to 20) told Rebecca, “Something’s just not right inside.” He was admitted to the hospital that day. County health officials registered his as a COVID-19 death.
Garrett, who transported senior residents to medical appointments, became ill before the use of protective gear became widespread. “We had that conversation that all these people would be so vulnerable,” Rebecca said. “He became ill so early on that no one was [wearing] masks.”
A spokesperson for his employer did not respond to requests for comment about whether Garrett was exposed to COVID-19 at work.
On Facebook, Garrett’s nephew, Brandon Guthrie, posted that Brian was a protective figure. “He was our tall older brother,” Guthrie wrote. Despite his imposing stature, it was his kindness that stood out. In an interview, Guthrie said, “He genuinely cared about everybody.”
From A Traumatic Childhood To A Life ‘Bigger Than Himself’
(Courtesy of the Simpson family)
Age: 28 Occupation: Mental health technician Place of Work: Sunstone Youth Treatment Center in Burien, Washington Date of Death: April 10, 2020
James Simpson’s difficult childhood in the foster care system led him to a career at a youth mental health center — where he worked with kids who reminded him of himself. “He had been through so much trauma and abandonment as a child,” said Chezere Braley, his cousin. “And he did not become a product of his environment.”
James’ sister Kamaria Simpson described him as the life of the party. “He was always smiling, even if he was having a bad day,” she said.
James’s family believes he contracted COVID-19 during an outbreak at work, where eight of the center’s 15 residents were infected. Sunstone waited over a week before telling James he may have been exposed to the virus, Kamaria said. She said the center also delayed in providing employees with adequate protective gear and that when her brother became sick, he was told to come in anyway. On April 6, he was sent home with a fever; he died in his apartment four days later.
In a written statement, Sunstone’s parent company, Multicare, said the organization “took early and aggressive steps to prevent the spread of the virus” at work, including “early access to PPE, sanitizer, training for staff and testing.” It added that the company’s policy was always to direct staff to stay home when sick.
Braley and Kamaria said they’re grieving, but they’re also angry. “He risked his life,” said Braley. “He deserved so much better.”
— Holly DeMuth, City University of New York | Published June 12, 2020
Age: 29 Occupation: Clinical interpreter Place of Work: University of North Carolina Hospitals in Chapel Hill, North Carolina Date of Death: May 26, 2020
Dulce Garcia loved to dance. On weekends, she would escape with friends to the Luna Nightclub in Durham, where they would romp to bachata, merengue and reggaetón. “It was our ritual,” said Brittany Mathis, one of her close friends.
At dawn, those unable to safely drive would sleep over at Garcia’s. “She was the group mom,” Mathis said. “She’d tell us, ‘We don’t want to lose anyone.’”
Garcia was “the rock and foundation” for her family, Mathis said. As a teen, Garcia cared for siblings while her parents worked. She also volunteered at the neighborhood Boys & Girls Club.
When Garcia learned about the health care gaps faced by Spanish speakers, she joined the hospital. There, she was “surprised at how much she could help,” Mathis said, “and how many needed her.”
The week after she picked up a Sunday shift, she developed a fever. Mathis was not sure whether she received personal protective equipment (PPE). “Our PPE policies have always followed CDC guidance,” the hospital said through a spokesperson.
The symptoms “wouldn’t go away,” Mathis said. “It just doesn’t feel real. There were so many things she had unfinished.”
A Friendly Nursing Assistant Who Worked Into Her 70s
Antonia ‘Tony’ Sisemore
Age: 72 Occupation: Certified nursing assistant Place of Work: Stollwood Convalescent Hospital at St. John’s Retirement Village in Woodland, California Date of Death: April 30, 2020
Antonia Sisemore always wore a smile — around her family, at church and at her job at a retirement home, where she worked through the coronavirus pandemic.
In a Facebook post, her colleagues called her “one of our most talented and dedicated CNAs.” She worked “tirelessly and unfailingly to deliver care, compassion, and love to those more vulnerable than herself,” it said. (Her family declined to be interviewed for this article.)
Comments remarking on her kindness and work ethic poured in from patients and their families. “She went the extra mile to [make] sure I had what I needed and was comfortable,” wrote a former patient. “Tony was one of my mother’s caregivers,” wrote another Facebook user. “She was selfless … it breaks my heart that the residents will no longer have her.” Some mentioned that Sisemore cheered people up with her sense of humor. “I remembered you [danced] in front of me,” another former patient wrote.
Sisemore’s obituary says she battled COVID-19 for four weeks after passing away from complications from the virus. The nursing home where Sisemore worked reported 66 confirmed cases and 17 deaths according to county data. Over half of the infections were among staff members. The facility did not respond to requests for comment.
Age: 56 Occupations: Certified nursing assistant and endoscopy technician Places of Work: NewYork-Presbyterian Hospital and Isabella Center for Nursing and Rehabilitation in New York City Date of Death: April 24, 2020
Adlin Thompson had 20 siblings and more than 30 nieces and nephews. Like her, many of them immigrated to New York City from St. Kitts and Nevis in the early 1980s. With such a large family, it was difficult to keep track of everyone, said Adlin’s son, Mario Thompson. But Adlin did — she was the glue who kept the family together.
Adlin worked long hours between her two jobs. When she wasn’t at the nursing home or the hospital, she visited family, and “never came home empty-handed,” often toting gifts of socks or perfume, Mario said.
Adlin cared for patients who had been diagnosed with COVID-19 at both her jobs. She was always covered in protective gear, said Mario. Still, he worried that her asthma made her particularly vulnerable to the coronavirus. Mario believes she contracted the virus at the nursing home, where he said she had more direct contact with patients.
A spokesperson for the facility said it “followed state guidelines as it relates to infection prevention and control procedures.”
Adlin died four days after testing positive for COVID-19. She was alone in her home, preparing to go to the hospital.
Housing Supervisor Committed Herself To Helping The Vulnerable
(Courtesy of Barbara Abernathy)
Age: 52 Occupation: Residential services supervisor Place of Work: Elisabeth Ludeman Developmental Center in Park Forest, Illinois Date of Death: April 13, 2020
Barbara Abernathy said she is trying to figure out what to do with six bins of toys her daughter bought for neighborhood children.
Growing up in Chatham, a middle-class neighborhood on the South Side of Chicago, Michelle Abernathy “was always trying to help somebody,” Barbara said.
Michelle spent decades investigating child abuse and neglect while holding night jobs mentoring children.
A supervisor at a state-run facility for developmentally disabled adults, she bought clothes, games and snacks for residents. A staff memo lauded her “big heart and nurturing personality.”
She fell ill March 28 and was hospitalized April 6, too weak to walk.
Three other workers at the facility died of COVID-19. A spokesperson for the American Federation of State, County and Municipal Employees, which represents workers at Ludeman, said that early in the pandemic the staff had a “huge struggle” to get personal protective equipment (PPE).
The Illinois Department of Human Services said it “can’t say precisely” how workers caught the virus and was working to provide sufficient PPE.
After long professing that she was too busy for marriage, Abernathy recently had become engaged to Torrence Jones, a colleague. She had planned to surprise her mother with the news but never had the chance.
A Loving Bookkeeper Who ‘Had The Most Awesome Laugh’
(Courtesy of Sean Diaz)
Cassondra Grant Diaz
Age: 31 Occupation: Nursing home bookkeeper Place of Work: Chelsea Place Care Center in Hartford, Connecticut Date of Death: April 29, 2020
Cassondra Diaz was a receptionist-turned-bookkeeper at a nursing home in her hometown.
“She was my therapist, my fashion consultant, my hair designer,” said her older sister, Takara Chenice. “I called her my ‘big little sister.’”
Loved ones described her as “an old soul,” loyal to her family, including her husband, Sean Diaz. In their free time, the couple would hit the highway for a long drive, venturing to parks, lakes and the beach.
Her family believes she contracted the coronavirus at work. A spokesperson for Chelsea Place confirmed that the nursing home had COVID cases among staff and patients. It said staffers were provided with personal protective equipment. Despite wearing protective gear, removing her work clothes at the door and showering after work, Cassondra developed symptoms in mid-April.
On April 29, she woke up having difficulty breathing and pain in her leg, said Sean, who called an ambulance. She died that day.
Sean keeps a photo of her in their car. “My six years with her were better than any lifetime I had before her,” he said.
— Madeleine Kornfeld, City University of New York | Published June 5, 2020
A Doting Family Man, He Was A Long-Standing Fixture At His Hospital
(Courtesy of Susan Ferranti and family)
Age: 60 Occupation: Hospital equipment coordinator Place of Work: St. Elizabeth‘s Medical Center in Brighton, Massachusetts Date of Death: May 2, 2020
David Ferranti was committed to his two families — both at home and at work. In his job on the engineering unit, he was really part of every team in the hospital, wrote St. Elizabeth’s president, Harry Bane, in a note to employees. “He was always worried about ‘his nurses’ and ‘his departments’ having what they needed to best care for our patients.”
Ferranti worked at the hospital for almost 42 years “and he loved every day of it,” said his father, Savino Ferranti. St. Elizabeth’s was treating many COVID-19 patients when David became infected with the virus, his father said, but it was impossible to say where he caught it. St. Elizabeth’s had no further comment about his case.
Ferranti was a family man “and the greatest son you can imagine,” his father said. He had a wife, Susan, and a son, John.
Ferranti worked in his garden and enjoyed walks in nature. A history buff, he was born in Wiesbaden, Germany. His father, a descendant of Italian immigrants, served in the military there, where he met David’s mother, Renate.
For his family, tragedy hit twice within weeks. David’s aunt Ann Ferranti died of the disease a few weeks before David. The advice David would have given to anyone, said his father, “is to stay safe, whatever it takes.”
A Nurse For Whom Family Was Everything — And Patients Were Like Family
(Courtesy of the Mazzarella family)
Age: 43 Occupation: Clinical nurse manager Place of Work: Montefiore Mount Vernon Hospital in Mount Vernon, New York Date of Death: May 8, 2020
Even as a girl, Kelly Mazzarella had her sights set on helping others. She turned this innate altruism into a 16-year career at a community-based teaching hospital.
Karen Jedlicka was blown away by the care her big sister showed every patient. “People would be going through the worst things in their lives and she was just there for them,” Jedlicka said.
Mazzarella showed that same compassion with her husband, Ronnie Mazzarella, and daughters, Hailey and Kristina. She never missed an opportunity to tell her daughters how proud they made her, Jedlicka said.
In July 2019, Mazzarella was diagnosed with lupus, an autoimmune disease that brought on painful bouts of swelling. She worked on and off through March, helping with the influx of COVID patients. She was diagnosed on April 2 and died five weeks later. Her employer did not respond to requests for comment.
Nicol Maursky, a lifelong friend, organized a GoFundMe for the family. A staggering outpouring has brought in close to $75,000.
“She just had such a love and a light that emanated from her,” Jedlicka said. It’s “very comforting to know everybody felt the same way that we did.”
— Suzannah Cavanaugh, City University of New York | Published June 5, 2020
Age: 43 Occupation: Case manager Place of Work: Salvation Army in New Orleans, Louisiana Date of Death: April 6, 2020
A “natural New Orleanian,” Jana Prince was bubbly and loving, her brother Paul Prince said.
Since high school, Jana knew she wanted to be a social worker. She grew up with cerebral palsy, wearing a leg brace and diligently practicing physical therapy so she could walk. Kids bullied her about her disability, but nothing would stop Jana from connecting with her community.
“She was trying to share her strength with other people, because she just didn’t want to see people suffer,” cousin Talisa Pace said. “She really wanted to help the Black community.”
One day in mid-March, Jana had trouble breathing, Paul said. She was hospitalized for more than a week before she was intubated, and died the next day. The family said they did not know whether she was infected at work, especially given how early she became infected; the Salvation Army declined to comment.
Her mother, Barbara Prince, died of the virus three days later.
The duo lived together and got on like Laverne and Shirley. They often took care of Paul’s twin 6-year-old boys. “I don’t know how one would have survived without the other,” Paul said.
Jana and Pace had dreamed of opening a coffee shop and counseling center. “She would have been the highlight of the whole place,” Pace said.
— Theresa Gaffney, City University of New York | Published June 5, 2020
Age: 58 Occupation: Licensed practical nurse Place of Work: Pickaway Correctional Institution in Orient, Ohio Date of Death: April 27, 2020
When Tina Reeves visited her grandchildren, music would blast from the car. Wale’s “On Chill” rang out: “Trying to hear all your problems, so I can lighten the load.”
“She loved her music,” said daughter Tiana Mohabir, “even though she had no rhythm for squat.”
Reeves had an ear for the rhythm in other people’s lives, though. Younger co-workers called her “Mother Advice,” Mohabir said. In interactions with prisoners and officers alike “she always listened,” Mohabir said, “and never judged.”
She called her three daughters daily, “checking in on all of us.”
When Reeves started coughing in early April, Pickaway Correctional had already reported more than 1,500 cases of COVID-19.
“PPE [personal protective equipment] was, and continues to be, available to staff,” a prison spokesperson said. The family said their mother did not have access to adequate PPE.
By April 13, Reeves was hospitalized with COVID-19. She called her daughter to ask her to take care of paying her utility, insurance and cable bills. “I didn’t think twice,” Mohabir said, “because I didn’t want them shut off when she got home.”
Within 24 hours, Reeves was intubated. On the bedside table, her phone kept ringing.
An ‘Icon,’ Hospital Secretary ‘Brightened Every Situation’
(Courtesy of Glenna Swann)
Age: 70 Occupation: Intensive care unit secretary Place of Work: Kent Hospital in Warwick, Rhode Island Date of Death: April 29, 2020
When things were slow at the hospital, Joan Swann would head down to the gift shop.
If someone was having a hard day — the security guard, the patient transporter, the barista — she might buy them a candle. Or charm bracelet. Or a Vera Bradley handbag.
“She brightened every situation,” said Glenna Swann, her daughter. A former nurse, Joan coached trainees from behind the administrative desk. They called her an “icon” who was the reason many stayed working in the intensive care unit.
When Joan was admitted to the hospital, those she had long cared for returned the favor. Her isolation room was adorned with blue hearts, and following her intubation, the nurses would FaceTime the family in. During quiet hours, they sat at her bedside.
The hospital did not respond to requests for comment.
After Joan died, the family found “thousands upon thousands” of unused greeting cards, sorted by occasion (weddings or Christmas) and emotion (sympathy or humor).
In the coming weeks, Joan’s cherished grandson, Adam, will complete high school. Glenna is still choosing from among Joan’s graduation cards for him.
In A Family Who Lost Both Mother And Son, Food Was Love
(Courtesy of Lloyd Torres)
Age: 47 Occupation: Food service director Place of Work: Queens Boulevard Extended Care Facility in Woodside, New York Date of Death: April 8, 2020
Louis Torres went into the family business. He grew up adoring his mother’s Philippine home cooking, so it was natural to channel his passion for food into comforting others. As a food service director at a nursing home in his native Queens, he could cook and work in health care as his mother did.
Feeling terrible on March 30, Louis called his older brother, Lloyd, after work. “He was struggling to make it from the subway station,” Lloyd said.
Louis lived with his mother, Lolita, 73, a retired hospital clerk. She also had severe COVID-19 symptoms.
By the next day, mother and son had been taken by ambulance to separate hospitals. In the chaos, Lloyd said, it took an entire day of panicked calls to find their mother, who was still in the emergency room.
A few days later, Lloyd was able to pray the rosary with Lolita over the phone, and it seemed to calm her. Before they hung up, she asked that Lloyd take care of his brother. Louis made the same request about his mother before going on a ventilator.
“Their last words to me [were to] take care of each other, my God,” Lloyd said, his voice cracking.
On April 7, Lolita died. Louis died the next day.
In the weeks since then, Lloyd was comforted by a powerful dream.
“I woke up and smelled the frying of food,” he said, invoking his mother’s cooking. “That’s how she showed her love.”
Theater Brought Them Together, Then Life Imitated Art
(Courtesy of Harriet Clark Webber)
Age: 67 Occupation: General surgeon Place of Work: Mount Sinai Queens in New York City Date of Death: April 18, 2020
Barry Webber wanted to understand how things worked. That curiosity and drive motivated him to reconstruct an old Jeep, build a computer, take up rock climbing and, of course, become a surgeon.
He pursued medicine when he realized he wasn’t going to become a concert pianist, said his wife, Harriet Clark Webber.
They met when Harriet was a dancer with the American Ballet Theatre and Barry moonlit as a supernumerary — a non-dancing extra on stage — for the company. “He just wanted to be around the theater,” she said.
Barry honed his surgery skills in a Brooklyn emergency room in the 1980s. “It was a rough time to be in an ER in Brooklyn,” Harriet said. “He was treating a lot of gunshot wounds and trauma.”
They married in 1996 and had two sons, now 22 and 20.
Like so many Americans, when COVID-19 struck, the couple watched “Contagion,” a 2011 film about a pandemic. Barry said it gave him a bad feeling.
On March 27, his fears were realized. He texted his wife: “I’m sick.”
Harriet believes he contracted the virus at work before the hospital ordered the universal use of protective gear.
Brooklyn Radiologist Was ‘Kind, Simple, Loving And Devoted’
David Wolin and his daughter, Helena Cawley (Courtesy of Helena Cawley)
Age: 74 Occupation: Radiologist Place of Work: The Brooklyn Hospital Center in New York City Date of Death: March 30, 2020
By 10 a.m. on Sundays, David Wolin and his wife, Susan, would have completed one-quarter of the New York Times crossword.
When the grandchildren arrived, Wolin greeted them with bagels, lox, whitefish “and the best scrambled eggs in the entire world,” said Helena Cawley, his daughter.
Wolin was “kind, simple, loving and devoted.” A radiologist specializing in mammography, he was “committed to learning everything he could,” Cawley said. “The latest medical journal was always on his nightstand.”
He and Susan would skip off to their home upstate on Wolf Lake, where they might take out a rowboat, a bottle of chardonnay and a brick of Roquefort cheese under the stars. “All they needed was each other,” Cawley said.
In late March, Wolin complained of “bad colds” but deferred testing. Brooklyn Hospital was overwhelmed with COVID-19. A hospital spokesperson could not be reached for comment.
On March 30, when Cawley couldn’t reach her father, she called the doorman of his building. He reluctantly shared the news: Wolin had died overnight.
Susan was hospitalized that day and died weeks later. “We’re grateful in a way,” Cawley said, “because we don’t know how they could have lived without each other.”
‘Working There Was The Proudest Accomplishment Of His Life’
(Courtesy of Maria Joy Agtarap)
Age: 63 Occupation: Emergency room nurse Place of Work: NewYork-Presbyterian/Columbia University Irving Medical Center in New York City Date of Death: April 24, 2020
Joy and Romeo Agtarap met in Queens in the 1980s, when they were both young nurses, newly arrived from the Philippines. Joy Agtarap said her husband was a jokester who had a vibrant personality that often made him the life of the party. At gatherings, he liked to get people onto the dance floor.
“He’s a very good dancer ― sometimes he made the line dances too hard and people would get lost!” she remembered.
He was also a dedicated emergency room nurse. Agtarap had spent 20 years at what his wife said was his “dream job” at the NewYork-Presbyterian/Columbia University Irving Medical Center.
“Working there was the proudest accomplishment of his life,” she said. He was still seeing patients when the pandemic hit. (The hospital did not respond to requests to comment on whether he had adequate personal protective equipment).
Romeo was diagnosed with COVID-19 in late March. Joy, who had left nursing due to an injury, became sick a week later. They were both hospitalized ― he at NewYork-Presbyterian and she at a facility on Long Island. As Joy recovered, she anxiously awaited updates on her husband’s condition.
“It was the most devastating thing that’s ever happened to me. I was going crazy in there waiting for calls about him,” she said. He died on April 24. “I believe he took the worst of the virus for me, that’s why I’m still here,” she said.
As Nurse And Minister, She Tended To Her Patients, Flock ― And Garden
(Courtesy of Elijah Ailende)
Age: 67 Occupation: Registered nurse Place of Work: Bria of Forest Edge in Chicago Date of Death: April 20, 2020
Felicia Ailende was a beacon of unity to her family and members of Maranatha Chapel in Evergreen Park, Illinois, where she was a minister. She counseled many, helping keep marriages intact and lives on track, her son Elijah Ailende said. Though her six children were very different from one another, she saw the best in each.
An immigrant from Nigeria, she planted a garden each year and used the produce to cook West African dishes. When there were too many cucumbers, hot peppers or greens, she shared with neighbors.
At Bria of Forest Edge, a nursing home, Felicia cooked for residents at times or prayed for them, Elijah said.
Administrator Julie Kosman said in a statement that Ailende was a hardworking nurse who was pleasant and funny and had a great rapport with residents.
She is one of three workers at the facility who have died of COVID-19; two residents also died. The facility reported 132 infections.
Elijah said staffers had to reuse surgical masks provided by the facility. Administrators did not tell them when residents and other staff members got the virus “so they could take precautions and safeguard their lives,” he said.
Kosman’s statement says “full PPE” — personal protective equipment — was available to staffers and there is no reason to believe Ailende was exposed to COVID-19 “within our facility.” She “had no known contact with any resident or staff member who showed symptoms or had tested positive for COVID-19.”
He Practiced What He Preached, Caring For Inmates With Mental Illness
(Courtesy of Gwendolyn Davis)
Bishop Bruce Edward Davis
Age: 57 Occupation: Shift leader for forensic service technicians Place of Work: Central State Hospital in Milledgeville, Georgia Date of Death: April 11, 2020
In sermons at his Pentecostal church, Bishop Bruce Davis preached love. On weekdays, he practiced it by feeding, bathing and caring for patients at a maximum-security psychiatric hospital. Davis worked for 27 years at the state facility, said his wife, Gwendolyn Davis.
As a boy, Davis would break his pencils in half to share with his twin sister. At church, he hosted youth parades and gave away computers, bicycles and groceries. He distilled the Bible into simple lessons, she said, once winning over a parishioner with a sermon based on “The Wizard of Oz.”
When COVID-19 emerged, Davis and his co-workers at the psychiatric facility were told they couldn’t wear masks or gloves because it wasn’t part of their uniform, she said. Five days after a close co-worker tested positive for COVID-19, Davis was hospitalized, she said.
More than 70 workers at the hospital have tested positive for COVID-19, according to state data; Davis is one of two who have died. A hospital spokesperson declined to comment on Davis’ case.
After Davis’ illness, his entire household – Gwendolyn, three children and a grandchild – got sick with COVID-19, Gwendolyn said. Their adult son, who has autism, was hospitalized, Gwendolyn said. Their daughter, 22, recovered and returned to work at the same hospital.
“It is extremely hard for her to go back to work there,” Gwendolyn said.
A Pediatric Neurosurgeon Who Separated Conjoined Twins
(Courtesy of Judy Goodrich)
Age: 73 Occupation: Pediatric neurosurgeon Place of Work: Montefiore Medical Center in the Bronx, New York City Date of Death: March 30, 2020
James Goodrich was a renowned pediatric neurosurgeon, best known for separating conjoined twins ― a rare and risky procedure. Over the course of his career, he was directly involved in about 10 cases, advising on dozens more.
A late bloomer academically, Goodrich began his undergraduate studies at age 24, after returning from Vietnam, where he served in the Marines.
“He had seen a neurosurgeon when he was in Vietnam, and he just was fascinated at what they were able to do,” said Judy Goodrich, his wife of 50 years. “I thought, just try to become a doctor first.”
He was also known for innovations regarding conditions affecting the skull. He helped develop standards for treating craniosynostosis, in which the bones of a child’s skull fuse too soon, preventing the brain from growing properly.
Goodrich was an avid collector ― of antique medical books, pre-Columbian medical artifacts, rare watches and fine wines, among other things. He surfed, cultivated bonsai trees and played the didgeridoo.
He had seen patients in the clinic in early March, just before flying to Mexico for a family vacation. He soon began to feel ill, and when he returned to New York, he was diagnosed with COVID-19. He was hospitalized on March 25 and died five days later.
She Brought ‘Calming Presence’ And Fun To Nursing Home
(Courtesy of Howard Fox Jr.)
Age: 59 Occupation: Recreational aide Place of Work: Bria of Forest Edge in Chicago Date of Death: April 10, 2020
Leola Grady had planned to be with her son and granddaughter in Mississippi for Mother’s Day but did not live to make the trip.
At the Bria of Forest Edge nursing home, she entertained residents, including with a “good game of cards,” administrator Julie Kosman said. “She had a calming presence about her.”
When Grady fell ill, a nurse at the facility was already sick with the coronavirus. A nursing aide whose name has not been released also died of COVID-19. Staff at the facility, with SEIU union leaders, spoke out saying they were unaware their co-workers were dying until they saw it on the news.
Howard Fox Jr., Grady’s son, said his mother was his best friend. An honest, straightforward and loving person, she enjoyed listening to the blues. “I’m not going to sit here and sugarcoat it,” he said. “It hurts. … I look at our picture. I cry.”
Fox said his mother went to a Chicago hospital with COVID symptoms but was sent home. She was found dead several days later. A Cook County spokesperson confirmed she died of pneumonia due to COVID-19.
Kosman said the facility does not believe Grady or the nurse, Felicia Ailende, “were exposed to COVID-19 within our facility. They had no known contact with any resident or staff member who showed symptoms or had tested positive for COVID-19.”
As of May 27, Bria of Forest Edge has reported 132 coronavirus cases and two deaths to Illinois officials. In the statement, Kosman said it reported worker deaths to the Occupational Safety and Health Administration, which shows three pending death investigations at the facility.
Age: 35 Occupation: Licensed practical nurse Place of Work: Meadowbrook Manor in Bolingbrook, Illinois Date of Death: May 2, 2020
Krist Guzman packed a lot into her short life. She worked full time while studying to become a registered nurse. She had three children, one a newborn.
Smart, funny and outgoing, she nurtured relationships.
“Hers was a life of no regrets,” said a cousin, Jeschelyn Pilar.
In a Navy family that moved often, she was close with her brother, Anjo Castro.
“She was my role model,” said Castro, who also pursued a medical career as an independent duty corpsman in the Navy.
The pandemic hit home when their uncle, pediatric surgeon Dr. Leandro Resurreccion III, died March 31.
Guzman told family she had seen COVID patients. Worried she didn’t have adequate protective gear, she scrambled to find some online.
Meadowbrook has registered the worst COVID outbreak in Illinois, with more than three dozen deaths. Nursing home spokesperson Marissa Kaplan said in a statement: “Meadowbrook puts the safety and welfare of its residents and staff at the forefront of everything we do.” She did not address whether there was sufficient protective gear.
Selfless Nephrologist Fought For Her Life While Treating Others
(Courtesy of the Khanna family)
Age: 43 Occupation: Nephrologist Place of Work: Khanna Nephrology in Glen Ridge, New Jersey Date of Death: April 13, 2020
Priya Khanna came from a family of doctors, and she knew the risks of contracting the deadly coronavirus. She was immunocompromised and actively seeing patients days before she became ill with COVID-19.
On April 1, Priya was hospitalized in the same facility where her father, Satyender Dev Khanna, had been brought days earlier. He was also being treated for COVID-19.
From her hospital bed, Priya checked in on friends, reviewed patient files and communicated with the physician who was seeing patients in her stead. She continued to do so until she was put on the ventilator.
“She literally worked for others until she could no longer breathe for herself. That was Priya,” said childhood friend Justin Vandergaag. “Always putting others first with a smile.”
“She was a devoted daughter, sister and aunt,” said childhood friend Laura Stanfill. “Her healing gifts extended not only to her patients but, in the many ways, she made everyone in her life feel important and loved.”
Age: 62 Occupation: Pulmonologist Place of Work: SUNY Downstate Medical Center in Brooklyn, New York City Date of Death: April 27, 2020
James “Charlie” Mahoney eschewed hospital hierarchies.
“He didn’t treat people like underlings,” said his sister, Saundra Chisholm. “He would talk to housekeeping like he would talk to the chief of the hospital. That’s why he was so well respected.”
Growing up on Long Island, Mahoney was an ace student and athlete. He was one of only a handful of Black students at his medical school and throughout his training. He and his brother, Melvin Mahoney, worked side by side at SUNY Downstate for many years, a public hospital that treats a mostly minority and low-income patient population.
When the pandemic hit New York in March, Mahoney, who specialized in respiratory care, “ran into the fire,” Melvin said. But his hospital, like other underfunded public institutions in the city, was short of protective equipment and staff.
Mahoney started experiencing symptoms in early April, and was hospitalized soon after. He died on April 27.
“He’s one of our legends ― he’s one of our giants,” said Julien Cavanaugh, a neurology fellow at SUNY Downstate who trained under Mahoney.
Psychiatric Nurse Knew Her Patients’ Hometowns And Hobbies
(Courtesy of Eddie Ballard)
Age: 44 Occupation: Licensed practical nurse Place of Work: Legacy Nursing and Rehabilitation of Port Allen, Louisiana Date of Death: May 1, 2020
Eddie Ballard was baking “Pecan Delight” pie at the Piccadilly Cafeteria in Baton Rouge, Louisiana, when Shenetta White, accompanying her auntie and grandmother, leaned over the buffet counter to grab a Jell-O.
“She gave me this look,” Ballard said, and he gathered the confidence to ask for her number. On their first date he quickly realized “not only was she beautiful, but she was mature beyond her years.”
That maturity manifested across her life.
As a nurse to psychiatric patients, she was adored by those she “saw as people more than just patients,” Ballard said. She knew their parents’ names, their hometowns and hobbies. At home, White-Ballard was “queen of the house,” Ballard said. She handled the errands and the finances, while “her two boys [Ballard and his son, Warren] hung on whatever she asked.”
With a preexisting condition, White-Ballard depended on supplemental oxygen. She died May 1, just three days after developing COVID-19 symptoms.
In an email, a Legacy spokesperson wrote that the facility had followed all guidelines and “had more than enough PPE.”
The first piece of jewelry Ballard bought his wife was a bracelet that read: “Love is patient, love is kind, love never ends.”
“I hadn’t read that in 11 years,” he said, “but boy, it’s still true.”
A Robotic Surgery Expert Who ‘Just Made Everything Fun’
(Courtesy of the Lopez family)
Age: 63 Occupation: Registered nurse Place of Work: University of Illinois Hospital in Chicago Date of Death: May 4, 2020
“What lady? I don’t see a lady here.”
That was the sort of self-deprecating comment Maria Lopez would fire back when teased by a co-worker about an etiquette faux pas in the operating room.
Lopez knew how to break the tension, said chief nurse anesthetist Mary Ann Zervakis Brent, a colleague since 2005. Lopez called everyone “amigo” or “amiga,” regardless of rank.
“She just made everything fun,” Zervakis Brent said.
Lopez was an expert in robotic surgery and trained others to use the equipment.
She taught her two daughters to be independent. The oldest of nine kids, Lopez fought her father’s expectation that she forgo college, said her daughter Maria, who was named for her.
Lopez’s symptoms appeared days after she returned to work from leave for knee surgery. She planned to retire April 30.
In the hospital, Lopez tried to stay positive. Yet during one FaceTime call, daughter Maria said, “she just broke down. She said, ‘I wouldn’t want anyone I love going through what I’m going through right now.’”
A hospital official confirmed in a statement that Lopez died of complications of COVID-19.
With Retirement In Sight, She Died Awaiting COVID Test Results
(Courtesy of Hannilette Huelgas)
Age: 66 Occupation: Licensed practical nurse Place of Work: Amsterdam Nursing Home in New York City Date of Death: March 30, 2020
Faith was central to Hazel Mijares’ life. She was a lay leader at Trinity United Methodist Church in Jersey City, New Jersey.
She was drawn to church as a child in the Philippines, sister Hannilette Huelgas said. Theirs was a big family with nine children. At get-togethers, Mijares always led the prayers.
After a long career, Mijares was finally ready to retire in late March.
She worked through March 13, burned up accrued paid time off, then stopped back a week later for her last day. As she said her goodbyes, she noticed a little cough.
Learning that one of her patients had died of COVID-19, Mijares tried several times to get tested. Her results were expected March 30. When Huelgas called that day, Mijares didn’t answer. She had died waiting for the results, which the family learned were positive.
As of May 24, the nursing home had recorded 45 presumed-COVID deaths. Officials there did not respond to requests for comment, but a phone recording updated May 21 said they had “completed COVID-19 testing of residents” and had “begun testing of all staff.”
“Our dedicated and caring staff are continuing the Amsterdam tradition of providing exceptional care,” the recording noted.
Mijares “had wanted to go to Jerusalem, to the Philippines,” Huelgas said. “And she didn’t even get to enjoy retirement.”
Age: 39 Occupation: Security guard Place of Work: Kingsbrook Jewish Medical Center in Brooklyn, New York Date of Death: April 5, 2020
When Griselda Bubb-Johnson couldn’t reach her friend Marva — hospitalized with COVID-19 — Bubb-Johnson called her son, Adiel Montgomery.
Montgomery, a security guard in the hospital’s emergency department, found Marva in the ICU. He then did “everything for her,” Bubb-Johnson said. When Marva was cold, he got a blanket. When she was hungry, he got food. When her phone died, he found a charger.
“Some people boast about their children, but I didn’t have to,” Bubb-Johnson said, “because everybody knew you could count on Adiel for anything.”
Montgomery doted on residents as a part-time supervisor at the Urban Resource Institute, a domestic violence shelter. He invited his godbrothers for Golden State Warriors games, Thanksgiving and sometimes for his mom’s renowned oxtail dish.
Two weeks after Montgomery noted he couldn’t taste his lunch, he experienced acute chest pain. When, after 12 hours in the ER, his heart stopped “nobody could believe it,” Bubb-Johnson said.
Montgomery was vocal about a lack of personal protective equipment for hospital security guards, according to a New York Times report. The hospital did not respond to requests for comment.
Montgomery’s 14-year-old daughter, Aaliyah, never got to say goodbye. She wrote a poem to put in the coffin.
“Don’t worry,” Bubb-Johnson told her. “He’ll read it. I promise.”
Age: 35 Occupation: Traveling registered nurse Place of Work: Lakeside Health & Wellness Suites in Reno, Nevada, via MAS Medical Staffing Date of Death: April 19, 2020
David Joel Perea would call in from Maine, Vermont, Minnesota and, ultimately, Nevada, with the same request: “Mom, can you send tamales?” Dominga Perea would ship them overnight. This is how she always knew where her son was.
A traveling nurse routinely pulling 80-hour weeks, David “had a tremendous work ethic,” said his brother, Daniel. A young David, returning from his father’s mechanic shop, said, “I don’t want to spend life sweating under a car,” Dominga recalled. “I want to be somebody.”
Dominga was proud of him, “for doing God’s work.”
When “mijito” didn’t respond to her text April 6, Dominga knew something was wrong: “I could always tell how David was. If he said ‘Hi, Mama,’ he was happy. If he said ‘I’m fine, Mom,’ he was tired.”
This time he said neither. “Don’t panic, Mama,” David wrote, “just pray for me. I have the COVID.”
His workplace did not respond to requests for comment.
David FaceTimed with his mother on Easter Sunday. “He was starving, but he struggled even eating mashed potatoes,” Dominga said, “because he couldn’t breathe.” The next morning, he was on a ventilator and never woke up.
Age: 44 Occupation: Physical therapist Place of Work: SportsMed Physical Therapy clinic in Glen Rock, New Jersey, placed by AHVIA Staffing Solutions in Jersey City Date of Death: April 15, 2020
When Ritchie Villena emigrated from the Philippines in 2011 after studying physical therapy, he struggled. Then he got in touch with Lean Carlo Romualdo, a fellow Filipino physical therapist in New York state. Villena moved in with him and secured a good job at a sports medicine clinic.
He became devoted to his church, Iglesia Ni Cristo, where he spent hours singing with the choir and practicing the organ. “He’s not an outgoing person,” Romualdo said. “But if you ask people in his religious group here in Rockland County, everyone will know him.”
Romualdo’s 7-year-old still plays the “Baby Shark” song Villena taught him on the piano, asking, “Is Uncle Ritchie coming back home?”
It’s unclear how Villena contracted the coronavirus. According to the staffing agency, he worked until March 13 and took ill the following week. On March 26, he called 911 with difficulty breathing; he was hospitalized until his death.
Villena, who only recently gained permanent residency status, hadn’t seen his family in nine years. “Every time his mom calls me, she wants to see Ritchie’s stuff,” Romualdo said. As he gives a video tour of Villena’s room, she can’t stop crying. He promised to pack everything and send it home.
Nurse With ‘Heartwarming’ Smile Did Her Best For Her Children
(Courtesy of Anderson Family)
Age: 44 Occupation: Licensed practical nurse Place of Work: Meramec Bluffs Life Plan Community in Ballwin, Missouri Date of Death: April 14, 2020
As a single mother, Jenniffer Anderson-Davis was determined to give her three children everything they needed, so she pursued her nursing degree while delivering pizza to make ends meet.
“She always did the best that she could to give them the best life,” her brother Earl Anderson said.
Most recently, Anderson-Davis worked as an admission and discharge nurse at a senior living community. Her mother, Edna Anderson, said that Anderson-Davis was concerned about residents who returned to the facility after visiting Florida (it has since banned reentry for residents who spent time away).
Anderson-Davis tested positive for COVID-19 on April 9 and died at home five days later. The Occupational Safety and Health Administration opened a fatality investigation at Meramec Bluffs on April 16.
Lutheran Senior Services, the nonprofit that operates Meramec Bluffs, acknowledged Anderson-Davis’ death but did not respond to specific questions about her case. In a statement, a spokesperson said: “Jenniffer’s coworkers remember her as a thorough and well-respected nurse who had a smile that could warm any heart.”
A Tireless Nurse, She Loved Her Children And Travel
(Courtesy Stefaney Cicala)
Age: 60 Occupation: Registered nurse Places of Work: Northern State Prison in Newark, New Jersey; Clara Maass Medical Center in Belleville, New Jersey Date of Death: April 4, 2020
Susan Cicala worked long hours. A typical workday began at the hospital surgery department at 5:30 a.m. She’d work there until 2 p.m., and an hour later would start her next eight-hour shift at a nearby state prison. She worked weekends, too.
As for sleep? “She must have slept somewhere, but I don’t know,” her son, Steven Cicala, said with a laugh. “She was the hardest worker I ever met.”
Reminiscing on Facebook, colleagues said she talked about her two children constantly. She started wrapping Christmas presents in May. She loved to travel, to Disney World and national parks, and saw vacations as opportunities to learn about the world beyond New Jersey — on a trip to Hawaii, she delved into the attack on Pearl Harbor.
Cicala became sick in late March and died in early April; her family said they presume she contracted the virus at one of her jobs.
“She didn’t go anywhere else,” Steven said.
As of May 21, the New Jersey Department of Corrections had tallied 152 COVID-19 cases at the prison where Cicala worked; 134 of those diagnoses were among staffers. In early May, the union representing Cicala and other workers filed a safety complaint saying precautions have been inadequate and may have led to Cicala’s death. A spokesperson for the prison health care agency that employed Cicala said that it had followed all state and federal guidelines, and that the staff was provided with personal protective equipment.
The Single Mother Dreamed Of Opening A Nursing Home
(Courtesy of Rebecca Gbodi)
Age: 54 Occupation: Registered nurse Place of Work: MedStar Washington Hospital Center in Washington, D.C. Date of Death: April 19, 2020
Helen Gbodi was known for helping elderly neighbors and fellow churchgoers — picking up their medications and groceries and accompanying them on walks. She even dispatched her daughter, Rebecca Gbodi, to shovel snow in neighbors’ driveways.
“Even when she didn’t have a lot, she would always give,” Rebecca said of her mother, who worked long hours to put her children through college and helped pay school fees for other relatives. This year, she embarked on her own dream: crafting plans to open her own nursing home, her daughter said.
Gbodi understood the severity of COVID-19 early on. In March, she called every person in her contacts list, including people she hadn’t talked to in years, to make sure they were aware and taking precautions, her daughter said. Though she did not actively care for patients who had been diagnosed with COVID-19, such patients were being treated on her floor, her daughter said.
Days later, she was fighting for her life. By the time she was hospitalized with COVID-19, she was too weak to lift her arm for a virtual handshake with her daughter on FaceTime.
“At the end of the day, she was willing to put her life in danger for others,” Rebecca said.
Always Upbeat, Patient Transporter Was A Sewing Wiz
(Courtesy of the Ismayl family)
Gabrail ‘Gabe’ Ismayl
Age: 62 Occupation: Patient transport worker Place of Work: Swedish Hospital in Chicago Date of Death: May 6, 2020
Caring, upbeat, always first to arrive at a party. Gabrail Ismayl loved an excuse to don a suit and splash on cologne.
That’s how Fidelline Youhanna remembers her uncle. “Everybody loved Gaby,” she said.
After migrating from Syria in the 1980s, Ismayl ran wholesale clothing shops on Chicago’s North Side. He was a wiz with the sewing machine and enjoyed altering dresses, making curtains and doing creative projects for family and friends.
Later, his people skills were an asset as he wheeled patients where they needed to go.
As the pandemic took hold, Ismayl worked despite health conditions that elevated his risk, Youhanna said.
“I think he just liked his job,” she said. “He made a lot of friends there.”
On May 6, Ismayl was self-isolating in the basement of the house he shared with two sisters. He was short of breath, Youhanna said. By evening, he was dead.
Ismayl was employed by management services company Sodexo. The CEO of its health care division in North America, Catherine Tabaka, said in a statement that his passing “is a tragic loss for Sodexo and we mourn an incredible friend and presence.”
Age: 56 Occupation: Licensed practical nurse Place of Work: Silverado memory care facility in Alexandria, Virginia Date of Death: April 25, 2020
Nina Forbes refused to let fear stop her from living.
She was terrified of flying. But a few years ago, Forbes got on a plane for the first time to watch her younger daughter Jennifer play volleyball.
COVID-19 also scared Forbes, and as a nurse at an assisted living facility, she knew the virus posed a serious risk. Still, she continued showing up to work.
Forbes tested COVID-positive just after Easter. Chills, body aches and a fever kept her from attending family dinner that Sunday. By the following weekend, she struggled to breathe and couldn’t walk on her own. An ambulance took her to the hospital.
Her older daughter, Jessica, said her mother didn’t have the necessary protection at work. Forbes sometimes wore trash bags to protect herself, she said.
In a statement, a representative for the facility said it met the Centers for Disease Control and Prevention guidelines for personal protective equipment. Employees sometimes used trash bags as an added layer of protection, worn over a disposable gown, according to the representative.
Forbes appeared to do what she wanted even in her final moments. Jennifer was able to visit her mother in the hospital, and Forbes died shortly after she left, Jessica said. “It was like she waited for her to leave.”
A Family Man Who Loved Disney, Took Risks To Help Others
(Courtesy of AMR Southwest Mississippi)
Age: 52 Occupation: Paramedic Place of Work: AMR Southwest Mississippi, covering Amite and Wilkinson counties Date of Death: April 22, 2020
On March 22, David Martin changed his Facebook profile picture. Around his smiling face, the frame read, “I can’t stay home … I’m a healthcare worker.”
Outside of work, he was a dedicated family man with two children, known for his love of Disney.
Martin, who covered 1,420 square miles across two rural counties, had cared for people with suspected COVID-19 in the weeks leading up to his death, said Tim Houghton, chief of operations for AMR Southwest Mississippi.
“We do what we do knowing the risks,” Houghton said. But Martin’s death was “a hard hit.”
On March 23, at the end of a shift, Martin told a supervisor he had mild flu symptoms. A month later, he died at a hospital in Baton Rouge, Louisiana.
AMR paramedics had N95 masks and protective gear and followed Centers for Disease Control and Prevention guidelines, Houghton said. “We have not yet had a shortage.”
In Facebook posts honoring Martin, colleagues described his excitement before trips to Disney World. In his memory, his fiancee, Jeanne Boudreaux, shared a photo of a hot air balloon ride at Disney Springs.
For a 9/11 First Responder, ‘Sitting on the Sidelines Was Never in His DNA’
(Courtesy of Erin Esposito)
Matthew ‘Matty’ Moore
Age: 52 Occupation: Radiologic technologist Place of Work: Northwell Health’s GoHealth Urgent Care in Eltingville, Staten Island, New York City Date of Death: April 17, 2020
Matthew Moore “would give the shirt off his back to help others,” said his sister, Erin Esposito.
A former firefighter and Staten Island native, “Matty” Moore volunteered as a first responder for weeks after 9/11, “even when everyone else stopped going,” Esposito said.
Moore was known as “a gentle giant” in Prince’s Bay, his brother-in-law Adam Esposito said. He was a devoted churchgoer and a beloved member of “The Beach Boys Firehouse” (as Engine 161/81 was nicknamed).
He even came through as Santa Claus, delivering gifts on Christmas morning to the children of two firefighters who died on 9/11.
Moore became an X-ray technologist, cherishing the ability to help those seeking urgent care. When COVID-19 emerged, he continued showing up to work. “Sitting on the sidelines was never in his DNA,” Erin Esposito said.
At the time, the family was reassured that he was receiving the personal protective equipment he needed. Despite his precautions, when Matty contracted COVID-19, it tore through his lungs, which had been damaged at ground zero.
As Matty lay dying, Esposito sought to reassure her brother. “You’ve done enough for us,” she told him, over the phone. Moments later, Matty’s heart stopped beating.
‘Gentle Soul’ Had A Brilliant Mind And A Big Heart
Neftali “Neff” Rios
Age: 37 Occupation: Registered nurse Place of Work: St. Francis Hospital’s intensive care unit in Memphis, Tennessee Date of Death: April 26, 2020
Hospital colleagues loved working with Neftali “Neff” Rios. He was humble, kind and capable, a “gentle soul” who always strived to learn something new. Not just smart — “I’m talking extremely intelligent,” his brother Josue Rios said. And he simply loved people. Nursing was a perfect fit.
Neff worked at a small hospital in Clarksdale, Mississippi, then earned his master’s in business administration with an emphasis on health care, and moved to St. Francis, hoping to enter management.
In mid-April, he came down with fever, body aches and a terrible cough and tested positive for the coronavirus. Several family members got sick, too. His parents were hospitalized.
On April 26, Neff collapsed at home, unable to catch his breath. His wife, Kristina, called 911, started CPR and waited for the EMTs. When they arrived, he had already died.
The family believes he was exposed at work. A spokesperson for the hospital declined to comment, citing family privacy.
“Neff was never scared” of catching the virus at work, Rios said. “You take an oath to take care of people, no matter what.”
His Warmth And Generosity Brought Diverse Clients To His Pharmacy
(Courtesy of the Titi family)
Age: 72 Occupation: Pharmacist Place of Work: Noble Pharmacy in Jersey City, New Jersey Date of Death: April 7, 2020
When the pandemic hit, Saif Titi was working six days a week at his Jersey City pharmacy and had no interest in slowing down. As was his way, he wanted to be helpful.
“He didn’t really run it as a business,” said Titi’s son, Justin. “He wasn’t trying to make profit. He was really just trying to help people.”
Titi was born in Jaffa in the last days of British rule in Palestine and grew up a refugee in the Gaza Strip. After studying in Egypt, Austria and Spain, he immigrated to New Jersey in 1972 and bought Noble Pharmacy a decade later.
The pharmacy became a fixture in the community, known as a place immigrants could go for help and advice, often in their native language. If they couldn’t afford medication, Titi would give it to them for free. “All different types of people from different cultures would come and they would instantly fall in love with him,” Justin said.
Active in the local Arab American community, Titi gave to charity and sent money home regularly. A Facebook tribute included dozens of stories of his generosity and mentorship. “We all lost the sweetest and the most noble man on earth,” wrote one relative.
Titi, a father of three adult children, developed symptoms of COVID-19 in late March. He died in the hospital on April 7. His wife, Rachelle, also became infected and has taken some six weeks to recover. In quarantine, the family has been unable to grieve together.
Age: 56 Occupation: Social worker and behavioral specialist Place of Work: Opportunity Behavioral Health in Reading, Pennsylvania Date of Death: April 15, 2020
Donna Welch had sworn she would “never, ever, ever get married again.” Then Gerald appeared.
They met on MySpace, and she quickly realized that “our spirits connected.” On their first date, at Donna’s house in Harrisburg, Pennsylvania, Gerald proposed — and Donna said yes. “It was like he came down on a bolt of lightning from heaven,” she said.
Gerald’s fiery passion and courage to speak out served him as a boardroom advocate for underperforming students in the school district, and at the St. Paul Missionary Baptist Church, where he resurrected a scholarship now named in his honor.
“He had a big voice,” Donna said, “and he was not afraid to use it.” His “Families, Organizations and Communities United in Service” podcast combined Gerald’s lived experience overcoming drugs and his spirituality to support others struggling with addiction.
So even as the state’s COVID cases mounted, Gerald was a dutiful companion for his clients with severe autism — he took them to the supermarket in Lancaster and the laundromat in Lebanon. “Wherever they needed to go, he went,” Donna said. “He cared so much for them, and they loved him dearly.”
Hardworking Immigrant Realized His Dream To Practice Medicine In US
Jesus Manuel Zambrano and his son, Jesus Manuel Jr.
(Courtesy of the Zambrano family)
Jesus Manuel Zambrano
Age: 54 Occupation: Pediatrician Place of Work: Private practice in Freeport, New York; attending physician at Mount Sinai South Nassau hospital Date of Death: March 30, 2020
Jesus Manuel Zambrano studied medicine in the Dominican Republic and immigrated to New York in the 1990s.
He hustled, working in fast food and as a school bus driver between studies, his wife, Sandra, said. He completed his residency in 2010.
In the meantime, they had two children: Jesus Manuel Jr., 22, and Angelyne Ofelia, 18. Jesus Manuel Jr., who uses a wheelchair, never veered far from his father during family outings to restaurants and parks, and Holy Week vacations.
Zambrano’s bond with his son informed his care for his patients. “There was not a single day we met and talked when we didn’t talk about his son,” said Dr. Magda Mendez, a former colleague.
Zambrano spent days in private practice, Sandra said, and in the evenings treated others at the hospital, which saw COVID cases.
In early March, he felt ill. He took the next day off — a rare occurrence, Sandra said. He was taken to the hospital where he worked, where he died after a week and a half of care.
In becoming a physician in the United States, Zambrano had realized his lifelong dream. He wished the same for his family.
“He had a lot of plans for his children, a lot of dreams,” Sandra said. “He took them with him.”
Quick-Witted And Quick To Serve, Firefighter ‘Always Had Your Back’
(Courtesy of the Zerman family)
Age: 49 Occupation: Volunteer firefighter Place of Work: Pioneer Hose Company No. 1 in Robesonia, Pennsylvania Date of Death: April 16, 2020
Anyone who met Robert Zerman would see two things: He was devoted to firefighting and emergency medical services, and he had a quick sense of humor.
“He probably went on tens of thousands of calls,” said Anthony Tucci, CEO of the Western Berks Ambulance Association. Tucci, who knew Zerman for over three decades, added, “he always had your back, always knew his stuff.”
Most recently, Zerman was a volunteer assistant fire chief. He responded to an emergency in March in which the patient had COVID-19 symptoms.
“That was before there was really any guidance to wear PPE,” Tucci said.
Soon Zerman got sick, leading the family to suspect that he’d contracted the coronavirus on that call, Tucci said. Zerman tested positive and was hospitalized. He seemed to be improving before taking a bad turn.
Age: 45 Occupation: Licensed practical nurse Place of Work: Wildwood Healthcare Center in Indianapolis Date of Death: April 13, 2020
Even on bad days, Linda Bonaventura’s lighthearted sense of humor made people feel better, her sister Alisa Bowens said.
Bonaventura dedicated her career to children with special needs and seniors. She did her best to keep her spirits up while working 16-hour days.
“We like to say she was laughter,” Bowens said. “She lit up the room.”
In a statement, Ethan Peak, executive director of Wildwood, called Bonaventura a dedicated nurse who “would do anything for her residents and co-workers.”
As the list of patients and employees with COVID-19 grew longer at Wildwood, Bonaventura refused to live in fear, Bowens said.
Bowens recalled the day her sister confessed she was spraying herself with Lysol to kill the germs on her clothes. She did the same for a co-worker. A Wildwood spokesperson said the nursing home had sufficient personal protective equipment for employees.
The sisters, in one of their last conversations, told each other they would be at peace if death came during the pandemic. A short time later, Bonaventura tested positive for COVID-19. Just a week after coming down with a sore throat and fever, she died.
“She believed in fate,” Bowens said. “We shared that belief. But it was still a shock.”
Nurse’s Death Ripples Through The Heart Of An Extended Community
(Courtesy of Courtney Christian)
Sheila Faye Christian
Age: 66 Occupation: Registered nurse Place of Work: Care Pavilion Nursing and Rehabilitation Center in Philadelphia Date of Death: April 19, 2020
So many people are mourning the death of Sheila Christian, her daughter set up a website to comfort them all.
Christian was a longtime friend of Tina Knowles-Lawson ― the mother of Beyoncé — who posted about the loss on Instagram.
But Christian was also a superstar at the center where she worked for 26 years and among those who knew her. She was the kind of person who brought lunch to a new co-worker and hosted a baby shower for someone without close family, according to her daughter and a memorial board.
At the outset of the COVID crisis, Christian was not given personal protective equipment, her daughter, Courtney Christian, 30. She said her mother received a mask only in late March. A lawyer for the center acknowledged Christian’s death and said federal guidelines were followed but didn’t respond to specific questions about protective gear.
Christian was diagnosed April 2. She endured more than a week of fever, chills and coughing, but seemed to be on the mend. She had been cleared to return to work when she collapsed at home. An outpouring of grief followed, her daughter said.
“She just helped and cared for so many people,” she said. “People I had never met.”
At Work, Church And Home, Army Veteran Gave It His All
(Courtesy of Shlonda Clark)
Roy Chester Coleman
Age: 64 Occupation: Emergency medical technician Place of Work: Overton Brooks VA Medical Center in Shreveport, Louisiana Date of Death: April 6, 2020
Shlonda Clark calls her father her “favorite superhero.”
It was one of Roy Coleman’s many roles. For the past 11 years, the Army veteran and EMT worked as a housekeeper at the VA hospital in his hometown. He was a church deacon, Sunday school teacher and usher. He also volunteered with special-needs adults.
Roy had a big family, with three children, eight grandchildren and two great-grandchildren.
“He was funny, he was kind, he was giving,” said Mabel Coleman, his wife of 40 years.
“If he didn’t like you, something was wrong with you,” added Clark.
Coleman fell ill March 23. After three trips to the emergency room, he was admitted March 27, with a fever and labored breathing.
“It was the last time I saw him,” Mabel said.
He tested positive for COVID-19 and died at the hospital where he had worked.
His family said he was concerned about the lack of personal protective equipment. The VA medical center said by email it “has and continues to use PPE in accordance with CDC guidelines.”
Beloved Doctor Made House Calls, Treated Patients Like Family
(Courtesy of the Giuliano family)
Age: 64 Occupation: Family practice physician Place of Work: Mountainside Medical Group in Nutley, New Jersey Date of Death: April 18, 2020
For 39 years, Michael Giuliano practiced old-fashioned family medicine.
He made house calls. He visited his patients in the hospital rather than asking another physician to check in on them. He saw generations of the same family.
“Some patients would show up here at the house,’” said Giuliano’s wife, Marylu, a nurse and the office manager of his solo practice. “Patients would call and he’d say, ‘Come on over, I’ll check you out.’ He always went above and beyond.”
A father of five and a grandfather of four, Giuliano was jovial, with a quirky sense of humor and love of Peanuts characters, especially Charlie Brown. He liked to tell patients, “I’ll fix you up.”
“He treated all of his patients like family,” said Nutley Mayor Joseph Scarpelli.
When COVID-19 hit the U.S., Giuliano ordered N95 masks, his family said, but suppliers were out and sent surgical masks instead. Giuliano wore two at a time.
The week of March 16, Giuliano saw four patients with respiratory symptoms who later tested positive for COVID-19. About two weeks later, he tested positive.
Giuliano continued to see patients from home using telemedicine until he was hospitalized. He died 11 days later.
Age: 68 Occupation: Orderly Place of Work: Hackensack Meridian Health Palisades Medical Center in North Bergen, New Jersey Date of Death: March 26, 2020
After 44 years of marriage, Alfredo Pabatao still bought his wife, Susana, flowers.
“They were that type of couple that you rarely see nowadays,” their youngest daughter, Sheryl Pabatao, 30, said. “They set such a high standard for us, their kids — that may be the reason why I’m still single.” She said her father was a patient man who could fix just about anything.
The Pabataos came from Quezon City, just outside Manila, in the Philippines. Alfredo worked at a car dealership, and Sheryl said she and her siblings grew up comfortably.
But the couple wanted more for their five children, and immigrated to the United States in October 2011. “The first year that we were here, was really, really tough,” Sheryl remembered. Her oldest two siblings, already adults by the time the Pabataos’ immigration application cleared, had to stay behind.
Alfredo found a job as an orderly at a hospital in New Jersey, where he worked for nearly two decades. In mid-March, he told his family he had transported a patient with signs of COVID-19; he fell ill days later. In a statement, his employer wrote: “We have policies and procedures in place to protect our team members and patients that are all in accordance with CDC guidelines.”
Sheryl said the family’s last conversation with her father was via FaceTime, with him on his hospital bed. Connected to oxygen, he insisted he wasn’t gravely ill. He made jokes and even demonstrated yoga poses to reassure his wife and children. He died soon after.
A ‘Selfless’ Mother Who ‘Always Had The Right Words’
(Courtesy of Sheryl Pabatao)
Age: 64 Occupation: Assistant nurse Place of Work: Bergen New Bridge Medical Center in Paramus, New Jersey Date of Death: March 30, 2020
Susana Pabatao became a nurse in her late 40s, after her family immigrated to the United States.
It eased some of her longing for her own mother, whom she had left behind in the Philippines, her daughter, Sheryl Pabatao said. “It helped her to know that she was helping other people — something that she couldn’t do for my grandmother,” Sheryl said. Susana treated her older patients as if they were her own parents, she added.
Susana was warm, selfless and a constant source of comfort. Sheryl said, “My mom always had the right words.”
Susana’s husband, Alfredo Pabatao, began showing symptoms of COVID-19 in mid-March, and Susana became ill soon after. Sheryl, who described the two as “inseparable,” said: “When my dad got sick, it’s like part of her was not there anymore.”
Alfredo was hospitalized, and Susana spent her last days at home resting and speaking with him on FaceTime. Sheryl, who lived with her parents, said she overheard the two console each other one morning. “My mom was telling my dad, ‘We’ve gone through so many things, we’re going to get through this.”
Alfredo died on March 26. Susana died four days later.
Age: 68 Occupation: Internal medicine physician Place of Work: Medical Center of Annandale in Annandale, Virginia Date of Death: May 7, 2020
When George H.W. Bush announced his 1988 run for the presidency, Steven Perez was one of the doctors who gave him a clean bill of health.
An “Air Force brat” who was born in the United Kingdom, Perez served as a flight surgeon and medical director in the Air Force Medical Service Corps before practicing as a physician in the White House from 1986 to 1990, according to a statement from his family.
“It was the honor of his life,” his son, Benjamin Perez, said.
Perez went into private practice in San Antonio in the early ’90s before opening his own clinic in Northern Virginia. He also taught at the University of Virginia.
According to his family, he made a promise to God and “never refused medical aid to the poor who came to his office, even accepting yams as payment on occasion.”
Perez’s family describes him as a proud grandfather to his three grandchildren (with two more on the way); he loved the University of Southern California Trojan football, the Dallas Cowboys and the Nationals.
“He could make anyone laugh, knew just what to say, and showed profound love for his friends and family,” his family wrote in an obituary. “Every person he met felt like they were the reason he was there.”
She Jumped At Chance To Lend Her Nursing Skills To Her Beloved New York
(Courtesy of the Sell family)
Age: 80 Occupation: Pediatric nurse practitioner Place of Work: New York City public schools Date of Death: April 17, 2020
Rosemary Sell was a New Yorker through and through. Born in Washington Heights in northern Manhattan, she went to nursing school in Greenwich Village and raised her five boys on the Lower East Side.
In the 1960s, she traveled to Berlin, where she worked as a nurse for the British army and met her future husband, Peter. A lifelong love of travel was born. Gregarious and high-energy by nature, she loved meeting new people. “Wherever she’d go, she’d make a new friend,” said her son, also named Peter.
In later years, Sell spent much of her time in Florida. But she jumped at opportunities to lend her nursing skills to her home city and see her grandchildren and friends.
In February, she was contacted by a firm that places nurses on temporary assignments. Her children were concerned about the encroaching pandemic, especially given her age. “But they need a nurse,” she responded. She traveled to New York to fill in as a nurse at several schools citywide just as the pandemic took hold. The firm, Comprehensive Resources, did not respond to questions on protections for its contractors.
Sell began developing symptoms in mid-March, just before the citywide school closure went into effect. She returned home to Florida, where she died from pneumonia caused by COVID-19.
Before Rosemary died, she had been hatching her next adventure with a friend: to travel to India. She wanted to see the Taj Mahal.
A Hands-On Pharmacist Who Made The Big City Feel Smaller
(Courtesy of Zair Yasin)
Age: 67 Occupation: Pharmacist Place of Work: New York City Pharmacy in East Village, Manhattan Date of Death: May 4, 2020
Ali Yasin was a small-town druggist in a big city filled with impersonal, chain-store pharmacies. He found a way to operate a robust business and still be on a first-name basis with his customers. Over the years, he became their medical consultant, insurance whisperer and friend.
Jen Masser said she stumbled into Yasin’s pharmacy the first time, covered from hands to elbows in hives. “Something is happening, see someone right away,” Yasin advised. “This could be a serious disease.” He turned out to be right, encouraging her to keep seeing doctors until she finally got the proper autoimmune diagnosis.
Born in Pakistan, Yasin moved to the United States in 1979 and worked in various pharmacies before opening his own in 2001. He ran it with the help of his four sons.
In March, after serving customers in hard-hit Manhattan in his typical hands-on manner, Yasin contracted a cough and tested positive for COVID-19. By month’s end, he was in the hospital on a ventilator. He died May 4.
The storefront window of the Yasin family pharmacy is pasted with condolence cards. Son Zair Yasin said the outpouring has been immense: “I didn’t realize until he was gone how many people he touched.”
Nurse Wouldn’t Abandon Her Patients Or Let Family Worry
(Courtesy of the Isaacs family)
Age: 65 Occupation: Registered nurse Place of Work: Signature Healthcare in Newburgh, Indiana Date of Death: May 1, 2020
Marsha Bantle’s family begged her to quit after a resident in the nursing home where she worked was diagnosed with COVID-19.
But Bantle wouldn’t leave. “My patients can’t leave their rooms, they can’t see their families. They really need me right now,’” she told her cousin Carol Isaacs.
Bantle tried to reassure relatives she would limit her exposure, but, on April 17, her temperature spiked. Bantle, who lived alone, holed up at home. She finally called her family when it was clear she needed to be hospitalized.
“That’s Marsha for you,” her cousin John Isaacs said. “She didn’t want us to worry.”
Even while hospitalized, Bantle was selfless, said Shay Gould, the ICU nurse who cared for her. She offered to turn off her medication pump to save the nurse a trip. She asked for other patients’ names to pray for them.
After about a week, Bantle had a stroke, likely brought on by the COVID-19 infection. Within days, she died.
Since April, the nursing home has had 52 positive cases and 13 COVID-19 deaths, including Bantle’s. In a statement, Signature Healthcare said: “The loss of any of our residents or staff, for any reason, is devastating.”
Pharmacist, Feeling Sick, Didn’t Want To Let Patients Down
(Courtesy of the Boynes family)
Age: 46 Occupation: Pharmacist Place of Work: AbsoluteCare Medical Center & Pharmacy in Greenbelt, Maryland Date of Death: April 2, 2020
When the coronavirus began circulating in the Washington metropolitan region, Sean Boynes went to work.
“Patients need their medicine,” he told his wife, Nicole.
The medical center where he worked bills itself as “a medical home for the sickest of the sick”; many of its patients struggle with chronic illness and poverty. Boynes was the Greenbelt branch’s first pharmacist.
He was an “incredible, loving guy,” said Dr. Gregory Foti, chief of innovative operations at AbsoluteCare.
Boynes was a proud Howard University alumnus and had three degrees — a bachelor’s of science in biology, a master’s in exercise physiology and a doctorate in pharmacy — from the institution.
In early March, Boynes and his wife began feeling sick. Boynes didn’t want to stop working but thought “taking a sick day might be OK,” Nicole said. He also took a break from being a jungle gym to his eight- and 11-year-old girls. Nicole called him “Super Dad.”
Nicole got better, but Sean, who had asthma, saw his breathing deteriorate.
On March 25, Nicole dropped him at the hospital doors. The medical staff confirmed COVID-19. The family never saw him again.
Foti said AbsoluteCare follows CDC recommendations, such as providing staff with face masks, and declined to comment on where Boynes became infected. He said “it was literally impossible to tell” where Boynes had contracted the virus.
To honor him, AbsoluteCare is naming the Greenbelt pharmacy after Boynes.
Age: 74 Occupation: Emergency medical technician and rescue squad chief Place of Work: Woodbridge Township Ambulance and Rescue Squad in Iselin, New Jersey Date of Death: April 17, 2020
“That’s not the way you throw a curveball!” John Careccia famously declared to his grandson at a family picnic, according to his daughter, Toni Lorenc. Careccia then threw the ball so wide that it broke a window in her shed.
“That’s how you throw the batter off,” he said, brushing off the mishap.
“Typical Pop-Pop,” Lorenc said. “He had so much confidence in himself.”
Careccia, who worked for the Port Authority of New York and New Jersey for 30 years, harnessed his self-confidence into a second career. Inspired by two EMTs who saved his son’s life, he became a volunteer EMT in 1993. A consummate educator, he taught CPR, mentored young EMTs and gave catechism classes at his church, Lorenc said.
A spry 74, Careccia responded to 911 calls as chief of his rescue squad, a volunteer position. On a March 25 call, he evaluated a coronavirus patient, said Ed Barrett, squad president. Careccia died of COVID-19 several weeks later.
At his firehouse memorial service, Careccia was summoned over a loudspeaker for his “last call.”
“Having heard no response from Chief Careccia, we know that John has made the ultimate sacrifice,” said Steve Packer, a previous squad president. “His leadership, dedication, compassion and friendship will be greatly missed.”
Police Officer Turned Nurse Practitioner Was Pursuing A Doctorate
(Courtesy of Dennis Graiani)
Age: 56 Occupation: Family nurse practitioner Place of Work: Rockland Medical Group in Garnerville, New York Date of Death: March 30, 2020
Kevin Graiani always wanted to work in health care, according to Dennis Graiani, one of his three sons. But his mother told him he needed a pension, so he became a cop.
Kevin, who grew up in the Bronx, served five years on the New York City Housing Authority police force, then 15 on a suburban police force in Spring Valley, New York. He was a “brilliant officer,” said Lt. Jack Bosworth of Spring Valley.
Known for his dry sense of humor, Kevin often rattled off quotes from movies. He played bagpipes for the Rockland County Police Emerald Society, a law enforcement group. When he retired from police work, he began nursing school and became a nurse practitioner in 2018.
Kevin, who worked at a private practice, became sick on March 10 and was later diagnosed with COVID-19, Dennis said.
He loved learning and was set to finish classes this summer for his doctorate of nursing practice, said Lynne Weissman, his professor and program director at Dominican College.
He was an “extremely bright student” with a 3.7 GPA, Weissman said.
Age: 53 Occupation: School nurse Place of Work: Spring Creek Community School in Brooklyn, New York Date of Death: April 4, 2020
Marilyn Howard was known for her generosity and never missing a party. Born in Guyana, she came to the U.S. as a teenager. She helped raise her five brothers, putting her ambitions on hold. “She was a mother to many,” her brother Haslyn said.
In her mid-30s, she turned to her own career goals. She steadily racked up four nursing degrees and recently had begun studying to become a nurse practitioner.
Howard, who lived in Queens, New York, was a school nurse in Brooklyn, where she regularly treated children with chronic illnesses associated with poverty. The week before the pandemic shuttered schools, a fellow nurse had a fever and cough.
Days later, Howard developed the same symptoms. After initially improving, she took a sudden turn for the worse April 4. As her brother drove her to the hospital, her heart stopped. She was declared dead at the hospital.
In tribute, hundreds turned out on Zoom to mark Nine-Night — a days-long wake tradition in the Caribbean — where loved ones shared photos, sang songs and recounted Howard’s effect on their lives.
The pandemic has since ripped through Howard’s extended family, infecting at least a dozen relatives. (One cousin was hospitalized but was released and is recovering.) The family has evolved into a sprawling triage team, monitoring one another’s temperatures, delivering food, charting emergency contacts and nearby hospitals.
Howard’s brothers hope to start a foundation in her name to help aspiring nurses in the U.S. and West Indies. “The best way to honor her spirit and her memory is to bring more nurses into this world,” said her brother Rawle. “We need more Marilyns around.”
Post-Retirement, She Tirelessly Rejoined Workforce
(Courtesy Bethany MacDonald)
Age: 74 Occupation: Receptionist Place of Work: Orchard View Manor, a nursing home and rehabilitation center in East Providence, Rhode Island Date of Death: April 25, 2020
Nancy MacDonald tried retiring, but couldn’t make it stick.
For 20 years, she was a middle school teaching assistant and cheerleading coach. At home, she loved painting rocks and watching “Blue Bloods” and “American Idol.” She was married with two adult children.
A lifelong Rhode Islander, Nancy was a people person, her daughter, Bethany MacDonald, said. “She always wanted to help others.”
So, in 2017, it was natural that she’d go back to work, this time at a nursing home.
As Orchard View’s COVID case count escalated, MacDonald worried. Still, she kept coming in — washing and reusing her N95 respirator and having her temperature taken daily.
Tim Brown, an Orchard View spokesperson, said the facility has “extensive infection control,” satisfying government guidelines. He would not say how often employees receive new N95s.
On April 13, MacDonald began coughing. By April 16, she was hospitalized. Her COVID test came back positive. She died 10 days later ― almost a week after her last conversation with her daughter.
“I said, ‘Mama, we love you,’” Bethany said. “The last words she said to me were, ‘I love you, too.’”
Despite Danger, Semi-Retired Nurse Kept Caring For ER Patients
(Courtesy of the Miles family)
Age: 60 Occupation: Registered nurse Place of Work: Scott Regional Hospital in Morton, Mississippi Date of Death: May 1, 2020
At age 60, Sheena Miles was semi-retired. She usually worked every other weekend, but as COVID-19 emerged in Mississippi, she worked four weekends in a row from mid-March to mid-April.
“I’ve got a duty,” she told her son, Tom Miles.
The economy where she lived is dominated by poultry plants, and the county has been a coronavirus hot spot. Sheena was diligent with protective gear, wearing her mask and doubling up on gloves, Tom said. She stayed home when she wasn’t working.
“Losing Sheena has been a tragic loss, as she had been a part of our hospital for 25 years,” said Heather Davis, a hospital administrator.
Sheena took ill on Easter Sunday. By Thursday, Tommy Miles, her husband of 43 years, drove her to the University of Mississippi Medical Center in Jackson.
Two long weeks passed. The family was allowed to say goodbye in person, and on their way into her room, an ICU nurse told them that years ago Sheena had cared for his infant daughter. “‘Your mom saved her life,’” the nurse said.
“That was a little comfort in the storm,” Sheena’s son said.
A Nurse Who Was Living Her Dream Of Working In The U.S.
(Courtesy of Venus Donasco-Delfin)
Age: 38 Occupation: Registered nurse Place of Work: Community First Medical Center and Kindred Chicago Lakeshore in Chicago, and Bridgeway Senior Living in Bensenville, Illinois Date of Death: April 14, 2020
As a child, Anjanette Miller dreamed of becoming a nurse in the U.S. She studied in her native Philippines and worked briefly in Saudi Arabia before fulfilling her wish in 2001.
Miller settled in Chicago and worked as a supervising nurse at three facilities. Her sister, Venus Donasco-Delfin, said Miller got along well with co-workers who shared her work ethic.
“At work, I think, she was strict, but beyond work, she’s a great friend,” Donasco-Delfin said. One of five siblings, she was the “pillar of the family” and supported relatives back home.
“I studied psychology for two years,” Donasco-Delfin said, “but she kept calling me [in the Philippines] and said, ‘No, Venus. … You have to pursue nursing. You will make a difference.’” Donasco-Delfin, now in Canada, became a nurse.
Miller started feeling sick in mid-March and was diagnosed with COVID-19 in early April. She self-isolated, chronicling her illness on YouTube and Facebook. She was hospitalized April 5 and died nine days later.
Miller had hoped to retire to the Philippines and pursue her other passion, filmmaking. Last year she traveled back home to shoot scenes for a project. “The movie she was making is about her life story,” Donasco-Delfin said. “But it’s not finished yet.”
Age: 75 Occupation: Patient transport worker Place of Work: Holy Name Medical Center in Teaneck, New Jersey Date of Death: April 3, 2020
After Jesus Villaluz died from COVID-19 complications, colleagues lined the hallway at Holy Name Medical Center in Teaneck, New Jersey, to say goodbye. They’d never done that for anyone else.
“Jesus knew many and meant a lot to all of us, so this gesture felt like the right thing to do,” said hospital spokesperson Nicole Urena.
The hospital, and surrounding Bergen County, have been hit hard by the pandemic. By May 8, Holy Name had treated more than 6,000 COVID patients, 181 of whom died.
Villaluz worked at Holy Name for 27 years. In a Facebook post, the hospital memorialized Villaluz’s generosity: He once won a raffle and shared the winnings with colleagues, an anecdote New Jersey Gov. Phil Murphy repeated at a news conference. Family members declined requests for an interview.
Co-worker Hossien Dahdouli said Villaluz’s compassion for patients was exemplary. He never rushed anyone, took the time to chat with patients and was always concerned for their privacy and safety, Dahdouli said.
Years ago, after Dahdouli had a sad day caring for deteriorating ICU patients, he asked Villaluz why he always appeared so happy.
“He said, ‘My worst day at work is better than someone’s best day as a patient.’”
Family Vacations And Reggae Gave Rhythm To His Life
(Courtesy of Nina Batayola)
Don Ryan Batayola
Age: 40 Occupation: Occupational therapist Place of Work: South Mountain Healthcare and Rehabilitation Center in Vauxhall, New Jersey Date of Death: April 4, 2020
April 4 was the day Don and Nina Batayola had planned to leave for London on a 10-day European vacation. Instead, that was the day Don died of COVID-19.
The Springfield, New Jersey, couple loved to travel ― on their own or with their children, Zoie, 10, and Zeth, 8. Disney World. Road trips to Canada. Every year for a week they would savor the beach on North Carolina’s Outer Banks.
Don’s love of reggae music prompted a trip to Jamaica to visit Bob Marley’s birthplace.
The Batayolas, both occupational therapists, moved to New Jersey from the Philippines 13 years ago to pursue their careers.
“He loved to help,” Nina said. “He had such the ability to make everybody smile or laugh.”
Don worked with at least one patient and a handful of colleagues who subsequently tested positive for COVID-19, and in late March, he developed symptoms. Nina came home from work for lunch on March 31 to find him struggling to breathe. She dialed 911.
He was hospitalized, then she also developed COVID symptoms. Self-isolating at home, Nina talked with Don once a day. She thought he seemed stronger but, on the fourth day, his heart suddenly stopped.
Even On ‘The Saddest Day … She Could Make You Laugh’
(Courtesy of Kim Bruner)
Age: 32 Occupation: Licensed vocational nurse Place of Work: Silverado Beverly Place in Los Angeles Date of Death: April 20, 2020
When it was Brittany Bruner-Ringo’s turn to pick the family vacation, it was always New Orleans. A city so full of life.
And that is how family described the 32-year-old who left the Oklahoma plains for the excitement of Southern California.
“She always made the best of things,” her mother, Kim Bruner, said. “It could be the saddest day, and she could make you laugh.”
Bruner-Ringo worked at a dementia care center. On March 19, she admitted a patient flown in from New York. She suspected he might have COVID-19, and she was nervous. For fear of frightening the patients, she hadn’t been allowed to wear a mask or gloves, she told her mom by phone that night. (A spokesperson from her employer said, “We have no issues in our environment using appropriate masking and gloves and have followed CDC guidelines throughout this pandemic. We have always had adequate PPE to protect our residents and associates.”)
The following day, the patient grew worse. Bruner-Ringo checked into a hotel to isolate from her roommate. She later tested positive for COVID-19, but when she developed symptoms did not complain ― even to her mom: “She would say, ‘I’m fine. I’m going to beat this. Don’t worry about me.’”
Bruner, a veteran nurse herself, called the hotel front desk for help getting an ambulance to her daughter. She had just hung up with her daughter, who insisted she was fine, while struggling to breathe.
He And His Wife Shared A Lust For Travel ― And A COVID Diagnosis
(Courtesy of LaKita Bush)
Age: 30 Occupation: Nurse and nursing student Place of Work: Benton House of Aiken in Aiken, South Carolina Date of Death: April 17, 2020
Joshua Bush never let his wife, LaKita, forget that she was five hours late for their first date.
“He never held back telling the truth,” LaKita said, with a doleful laugh.
They met online in 2011, each attracted to the other’s lust for travel. For Joshua’s 30th birthday, they took a cruise to Bermuda. He yearned to go farther afield to Tokyo to revel over anime.
Joshua began his nursing career after high school, eventually ending up at Benton House of Aiken, an assisted living facility. Joshua and LaKita, who works in human resources for a hospital, thought it was allergy-related when they both fell ill in late March. Benton House had no confirmed COVID cases at the time, LaKita said. Even still, the staff was taking precautions.
A doctor prescribed Joshua flu medication, but his symptoms — fever and aches but no cough — worsened, and he was admitted to a hospital in Augusta, Georgia, on April 4.
“That was the last time I saw him alive,” LaKita said.
Over the next few days, both tested positive for the coronavirus. Joshua was sedated in the hospital for two weeks and died on April 17. LaKita recovered at home.
Joshua was earning a bachelor’s degree in nursing at the University of South Carolina-Aiken. May would have marked the couple’s fifth anniversary.
Her Sudden Death Blindsided Husband And Autistic Son
(Courtesy of Vincent Carmello)
Age: 57 Occupation: Licensed practical nurse Place of Work: Maryhaven Center of Hope in Port Jefferson Station, New York Date of Death: April 16, 2020
Karen Carmello had an intimate understanding of working with intellectually disabled patients.
Her 26-year-old son, Steven, has autism. According to her husband, Vincent, the two spoke by phone every day. Steven would recall exactly what he did, and Karen listened intently.
“She could do no wrong in his eyes, ever,” Vincent said. “It’s a very special bond, but it’s one that she earned.”
Sharing the news of her death was shattering: “It was the hardest thing I’ve ever had to do — letting him know.”
When Karen took ill, she discovered that a patient in her ward had tested positive for COVID-19. She was hospitalized March 23. Eight days later, she sent Vincent her last text, at 2:17 a.m., before going to the ICU.
On April 16, hospital staff called and asked whether Vincent would be comfortable signing a do-not-resuscitate order. He hadn’t been able to see his wife, so he didn’t completely grasp how grave her condition was.
“I thought, ‘OK, this must be a formality,’” he said. “I authorized it. And I got a call within two hours that she passed. I was stunned.”
— Shoshana Dubnow, Kaiser Health News | Published May 8, 2020
His Facebook Posts Left Clues Of A Tragic Timeline
(Courtesy of Felicia Dodson-Hill)
Age: 51 Occupation: Certified nursing assistant Place of Work: West Oaks Nursing and Rehabilitation Center in Austin, Texas Date of Death: April 17, 2020
Maurice Dotson’s sister knew something was wrong when her older brother didn’t post his daily Facebook update.
“We knew he was good as long as he posted every morning,” Felicia Dodson-Hill, of Jacksonville, Arkansas, said.
Dotson, 51 ― a certified nursing assistant for 25 years at the West Oaks Nursing and Rehabilitation Center in Austin — had begun caring for COVID-19 patients.
He sounded positive on Facebook, posting on March 30: “We are going through scary, difficult times, but better days are coming.”
Days later, family in Arkansas couldn’t reach him.
“We had been trying to get in contact with him since April 1st,” his sister said. “On April 3rd, he posted that he had to go to the hospital ― that he was not feeling good.”
Dodson-Hill said the hospital sent him home. Her mother finally reached him on April 6 or 7.
“He told my mom he didn’t have the energy to barely talk,” Dodson-Hill said.
Dawunna Wilson, a cousin from Hazen, Arkansas, said Maurice called an ambulance on April 8. Results from his coronavirus test done at the hospital came back positive the next day. “From there, it was pretty much downhill,” Wilson said.
Age: 63 Occupation: Licensed practical nurse Place of Work: Southern Virginia Regional Medical Center in Emporia, Virginia Date of Death: March 29, 2020
When Barbara Finch got excited, she’d scrunch her hands into fists and wave them around like a kid at Christmas. She did it when the Atlanta Braves scored, or while watching her grandkids play baseball, her No. 1 passion outside work.
Finch spent her 37-year nursing career in the emergency department of the hospital in Emporia, Virginia (population of about 5,000), where one of her four children, Leigh Ann Lewis, worked as an EMT.
Lewis knew her mother was well liked: Patients she transported from the hospital would rave that Finch had been sweet and compassionate.
Finch fell ill on March 17 and died in an ICU 12 days later. As a hearse carried her casket to the graveyard, Lewis said, people lined the way at driveway mailboxes, churches and stores, holding signs that read, “We love you,” “Praying for you,” “Hugs.” At her hospital, employees released balloons to the sky.
“It seemed like, in our area, she knew everybody — either she worked with them, or they were a patient of hers at some point,” Lewis said. “It was a very, very large outpour of love and comfort and solidarity.”
Age: 70 Occupation: Internal medicine physician Place of Work: Private practice in Jamaica, Queens, New York Date of Death: March 29, 2020
Tomas Pattugalan’s kids had been encouraging him to retire. Even after 45 years of medicine, Pattugalan wasn’t ready to slow down.
“He loved his patients. He loved to work. He loved to help others,” said Giancarlo, his son. “He had an enormous capacity to give of himself.”
A father of three, Pattugalan grew up in the Philippines, immigrating to the U.S. in the 1970s. He was a devout Catholic — attending Mass weekly ― and “karaoke master,” Giancarlo said.
In early March, Pattugalan began testing patients for COVID-19. His medical history, including a family history of strokes and high blood pressure, heightened his own risk. So after tests of two patients returned positive, he got tested himself. On March 24, he learned he had the coronavirus.
“He made a joke and said Prince Charles had tested [positive] too, and he was sharing royalty,” Giancarlo said. “He was making light of it, not trying to get any of us worried.”
Pattugalan had a cough. Then came wheezing. His oxygen levels dropped. He tried hydroxychloroquine, an experimental treatment touted by President Donald Trump that has yielded mixed results. Nothing helped.
On March 29, Pattugalan agreed to seek hospital care. He died that day.
Age: 50 Occupation: Transportation supervisor Place of Work: NewYork-Presbyterian Westchester Behavioral Health Center in White Plains, New York Date of Death: April 4, 2020
Melissa Castro Santos had just started a new treatment for multiple myeloma when her husband, Darrin, got sick.
For nearly two weeks, he isolated in their bedroom, but after he began gasping for air, he went to the hospital. He died of COVID-19 days later.
“It’s just unbelievable,” Castro Santos said.
As a transportation supervisor, Santos delivered health care workers and equipment between hospitals in the New York metropolitan area. He loved his job, Castro Santos said, and was known to drive doctors wherever and whenever they were needed, through heavy traffic and snowstorms.
Castro Santos, who has been battling cancer since 2012, said her husband doted on their three teenagers, all avid athletes. He arranged his work schedule to attend as many of their games as possible. When he couldn’t make it, she would call him on FaceTime so he could catch glimpses of the action.
Unable to hold a funeral, they arranged for burial five days after Santos died. Friends lined the streets in cars in a show of support as the family drove to and from the cemetery.
Now Castro Santos is confronting cancer without her husband. “He was my backbone. He was the one who took me to chemotherapy and appointments.”
An Animal Lover Who Loved Aerospace, She Died Alone At Home
(Courtesy of Aubree Farmer)
Age: 53 Occupation: Registered nurse Place of Work: Henry Ford Hospital in Detroit Date of Death: April 1, 2020
Lisa Ewald was a nurse to many living things, human and otherwise.
When her neighbor Alexis Fernandez’s border collie had a stomach blockage, Ewald hooked the dog up to an IV four times a day. “She was this dedicated nurse who nursed my dog back to health,” Fernandez said.
Ewald also loved gardening, aerospace and comic book conventions.
Ewald told Fernandez that a patient she had treated later tested positive for COVID-19, and that she was not wearing a mask at the time. Two days later, after seeing the patient, she got sick. After delays in accessing a test, she learned on March 30 that she was infected with the coronavirus.
A hospital spokesperson acknowledged that staff who treat coronavirus patients have a higher risk of exposure, but said there was “no way to confirm” how a staff member contracted the virus.
On March 31, Ewald didn’t answer when Fernandez texted her. The next day, Fernandez and a hospital nurse went to Ewald’s home to check on her and found her unresponsive on the couch.
“I said, ‘Aren’t you going to go take her pulse or anything?’” Fernandez said. “The nurse just said, ‘She’s gone.’”
Age: 47 Occupation: Emergency medical technician Place of Work: Atlantic Health System in Mountainside and Warren, New Jersey Date of Death: April 13, 2020
Scott Geiger wasn’t always enthusiastic about school, but at age 16 he brought home a tome the size of two phone books. It was a manual for emergency medical technicians, and he devoured it, said his younger brother, Ben Geiger.
Scott was certified as an EMT at 17. He never married or had kids, but did not seem to miss those things.
“He was so focused on being an EMT and helping people in their most vulnerable and desperate moments,” Ben said. “That’s really what made him feel good.”
Scott loved playing pool each week with friends. He was a loyal New York Jets football fan, content to joke about their follies and watch them lose. He was quiet. And he seemed to have nine lives, his brother said, surviving hospitalizations for epilepsy as a kid and blood cancer around age 40.
When the coronavirus began to tear a path through northern New Jersey, he faced his EMT work with resolve. He downplayed his symptoms when he first fell ill in late March, but wound up spending 17 days on a ventilator before he died. The family has had to mourn separately, with the brothers’ father, who lived with Scott, in quarantine, and their mother confined to her room in a nursing home that has COVID-19 cases.
Theresa had dogs — “sometimes too many,” Lisa said — and lived with her son, Anthony, in the home she owned for decades. She loved cooking and watching cooking shows, reading and following soap operas.
Theresa wasn’t tested for COVID-19. But Kings County Hospital, in Brooklyn, was hit hard by the coronavirus.
Days before dying, she described nausea. Friends recalled a cough. Her supervisor encouraged her to stay home, her daughter said.
Lisa called her mother on March 27, just as Anthony was dialing 911 for help.
“She always put others first,” Lisa said. “She always put herself last.”
Age: 62 Occupation: Emergency room nurse Place of Work: Trinitas Regional Medical Center in Elizabeth, New Jersey Date of Death: April 9, 2020
Tom Luna was a joker, a lively and outgoing man who thrived on the fast-paced and varied action of the emergency room. He also adored his three daughters, something clear to all who knew him.
“Tom was a fantastic emergency nurse. He was well liked and loved by his peers,” Gerard Muench, administrative director of the Trinitas emergency department, said in a statement. “His greatest love was for his wife and daughters, who he was very proud of.”
His oldest daughter, Gabrielle, 25, followed his path to become an ER nurse. When Tom fell ill with the coronavirus, he was admitted to the hospital where she works. At the end of her 12-hour night shifts, she made sure he had breakfast and helped him change his clothes. She propped a family photo next to his bed.
Tom’s wife, Kit, also a nurse, said that when some of his symptoms appeared to let up, they talked about him recovering at home. He was a planner, she said, and was already talking about their next family vacation, maybe to Spain.
Air Force Veteran Went ‘Above And Beyond For Patients’
Michael Marceaux and his wife, Dunia, when he graduated from nursing school in 2018 (Courtesy of Drake Marceaux)
Age: 49 Occupation: Registered nurse Place of Work: Christus Highland Medical Center and Brentwood Hospital in Shreveport, Louisiana Date of Death: April 16, 2020
After Michael Marceaux retired from the Air Force, he went back to school. In 2018 he launched a new career as an emergency room nurse.
“Everyone who worked with him said he was so happy,” said Drake Marceaux, one of his four sons. “He was willing to go above and beyond for patients.”
As the coronavirus spread throughout Louisiana, Michael developed a cough and fever. Soon afterward, he tested positive for COVID-19.
“He didn’t seem too worried,” Drake said. “He just wanted to make sure not to give it to other people.”
A spokesperson with Christus Health said Michael would be missed for “how he always had a positive attitude, even after a hard shift. His laughter brought joy to others.” The spokesperson declined to answer questions about workplace safety conditions.
Drake said he wanted his father to be remembered for how much he was loved.
His funeral was livestreamed on Facebook. “At one point, there were 2,000 viewers watching his service,” Drake said. “As much as he didn’t want attention, it gravitated toward him.”
She Loved To Give Gifts And Never Forgot Her Hometown
(Courtesy of Courtesy of Donald Jay Marcos)
Celia Lardizabal Marcos
Age: 61 Occupation: Telemetry charge nurse Place of Work: CHA Hollywood Presbyterian Medical Center in Los Angeles Date of Death: April 17, 2020
Whenever she traveled to her hometown of Tagudin in the Philippines, Celia Lardizabal Marcos showered family with gifts and delighted in planning weekend outings for everyone, said her eldest son, Donald.
And when she returned home to California, she brought presents for her sons. “She always thought of how her family could be happy,” he said.
Trained as a nurse in her home country, Marcos immigrated to the United States in 2001 and settled in Los Angeles. Three years later, she became a telemetry charge nurse, a specialist who tracks patients’ vital signs using high-tech equipment.
On April 3, she was one of three nurses who responded after a suspected COVID patient went into cardiac arrest. Wearing a surgical mask, she intubated the patient. Three days later, she had a headache, body aches and difficulty breathing.
Her symptoms worsened, and she was admitted April 15 to the hospital where she had worked for 16 years. That was the last time Donald spoke to his mother. Two days later, she went into cardiac arrest and died that night.
Her sons plan to honor her wishes to be cremated and buried in Tagudin, alongside her parents.
‘Hero Among Heroes,’ Doctor Cared For Generations Of Patients
Francis Molinari (right) with his siblings (from left) Janice, Albert and Lisa (Courtesy of Lisa Molinari)
Age: 70 Occupation: Physician Place of Work: Private practice in Belleville, New Jersey; privileges at Clara Maass Medical Center Date of Death: April 9, 2020
In late March, Dr. Francis “Frankie” Molinari told his sister Lisa he was “down for the count,” with chills, fever and trouble breathing.
“Frankie, you know what you have,” she recalled telling him.
Two days later, he collapsed at home and was rushed to Clara Maass Medical Center. Colleagues stayed by his side as he succumbed to COVID-19.
“We take solace in the fact that he was cared for by colleagues and friends who deeply loved and respected him,” his sister Janice wrote in a blog. “He died a hero among heroes.”
Molinari, a New Jersey native who was married with an adult daughter, was the oldest of four siblings. His sisters describe him as a positive guy who loved music, fishing and teasing people with tall tales: He went to medical school in Bologna, Italy, and he liked to say he had played pinochle with the pope.
Molinari practiced medicine for over four decades, caring for generations of patients in the same family. His family suspects he contracted the coronavirus at his private practice.
“A friend had once described us as four different legs of the same table,” Janice wrote. “Now I’m stuck on the fact that we are only a three-legged table. Less beautiful, less sturdy. Broken.”
5-Foot-Tall ‘Fireball’ Was A Prankster To Her Sons
(Courtesy Josh Banago)
Age: 69 Occupation: Registered nurse Place of Work: Research Medical Center in Kansas City, Missouri Date of Death: April 21, 2020
Celia Yap-Banago was a 5-foot-tall “fireball,” said one co-worker. She had moved to the U.S. from the Philippines in 1970 and worked for nearly 40 years for the HCA Midwest Health system. Her family said she was planning for retirement.
Her son Josh said she showed her love through practical jokes: “You knew she loved you if she was yelling at you or if she was pranking you.”
“She was very outspoken,” said Charlene Carter, a fellow nurse. “But I later learned that’s a really good quality to have, as a nurse, so you can advocate for your patients and advocate for yourself.”
In March, Yap-Banago treated a patient who later tested positive for COVID-19. Carter said Yap-Banago was not given personal protective equipment because she was not working in an area designed for COVID patients. She spent her final days in isolation to protect others.
A spokesperson for HCA Midwest Health said that medical staff received adequate personal protective equipment in line with CDC guidelines.
Josh said she spoke with reverence of her patients and their families. “She was always focused on the family as a whole, and that the family was taken care of, not just the patient in the bed,” he said.
In Ministry And Rescue Missions, ‘He Put His All Into It’
(Courtesy of the Birmingham Family)
Billy Birmingham Sr.
Age: 69 Occupation: Emergency medical technician Place of Work: Kansas City Missouri Fire Department Date of Death: April 13, 2020
Bill Birmingham Jr. fondly remembers the year his father took on a new career. The whole family studied, even acting out scenes to ensure Billy Birmingham Sr., a minister, was ready for his emergency medical technician exam.
“He put his all into it,” the son recalled.
Billy Birmingham passed the test. And from the late 1990s on, he served as an EMT and a minister.
His family rallied again for his doctorate in pastoral theology. During nearly four decades as a minister, he founded two churches.
“He had a heart for other people,” his son said. “Whatever he could do for other people, he would do it.”
As an EMT with the Kansas City Fire Missouri Department, he was exposed to the novel coronavirus. The cough came in March.
“‘I’m just tired.’ That’s what he kept saying,” his son said. His dad went to the hospital twice. The first time he told the staff about his symptoms and underlying health conditions, then they sent him home.
The second time he arrived in an ambulance. Just over two weeks later, his final hours arrived.
Hospital staff set up a video chat so his family could see him one last time.
Jovial Man Trained Scores Of Doctors In Obstetrics, Gynecology And Kindness
(Courtesy of Ashley Ulker)
Age: 63 Occupation: OB-GYN doctor Place of Work: University of Miami and Jackson health systems in Miami Date of Death: April 8, 2020
“Somos felices.” That was Dr. Luis Caldera-Nieves’ signature signoff after a cesarean section or patient visit or at the end of a difficult shift. “We’re happy,” he meant, and often, when he was around, it was true.
Caldera-Nieves, a popular OB-GYN, trained scores of doctors and helped bring thousands of babies into the world in his 25 years at the University of Miami and Jackson health systems.
Born in Bayamón, Puerto Rico, he worked as an Air Force doctor before joining UM, said longtime co-worker Dr. Jaime Santiago. Caldera-Nieves was so devoted to his patients that he often gave them his private phone number — and his wife’s, Santiago said.
Because he was so jovial, he earned the nickname “the Puerto Rican Santa Claus,” Santiago said.
“He was truly loved and admired by everyone who worked with him, and will be remembered for his humor and never-ending positive energy,” said Dr. Jean-Marie Stephan, who trained under Caldera-Nieves.
In a statement, UM and Jackson confirmed Caldera-Nieves died from complications of COVID-19 and said they “grieve the loss of our esteemed and beloved colleague.” He is survived by his wife and six adult children.
A Cluster Of Illness Robs Community Of Another Fearless EMT
(Courtesy of Vito Cicchetti)
Age: 24 Occupation: Emergency medical technician Place of Work: Saint Clare’s Health in Passaic, New Jersey Date of Death: April 7, 2020
When Kevin Leiva died of COVID-19 in early April, it was a second crushing loss to his close-knit team of EMT workers. Their colleague, Israel Tolentino Jr., had died one week before.
“People were scared that everyone was going to die from it,” said Vito Cicchetti, a director at Saint Clare’s Health, where the men worked. “After Izzy died, we all started getting scared for Kevin.”
Leiva, according to an obituary, “was always worried about his crew.” He was “very proud” of his work and was recalled to have said “becoming an EMT was an act of God.”
He met his wife, Marina, online while they were in high school. She moved a thousand miles to build a life with him. He loved spending time at their home, playing guitar and tending to his tegu lizards, AJ and Blue.
As COVID-19 ramped up, the station’s three ambulances each handled up to 15 dispatches a shift, roughly double the usual number. In a busy 12-hour shift, EMTs often responded to calls continuously, stopping only to decontaminate themselves and the truck.
Leiva “always had a joke” that helped to defuse stressful situations and bring his co-workers together, Cicchetti said.
Firefighting And ‘Helping People’ Were In His Blood
(Courtesy of the Terre Haute Fire Department)
Age: 41 Occupation: Paramedic and firefighter Place of Work: Terre Haute Fire Department in Terre Haute, Indiana Date of Death: April 12, 2020
John Schoffstall grew up around firehouses, and it was at his own firehouse in Terre Haute, Indiana, that he was exposed to the coronavirus.
A paramedic and firefighter with the Terre Haute Fire Department for almost 12 years, Schoffstall died April 12 at age 41. Deputy Chief Glen Hall said investigations by the county health department and his own department “determined John contracted the virus from another firefighter in the firehouse.” Four other firefighters “had symptoms but none progressed.”
“We respond every day to potential COVID patients,” Hall said.
Jennifer Schoffstall, his wife of 18 years, said her husband went to the hospital March 28.
“His breathing was so bad in the ER, they just decided to keep him,” she said. “He regressed from there.”
Hall said Schoffstall’s “biggest hobby was his family,” with a son, 17, and a daughter, 13.
Schoffstall’s father had been a volunteer firefighter, Jennifer said, and her husband signed up for the New Goshen Volunteer Fire Department when he turned 18.
“He loved the fire service and everything about it,” she said. “He loved helping people.”
Boston Nurse, A Former Bus Driver, Was A Champion For Education
(Courtesy of Teadris Pope)
Age: 63 Occupation: Nurse Place of Work: New England Baptist Hospital in Boston Date of Death: April 12, 2020
Rose Taldon was just 5 feet tall. But when she bellowed out the window, her kids ran right home.
“She didn’t take any crap,” said her daughter, Teadris Pope.
Taldon raised three children with her husband on the street where she grew up in Dorchester, Boston. She was respected as a strong Black woman, earning a nursing degree while working in public transit for 23 years. Described as stern, she still was quick to tickle her eight grandkids.
Taldon was generous: Even as she lay in a hospital in April, exhausted from the coronavirus, she arranged to pay bills for an out-of-work friend, her daughter said.
It’s unclear whether Taldon caught the virus at her hospital, designated for non-COVID patients. Hospital officials said three patients and 22 staff have tested positive.
Once her mother was hospitalized, Pope couldn’t visit. On Easter morning, a doctor called at 2 a.m., offering to put Taldon on a video call.
“I just talked until I had no words,” Pope said. “I was just telling her, ‘We’re so proud of you. You worked so hard raising us. … You’ve gone through a hell of a fight.’”
Unflappable First Responder With An Ever-Ready Smile
(Courtesy of Vito Cicchetti)
Israel Tolentino Jr.
Age: 33 Occupation: Emergency medical technician and firefighter Place of Work: Saint Clare’s Health and the Passaic Fire Department, both in Passaic, New Jersey Date of Death: March 31, 2020
When Israel Tolentino Jr. arrived for his EMT shift one morning in March, he seemed fine. Then he got a headache. Then a fever came on, and he was sent home, said Vito Cicchetti, a director at Saint Clare’s Health.
Izzy, as he was called, was an EMT who fulfilled his dream to become a firefighter. In 2018, the former Marine took a job with the Passaic Fire Department but kept up shifts at Saint Clare’s.
He was husband to Maria Vazquez, whom he’d met at church, according to nj.com. They had two young children.
The work pace could be brutal during the pandemic. In a 12-hour shift, Tolentino and his partner were dispatched to one emergency after another, each typically lasting under an hour but requiring nearly that long to decontaminate their gear and truck.
Izzy died in hospital care. The coronavirus tore through his EMT team. Most eventually recovered. But his friend and co-worker Kevin Leiva also died.
Izzy’s unflappable, cheerful presence is missed, Cicchetti said: “No matter how mad you were, he’d come up with a smile and you’d be chuckling to yourself.”
Cicchetti hasn’t replaced either man: “I don’t know if I’m ready for that yet.”
Their Decade-Long Dream Marriage Ends In Nightmare
(Courtesy of the Detroit Fire Department)
Capt. Franklin Williams
Age: 57 Occupation: Firefighter and medical first responder Place of Work: Detroit Fire Department in Detroit Date of Death: April 8, 2020
Capt. Franklin Williams stood at the altar on his wedding day and pretended to hunt for the ring. He patted his chest, then his pants legs and looked up at his soon-to-be wife with a million-dollar smile.
He was always clowning and “so silly,” said Shanita Williams, his wife, recalling how he wanted to make her laugh. Williams, 57, died from complications of the novel coronavirus on April 8 — one month before the couple’s 10-year wedding anniversary.
Williams had been on an emergency call with a verified COVID patient before falling ill, according to Detroit Fire Department Chief Robert Distelrath. He died in the line of duty.
Crews are equipped with personal protective equipment including a gown, N95 mask and gloves. But it’s easy for a mask to slip ― “when you’re giving [chest] compressions, your mask isn’t staying in place all the time,” said Thomas Gehart, president of the Detroit Fire Fighters Association.
When Williams fell sick on March 24, he moved to the guest bedroom and never returned to work.
“I’m thankful and thank God for having him in my life,” Shanita said, adding that she keeps hoping this is a nightmare and she’ll soon wake up.
A 9/11 First Responder, He Answered The Call During The Pandemic
(Courtesy of the Valley Stream Fire Department)
Age: 59 Occupation: Volunteer emergency medical technician Place of Work: Village of Valley Stream on New York’s Long Island Date of Death: April 8, 2020
Mike Field had a strong sense of civic duty. An emergency medical technician, he was a first responder with the New York Fire Department (FDNY) on 9/11. He was also a member of his community’s all-volunteer fire department since 1987.
After he retired from FDNY in 2002, he took a job making and posting street signs with his local public works department. He continued to volunteer with Valley Stream’s fire department and mentoring the junior fire department. When he wasn’t responding to emergencies or training future emergency technicians, he led a Boy Scout troop and volunteered for animal causes.
“Here’s somebody who cares about the community and cares about its people,” said Valley Stream’s mayor, Ed Fare, who had known Mike since the seventh grade.
Stacey Field, Mike’s wife, said he found his calling early, after his own father experienced a heart attack. “When the fire department EMTs came and helped his dad, he decided that’s what he wanted to do,” she said.
Their three sons ― Steven, 26; Richie, 22; and Jason, 19 — have followed in their father’s footsteps. Steven and Richie are EMTs in New York; Jason plans on training to become one as well. All three volunteer at the same fire station their father did.
In late March, Mike and fellow volunteer responders were called to an emergency involving a patient showing symptoms of COVID-19. Field died on April 8.
Nurse Fought For His Life In Same ICU Where He Cared For Patients
(Courtesy of Romielyn Guillermo)
Ali Dennis Guillermo
Age: 44 Occupation: Nurse Place of Work: Long Island Community Hospital in East Patchogue, New York Date of Death: April 7, 2020
In 2004, Ali Dennis Guillermo, his wife, Romielyn, and their daughter came to New York from the Philippines to find a better life.
Everything fell into place. The former nursing instructor landed a job at Long Island Community Hospital, often working in intensive care or the emergency room. He enjoyed the intensity of ER work, his wife said. As years passed, the couple had two sons and settled into a close-knit Philippine community.
As COVID-19 emerged, Guillermo was posted to the step-down floor, working with patients transitioning out of intensive care.
A lot of the nurses on his floor had gotten sick with the virus, his wife said, and “everybody was scared.”
And then, Guillermo felt achy, with a fever that soared to 102. He went to the hospital and X-rays were taken, but he was sent home. Within days, his blood oxygen level plummeted.
“My nails are turning blue,” he told his wife. “You should take me to the ER.”
He was admitted that night in late March, and they never spoke again.
In the ICU unit where he’d often worked, Guillermo was intubated and treated. Nearly two weeks later, he died.
An Eager Student, He Aimed To Become A Physician Assistant
(Courtesy of Catrisha House-Phelps)
Age: 40 Occupation: Registered nurse Place of Work: Omni Continuing Care nursing home in Detroit Date of Death: March 31, 2020
James House had a voracious appetite for learning about and a fascination with the human body.
His sister, Catrisha House-Phelps, traces it back to childhood visits to a dialysis center where their father received treatments. “That was what tugged at his heart,” she said. “He just always wanted to know ‘why.’”
House-Phelps said her brother adored his five children, treasured his anatomy and physiology books and got a kick out of the residents he cared for at Omni Continuing Care. “He thought they were family; he just said they were funny people,” she said. He had hoped to go back to school to become a physician assistant.
House came down with what he thought was the flu in mid-March. His sister said he tried to get tested for COVID-19 but was turned away because he was not showing textbook symptoms and had no underlying health issues. On March 31, after resting at home for over a week, House returned to work. Hours later, he collapsed and was rushed to the hospital.
He texted his sister with updates on his condition. “I’m about to be intubated now,” he wrote. It was the last message he sent her.
Pamela Hughes and her daughter, Brie
(Courtesy of Angie McAllister)
Age: 50 Occupation: Nursing home medication aide Place of Work: Signature HealthCARE at Summit Manor in Columbia, Kentucky Date of Death: April 13, 2020
Pamela Hughes lived her entire life in rural Columbia, Kentucky, but longed for wide, sandy beaches. For vacation, Hughes and her daughter, Brie, 26, eagerly drove 14 hours to Daytona Beach, Florida, or Myrtle Beach, South Carolina.
After high school, Hughes worked at Summit Manor, a nursing home in Columbia, for 32 years. She knew which residents preferred chocolate milk or applesauce with their medication; she remembered their favorite outfits and colors. Hughes’ shy demeanor vanished each December when she and co-worker Angie McAllister built a float for the town’s Christmas parade competition.
“We built 10 floats over 10 years,” McAllister said. “We got second place every year.”
Even after several residents tested positive for the coronavirus, Hughes dismissed her worsening cough as allergies or bronchitis. The nursing home was short on help and she wanted to serve her patients, Brie said.
Days later, the public health department suggested her mother get tested. She tested positive, and her health worsened — food tasted bitter, her fever soared, her hearing dulled. On April 10, Hughes was taken by ambulance to a hospital, then by helicopter to Jewish Hospital in Louisville. Barred from visiting, Brie said goodbye over FaceTime.
The Family Matriarch And ‘We’re Failing Miserably Without Her’
(Courtesy of Ginu John)
Age: 65 Occupation: Registered nurse Place of Work: Queens Hospital Center in New York City Date of Death: April 5, 2020
Aleyamma John’s family wanted her to retire. Her husband, Johnny, an MTA transit worker, had stopped working a few years earlier. He and their son Ginu urged her to follow suit. “We told her, ‘I’m sure Dad wants to see the world with you — you need to give him that opportunity,’” Ginu said.
She demurred. “I think she found fulfillment in being able to serve,” Ginu said. “She was able to hold people’s hands, you know, even when they were deteriorating and be there for them.” She began her career as a nurse in India 45 years ago; she and her husband immigrated to the United Arab Emirates, where their two sons were born, and moved to New York in 2002.
Ginu said his mother, a devout Christian, found joy in tending to her vegetable garden and doting on her two grandchildren. She cooked dishes from her native India and filled the Long Island home she shared with Johnny, Ginu and Ginu’s family with flowers.
In March, as Queens Hospital Center began to swell with COVID-19 patients, John sent her family a photo of herself and colleagues wearing surgical hats and masks but not enough personal protective equipment. Days later, she developed a fever and tested positive for the virus. Johnny, Ginu and Ginu’s wife, Elsa, a nurse practitioner, also became ill.
When John’s breathing became labored, her family made the difficult decision to call 911. It would be the last time they saw her. “We’re 17 days in, and I feel like we’re failing miserably without her,” Ginu said.
‘Blooming’ In Her First Job On Path To Becoming A Nurse
(Courtesy of the Viveros family via GoFundMe)
Age: 20 Occupation: Nursing assistant Place of Work: Extended Care Hospital of Riverside, California Date of Death: April 5, 2020
At 20 years old, Valeria Viveros was “barely blooming,” developing the skills and ambition to pursue a nursing career, said Gustavo Urrea, her uncle. Working at Extended Care Hospital of Riverside was her first job.
Viveros, born in California to Mexican immigrants, grew attached to her patients at the nursing home, bringing them homemade ceviche, Urrea said. About a month ago, as he watched her cook, play and joke with her grandmother, he noticed how much her social skills had grown.
When she would say “Hi, Tío,” in her playful, sweet, high-pitched voice, “it was like the best therapy you could have,” Urrea recalled. Viveros, who lived with her parents and two siblings, was enrolled in classes at a community college.
Viveros felt sick on March 30, went to a nearby hospital and was sent home with Tylenol, Urrea said. By April 4, she couldn’t get out of bed on her own. She left in an ambulance and never came back.
“We’re all destroyed,” he said. “I can’t even believe it.”
On April 5, county health officials reported a coronavirus outbreak had sickened 30 patients and some staff at her nursing home. Trent Evans, general counsel for Extended Care, said staffers are heartbroken by her death.
Viveros was “head over heels in love with the residents that she served,” he said. “She was always there for them.”
Surgical Technician Made Friends Everywhere She Went
(Courtesy of Jorge Casarez)
Monica Echeverri Casarez
Age: 49 Occupation: Surgical technician Place of Work: Detroit Medical Center Harper University Hospital in Detroit Date of Death: April 11, 2020
Monica Echeverri Casarez was in constant motion, said her husband, Jorge Casarez. The daughter of Colombian immigrants, she worked as a Spanish-English interpreter in clinical settings. She was the kind of person whose arrival at a mom and pop restaurant would elicit hugs from the owners. She also co-founded Southwest Detroit Restaurant Week, a nonprofit that supports local businesses.
Twice a month, she scrubbed in as a surgical technician at Harper University Hospital. “She liked discovering the beauty of how the body works and how science is clear and orderly,” Casarez said. She was organized and intuitive, qualities that are assets in the operating room. On March 21, she posted a photo of herself in protective gear with the caption: “I’d be lying if I said I wan’t at least a bit nervous to be there now.” Since many elective surgeries had been canceled, Echeverri Casarez was tasked with taking the temperatures of people who walked into the hospital and making sure their hands were sterilized.
Soon after, Echeverri Casarez and Casarez began feeling ill. Quarantined together, Echeverri Casarez tried to make the best of the situation. She baked her husband a cake — chocolate with white frosting. She died a few days later.
A Whip-Smart Neurologist Endlessly Fascinated With The Brain
(Courtesy of Jennifer Sclar)
Age: 66 Occupation: Neurologist Place of Work: Mount Sinai Queens in New York City Date of Death: April 12, 2020
Gary Sclar was a whip-smart neurologist who loved comic books, “Game of Thrones” and “Star Wars,” said his daughter, Jennifer Sclar. He was deeply compassionate with a blunt bedside manner.
“My dad was fascinated with the brain and with science,” Jennifer Sclar said. “His work was his passion, and it’s what made him the happiest, besides my brother and me.” Set to retire in June, he was looking forward to writing about politics and neurology.
Gary Sclar saw patients who were showing COVID-19 symptoms and knew his age and underlying health conditions ― he had diabetes — put him at risk for developing complications from the illness. His daughter pleaded with him to stop going to the hospital.
In early April, he mentioned having lost his sense of smell, and on April 8 he collapsed in his home. He was hospitalized a few days later and agreed to be intubated. “I don’t think he realized, like, that this was the end,” Jennifer Sclar said. “He brought his keys. He brought his wallet.”
An Exacting But Loving Aunt, She Was A Mentor Until The End
(Courtesy of Jhoanna Mariel Buendia)
Araceli Buendia Ilagan
Age: 63 Occupation: Intensive care unit nurse Place of Work: Jackson Memorial Hospital in Miami Date of Death: March 27, 2020
For Jhoanna Mariel Buendia, her aunt was a constant ― if distant — presence. Araceli Buendia Ilagan emigrated from their hometown Baguio, in the Philippines, to the U.S. before Buendia was born, but she remained close to her family and communicated with them nearly every day.
“She was one of the smartest people I ever knew,” Buendia, 27, said. Buendia Ilagan, who at one point looked into adopting her niece so she could join her and her husband the United States, encouraged Buendia to become a nurse, and talked her through grueling coursework in anatomy and physiology. Buendia is now a nurse in London.
Buendia Ilagan was also demanding. “Whenever she visited the Philippines, she wanted everything to be organized and squeaky-clean,” Buendia said.
The last time the two spoke, in late March, Buendia Ilagan didn’t mention anything about feeling ill. Instead, the two commiserated over their experiences of treating patients with COVID-19; as always, her aunt offered her advice on staying safe while giving the best possible care. She died four days later.
A Beloved Geriatric Psychiatrist And Church Musician Remembered For His Cooking Skills
(Courtesy of Nida Gonzales)
Leo Dela Cruz
Age: 57 Occupation: Geriatric psychiatrist Place of Work: Christ Hospital and CarePoint Health in Jersey City, New Jersey Date of Death: April 8, 2020
Dr. Leo Dela Cruz was nervous about going to work in the weeks before he died, his friends said. Like many in the region, Christ Hospital had an influx of COVID-19 patients and faced a shortage of ventilators and masks.
Dela Cruz was a geriatric psychiatrist and didn’t work in coronavirus wards. But he continued to see patients in person. In early April, Dela Cruz, who lived alone, complained only of migraines, his friends said. Within a week, his condition worsened, and he was put on a ventilator at a nearby hospital. He died soon after.
Friends said he may have been exposed at the hospital. (In a statement, hospital representatives said he didn’t treat COVID-19 patients.)
Dela Cruz, the oldest of 10 siblings, came from a family of health care professionals. His friends and family — from Cebu, Philippines, to Teaneck, New Jersey — remembered his jovial personality on Facebook. He won “best doctor of the year” awards, played tennis and cooked traditional Cebu dishes.
Nida Gonzales, a colleague, said he always supported people, whether funding a student’s education or running a church mental health program. “I feel like I lost a brother,” she said.
Age: 60 Occupation: Nurse Place of Work: Marion Regional Nursing Home in Hamilton, Alabama Date of Death: April 6, 2020
Rose Harrison, 60, lived to serve others ― her husband, three daughters, grandchildren and the residents of the nursing home where she worked. Though the Alabama nurse was selfless, she also had a sassy edge to her personality and a penchant for road rage, her daughter, Amanda Williams said.
“Her personality was so funny, you automatically loved her,” Williams said. “She was so outspoken. If she didn’t agree with you, she’d tell you in a respectful way.”
Harrison was not wearing a mask when she cared for a patient who later tested positive for COVID-19 at Marion Regional Nursing Home in Hamilton, Alabama, her daughter said. She later developed a cough, fatigue and a low-grade fever, but kept reporting to duty all week. Officials from the nursing home did not return calls for comment.
On April 3, Williams drove her mother to a hospital. The following evening, Harrison discussed the option of going on a ventilator with loved ones on a video call, agreeing it was the best course. Williams believed that her mother fully expected to recover. She died April 6.
Connecticut Social Worker Had Angelic Singing Voice And A Zest For Life
(Courtesy of the Hunt family)
Age: 57 Occupation: Social worker Places of Work: Cornell Scott-Hill Health Center and New Reach, both in New Haven, Connecticut Date of Death: March 23, 2020
At a shelter for adults recovering from addiction, residents looked forward to the days when Marion “Curtis” Hunt would take the stage, emceeing talent shows and belting out Broadway and gospel tunes.
It wasn’t part of his job description as a social worker. It was just one of the ways he went “above and beyond,” said his supervisor at Cornell Scott-Hill Health Center, Daena Murphy. “He had a beautiful voice,” she said. “He was just a wonderful person — funny, engaging, always a huge smile on his face.”
Hunt, the youngest of four brothers, earned his master’s in social work from Fordham University at 52, and was baptized at his brother’s Pentecostal church at 54. He was a devoted uncle who doted on his dog and cat, Mya and Milo.
It’s unclear how Hunt got infected, but one patient he worked with had tested positive for COVID-19, as did two co-workers, according to Dr. Ece Tek, another supervisor at Cornell Scott-Hill Health Center. Hunt died on March 23, one week after developing flu-like symptoms, said his brother John Mann Jr.
To The End, King-Smith Was Driven By A Desire To Help Others
(Courtesy of Hassana Salaam-Rivers)
Age: 53 Occupation: Electrocardiogram technician Place of Work: University Hospital in Newark, New Jersey Date of Death: March 31, 2020
Kim King-Smith was a natural caregiver. An only child, she grew up close to her extended family, including her cousins Hassana Salaam-Rivers and Sharonda Salaam. After Salaam developed multiple sclerosis, King-Smith visited her every day.
“She’d bring her sweets that she wasn’t supposed to have and share them with her,” Salaam-Rivers said. King-Smith’s desire to care for others was the reason she became an electrocardiogram technician, her cousin added. “If a friend of a friend or family member went to the hospital, she would always go and visit them as soon as her shift was over,” she said.
In March, King-Smith cared for a patient she said had symptoms of COVID-19; she soon fell ill herself and tested positive for the virus. It seemed like a mild case at first, and she stayed in touch with family via FaceTime while trying to isolate from her husband, Lenny.
On March 29, Salaam-Rivers checked in on her cousin and noticed she was struggling to breathe. She urged her to call an ambulance. After King-Smith was hospitalized, she exchanged text messages with her mother and cousin. As the day progressed, her messages carried increasingly grave news, Salaam-Rivers said. Then she stopped responding.
On The Eve Of Retirement, VA Nurse Succumbs To COVID-19
(Courtesy of Mark Accad)
Age: 72 Occupation: Clinical nursing coordinator Place of Work: Detroit VA Medical Center in Detroit, Michigan Date of Death: March 30, 2020
Nurse Divina “Debbie” Accad had cared for veterans for over 25 years and was set to retire in April. But after contracting the novel coronavirus, she spent her final 11 days on a ventilator — and didn’t survive past March.
She joined a growing list of health care professionals working on the front lines of the pandemic who have died from COVID-19.
Accad, 72, a clinical nursing coordinator at the Detroit VA Medical Center, dedicated her life to nursing, according to her son Mark Accad.
“She died doing what she loved most,” he said. “That was caring for people.”
California Nurse Thrived In ER and ICU, But Couldn’t Survive COVID-19
Jeff Baumbach and his wife, Karen
(Courtesy of the Baumbach family)
Age: 57 Occupation: Registered nurse Place of Work: St. Joseph’s Medical Center in Stockton, California Date of Death: March 31, 2020
Jeff Baumbach, 57, was a seasoned nurse of 28 years when the novel coronavirus began to circulate in California. He’d worked in the ER, the ICU and on a cardiac floor. Hepatitis and tuberculosis had been around over the years but never posed a major concern. He’d cared for patients who had tuberculosis.
Jeff and his wife, Karen Baumbach, also a nurse, initially didn’t consider it significantly riskier than challenges they’d faced for years.
“He’d worked in the ICU. He was exposed to so many things, and we never got anything,” she said. “This was just ramping up.”
One day during work, Jeff sent a sarcastic text to his wife: “I love wearing a mask every day.”
Within weeks, he would wage a difficult and steady fight against the virus that ended with a sudden collapse.
Nurse’s Faith Led Her To Care For Prisoners At A New Jersey Jail
(Courtesy of Denise Rendor)
Age: 60 Occupation: Registered nurse Place of Work: Hudson County Correctional Facility in Kearny, New Jersey Date of Death: April 5, 2020
Daisy Doronila had a different perspective than most who worked at the Hudson County Correctional Facility, a New Jersey lockup 11 miles from Manhattan. It was a place where the veteran nurse could put her Catholic faith into action, showing kindness to marginalized people.
“There would be people there for the most heinous crimes,” said her daughter, Denise Rendor, 28, “but they would just melt towards my mother because she really was there to give them care with no judgment.”
Doronila, 60, died April 5, two weeks after testing positive for the coronavirus that causes COVID-19. The jail has been hit hard by the virus, with 27 inmates and 68 staff members having tested positive. Among those, another nurse, a correctional officer and a clerk also died, according to Ron Edwards, Hudson County’s director of corrections.
Doronila fell ill before the scope of the jail infections were known. She was picking up extra shifts in the weeks before, her daughter said, and planning on a trip to Israel soon with friends from church.
That plan began to fall apart March 14, when someone at the jail noticed her coughing and asked her to go home and visit a doctor.
An Army Veteran, Hospital Custodian ‘Loved Helping People’
(Courtesy of Michelle Wilcox)
Age: 54 Occupation: Environmental service assistant Place of Work: Rochester General Hospital in Rochester, New York Death: March 17, 2020
Alvin Simmons started working as a custodian at Rochester General Hospital, in New York state, weeks before he fell ill. “He loved helping people and he figured the best place to do that would be in a hospital,” his sister, Michelle Wilcox said.
An Army veteran who had served in the first Gulf War, Simmons loved karaoke and doted on his three grandchildren, Wilcox said. “He was a dedicated, hardworking individual who had just changed his life around” since a prison stint, she said.
According to Wilcox, Simmons began developing symptoms shortly after cleaning the room of a woman he believed was infected with the novel coronavirus. “Other hospital employees did not want to clean the room because they said they weren’t properly trained” to clean the room of someone potentially infected, she said. “They got my brother from a different floor, because he had just started there,” she said. (In an email, a hospital spokesperson said they had “no evidence to suggest that Mr. Simmons was at a heightened risk of exposure to COVID-19 by virtue of his training or employment duties at RGH.”)
On March 11, he visited the emergency room at Rochester General, where he was tested for COVID-19, Wilcox said. Over the next few days, as he rested at his girlfriend’s home, his breathing became more labored and he began to cough up blood. He was rushed to the hospital on March 13, where he was later declared brain-dead. Subsequently, he received a COVID-19 diagnosis. Simmons died on March 17.
Dr. J. Ronald Verrier Was Busy Saving Lives Before The Pandemic
(Courtesy of Christina Pardo)
J. Ronald Verrier
Age: 59 Occupation: Surgeon Place of Work: St. Barnabas Hospital in the Bronx, New York Date of Death: April 8, 2020
Dr. J. Ronald Verrier, a surgeon at St. Barnabas Hospital in the Bronx, spent the final weeks of his audacious, unfinished life tending to a torrent of patients inflicted with COVID-19. He died April 8 at Mount Sinai South Nassau Hospital in Oceanside, New York, at age 59, after falling ill from the novel coronavirus.
Verrier led the charge even as the financially strapped St. Barnabas Hospital struggled to find masks and gowns to protect its workers — many nurses continue to make cloth masks — and makeshift morgues in the parking lot held patients who had died.
“He did a good work,” said Jeannine Sherwood, a nurse manager at St. Barnabas Hospital who worked closely with Verrier.
America’s First ER Doctor To Die In The Heat Of COVID-19 Battle
(Courtesy of Debra Vasalech Lyons)
Age: 60 Occupation: Doctor Places of Work: St. John’s Episcopal in Queens, New York, and East Orange General in New Jersey Date of Death: March 26, 2020
At about 5 a.m. on March 19, a New York City ER physician named Frank Gabrin texted a friend about his concerns over the lack of medical supplies at hospitals.
“It’s busy ― everyone wants a COVID test that I do not have to give them,” he wrote in the message to Eddy Soffer. “So they are angry and disappointed.”
Worse, though, was the limited availability of personal protective equipment (PPE) — the masks and gloves that help keep health care workers from getting sick and spreading the virus to others. Gabrin said he had no choice but to don the same mask for several shifts, against Food and Drug Administration guidelines.
“Don’t have any PPE that has not been used,” he wrote. “No N95 masks ― my own goggles — my own face shield,” he added, referring to the N95 respirators considered among the best lines of defense.
Less than two weeks later, Gabrin became the first ER doctor in the U.S. known to have died as a result of the COVID-19 pandemic, according to the American College of Emergency Physicians.
This story is part of “Lost on the Frontline,” an ongoing project from The Guardian and Kaiser Health News that aims to document the lives of health care workers in the U.S. who die from COVID-19, and to investigate why so many are victims of the disease. If you have a colleague or loved one we should include, please share their story.