--:-- Sean Rameswaram: It's Tuesday, April 21st, 2020, and the president has reached a deal with Congress. I'm Sean Rameswaram. This is your coronavirus update from Today Explained.
--:-- Sean Rameswaram: Congressional leaders and President Trump are shaking on a $500 billion relief package that will replenish the Paycheck Protection Program, which provides loans to small businesses. The package also funds hospitals and coronavirus testing around the country.
--:-- Sean Rameswaram: President Trump's solution to the pandemic sounds a lot like his solution to everything else. Close the borders. He announced the plan last night on Twitter, writing that in light of the attack from the invisible enemy, as well as the need to protect the jobs of our great American citizens, I will be signing an executive order to temporarily suspend immigration into the United States.
--:-- Sean Rameswaram: It's worth remembering that the United States has more confirmed cases of COVID-19 than any other country on Earth. That hasn't stopped the governor of Georgia from promising to open up some businesses by Friday of this week, including gyms, salons, bowling alleys, and tattoo parlors, just the super dangerous stuff.
--:-- Sean Rameswaram: Meanwhile, the mayor of Atlanta is urging residents to stay at home, and an infectious disease specialist at Emory University's School of Medicine in Atlanta said, opening up a section of the country is like having a peeing section in a swimming pool.
--:-- Sean Rameswaram: Hong Kong reported no new infections for the first time since early March on Monday, but still announced an extension of social distancing measures today. They're going to keep gyms, bars, and playgrounds closed through early May and maintain a ban on public gatherings of more than four.
--:-- Sean Rameswaram: Italy's looking to ease its lockdown in early May. The country's north was hit hardest, but now the south is suffering. Italy's prime minister promised to proceed with caution.
--:-- Sean Rameswaram: And the price of oil has gone negative. I don't traffic in oil. I ride a bike. So I looked up what that means in the New York Times and learned that if you happen to be in the position to accept delivery of a thousand barrels of oil in Oklahoma next month, you could have been paid $37,000 to do so.
--:-- Sean Rameswaram: That's how much demand for oil has fallen. There's way too much to go around and storage is running out. President Trump today said we will never let the great U.S. oil and gas industry down. He said that on Twitter, in case you're wondering.
--:-- Sean Rameswaram: Today Explained will try and never let you down. Keep us honest. Email todayexplained at vox.com or tweet at us. We're at today underscore explained. I'm at Ramisverham. Or you can call us at 202-688-5944 and leave us a message on our listener voicemail line.
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--:-- Sean Rameswaram: A few weeks ago, I talked to a doctor who was working different emergency rooms in New York City. He talked a bit about his day-to-day, but we mostly focused on the fact that he didn't have the proper personal protective equipment at his disposal.
--:-- Sean Rameswaram: He kept reusing the same N95 mask. We've heard a lot from doctors during this crisis, and rightly so. But there are a lot of healthcare workers who aren't doctors, who are still out there risking their lives every day.
--:-- Sean Rameswaram: And on today's show, you're going to hear from them directly. No interviews, no questions, just a nurse, a physician's assistant, and a paramedic walking us through a day in their lives.
--:-- Sean Rameswaram: The day was Friday, April 10th.
--:-- Katie: My name is Katie. I'm a registered nurse in a pediatric intensive care unit in New York City. It's about 6:35 in the morning, and I am just arriving at work to start my day.
--:-- Katie: Working as a critical care nurse in an ICU, we are used to seeing critically ill patients. However, I don't think anything could have really prepared us for what we are seeing now during this pandemic.
--:-- Katie: Thankfully, children have been largely spared from getting critically ill. That said, our pediatric intensive care unit has now been turned into an adult ICU, that's kind of flipped our world upside down.
--:-- Katie: Many of us don't even have adult ICU experience, and now we are treating some of the sickest patients I've ever seen. And they're all adults.
--:-- Katie: Patients are having to wait in the emergency room for ICU beds. And then once they are finally admitted to us, they get so sick so quickly.
--:-- Katie: And, you know, I've heard a lot of people say it's almost like falling off a cliff. A lot of these patients present and they look like, you know, they're going to maybe do okay.
--:-- Katie: And then all of a sudden you have to rapidly intubate them. They are requiring, you know, ventilators, not just for a few days, but for weeks at a time.
--:-- Katie: And then the effects of everything that follows. Many of them go into kidney failure and multi-system organ failure.
--:-- Katie: I think the hardest part about this is when we go in to see a patient, everything except our eyes are covered. And even then, we have a face shield on.
--:-- Katie: Not one part of our skin is exposed. And these patients are alone. And that is really the hardest part is that we are sometimes the last person that they see in this life.
--:-- Katie: You know, you want to hold their hand and you want to hug them and let them know that they are not alone and let their family know that you were there to provide that human touch.
--:-- Katie: And that's one thing we can't do. A lot of times the units are so busy because we have so many patients that it's really hard to keep families updated as much as they should.
--:-- Katie: And it's just torture for them to sit at home and have to wait for a phone call. You know, and oftentimes it's once a day. Once a day, a doctor will call and update them on their family member's status.
--:-- Katie: And it's just painful to think about the number of people that are alone. Just yesterday, there was a patient that last week, many of us thought would not survive.
--:-- Katie: He is a young man, and he was one of the sickest patients that I had ever taken care of. And yesterday, we were able to take the breathing tube out, and he was able to look at us and talk to us.
--:-- Katie: And at that moment, I think everybody in the entire room just broke down in tears. And this poor young man looked at us, not quite understanding what had just happened to him.
--:-- Katie: But knowing that he made it through this gave us so much hope. It's moments like that that really carry us through.
--:-- Katie: On that note, it's about 10 minutes before my shift starts.
--:-- Kira Bhandari: My name is Kira Bhandari, and I'm a physician assistant in the hematology department. I'm actually in the parking structure right outside work right now.
--:-- Kira Bhandari: One small blessing of working in the time of COVID for anyone that has lived in L.A. or visited L.A., you know the traffic is really as bad as they say it is.
--:-- Kira Bhandari: So my commute to and from work, and I'm sure all of my colleagues would agree, has been just fabulous. So that has been one small blessing.
--:-- Kira Bhandari: So I'm in the hematology department, but one sector of that is the bone marrow transplant team. Patients are incredibly vulnerable after that procedure.
--:-- Kira Bhandari: So vulnerable that we have actually decided to put off a lot of our transplants. There's just been so much concern about what the COVID would look like here.
--:-- Kira Bhandari: Would we have enough blood product? Would we have enough platelet? We have the things that we need. You know, those patients can get really sick and need ICU, need ventilators.
--:-- Kira Bhandari: We've been wanting to save that for the potential COVID surge here in L.A. And so the biggest change to my department has been sort of the negotiating of, I mean, literally life and death for some patients in deciding, okay, if we put off this transplant for this leukemia patient another three months, are we going to be able to keep that leukemia at bay long enough to take them to transplant after this is all over?
--:-- Kira Bhandari: About two or three weeks ago at the hospital, we stopped allowing visitors of any kind, you know, family. We had been making some exceptions for end of life.
--:-- Kira Bhandari: And unfortunately, in the last week or so, we've really had to really clamp it down. At this point, walking into the hospital, I'm going to have my temperature taken, take a short survey.
--:-- Kira Bhandari: I'll get a little green sticker that says I'm allowed to be there in addition to my special badge, which says I'm allowed to even be on campus right now.
--:-- Kira Bhandari: Especially in a cancer ward, as you can imagine, having family, friends and visitors is super important. Some patients that are here are getting chemotherapy.
--:-- Kira Bhandari: They might be in for an entire month getting chemotherapy. And because of COVID and because of the no visitors, they're not allowed to leave the room.
--:-- Kira Bhandari: They're not allowed to walk to the garden. They're really not seeing any other people. One of the toughest cases was a young man a few weeks ago who had a very aggressive form of blood cancer.
--:-- Kira Bhandari: And he was in his 20s and wasn't going to make it very long. He had a young child at home, three or four months old, and his wife. And I don't think she really understood the extent of how sick he had gotten because she had not been able to see him during his hospitalization.
--:-- Kira Bhandari: And we had to have a discussion with the palliative care team and the doctors and the nurses and his wife over FaceTime, you know, sort of holding the iPad up to him and talking about his death, essentially, in this really strange sort of robotic way.
--:-- Kira Bhandari: Meanwhile, everyone who's in the room trying to connect with him and talk to him is wearing masks and some form of protective gear.
--:-- Kira Bhandari: You know, conversations like that, they're not supposed to go that way. To be honest, I'm doing pretty well.
--:-- Kira Bhandari: I think it's kind of nice to have a purpose in this climate. My friends are, a lot of them are at home working and I know they're struggling.
--:-- Kira Bhandari: You know, they want to help. At least I get to see folks every day. I get to come in and take care of my patients and know that I'm ready to be deployed to go do other things.
--:-- Kira Bhandari: That being said, I'm probably running late, so I'm going to run into work, but that's been my morning check-in.
--:-- Chris Root: My name is Chris Root. I'm a paramedic in New York City. It is 3 o'clock on a Friday afternoon, and I just arrived at the hospital to start a 16-hour shift.
--:-- Chris Root: I'll be responding to 911 calls until 7 a.m. tomorrow morning. You know, on a typical day before the pandemic, as a paramedic, you can normally expect like a little bit of downtime.
--:-- Chris Root: Now, it's pretty much nonstop. It just takes so much longer to do every call because you get on scene and you have to put on all the PPE and you have to get upstairs.
--:-- Chris Root: You have to assess the patient. You have to get to the hospital. You have to turn the patient over. You have to take off all your PPE. You have to clean the ambulance from top to bottom.
--:-- Chris Root: Just everything is slower and more difficult now. I work in a neighborhood with a lot of old buildings, a lot of walk-up apartments with no elevators, and doing a five-floor walk-up with 50 pounds of equipment is not easy on a good day.
--:-- Chris Root: And if the patient is unconscious or too ill to walk, we have to then carry them back down five flights of stairs. But now doing all of that in PPE, wearing an impermeable gown and two pairs of gloves and goggles and an N95 mask.
--:-- Chris Root: It's just brutal. And you just feel so drained at the end of a shift. Over the past few weeks, I feel like I've seen the acuity of what we're responding to change.
--:-- Chris Root: Almost shift by shift. Just the patients are getting sicker every shift. On my last shift, I pronounced three people dead in three hours.
--:-- Chris Root: The volume of death that we're being exposed to on a daily basis is so much higher than anything we've seen before.
--:-- Chris Root: My family worries about me constantly. My girlfriend is scared when I leave for work. I text her throughout the shift so she knows I'm okay.
--:-- Chris Root: I bought my own respirator a week ago. So that I would have something in case our stockpiles ran out. And she burst into tears when she saw me trying it on.
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--:-- Katie: My name is Katie. I'm a registered nurse in a pediatric intensive care unit in New York City. I am just sitting in my car getting ready to leave work after what was a very busy, I guess now, 13-hour shift.
--:-- Katie: We're back with the stars of the show, three health care workers in their own words, Chris. He's a paramedic, Kira, a physician's assistant, and Katie, who's a nurse.
--:-- Katie: Today I didn't really get a lunch break. Most people didn't get a lunch break. We have a little room in the center of our unit, and whenever you were able to have a moment, you just snuck in, ate a granola bar, drank some water, did whatever you needed to do to get through these 13 hours.
--:-- Katie: Pretty much every patient on our unit is COVID positive. All of them are requiring ventilators. Some patients need to be turned over onto their belly to help with their oxygen saturations.
--:-- Katie: We've had many successes with sending patients to the floor after successful extubations. However, now one patient leaves and one more comes. Needless to say, I'm utterly exhausted and I will be going back tomorrow, so it will be a few hours of sleep and then back again for another day.
--:-- Katie: Physically, it's really taxing taking care of these patients. Mentally, you worry about doing the very best you can for that patient, but then you start to worry, what if I get this? What if this becomes me?
--:-- Katie: What if this becomes my parents or my husband or my brother or sister? Or what if this becomes my coworkers? We like to think that we're taking the best possible precautions.
--:-- Katie: However, with reusing masks and with the virus spreading as easily and quickly as it does, it's a big question mark a lot of the times. I worry about how this will change not only myself, but my colleagues every single day.
--:-- Katie: We are giving everything we have and I worry that some may burn out. I worry that some may decide they can't do this anymore. I worry that sometimes I may not be able to do this in the future because it is just so draining.
--:-- Katie: Yet every day we wake up and we go to work and we do the very best we can and we're all hanging on, but sometimes it feels like we're hanging on by a string.
--:-- Kira Bhandari: My name is Kira Bhandari. I'm a physician assistant in the hematology department. Basically what's been going on, at least at this hospital here in Los Angeles, is just a day-to-day switching of the rules and of the game plan.
--:-- Kira Bhandari: And we still don't really know what's coming. I think that's been the strangest part. I mean, we had a meeting a few weeks ago when we were afraid we might have a shortage of PPE, which right now we were okay, but again, we don't know.
--:-- Kira Bhandari: We even talked about purchasing motorcycle helmets. So at least we have proper face and head protection to protect both the patients and ourselves.
--:-- Kira Bhandari: So we really have trying to think outside the box and prepare for this the best that we can. The rules of the game are changing every single day.
--:-- Kira Bhandari: You know, one day it's wear this kind of mask in this room and then throw it out and the next day it's wear this mask and wear it all day and don't take it off and don't get a new one.
--:-- Kira Bhandari: And I'm so impressed and proud to be part of a medical team where, you know, we just get our marching orders in the morning and we're all trying to do our best to sort of adapt and be flexible to respond to this pandemic the best way that we can.
--:-- Kira Bhandari: Without being too macabre, I think something like this is exactly why I went into medicine, and I'm sure I'm not alone in that. It's not that you want bad things to happen, but you want to be the sort of person that can respond when they do.
--:-- Kira Bhandari: And so I'm ready to help in any way I can, and I'm really happy to be doing it, and I just hope that I can stay healthy enough to keep doing that.
--:-- Kira Bhandari: I'm not scared myself of getting sick, but even if we have an exposure, it can wipe out the whole workforce. Just last week, one of our resident physicians had a positive COVID test, and it meant that all of us had to get tested and basically stay out of work for two or three days.
--:-- Kira Bhandari: Which one person doing that is fine, but four or five people doing that on a team is catastrophic, as you can imagine. So I think that's what everyone is most worried about.
--:-- Kira Bhandari: It's about not necessarily us getting sick, but us having an exposure that means that we can't come into work and do the job that we need to do.
--:-- Chris Root: My name is Chris Root. I'm a paramedic in New York City. I just got into my car after my double shift overnight.
--:-- Chris Root: It is about 8:15 in the morning. I've been at work for a little over 17 hours. Something that we're seeing a lot of, we're seeing patients who are really far along into having significant heart attacks and strokes, who waited at home with their symptoms for hours because they're afraid to go to the emergency room because the emergency room is full of patients with COVID.
--:-- Chris Root: I feel really, really tired. I was supposed to get off at 7 a.m., but we got an assignment at 6:45, and an assignment typically takes about an hour minimum to turn around by the time you get to the scene and assess the patient and treat the patient and then turn them over in the emergency room.
--:-- Chris Root: So now it's an hour and 15 minutes after my shift was supposed to end and I get to go home. First thing I do when I get home I take my boots off outside I walk directly to the laundry hamper take off my uniform I don't touch my girlfriend or her dog until I've taken a long shower.
--:-- Chris Root: I'm really looking forward to taking a shower right now after 17 hours at work. The pandemic has definitely made me feel differently about being a paramedic.
--:-- Chris Root: I've never felt like the work was so important as it is right now, but I've also never been so scared being a paramedic. I've been in dangerous situations before with violent patients and on active crime scenes and things like that.
--:-- Chris Root: But there's something that's so much scarier about this invisible threat waiting for you behind every door.
--:-- Sean Rameswaram: Thanks to Katie, Kira, and Chris for making time to speak with Jillian Weinberger and Noam Hassentfeld from the Today Explained team. And thanks for listening. Thank you.
