March 18, 2020 at 1:08 p.m.
When the message arrived Monday morning, Katie Patel was sitting on the floor in her living room, watching two of her children build a tower from multicolored tiles as her third, a newborn, lay sprawled on a mat beside her.
Patel, 32, suddenly faced one of the most difficult choices of her life, so she called her husband, an emergency room doctor at Mercy Hospital South in St. Louis. Busy with patients, he could not pick up then but called her back later that day.
A colleague at the urgent care clinic where Patel worked as a nurse practitioner had self-quarantined after feeling sick and being tested for the coronavirus, which causes the deadly disease covid-19, she told her husband. Short-staffed, the clinic wanted Patel, who still had two weeks of maternity leave left, to come back early.
By then, the threat of the virus no longer felt distant. It had arrived, not just in America, but Missouri, St. Louis, and maybe one day soon, the couple feared, it would appear in their own home. Patel knew she would go back to work eventually, but she had thought those two weeks would give her enough time to prepare: to buy a new breast pump, to rehearse in her mind how she’d stay safe at work, to make a plan for who would look after the children — the oldest was 3 — since it had become too risky for her mother, in her 60s, to care for them.
Now, though, on the phone with her husband, Patel decided she could not wait. People needed her. She would go back.
“If we get sick,” she thought, “we’re just going to hope for the best.”
It is a grim sentiment shared by thousands of health-care workers on the front line of a pandemic that is expected to deluge the nation’s hospitals with new patients in the coming weeks. The people treating them understand what that means. They have read the stories from Italy, about doctors dying. They have heard of the findings from Wuhan, China, where nearly 1 in 5 health workers who caught the virus ended up in severe or critical condition. In the United States, where everyday activities have almost skidded to a halt, the virus has upended the lives of doctors and nurses more than anyone else.
Many are working in hospitals and clinics where the supply of protective gear is quickly dwindling. And yet, they often do not know which of their patients are sick, because testing kits nationwide are in such short supply.
Dozens of U.S. health-care workers have already fallen ill in the early days of the pandemic, some seriously. This week, the American College of Emergency Physicians announced two member doctors were in critical condition after contracting the coronavirus: a Washington state ER doctor in his 40s and a 70-year-old physician in New Jersey.
As physicians contend with a burgeoning angst that, for some, has begun to manifest in nightmares, many of them have drawn up wills or placed themselves into makeshift quarantines, sleeping in hotel rooms, garages and basements in hopes that they will not infect their families.
“Nobody has any idea what health-care workers are going through,” said a Maryland doctor, who spoke on the condition of anonymity because she did not have permission from her hospital to talk to the news media. “It’s unreal.”
“We approached it like any other medical or scientific decision,” said the woman. Her husband considered checking into a hotel room but decided not to because it could put staff and other guests at risk. Eventually, he moved into his office, at work. His family has not seen him in nearly a week, and they will not for at least another month — maybe longer, if he gets sick.
“If he does, it’ll be 14 days after he gets infected, unless he’s admitted, intubated or dies,” she said.
The woman now works remotely from home, where she conducts telehealth consultations. She sleeps only a few hours a night, emerging from her room each morning to cook. After carefully washing her hands, she leaves her kids’ meals on the table, then takes her own up to her room.
Since last week, she has not come within six feet of any of them. No back rubs. No brushes through their hair. No hugs.
“We can’t risk our kids’ health for this,” she said. “It is one thing to say that we took an oath to do this, but our kids didn’t take an oath.”
Though she monitors herself for signs of infection, she worries most about her husband, who, like many physicians, continues to work even as protective gear runs out.
He has been so busy treating coronavirus patients that they have only FaceTimed twice since he moved to the hospital, once for just a few seconds. She follows his movements on a GPS app to make sure he is okay.
On Tuesday night, she watched “Ferris Bueller’s Day Off” with her kids — them in the living room and her, alone, in the master bedroom. The kids had their TV, and she had hers, all of them with their own bowls of popcorn.
By then, Roberta Lenoir had already waited three days, at times in fleeting terror, to find out whether the pandemic would change her life more than it already had.
She was with her family on Saturday when the news came. At the time, Lenoir, a 61-year-old emergency department nurse at United Medical Center in Southeast Washington, was trying to avoid an attack of seasonal allergies by staying inside with the relatives who share her home. Then her phone rang. On the line, she heard the voice of a manager from the hospital.
A doctor Lenoir worked with had tested positive for the coronavirus.
For anyone, the news would have been sobering. But it was especially so for Lenoir, who had been home for several days in Oxon Hill, Md., mingling with loved ones who could be especially vulnerable to the coronavirus. There was her mother, an 89-year-old kidney transplant patient; her disabled sister; her daughter, recovering from a Caesarean section; and the 2-week-old baby. Lenoir herself has the autoimmune disease lupus.
“I had already been around them three days,” Lenoir said. “So it was like, ‘We already got it, if I got it.’ ”
She had reasons to remain hopeful. Lenoir had shown no symptoms, and her family already practiced stringent hand-washing and other hygiene measures because of her mom’s compromised immune system and the presence of the newborn. Called into the hospital, she received a nasal swab to test for the presence of the virus, alongside others who had worked with the infected doctor.
Now she is waiting for the results, unable to return to work until she is cleared.
Because she is the breadwinner and caretaker to a crowded household, self-quarantine is not an option. Nor is isolation from the outside world. Lenoir continues to go to pharmacies for her family’s medications and grocery stores for their food. The baby needs formula. She now wears a mask when she leaves the house and has tried to limit excursions to those absolutely necessary.
“There are things that we have to do as a family, to start preparing for the possibility of being locked down for two weeks to a month,” she said.
If she develops a fever or other virus symptoms, Lenoir said, she will figure out how to isolate herself. As of Tuesday, she felt fine.
“Until I spike a temperature or show some real signs of having a virus or having an upper respiratory infection, there is really no need to go and isolate like that,” she said. “There is no need, because I’m not sick.”
She added: “I understand that society is frightened. I understand that very acutely, because I am frightened.”
But life does not stop. Her family’s needs have not disappeared. She is eager to go back to work, helping some of the District’s poorest and sickest patients — people she fears could be hit especially hard.
After struggling for decades with mismanagement and financial problems, United Medical Center is scheduled to close in 2023. But in some ways, Lenoir said, it was well prepared for this moment. The hospital still has unused supplies acquired during the 2014 Ebola outbreak, including an adequate stock of the N95 masks that have become scarce at other medical facilities.
One thing it does not have: test kits that can deliver rapid results. Few medical facilities in the Washington region have the capacity for rapid on-site testing, and UMC is no exception. Lenoir’s swab sample was sent off to a lab.
As she remains in limbo, she rues what she believes were the squandered weeks and months in which the U.S. government could have forestalled the pandemic’s spread.
“We could have been so far ahead of the 8-ball,” she said, “instead of now having to wake up and everybody is scrambling.”
She thinks about all the people walking around who, unlike her, will not have a definitive test result anytime soon. How many could be spreading the virus without knowing it? Even with an ample stock of hand sanitizer and disciplined “social distancing,” there is no way to fully remove the risk of contagion.
In Ohio, Heather Tubbs Cooley, a pediatric nurse, and her husband, a physician, accepted that reality two weeks ago, when they saw how the virus had begun to ravage Italy.
“If you’re going to start seeing these patients,” she asked her husband, “how are you going to come home?”
He works mostly with patients who come through his hospital’s emergency room but are not immediately admitted into the intensive care unit. Because the couple has three kids — ranging from 5 to 12 — he has long taken extra precautions not to bring home bugs he’s exposed to at work. When he arrives, he removes his clothes in the garage and packs them into a garbage bag before changing into a fresh wardrobe and going inside the house. Now, in addition, he touches nothing and heads straight for the shower.
He has not yet self-isolated, in part because Tubbs Cooley, a researcher not currently seeing patients, needs help educating their kids, whose schools have closed. He will quarantine, though, if he develops any symptoms.
Tubbs Cooley knows her husband is treating people presumed to be infected, but he has not told her how many, both because of patient confidentiality and because he is trying to protect her.
“He doesn’t want me to freak out,” she said.
Their kids have handled the upheaval well, but Tubbs Cooley can sense their concern. They ask, often, about their parents’ work schedules and have begun sleeping in the couple’s bedroom. They watch their father closely, glancing at him after every cough or throat clearing.
“Dad, are you okay?”
Tubbs Cooley and her husband have tried to be honest with them, explaining what the virus is and what it does, but making clear that the vast majority of people who catch it survive.
Still, the two of them decided that they could not ignore the most dire possibility, and they needed to plan for it. They came up with a shortlist of relatives who could care for the kids, in case of an emergency — or worse.
One recent evening, the family gathered to talk about it.
If Mom and Dad got sick, or died, the couple asked their children, where would they want to live?