By Edwin Quinabo
Just a few weeks after lifting some restrictions and launching a “soft” opening of Hawaii’s economy (tourism still largely closed), the state registered more than half (23) of its total deaths (49) due to COVID-19 for the month of August alone. The recent spike in both deaths and infections (consecutive triple-digit days) prompted Gov. David Ige and Honolulu Mayor Kirk Caldwell to reinstate a second Stay-atHome order with some of the initial restrictions imposed in early Spring.
Stress and anxiety over this merciless disease couldn’t be more pronounced than in hospitals across the nation. Psychology Today published an article showing that hospital frontline workers are experiencing high-stress levels and anxiety, largely in part, due to the risk to workers’ and patients’ health.
According to a database by The Guardian (newspaper) and KHN (Kaiser Health News) 900 frontline U.S. healthcare workers have died of COVID-19. The tally includes doctors, nurses, paramedics, hospital custodians, administrators and support staff. The database also shows many of them are immigrants, including healthcare workers from the Philippines.
While “front-liners” face intense potentially life-and-death situations treating COVID-19, hospital workers also report immeasurable satisfaction to be front and center helping patients in a most critical, historic time.
This Labor Day, September 7, Americans will have the opportunity to give thanks to the nation’s essential workers — hospital staff, farmers, meatpackers, grocery employees, cashiers, truck drivers, emergency responders, government-postal-banking-utility-hotel workers, and many others. The Brookings Institution estimates there are over 50 million essential workers.
Labor Day this year will have extra significance, extra gratitude for frontline workers who’ve laid it all on the line, risking their personal health to heal our sick, keep food on our table, and make life as close as possible to where it was before the pandemic.
First patient put on breathing tube at Pali Momi ICU; one of Hawaii’s first COVID-19 Survivor
Dr. Emilio Ganitano Jr. is a Critical Care Medicine Specialist physician (an intensivist) and Medical Director at Pali Momi ICU. He is the physician team leader of a large group of physicians, nurses, respiratory therapist and other healthcare providers who care for patients in the Intensive Care Unit (ICU), where patients are at high risk of death.
He describes the first patient with COVID-19 on a mechanical ventilator at Pali Momi’s ICU. “In the early spring of 2020, I remember transferring an elderly patient to the ICU for COVID 19 Pneumonia. The patient had first been admitted to a non-ICU floor, but in a matter of days, the patient’s condition had quickly deteriorated. The patient was very afraid as our discussions included the fact that patients who get placed on ‘breathing machines’ often did not do well. The patient wanted the best chance possible. After being moved to the ICU, I placed a ‘breathing tube’ into the patient’s lungs to allow our mechanical ventilators to support the patient through the pneumonia.”
As the first COVID-19 patient on a ventilator for his team, Dr. Ganitano Jr. called it a defining moment. “We were afraid for the patient, knowing that COVID 19 patients could deteriorate quickly. We were afraid for ourselves, fearful of catching COVID 19.”
What’s most memorable to Dr. Ganitano Jr. was seeing that patient get better, leave the hospital and go home.
“That patient was one of the first ICU survivors of COVID-19 in Hawaii.”
According to the Centers for Disease Control and Prevention (CDC), the mortality rate for COVID-19 is 0.65 percent. CDC’s best estimates currently are that 650 out of 100,000 who contract COVID-19 would die from it.
But the CDC also says contracting the virus could also leave the infected with long-term health problems.
CDC also says their estimate could be lower than what’s really occurring. “This parameter is not necessarily equivalent to the number of reported deaths per reported case because many cases and deaths are never confirmed to be COVID-19, and there is a lag in time between when people are infected and when they die,” the report states.
Dr. Ganitano Jr, who also is a member of the Philippine Medical Association of Hawaii (PMAH), said besides that patient in the early days of COVID-19, his most memorable moments relating to the pandemic is the hospital’s team pulling together each day providing the best care for their patients.
Dying with few to no family present for COVID and non-COVID patients
Dr. Mark Valdez also is an intensivist physician and PMAH member. He’s confirmed stories many have heard of COVID-19 patients dying without family around is true.
Due to visitor restrictions at hospitals to keep the virus from spreading, he said this holds true for non-COVID-19 patients as well. This is a fact many are not aware of.
Dr. Valdez said prior to COVID-19, it was common for a large group of families to be at a dying patient’s bedside. “Patients usually pass away during or after being surrounded by loved ones, with multiple family members able to console each other.”
Dr. Valdez recalls having to tell a non-COVID-19 patient’s family that their loved one would not make it. “Because of the risk of COVID spread, instead of the usual large gathering around her, we restricted her family (there were at least 12 of them) to two visitors at a time (10-15 minute time limit each) while the others had to wait outside the hospital.
“I still wonder if the family was able to cope adequately with how rushed their final goodbye was, but thankfully they were all able to see her before she passed away. I think this experience illustrates the reach of this pandemic, having indirect effects on those not even infected with it.”
The outcome Dr. Valdez describes is actually a fortunate one because some hospitals will not allow visitors to see dying patients at this time.
Dr. Lochan Shah wrote an article on how the pandemic is changing end-of-life care. He says at his hospital, the only way a family member can see their loved one in person is if the patient is actively dying, meaning after loved ones have requested the medical team to withdraw life-sustaining care.
Dr. Shah also writes not being able to see a patient struggling to survive, not only means that the patient is in distress alone, “but because the family cannot see their loved ones in person, it’s so much more difficult for the patient to understand what is happening medically. For example, what it means to be on a ventilator? What can modern medicine provide?”
He says “I realize just how unprepared we are as a society for this wave of current patients who are at the end of life in the COVID-19 era,” – again, which is affecting both COVID and non-COVID dying patients. Video chats, phone calls are painfully insufficient.
Nerve-Wrecking, uncontrolled heaviness
Tazialynn Lynam is an Emergency Room Registered Nurse (RN) at Hilo Medical Center. She said while contact with COVID-19 patients has been low until recently, most of her interactions are with people who are afraid they’ve contracted the virus.
Lynam describes working at any hospital’s ER as “nerve-wracking.”
“We are required to wear N95 masks, goggles and face shields. Each patient is required to wear a mask to enter, temperatures are being checked at the front entrance, and we sanitize each room per protocol. There is a limited number of staff in the break room at all times. Protocols are updated weekly and we are kept informed every step of the way.
“The overall mood of the staff and patients are feelings of uncontrolled heaviness. We are in the midst of this pandemic and we are all unsure of when and how this will be stopped. Most of us have families that we go home to or want to visit, but staying home and keeping our circles close and closed is what is necessary right now,” said Lynam.
In a study that examined 1,300 healthcare workers in China caring for COVID patients, researchers found 52 percent of frontline healthcare workers are more likely to have depression, 44.6 percent had symptoms of anxiety, 34 percent reported symptoms of insomnia, and 71.5 percent reported feelings of distress. The study was published in Medical News Today.
Recalling the first patient at Kaiser Hospital, Moanalua
Sherry Lopez has been a Ward Clerk at Kaiser Moanalua for 22 years, and a member of UNITE HERE Local 5.
She recalls Kaiser Moanalua having their first COVID-19 patient on March 26. “I remember it being a hectic and emotional day. We were all worried because it was our first. Nurses needed to be there for four hours, CNA’s had to go in and out of COVID rooms.
“We have to be consistent with safety. I remember seeing the first patient fighting for life—it was overwhelming. It was emotional and mentally stressful for all the staff. It felt quite different because these are innocent people catching the virus.”
Safety changes at hospitals and the possibility of contracting COVID-19
Dr. Ganitano is a part of the leadership team at Pali Momi working to implement guidelines to protect staff. “We practice physical distancing as much as possible. Gone are the days of having coffee at the water cooler or sharing a meal during a break. During the outbreak, the hospitals have limited visitors and during high infectious ‘surges’ eliminated visiting hours altogether, with few exceptions for certain situations.”
He said hospitals provide personal protective equipment (PPE), gowns, gloves, face shields and medical-grade facemasks. “In the pre-COVID 19 era, we would wear PPE when seeing patients with certain suspected infections. Now wearing PPE is the new normal. We wear facemasks and eye protection such as goggles, face shields at all times. We are often covered in head to toe in surgical caps, gowns, shoe protectors for those we think may have the risk of COVID. It is not unusual for our patients to have never seen our true faces during the course of their ICU stay.”
Dr. Ganitano Jr. is confident in the protective measures at the hospital that he’s more concerned about catching COVID outside the workplace. “Some may think that I should be worried about catching COVID 19 in the hospital because I have to work with so many COVID 19 patients. In reality, I am more concerned about catching it when I am not at work and in my normal life. At work, our whole team mentality is protecting ourselves so that we can help others.”
He elaborates, “outside of the hospital we don’t have those protections. This is why it is important for all of us as a community to participate in the measures which will help decrease the spread of this disease.”
But he is also well aware of the risks. “On the other hand, many of us, myself included, are stressed by the constant hypervigilance required when working in an environment where the caregivers could become as easily infected as those we care for. The state of attention required to make sure we are wearing the right PPE, doing good handwashing, and maintaining proper physical distance can be exhausting. The fear of frontline staff bringing home COVID-19 from work to their loved ones is a harsh reality.”
Dr. Valdez reiterated much of the safety precautions mentioned by Dr. Gantiano Jr., but adds that when patients are transported, as an extra precautionary measure, security is asked to clear the pathway so no one crosses the patient’s path.
Dr. Valdez mentioned that he’s worried about contracting the disease. “I worry about bringing the virus home. My young-at-heart, elderly parents see my son a lot so I worry that he’ll silently pass it on to them. I change before leaving and when I get home, I strip down right inside the door, put my clothes in a special COVID-only hamper and head to the shower before touching anything and anyone. I guess I think about it daily, but I try not to let it consume me cause I’d just be worried all day, every day.”
ER nurse Lynam echoed the doctors’ concerns of not just hospital spread but community spread. “Truthfully, I am worried that I may contract COVID. However, COVID is now community spread. I need to be mindful when I’m out buying groceries and shopping. I have a beautiful family of four that I want to cuddle and snuggle when I get home, but I can’t. I have to take the extra step of changing out my hospital clothes in my garage and head to the shower right away. My hospital clothes are separated from the family laundry. I sanitize the inside of my vehicle. I sanitize my phone, my ID badge reel and keys…”
Lopez talked about similar safety precautions that are also implemented at Kaiser Moanalua. On her possibly getting COVID, “I think about it all the time when I go to work. But you have to be alert and know the proper protocol—PPE, social distancing, safety, etc. But again, there is an uncertainty aspect of it. Who knows? There is a possibility of catching COVID when you touch the counter, or even outside when you’re in public.”
What hospitals are doing to safeguard workers and patients are challenges in the COVID era. But Dr. Maria Ver, General Surgery/Bariatric Surgery/Trauma Medical Director at Pali Momi, said another challenge is—“There is only a limited amount of physical ICU beds and a finite number of ventilator machines for the state of Hawaii. We have to take into account, that there are only a handful of doctors and nurses qualified and comfortable to care for ICU patients.”
On Aug. 25, the Healthcare Association of Hawaii (HAH) said staffed medical beds on Oahu have reached full capacity. HAH is preparing to send a formal request to the federal government to bring in 60 additional staffed beds on Oahu and 10 on Maui.
Also on Aug. 25, Jill Hoggard Green, CEO of the Queen’s Health Systems told Hawaii News Now the COVID-19 has left Hawaii’s largest hospital at 90 percent capacity.
Besides bed shortage, she said 100 positive or possibly exposed staff members are in quarantine. Queen’s is asking state emergency management officials for more than 40 traveling nurses.
Some harsh realities of COVID
Lopez painted a grim picture of COVID. “We see COVID-19 patients come in, they are talking, and they feel OK, then 5 minutes later they can’t breathe. The virus takes over your body.”
She says the public doesn’t realize some harsh realities about COVID, like that it is a long recovery process. “You may be discharged from the hospital, but you will still be recovering.”
Dr. Ganitano Jr. said unlike many ailments, patients who are hospitalized with COVID-19 stay in the hospital for weeks; many of them are placed on life support, are heavily sedated, and sometimes are near death or die.
Dr. Valdez elaborates on the confusion some COVID patients have. “When we hold their sedation to wake them up and make sure their neurological status hasn’t changed, there’s a sense of confusion and fear on their faces which is understandable given their circumstances. After all, they’re in an unfamiliar room with unfamiliar sounds and an unknown person who’s covered from head to toe except their eyes (which is behind a face shield/goggles) and they’re yelling at them trying to see if they can squeeze their hands or move their feet.”
Beyond the hospital setting
Workers helping to keep the economy going are also vital as they, too, put their health at risk.
Sherri Au, Kahala Hotel, UNITE HERE Local 5 member, works in the Pantry Department. She gets food ready for the Plumeria Beach House and preps for lunch and breakfast service, as well as banquet and room service. She was furloughed at the end of March. The hotel reopened in June so she returned to work on July 2.
“Things really changed when we went back. I am proud that the workers were able to successfully push the hotel, with the help of the Union, to adopt safety protocols—testing employees, training for and providing PPE, setting safety measures around the hotel, etc. We are operating on limited staff right now, but we are very busy. We have a lot of kama’aina staying and other local residents coming to eat in our restaurants.”
On the general mood of the hotel, she said everyone is a little concerned. But she believes Kahala is safe and setting a standard for hotel safety and reopening. She said all employees are tested and work with management to establish stringent safety measures.
“Personally, I am still scared of the tourists coming back, but I know we need them. I’m both worried about the economy and the public health, so it’s really hard as a frontline worker having to choose between safety or having the income, healthcare, and other benefits. I am lucky to be working in a safe place and to have medical benefits. I know that right now, thousands of my union and non-union brothers and sisters do not or are in danger of losing it [medical benefits] in the next couple of months. If we want tourism to open safely, we need to make sure we all have adequate healthcare so that our community, our families, and our guests stay safe,” said Au.
She said, “I live with my mother and my sister who are both immuno-compromised. As workers, we are really holding our employer accountable to keep the hotel safe.”
EDITOR’S NOTE: The Hawaii Filipino Chronicle has been paying tribute to workers each year on Labor Day. We are especially thankful this year to our many frontline and essential workers who’ve had to report to their jobs and keep our communities healthy, safe and fed. Mabuhay to all of you.