A month ago, when Lindsay Manning first asked whether she should steer clear of COVID-19 patients, her supervisor at Mercy Medical Center in Springfield tried to reassure her. It was primarily a respiratory virus. Pregnant women weren’t necessarily at greater risk, but as more details about the course of the illness emerged, the pregnant ICU nurse worried about the unknowns. What about fever, which can be linked to preterm labor and fetal abnormalities? What about the breathing problems COVID-19 patients were suffering, forcing them onto ventilators? Manning was only six months pregnant. What would happen to her fetus if her oxygen levels dropped or she ended up sedated on a ventilator?
Why would oxygen levels be dropping?
With her anxiety rising, the 30-year-old mother of a 3-year-old again asked if she could limit her exposure to coronavirus patients, but a manager made clear that a transfer was not guaranteed. A move would depend on staffing levels, Manning was told. The last day she worked, April 1, she tended to an array of patients, most of whom were being treated or tested for coronavirus.
Now, she has COVID-19 too. Two weeks after her positive test, she remains sick and sleepless, wracked with anxiety about what will become of her baby. Even now, the Catholic hospital where she works will not reassure her that if she recovers and returns to work, she will be reassigned.
“I just don’t know why they can’t just say, ‘hey — we’ll protect you,’ ” she said.
The unknown effects of the novel coronavirus are worrisome for all but particularly agonizing for pregnant women, who fear the ravages of a severe respiratory illness could harm the development of their fetuses, but those same uncertainties are being cited by some employers as a reason to maintain the status quo in the workplace.
While some hospitals — including Baystate Medical Center in Springfield and Massachusetts General Hospital in Boston — are giving pregnant health care workers the option of temporarily changing job responsibilities, Mercy Medical Center has made no such guarantees.
Twenty-eight weeks pregnant, Mercy Medical Center nurse Lindsay Manning has tested positive for COVID-19 and can't sleep, worried about any potential impacts on her baby. (Suzanne Kreiter/Globe staff).
Mercy Medical administrators did not comment on the hospital policy. Neither Deb Solomon, executive director of human resources, nor Amy Ashford, director of marketing and communications, responded to repeated calls and e-mails from The Boston Globe over one week.
Mercy Medical, a 182-bed acute care hospital in Springfield, is part of Trinity Health Of New England Medical Group, which also runs Providence Behavioral Health Hospital in Holyoke. Based in Michigan, Trinity Health is one of the largest multi-institutional Catholic health care delivery systems in the country, according to its website.
“We’re supposed to be a Catholic hospital. You’re making these women bring their unborn children in," said Jaime Dorunda, a fellow ICU nurse at Mercy Medical who co-chairs the hospital’s chapter of the Massachusetts Nurses Association. "You wouldn’t make me bring my 12-year-old in.”
Maybe they are doing the devil's work.
Each time Manning asked about her situation, she said, managers pointed her to a Trinity memo, citing the data currently available about the coronavirus.
The Centers for Disease Control and Prevention says that pregnant women do not appear to be at increased risk of the coronavirus, though they are known to have a higher risk of severe illness from influenza and other respiratory infections, but the virus raging around the world is so new that very little is known about how a fetus will weather a mother’s infection and the aggressive medical intervention that may be required to treat it.
“Are there any studies to show that it’s not a danger? That’s the whole point," said Dorunda. “This is a new virus. We don’t have studies yet."
They shut down and destroyed an economy over it.
The Trinity Health memo that Manning was provided, dated March 17, said there’s no data that suggest an increased risk of miscarriage or congenital effects on fetal development, but it also cites information from the Royal College of Obstetricians and Gynaecologists that, “infection with COVID-19 may pose some risks to a pregnant woman’s unborn baby: there is a possible risk of fetal growth restriction and a risk of premature birth for the health of the mother and baby, should the mother become seriously unwell.”
Unfortunately, getting and being pregnant does entail that even without COVID.
The Trinity memo says that pregnant health care workers can ask their supervisors to review assignments, but that “if staffing levels don’t permit reassignment,” they will have to rely on personal protective equipment.
It also cites guidance from the American College of Obstetricians and Gynecologists which does not recommend restricting the work of pregnant health care workers based solely on COVID-19, but it also notes ACOG’s conclusion that information is so limited that “facilities may want to consider limiting exposure of pregnant health care personnel to patients with confirmed or suspected COVID-19 infection, especially during higher-risk procedures, if feasible, based on staffing availability.”
Some hospitals have done so at the request of health care workers. Baystate Health, which operates Baystate Medical Center, also in Springfield, and other health care facilities, began offering an “accommodation request process” allowing employees who are at particular risk to seek changes in their roles to avoid potential exposure to COVID-19 patients.
“As a result, we have been excepting pregnant workers from caring for COVID-19 patients or those under investigation for the novel coronavirus, and redeploying them to different departments or positions altogether," Kristin Morales-Lemieux, a Baystate Health vice president, said in a statement. Pregnant nurses have been mobilized to staff employee hotlines, for instance, she noted.
“Our goal has been to keep pregnant workers in their core roles wherever possible, but allowing them not to participate in direct care of suspected or confirmed COVID-19 patients,” she said.
I'm surprised they talked to the Globe because they haven't reported numbers to them.
At MGH, employees over 37 weeks pregnant are being encouraged to avoid all in-person patient contact “to decrease the risk of inadvertent infection through unrecognized exposure,” according to Jovita Thomas-Williams, MGH’s senior vice president for human resources.
Until that stage of pregnancy, she said, they can discuss their specific medical needs with their managers while they request accommodations through human resources and Occupational Health.
Pregnant women across Massachusetts already have the right to request changes to their work conditions to accommodate their needs under the state’s Pregnant Workers’ Fairness Act, which took effect two years ago. That law — the same that made lactation rooms available in the workplace for breast-feeding mothers — made it illegal to deny a “reasonable accommodation” requested by a pregnant employee unless the employer can show it would impose an “undue hardship” on the business.
“It’s not just a nice thing for the employer to do,” said Dina Bakst, co-president of A Better Balance, a national legal advocacy organization that advocates for pregnant workers and caregivers. “It’s actually a law.”
Are they following it or not?
Manning, meanwhile, remains home sick with COVID-19, at 28 weeks pregnant. So far, the baby seems fine, based on an ultrasound and her own medical tests. Manning’s symptoms — including a tight chest, an unremitting raging cough, and the need for an inhaler — have not required hospitalization, though her doctor has ordered a chest X-ray, steroids, and now, sleeping pills, which she would rather have avoided while pregnant, but she’s still agonizing on how she can return to work when she’s better; Mercy has not offered her a different shift.
On Monday, after weeks of filling out paperwork and repeatedly sending doctors’ notes, she beseeched her chief nursing officer for help, saying, “I don’t know where else to turn and I’m desperate for your help."
“This is my Hail Mary,” she told the Globe. “I don’t want to return back to work without people understanding and accommodating me.”
She is lucky she has a job to go back to!
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The Globe reminds her that there are other options.
"Mass. pausing part of its nursing home testing program; state data riddled with inaccuracies" by Laura Krantz, Laura Crimaldi and Robert Weisman Globe Staff, April 21, 2020
As the number of deaths in nursing homes from COVID-19 surpassed 1,000 on Tuesday, the state announced it will pause a key component of its plan for testing residents of long-term care facilities.
Secretary of Health and Human Services Marylou Sudders at a State House news conference said the state would temporarily stop shipping coronavirus test kits to nursing homes. Long-term care facilities appeared to be ill-equipped to collect the samples properly, officials said in subsequent statement.
Repeated, universal testing of nursing home residents and staff is widely seen as a key to containing the epidemic in long-term care facilities, which have emerged as an epicenter of the COVID-19 crisis.
On April 8, the state announced nursing homes could order test kits to be delivered to their facilities and administered by trained personnel. The option was an alternative to the mobile testing program in which the state deployed Massachusetts National Guard members to administer tests at nursing homes, but after sending out 14,000 tests, Sudders said only 4,000 were returned, and many of those, the state said in a statement to The Boston Globe, were unlabeled or in leaking tubes. Sudders said the state will continue to offer mobile testing through the National Guard while they work through the problems with the test kit program.
Who cares if it freaks out the elders?
News of the setback came as the state released new data showing 1,059 residents of Massachusetts long-term care facilities have died from COVID-19, making up 54 percent of all deaths from the virus statewide.
The state also reported Tuesday that the overall death toll from the coronavirus outbreak had risen by 152 cases to 1,961, and the number of confirmed coronavirus cases had climbed by 1,556 to 41,199. The Department of Public Health also reported a total of 175,372 people in the state had been tested, up from 169,398 a day earlier.
They are just throwing numbers out there per model and simulation, or they are conflating all death figures and murdering people via neglect or worse.
The rising death toll in nursing homes has some worried families agonizing over whether to pull loved ones out of long-term care. On Tuesday state health officials released a checklist for those families to consider, advising them to be sure residents who move out have safe places to live, the necessary services and support, and a backup plan.
State officials for weeks resisted calls to release data that could help families make those difficult decisions: information about the number of cases and deaths in specific nursing homes. On Monday state officials took a step toward greater transparency, but the new information they made public was vague and riddled with inaccuracies.
Are you flipping kidding?
It initially listed the Belmont Manor Nursing Home as located in Western Massachusetts. On Tuesday, the Holyoke Soldiers’ Home, site of the state’s most deadly outbreak, was not even listed. Some case counts also appeared to be off.
“I’m looking forward to the day when we’re perfect in reporting data in the Commonwealth of Massachusetts. It probably won’t occur in my lifetime,” Sudders said.
How frikkin' cavalier and out-of-touch is that evil woman?
Corrections were made to the data on Tuesday, but some nursing home operators said some numbers for COVID-19 cases and licensed beds remained inaccurate. Sudders said the state would clean up the data.
You guys $hut down an economy of this $lopine$$, huh?
CRIMINALS!
The state House of Representatives on Tuesday passed legislation that would require much fuller disclosure, requiring long-term care facilities to report, and the state to disclose, daily figures on resident and staff cases and deaths.
The Baker administration’s data lacks such specificity. It offers a range, not a specific number of cases, at each facility — less than 10, between 10 and 30 or more than 30. It does not list the number of deaths at each facility, and some families and operators disputed the accuracy of the numbers.
“The first thing I looked at was my mother’s facility and it’s not accurate. If it’s inaccurate for all the facilities, what good is it? It’s just garbage," said one woman whose mother lives at Loomis Lakeside at Reeds Landing in Springfield, and who requested anonymity.
Aaaah, I see some things are still normal!
The state report said Loomis Lakeside at Reeds Landing has 15 beds, but there are actually 42 beds in the skilled nursing facility, said chief executive Margaret Mantoni. Fourteen residents have tested positive, she said; two have died. The state data listed fewer than 10 cases. Mantoni and her staff send out two e-mails daily to keep families informed. “As best we can, we are trying,” Mantoni said. “We share the community’s concern and heartbreak as we work tirelessly to mitigate the devastating toll the virus is having on frail seniors,” said administrator Jim Keane.
Most operators of nursing homes with the largest numbers of cases either did not respond to inquiries on Tuesday or issued prepared statements saying they follow public health guidance and were guarding the privacy of residents. Some, though, stressed the importance of transparency.
National Guard lab technicians two weeks ago found 47 residents tested positive and 40 negative at the Holy Trinity Nursing and Rehabilitation Center, a Worcester facility run by the Eastern Orthodox church, said administrator Ellen Belanger. She said Guard technicians will return for another round of testing Wednesday. Belanger, who said two Holy Trinity residents have died, said residents and their families appreciate open communication. “It doesn’t mean they’re not going to be anxious," she said, "but we try to over communicate.”
Al Norman, an advocate for nursing home residents, said the facilities listing was a step in the right direction but it contained “significant holes and gaps. Not listing deaths in these facilities is a strange oversight," he said.
What are they HIDING?
State health officials didn’t immediately respond to questions about how many older residents have been pulled out of long-term care facilities during the COVID-19 crisis.
Linda Vitagliano of Natick said her family considered bringing her 89-year-old mother home from her assisted-living residence in Boca Raton, Fla., after the facility said a woman there had been infected with COVID-19, but bringing her to Massachusetts presents risks, Vitagliano said. Her mother would have to take an airplane here and, if Vitagliano got sick, the family would have to scramble to identify new care options. “It’s too risky,” she said.
The state data also appeared to list incorrect information for Pine Knoll Nursing Center in Lexington. The state said the facility had more than 30 cases, but administrator Matt Sweeney said it had only 21 cases. Wednesday, he added, each of those 21 residents will have completed their 14-day quarantine. Reports of significant outbreaks continued Tuesday. St. Joseph Manor in Brockton, where the National Guard has conducted tests, confirmed 16 deaths.
You see that trash can over there?
--more--"
That is where you can file the state figures.
Related:
"Sixty residents of a Brewster nursing home have tested positive for COVID-19 amid the ongoing pandemic, town officials said. In a statement, the town said that as of Monday, 60 out of 92 residents of Pleasant Bay Nursing & Rehabilitation Center had tested positive, following three rounds of testing that began April 10. Five residents remain untested, the statement said. According to the town, the center voluntarily entered a state onsite testing program for nursing homes and long-term care facilities after several residents experienced COVID-19 symptoms......"
Let me take a breath for a moment:
"Do I want a ventilator? Coronavirus prompts more people to consider, or revisit, end-of-life care" by Naomi Martin Globe Staff, April 20, 2020
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At Massachusetts General Hospital, hazmat-suited EMTs wheeled in a patient into the emergency room on April 13. (Stan Grossfeld/ Globe Staff)
(GASP)
They confront death daily, but the young doctors rarely pondered their own mortality until the coronavirus pandemic, when clinicians like them started dying.
During an overnight lull last month, five Massachusetts General Hospital residents in their 20s and 30s recorded their health care proxies, naming who would make medical decisions for them if they became too sick to.
“We were feeling our own vulnerability,” said Dr. Samuel Slavin, who tweeted a photo of the residents with their forms, hoping to inspire others to follow suit. “COVID increased the feeling of urgency, but that was on top of the fact that we all knew this is something that everyone should have on file.”
The coronavirus pandemic has pushed the fact of human mortality to center stage, prompting scores of people, not just doctors, to consider or revisit their end-of-life wishes. Complicating matters, the pandemic has introduced ventilators — a life-support tool seldom discussed outside hospitals before the outbreak — into mainstream Americans’ worries.
Amid talk of hospitals rationing ventilators, some people are updating their living wills or proxies to say that they do want a ventilator to extend their lives, if necessary. Others, largely elderly people and those with serious health conditions, are making it clear that if their odds aren’t great, they wouldn’t want the machine to keep them alive.
“In the two-and-a-half years we’ve existed, we’ve never answered questions on ventilators, but now they’re pretty common,” said Renee Fry, cofounder of Gentreo, which offers low-cost estate planning.
It’s urgent that people clarify their wishes to family now, doctors say, because the coronavirus can progress quickly, making patients suddenly so sick that to stay alive, they must be put in a medically induced coma and on a ventilator.
In that moment, they may not have a chance — or be able — to fully consider the potential consequences such as brain and organ damage, or needing to live bed-bound with a feeding tube.
Most people who contract the coronavirus don’t become seriously ill, and only a small portion require intensive care. However, early data suggest that perhaps 50 percent to as many as 80 percent of coronavirus patients who are placed on ventilators don’t survive.
Has something to do with the oxygen levels.
“The reality is even if we have enough ventilators, that’s not going to save most people,” Dr. Breanne Jacobs, an emergency room doctor and professor at George Washington University School of Medicine who wrote about the issue.
Most elderly people would prefer to pass away at home with family rather than alone in a hospital, she said, so "if they understand a ventilator is not going to miraculously get them back to where they were, a lot of people would probably change their mind about allowing doctors to do intubation.”
The crisis has prodded many people to take up the oft-deferred task of discussing end-of-life goals. Thousands have downloaded a new coronavirus-related guide from The Conversation Project, which helps people broach the uncomfortable topic.
I have hesitated to comment much until know until I was sure what I was reading, but after easing you into this with the young doctors, this article appears to be promoting the do-not-resuscitate orders that the elderly are allegedly being pressured to sign.
It's diabolical, I know, but if the reporting is accurate and true then it possible that the beloved elders we can not see are being exterminated.
Doctors advise against using medical terms, like ventilator, in documents, because that’s not helpful to clinicians aiming to follow someone’s overarching wishes. Instead, they say, people should focus on big-picture values.
“A lot of people say, ‘I don’t want to be intubated,’ but they mean they don’t want to be intubated for the rest of their lives," said Suelin Chen, cofounder of Cake, which offers free end-of-life planning services. “If it were just to recover for a few days, they’d want that.”
Specialists say everyone over 18 should, at minimum, record their health care proxy, which in Massachusetts requires two witnesses. If that’s impossible during social distancing, people can complete a “trusted decision-maker” form, which is better than nothing, and they should discuss key questions with their chosen person before an emergency, such as what makes life worth living, how much suffering are they willing to endure, and for what odds of success.
I would say "peace. Not a Pax Americana enforced on the world by American weapons of war. Not the peace of the grave or the security of the slave. I am talking about genuine peace, the kind of peace that makes life on earth worth living, the kind that enables men and nations to grow and to hope and to build a better life for their children--not merely peace for Americans but peace for all men and women--not merely peace in our time but peace for all time."
That is certainly not what Bill Gates and David Rockefeller have devised for us, and I think JFK knew that.
These should be ongoing conversations, as people’s wishes change with age and health status, they said. “This isn’t just doom and gloom — it’s how do you want to live your life all the way through the end?” said Kate DeBartolo, senior director at The Conversation Project.
The downsides of inaction can be high. Someone may receive procedures they don’t want, as hospitals can be obligated to try to keep someone’s heart beating, regardless of whether their brain is alive. Without clarity, family members may disagree over stopping life support, prompting infighting and guilt. Planning reduces depression in grieving relatives, a 2010 study found.
In some instances, family members may have to go to court to take a loved one off life support.
“With my mom, I always say it was the greatest gift that she gave us,” said Patty Webster, 50, a Conversation Project community engagement leader, whose mother, a hospital chaplain, made her wishes so clear that when she suffered two strokes, her family all agreed when the heart-wrenching time came to stop prolonging her life. “She had an end-of-life that she wanted,” Webster said. “She had friends and family by her side, laughing and crying, together with her when she took her last breath.”
I don't know how I would react, and I'm getting the sense I won't have much of a chance to.
Amid coronavirus, Webster revisited the topic with her family. She shared an article by a doctor about the damage that ventilation can cause. Afterward, her in-laws, in their 80s, emailed to say they wanted to live to 110, but only if “cognizant, thinking, and communicative," and likely wouldn’t want ventilators. Webster and her husband, meanwhile, would be willing to try temporary ventilator treatment for a chance to remain in the lives of their children, 18 and 20, in an active, meaningful way.
I think we all want to keep living; however, I am prepared to die as well since the cause is just. Freedom and Liberty require defending.
People who have started end-of-life planning during the crisis say it offers a measure of control. That doesn’t mean thinking about death gets any easier. “It’s terrifying to think about when you flat-line, that’s the end," said Chris Haynes, 48, a South End restaurant publicist who recently crafted his will, but can’t bring himself to envision his end-of-life care. “It just shakes you to your core.”
Pushing past that discomfort can make a huge difference to families and doctors, said Slavin, the MGH resident. In one recent case, he said, a health care proxy for a critically ill coronavirus patient knew that the patient wanted to try a few days on a ventilator. Then, if her condition didn’t improve, she would switch to hospice care.
“It’s hard whenever a patient is dying," Slavin said, but “it felt like we were doing right by this patient and her family."
Lately, Slavin has discussed the coronavirus by phone with his primary care patients who have advanced cancer, dementia, or heart failure. He describes the potential harms and low odds they’d face on a ventilator. He recommends that, if infected, they not pursue intensive care. Most patients agreed, he said.
For Slavin personally, the calculus is different. At 33 and healthy, he faces a good chance of recovery if infected and would want to try every option to survive and build a future with his wife.
“At another point in my life," he said, "I might say, ‘I want a time-limited trial of intensive care, then shift to making comfort the top priority.’ ”
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Just wondering if all the deaths were labeled COVID-19.
Related:
More deaths, no benefit from malaria drug in VA virus study
The study was posted on an online site for researchers and has not been reviewed by other scientists. Grants from the National Institutes of Health and the University of Virginia paid for the work. Researchers analyzed medical records of 368 male veterans hospitalized with confirmed coronavirus infection at Veterans Health Administration medical centers who died or were discharged by April 11.
They then stepped outside for a cigarette.
Also see:
SAP co-chief executive leaves after six months
SAP co-chief executive Jennifer Morgan is leaving her job only six months after becoming the first female CEO of a company on Germany’s DAX index of blue-chip stocks, the business software maker said Tuesday.
The staff took her out for a beer.
French dentist must pay damages to former assistant
A dentist was ordered by France’s top court to pay damages for sexually abusing a female assistant after the man was cleared of related criminal charges.
She should have cancelled the appointments.
Jane Darrah Claflin, first woman on boards of MGH and Trinity Church, dies at 103
