Yale Daily News

The COVID-19 pandemic has plunged the Yale New Haven Health System into uncharted territory, and as staff members contract the illness and protocols change rapidly, hospital administrators are scrambling to adjust.

Across the YNHH System, 603 staff members have tested positive for COVID-19. About 400 others presented symptoms and stayed home last week to self-isolate, but ultimately tested negative.

On the frontlines of the fight against the pandemic, even under the best conditions, medical personnel are at risk of being infected by the novel coronavirus. But the unprecedented challenges posed by the pandemic have stretched hospital personnel and resources, with some hospital employees lamenting conditions that put them in danger of contracting COVID-19. In a petition calling for hazard pay, some YNHH workers detailed particular challenges of their experiences during the COVID-19 pandemic, including an ever-present shortage of personal protective equipment, unclear guidance and an increased workload. On the heels of this petition, YNHHS announced a pay bump for all employees.

“It’s a whole different atmosphere than it used to be,” Tina Nistico Capstick, an intensive care unit nurse at YNHH, told the News. Though she did not sign onto the petition herself, Capstick explained the pandemic breeds greater uncertainty and fear for nurses who receive new assignments with their personal protective equipment each day. “You walk in [to the medical ICU] just not knowing what you’re going to get, where you’re going to go. … It feels almost military,” she said.

Are the protective measures enough?

The hospital has taken a number of steps to protect staff members from catching COVID-19. On an organizational level, YNHH checks staff members’ temperatures when they enter the building each day.

At a departmental level, Michelle Maneevese, an interventional radiology fellow at YNHH, told the News that her chief split staff into two teams that would each work for two weeks before having two weeks off. Maneevese explained that if staff members were to fall ill, there would still be someone who could cover their shift.

Maneevese added that the hospital had formed a team to put in central lines — which allow doctors to quickly give patients fluids and medications — directly in the ICU to avoid having to move COVID-positive patients throughout the hospital. Maneevese explained that the demand for central lines had drastically increased, prompting this change.

Richard Martinello, YNHH medical director for infection prevention, noted that much of the hospital’s work to protect employees revolved around ensuring adequate access to PPE. Though the hospital has never faced a shortage of personal protective equipment, Martinello said, it has been forced to adapt its usage due to increased demand and dwindling supplies.

“We have had a few issues where we’ve found ourselves in a position where in a few weeks’ time we may have been running low, and so we had to make some changes to try to stretch the supplies we’ve had,” Martinello told the News.

In an online petition calling for hazard pay during the pandemic, some YNHH staff claimed that inadequate PPE had been a constant issue at the hospital. The petition — which quickly amassed over 11,000 signatures — noted that staff were given one N95 mask, one surgical mask and one face shield per day. It also added that they were reusing the same gown and face shields during procedures that posed a significant risk to them — including intubation and extubation.

Vincent Petrini, YNHH senior vice president for public affairs, told the News that the hospital’s PPE policies always aligned with CDC guidelines. But he explained that the CDC’s guidelines have shifted due to the unprecedented nature of the pandemic.

But Kathryn Cupo, a nurse at the St. Raphael’s campus who started the petition, said in a recent New Haven Independent article that she wore the same face shield and N95 mask for three 12-hour shifts. Cupo declined to comment for this article.

“I don’t know where that came from,” Petrini said about the petition. “We’ve had consistent and adequate supply of PPE for our employees.”

Nistico Capstick, who normally works as a nurse in the surgical ICU at YNHH but has floated to the medical ICU during the pandemic, said that in her experience, she had always had sufficient access to PPE. She said she received a new N95 mask for each shift and that she could get another if the first broke.

But she added that recently nurses have had to sometimes care for three ICU patients per day, when they traditionally only cared for one or two.

The petition also named relying on nurses to take on duties outside of their job description as rationale for a pay increase. The petition described instances where nurses were asked to remove trash, linens and sharps containers from patient rooms.

Martinello said that nurses caring for COVID-positive patients have been asked to transfer the patients into a wheelchair or stretcher and bring them outside their rooms so transport staff would not have to enter patient rooms directly, as they have during ordinary times. Martinello said the measure brings fewer staff members into rooms with COVID-positive patients to preserve PPE.

Petrini said that everyone within the health system had been forced to adjust their workload due to the pandemic, but that “keeping them safe, keeping our patients safe and keeping the community safe is the sole focus of everyone in our health care system right now.”

Nistico Capstick added that along with the altered workload, the pandemic has placed an emotional strain on nurses. Staff have been caring for critically ill patients who are not allowed visitors. As such, they carry with them the weight of serving as family members to their patients during their last moments. Capstick explained that she and her coworkers felt they were on “autopilot.”

“We have a wall up right now because we can’t stop to think about it because [we’ll] probably break down if [we] do,” she said. “You may have a husband intubated in your unit and his wife is intubated in another unit and the children calling not knowing what to do, where to go.”

She added that because the virus has dominated both her workplace and the media, its effects are inescapable.

Capstick said that staff are “saturated” both with treating COVID-19 patients at the hospital and with receiving briefings and updates on how to care for patients. Not even home is a respite, as the virus fills the news cycle.

“You’re around it all day, 12 hours a day. … There’s just no escaping it,” she said. “And then you dream about it.”

Business as usual?

When asked during a Tuesday press conference about the call for hazard pay — increased pay for performing dangerous work — YNHH CEO Marna Borgstrom explained that the hospital would not offer any.

“I think that people who are in health care have signed up for a different definition of ‘business as usual,’” Borgstrom said at the press conference.

But she added that YNHH would recognize its staff another way. That same day, the hospital system awarded its workers a pay bump amid the coronavirus pandemic. All staff below the director level will receive an additional five percent of their earnings from the months leading up to the pandemic through May 9. YNHHS announced the raise in a Tuesday letter signed by system leaders.

“I personally did not expect or demand additional income for doing what I’ve been trained to do,” Maneevese wrote in an email to the News. She added, however, that she still appreciated the award.

Cupo, who had started the petition calling for hazard pay, posted a celebratory update to the initial petition, writing “the hospital finally not only heard our calls, but listened and took action.”

Though she did not personally sign the petition, Capstick explained that the scenes within the hospital were far from normal. She described the severity of the illness and the fear that came with the realization that the virus could affect more people beyond the older population.

“You see 40-year-olds come in who are fine one minute and the next minute they are on a breathing machine, possibly paralyzed, proned — laying face down to allow them to breathe,” she said.

Throughout the hospital system, 614 employees are out sick from work. Of those 614 employees, 603 have tested positive for COVID-19, and the rest are symptomatic and awaiting test results.

At the peak, the system had 1,062 personnel out of work at one time. Throughout all of its campuses, the system has about 27,000 employees. Petrini explained that the number out of work was so high because there was a backlog in testing, but that this has largely been remedied.

Employees have tested positive for COVID-19 at all of the system’s campuses, Martinello said. And Nihar Desai, a doctor at YNHH, said that some of the COVID-positive staff members have become patients themselves, having been hospitalized at YNHH. Desai said this had been “interesting” to see, but that they have all “done quite well.”

Rose Horowitch | rose.horowitch@yale.edu

Correction, April 29: A previous version of this article stated that interventional radiology techs put in central lines. Interventional radiologist MDs put in central lines. The article has been updated to reflect this.