Karen Lin, Contributing Photographer

Patients with COVID-19 symptoms who come to Yale Health get shuttled upstairs in the service elevator, a practice that keeps the coronavirus out of the public elevators.

But it also brings the virus much closer to Yale’s custodial staff, since they use the service elevator to transport their cleaning supplies.

The News spoke to six Yale custodians, all of whom spoke on the condition of anonymity due to fear of retribution. Five of the staff members work at Yale Health, and one cleans science buildings. Four staff members told the News that they are not informed when a patient with virus symptoms arrives if the patient has not yet tested positive — a lack of transparency, they said, that puts them in danger of contracting the virus. They also expressed concerns about inadequate safety measures, pay and communication about testing protocols.

“We’re always running into COVID patients,” a custodian at Yale Health said. “You got to be real careful and I can’t afford to stay out [and not work] … it’s really, it’s hard.”

Known or suspected COVID-19 patients are taken to one of Yale Health’s seven negative pressure rooms or the Acute Care ambulance bay, University spokesperson Karen Peart wrote in an email to the News. If a patient is known to have tested positive for COVID-19, staff are informed before the patient comes into the building. Staff members who come into contact with someone who subsequently tests positive for COVID-19 after initially coming into Yale Health without a positive result are notified and instructed to quarantine. Additionally, Yale Health uses safety measures for all patient visits, Peart added.

Yale Health requires all patients to call ahead of a visit so the center can prepare for their arrival. Patients must also wear masks and have their temperatures checked before entering.

But the staff members interviewed by the News remain afraid — they feel that the precautions are inadequate and that they need to know if a symptomatic person enters the building.

“[The service elevator] is used mainly for our staff,” a male Yale Health custodian interviewed by the News said. “But I don’t get in it.” He warns others not to as well.

Another custodian at Yale Health, who has young children in her family, recalled finding out that a potential COVID-19 patient was in the small elevator only after she rode in it. Another time, she had to go into the elevator when her supervisor told her to clean it with Clorox wipes after a patient with COVID-19 symptoms had used it.

“I thought they should have someone do a type of high-touch cleaning in there as if they were cleaning a COVID room,” she said. “I didn’t think we should be wiping that down with Clorox wipes without being suited up.”

Yale’s guidelines require that door handles, elevator call buttons and other high-touch surfaces be cleaned and disinfected with a solution shown to be effective against COVID-19.

She works two custodial jobs to support her family. After her shifts, she takes care of children in her family. But being around him makes her nervous, she said, as she worries about COVID-19 exposure at work.

When a COVID-19 patient enters, what happens?

Another custodian said she wished there was a dedicated route for COVID-19 patients so she could know which places to be wary of.

“They [COVID-19 patients] come constantly, back-to-back,” she said. “We’re frontline, we’re doing the cleaning. I know the doctors and stuff are going in, but I believe we’re in there the majority of the time cause we’re actually cleaning.”

She said that one room needed to be cleaned four times in one day.

Peart said that staff are notified if a confirmed COVID-19 positive patient comes in. Additionally, if a patient tests positive within 48 hours of coming to the building, Yale investigates whether any employees came into close contact with them and instructs them to quarantine.

But when it comes to symptomatic rather than COVID-positive patients, staff have their own system for finding out when potential COVID-19 patients come in — if they see green shirts, there’s likely a symptomatic patient in the building.

Those wearing the green shirts are staff from AAIS Corporation, an asbestos removal and demolition company hired by the University during the pandemic. They come to the center with disinfectant and are the first to enter rooms with potential coronavirus patients. Peart declined to comment on whether AAIS employees are on a testing plan.

“They don’t say anything to us,” the male Yale Health custodian said. “The only way I can tell is we have a team that comes in if they suspect the patient has COVID. These people have a green shirt that says Demolition Crew, if you see them, then you know that we had a COVID patient.”

The third-party custodians put a piece of paper with a stop sign on the door so Yale’s staff know not to enter the room for the next hour or so. One Yale custodian reported her supervisor calling and alerting her of the contaminated room. The patients are mostly taken to the fourth floor.

According to another custodian at Yale Health, who has two kids, the nurses and doctors who treat the patients are the only ones who know if someone potentially has COVID-19. The custodian does not want to know the patient’s name or information, which would violate privacy laws, but he believes he should know if someone has symptoms. Under current protocol, he said, he can accidentally walk into a room where a coronavirus patient had been not long before.

At least one custodian has done so — the staff member who has young children in her family. A few months ago, her supervisor told her not to enter a room, as someone who had been in it had subsequently tested positive for COVID-19. But by the time she was notified, she had already entered the room to take out the trash. She is still not sure whether the third-party custodians forgot to put the sign on the door or whether she walked in before they cleaned it.

The Yale Health custodian who saw the room cleaned four times in a day said that at the pandemic’s start, after a room with a COVID-19 patient was disinfected, the stop sign would stay posted on the door for an hour. But sometimes, she said, there are so many COVID-19 patients that staff and new patients go in the room right after the hazard crew does. She fears the virus is still in the air.

The male custodial member, however, said staff do still have to wait an hour to enter the room.

Testing and testing positive 

And if a custodian does test positive for the virus — the custodian who saw the room cleaned four times in a day said she knows of at least four people who have — the rest of the staff will not be notified until the person finishes their two-week quarantine and is returning to work, according to two other staff members.

While Yale does not notify all custodial staff of each positive case, Peart said that patients who test positive for COVID-19 undergo a comprehensive contact tracing process to identify both work and household contacts.

Another staff member who caught COVID-19, though she did not contract it not at work, said that Yale asked her who she had come into contact with for more than 15 minutes so they could be tested. Staff members generally socially distance, so she informed Yale of the four people who had eaten lunch with her in the break room.

While waiting for her test results, she stayed away from work to avoid spreading the virus. After testing positive, she quarantined for 10 days before returning to work.

“There’s no one going to tell you anything. It’s like mum’s the word,” the male custodian said. “[The virus] is already invisible so we don’t know where it is, so if you’re not telling us what patient has it then we sure don’t know.”

But none of the staff who spoke to the News had participated in Yale’s asymptomatic screening program, though they have been working since March. According to the custodian who has two kids, that might be because many do not have their Yale emails set up, so they may not know it’s an option.

“The dining hall workers, they get tested every week,” he went on. “Custodial don’t get tested unless you actually get it or feel funny or you get some symptoms. I’ve been here since March and I haven’t gotten tested once.”

Peart said that staff are made aware of the voluntary testing program through emails and communications from supervisors. Staff may seek testing up to twice weekly, and those who work with students are required to get tested.

PPE and testing for University staff

In addition to optional testing during the pandemic, the University has taken other steps to protect custodial staff members from COVID-19.

Anyone older than 65 or with underlying health concerns does not have to come to work and still receives pay. Staff members who returned to campus for work received mandatory safety training, were advised on health guidelines, were given instructions on ordering face coverings and protective supplies and must undergo daily health checks.

Before they enter the building, staff must get their temperature taken. While they work, the custodians are provided with some personal protective equipment, including blue surgical masks and latex gloves, which they must wear. This week, they were given face shields, three custodians said, adding that there are no N-95 masks, which offer greater protection against the virus.

Peart also said that Yale Health employees were given personal protective equipment that provided eye protection, either goggles or face shields. Staff who have patient-facing contacts or who work in a clinical unit are also required to wear both surgical masks and eye protection, she added.

Additionally, staff have been given some protective equipment outside of their work shifts. In June, the custodian at the science building said that all staff received a small gift bag with fabric masks and hand sanitizer.

A hazardous situation: Time and a half?

Despite these provisions, custodial staff cited numerous safety concerns associated with their jobs. All staff interviewed by the News noted that the University has stopped offering hazard pay — increased rates that acknowledge the heightened risks associated with the unusual situation.

“We could go on and on about this,” the science building staff member said. “No one cares and that’s the big thing, that’s the whole thing. No one cares about us.”

In March, staff who came into work received pay for time and a half. But on June 7, that policy changed, and healthy people are now expected to come to work each day for the same pay that they would have received prior to the pandemic. They are also expected to use their allotted time off if they contract COVID-19 or have another health issue.

Peart said that about 200 service and maintenance staff with increased risk of severe COVID-19 infections still receive full pay and benefits without coming into work.

The six custodians interviewed by the News said they thought they should still receive time and a half. They stressed that times are not normal.

The actual custodial work remains much the same as before the pandemic, though with a greater attention to wiping down surfaces and fewer people to do the job, according to three staff members.

But the circumstances in which staff work bring heightened fear, confusion and risk. With transmission rates rising, there are patients coming into the health center with COVID-19 symptoms nearly every day, four Yale Health custodians said.

“Yale is doing everything for all the sick people, but they’re not doing enough for the healthy people,” the staff member with two kids said. “They’re treating us like it’s a regular day in 2019, but it’s not.”

There have been a total of 291 COVID-19 cases in the Yale community since the start of August.

Rose Horowitch | rose.horowitch@yale.edu

Editor’s note: This article has been updated to remove identifying information that a source later requested not be disclosed to the public, due to fear of retribution.

ROSE HOROWITCH