Prayers and faxed letters: Texas woman buries husband who died of COVID-19

By Callaghan O’Hare and Maria Caspani

HOUSTON (Reuters) – As hundreds of thousands of people in Texas fled their homes ahead of Hurricane Laura on Wednesday, Michelle Gutierrez was in Houston burying her husband David, who died of COVID-19 on Aug. 14.

The couple would have celebrated their 10th wedding anniversary on Sept. 4, a few days after David’s 54th birthday. Michelle and David met at a mechanic’s shop in Houston in 2009, when he had stepped in as a translator to help her with a mechanic who only spoke Spanish.

He then offered to fix her computer, and the rest is history. They built a life together in Houston, where they raised five children and he worked as a software engineer.

In early July, David was hospitalized after his symptoms of COVID-19, the disease caused by the new coronavirus, worsened. His wife and two daughters had tested positive but showed no symptoms.

David would fight the virus for over a month at Houston’s St. Luke’s in The Woodlands hospital, where he eventually died of heart failure.

“It’s been a roller coaster, every day is different,” Michelle said on the day of his funeral, her voice breaking with emotion. “One day you’re fine and the next day, you walk around and memories flood your mind… You just wish this was all a dream.”

About a week after her husband was hospitalized, Michelle and her daughters gathered under his hospital window to pray for him.

“And then after that first night I was like, ‘You know what, I’m gonna come in every night, honey, I’m going to be here every night, praying for you and just being there in spirit’,” she said.

And so she did, until the Friday in August when David passed away.

Michelle said she kept trying to communicate with her husband as his condition worsened. At first, before he was put on a ventilator, they managed to text one another, she said. But once he was in a coma, she began faxing letters to the hospital, and nurses would read them aloud to him.

David is one of thousands who have succumbed to the coronavirus in Texas, where a spike in cases in June and July strained hospital systems as the virus engulfed many southern states.

Nearly 180,000 people in the United States have died from COVID-19, the highest in the world, with 5.8 million cases recorded nationwide, according to a Reuters tally, also the highest in the world.

At David’s wake, a bottle of hand sanitizer and social distancing signs were prominently displayed as masked mourners walked to the casket to bid their farewells.

As for the future, Michelle said she was enrolling in a college nursing program. She had already planned to do so before her husband’s passing, but feels more motivated now.

“That’s more so now than before after seeing how these nurses took care of David and they were wonderful… And I could not have done it without them.”

(Reporting by Callaghan O’Hare in Houston, Texas and Maria Caspani in New York; Writing by Maria Caspani; Editing by Bernadette Baum)

A nurse struggled with COVID-19 trauma. He was found dead in his car

By Gabriella Borter

(Reuters) – Becoming a nurse in 2018 was a dream come true for William Coddington.

He loved helping people and feeling needed at his West Palm Beach, Florida hospital. The 32-year-old was on the upswing of a decade-long battle with opioid addiction and other substance abuse, according to friends and family, who said he was committed to his recovery.

It all started to unravel in March, as fatally ill COVID-19 patients showed up in his intensive care unit.

It rattled Coddington to see patients his age die, his mother Carolyn said. He could no longer attend his 12-step recovery meetings in person. He was scared about how little personal protective equipment he had. He had nightmares about alarms going off on ventilators in the ICU.

On the night of April 24, he spoke by phone to his best friend Robert Marks and sounded distraught, Marks said. Coddington was caught between the war zone at work and his confinement at home.

“Don’t take unnecessary risks but hang in there,” Marks texted him.

The next morning, Coddington was found dead in his car in a hotel parking lot in Deerfield Beach, Florida.

His family suspects a drug overdose. A spokeswoman for the Broward County Medical Examiner’s office said the case is pending. The Broward County Sheriff’s Office said it is still investigating but does not suspect foul play.

Reuters reconstructed Coddington’s last weeks through some of his text messages, Facebook posts and interviews with his parents, brother and two close friends. Reuters could not independently verify Coddington’s cause of death.

Frontline healthcare workers are trying to cope with the trauma of treating the novel coronavirus, which has inundated U.S. hospitals with desperately ill patients and killed more than 90,000 Americans in less than three months.

Healthcare workers with histories of substance abuse may have more difficulty coping with fear, isolation and witnessing so much death during the pandemic, psychiatrists told Reuters. Those factors could provoke relapses in workers recovering from addiction, they said.

“Patients who are being treated for opioid use disorder have reported increased stress and opioid craving since this pandemic began,” said Kelly Dunn, a psychiatrist at Johns Hopkins University who researches opioid use.

SCARED, BUT COMMITTED

Coddington grew up living with his mother, an executive assistant at a healthcare company, in Deerfield Beach after his parents got divorced in 2001.

Coddington’s family said he was addicted to opioids from a young age. It started with painkillers he received after a leg surgery, Coddington told his friend Skye Alexander, whom he met in nursing school.

Coddington entered inpatient rehabilitation at age 21, his mother said. When he emerged, he joined 12-step fellowships, self-help healing groups, and therapy.

“He was always trying different things to find the stability to interact with the world,” said Marks, a resident of Miami Beach who knew Coddington for 10 years.

When COVID-19 patients in March started arriving at JFK Medical Center’s North campus, where Coddington worked for 3 months, he volunteered for the coronavirus unit.

He did it because he was younger than some of his colleagues, and so potentially less likely to become severely ill, and because he was not a parent, said his friend Alexander.

“That was the type of person Will was,” she said.

Still, Coddington was scared, his friends said. He risked exposure and infecting his 65-year-old mother, with whom he still lived.

Palm Beach County ranks third in Florida behind Miami-Dade and Broward counties for confirmed coronavirus cases; nearly 300 people have died of COVID-19 there.

Coddington said in an April 13 Facebook post that his hospital had a shortage of protective equipment, especially crucial N95 respirator masks. He said he didn’t blame his employer because the issue was widespread.

“In my hospital we are rationing 1 n95 mask for my whole shift,” Coddington wrote. “We are running out of gowns. We are having people make makeshift face shields that end up snapping.”

Days before he died, his face shield fell off while he was helping with an intubation, which involves putting tubes into patients’ airways to assist breathing, said his father Ronald, a port engineer in Palm Beach.

“He literally felt things splash on his face,” Ronald recalled his son telling him.

Kathryn Walton, a spokeswoman for JFK Medical Center, part of the hospital group HCA Healthcare, declined to comment on Coddington’s death except to extend condolences to his family. She said the hospital’s goal was always to protect employees.

The hospital has “adequate supplies of PPE” and is “taking steps to conserve PPE because we do not know what our future needs will be,” Walton said.

She said the hospital offers mental health counseling by phone and video. Coddington’s friends and family say they don’t know if he used those services.

‘BRACING FOR IMPACT’

Coddington suffered from the social isolation imposed by the pandemic, his family and friends said.

He loved being around people, said Marks, who first met Coddington at a diner. Coddington’s “wacky” impersonations of TV characters endeared him to Marks right away.

“He was like a character all on his own,” Marks said.

Coddington relied on 12-step meetings to stay sober, but after one virtual video gathering, he told his mother it was not as helpful.

“He couldn’t meet with his sponsor,” she said. “And his friends, nobody wanted to see him because he worked in a hospital, not even to sit 6 feet apart.”

In his last weeks, Coddington came home from work, spoke little and played video games in his room, Carolyn said. His impersonations – including one of her Southern accent that always made them laugh – stopped.

His friend Alexander, of Sunrise, Florida, said she noticed the change too: “It was despair … creeping in.”

Coddington had relapsed before. In 2017, while on a break from nursing school, he had ended up on a ventilator, according to Alexander, who said she visited him in the hospital. She said Coddington told her he had overdosed on the club drug Gamma-Hydroxybutyrate (GHb).

With the pandemic weighing on Coddington, his loved ones were “bracing for impact,” Marks said. Carolyn checked on him constantly. His father and friends called and texted.

“You are so needed right now by others. You can be great,” Ronald Coddington said to his son in text messages on April 1. “Please please bury me some day. Don’t make me bury you … I love you.”

“I love you too,” Coddington replied.

CRAVING RELIEF

The night of April 24, Coddington argued with his mother, who feared a relapse was coming. They made up, but he announced he was heading to a hotel for a good night’s sleep.

Coddington kissed Carolyn and assured her she could track his location on her phone. He called Marks that evening, expressing how trapped he felt between the chaos at work and being cooped up at home.

“I couldn’t stop thinking about him because of how upset he sounded,” Marks said. Sleepless at 1:24 a.m., Marks sent his friend $20 on Apple Pay to buy himself coffee before his shift.

Coddington never responded. Carolyn checked his location the morning of April 25. He wasn’t at the hospital. She drove to the hotel and found him dead in his car.

Ronald Coddington said police told him they obtained a video, likely hotel security footage, showing his son sitting in his car in the parking lot that night when another car briefly pulled alongside. Ronald said there was “some kind of exchange” between his son and the other vehicle’s driver that he suspects was a drug deal.

The Broward County Sheriff’s office did not respond to Reuters’ request for the video.

Family members think the toxicology report, expected in a few weeks, will confirm an overdose – a temporary escape gone wrong.

“Do I think he wanted to die that night? 100% no,” said his friend Marks. “I would bet every dollar I have that it was in an effort to have some relief.”

(Reporting by Gabriella Borter; Editing by Ross Colvin and Marla Dickerson)

A day fighting COVID-19: U.S. hospital staff share hardest moments on shift

BALTIMORE, Md. (Reuters) – The shifts are long and the scenes are heartbreaking inside a Maryland hospital where nurses and doctors have been treating coronavirus patients for weeks, unable to let family inside to visit loved ones on their death beds.

One of the hardest moments of a recent work day for registered nurse Julia Trainor was intubating a patient, and then calling the patient’s husband so he could talk to his wife. He was not allowed in the hospital.

“I had to put him on the phone and hold the phone to her ear as he told her that he loved her so much, and then I had to wipe away her tears,” says Trainor, who works in a surgical intensive care unit. “I’m used to seeing very sick patients and I’m used to patients dying, but nothing quite like this.”

The highly infectious COVID-19 disease caused by the novel coronavirus has infected more than 580,000 people across the United States and killed nearly 24,000.

In Maryland, where residents have been ordered to stay at home since March 30 to stem the spread of the disease, around 9,000 have tested positive for the virus and more than 260 have died.

After finishing what for many was a more than 12-hour shift, some nurses and doctors at one hospital shared with Reuters the hardest moments of their days. The hospital asked that it not be named.

The medical workers agreed that one of the toughest parts of the job – more than the exhausting schedule or adjusting to work in a new unit – was witnessing the toll on patients and families.

Because of the hospital’s no-visitor policy, which was implemented to prevent further spread of the virus, the medical staff must care for the patients’ physical needs and offer as much emotional support as they can muster in the absence of the patients’ families.

“The hardest moment during the shift was just seeing COVID patients die helpless and without their family members beside them,” says Ernest Capadngan, a nurse in the hospital’s biocontainment unit.

Communicating with the families has weighed heavily on the hospital staff. Staff cannot bend the no-visit rules, even when a family calls in desperation.

“I had a patient fall out of bed today and I had to call his wife and tell her and she couldn’t come see him, even though she pleaded and begged to come see him,” says Tracey Wilson, a nurse practitioner.

“One of the hardest moments was having to see a family member of a COVID patient say goodbye over an iPad,” says Tiffany Fare, a nurse in the biocontainment unit. “You can’t see your loved one and then they’re gone.”

There are very few opportunities to rest during a shift, although colleagues look out for one another and try to cover for each other when someone needs a break.

Cheryll Mack, a registered nurse in the emergency room, says she tries to get outside for 15 minutes during the day to breathe.

“It has given me relief, just fresh air,” Mack says.

Each shift concludes with a similar decontamination drill. Nurses and doctors must remove their personal protective equipment and shower immediately before coming in contact with their family at home.

“I take a very long, very hot shower. And then I usually sit on the couch and… read a book or watch some mindless reality show in order to destress,” says Martine Bell, a nurse practitioner.

Laura Bontempo, an emergency medicine physician, says she removes her work clothing and gear in a decontamination tent she has set up outside her home, and then wraps herself in a towel and runs inside to shower.

Then she puts the scrubs in the washing machine by themselves to not contaminate any other items.

Meghan Sheehan, 27, a nurse practitioner, says she drives home each night without turning on the radio and uses the quiet time to reflect on her shift and her patients. When she gets home, she tries hard not to dwell on the day.

“I go home, I shower immediately and try to have dinner with family, and try to not talk about it,” she said. “Nighttime is definitely the hardest because you’re constantly thinking about what the next day will brin

(Writing by Gabriella Borter in New York, Editing by Rosalba O’Brien)

With cheers, New York nurses greet reinforcements from across the U.S.

NEW YORK (Reuters) – With loud cheers and applause, medical staff at New York’s Northwell Health network greeted 46 nurses on Tuesday who had arrived from all over the United States to reinforce hospitals as they battle the coronavirus pandemic.

U.S. deaths from the novel coronavirus topped 24,000 on Tuesday, according to a Reuters tally. There were nearly 583,000 confirmed cases, over 200,000 of which were in New York state alone.

Treating the large number of patients with COVID-19, the disease caused by the new coronavirus, has challenged hospitals in its U.S. epicenter. They have scrambled to find enough ventilators and other equipment, as well as beds and staff.

Northwell, the largest healthcare provider in New York, said it had contracted medical staffing companies to help it buttress efforts to treat patients at 18 hospitals across New York City, Long Island and Westchester county.

The “clap-in,” with dozens of staff cheering loudly and holding signs saying “Nurses are the heart of healthcare” and “Welcome, healthcare heroes,” was a surprise for the nurses who arrived on Tuesday afternoon for a half-day training session. Hailing from states including California, South Carolina, and Indiana, they are undergoing training in subjects ranging from operating ventilators to dealing with electronic medical records.

“It’s so heartwarming to see so many nurses come from so far away to assist us in our time of need,” said Maureen White, executive vice president and chief nurse executive at Northwell.

About 300 nurses from other areas have been enlisted over the past three weeks, said Launette Woolforde, Northwell’s registered nurse and vice president for nursing education.

Marybella Cole, who had arrived in New York from Lewiston, Idaho, said community was important to her.

“There’s no bigger calling than something like this,” she said.

Raymond Woods said he had left kids and grandchildren behind in Indiana so he could help.

“I have never been more proud to be a nurse. This is by far the most rewarding career I’ve had in my life,” he said.

(Reporting by Andrew Hofstetter; Writing by Bernadette Baum; Editing by Rosalba O’Brien)

‘Here Comes the Sun’ gets U.S. hospitals through dark days of pandemic

By Barbara Goldberg

NEW YORK (Reuters) – The most powerful medicine being used to bolster the morale of New York area healthcare workers at the epicenter of the U.S. novel coronavirus crisis may well be music.

Daily infusions of upbeat songs from The Beatles’ classic “Here Comes the Sun” to the theme from the hang-tough movie “Rocky” are being pumped through hospital public address systems to boost the spirits of nurses, doctors and support staff.

About 545,000 people were diagnosed with COVID-19 in the United States as of Sunday, and roughly 21,600 have died of the highly contagious illness.

A 4:30 p.m. daily dose of Australian pop singer Starley’s “Call On Me” has given strength to staff at one of Mount Sinai’s hospitals in New York City, who clap as a growing number of patients are discharged from the overwhelmed facility across the street from Columbia University.

“Some people would say to accept their fate. Well if this is fate then we’ll find a way to cheat,” Starley sings. “You know you can call on me, if you can’t stop the tears from falling down.”

In New Jersey, the “Rocky” theme song filled the air at St. Joseph Regional Medical Center in Paterson when Dr. James Pruden, the hospital’s director of emergency preparedness, was discharged last week as he recovered from the virus, rolling in his wheelchair past cheering staff.

On New York’s Long Island, the joyful “Here Comes the Sun” blasts overhead on the public address system at Mount Sinai South Nassau in Oceanside every time a COVID-19 patient is discharged.

In Detroit, one of the newest U.S. hot spots for the fast-spreading disease, a Beaumont Health nurse said the 1969 Beatles hit was played not just when patients are discharged but each time they are taken off a ventilator to breath on their own.

“The smiles returning to the faces. Little darling, it seems like years since it’s been here,” rings out the song that George Harrison wrote about renewal after a long, dark winter.

(Additional reporting by Herbert Lash and Jonathan Allen in New York; Editing by Tom Brown)

‘We’re trying to keep our heads above water’: U.S. healthcare workers fight shortages – and fear

By Kristina Cooke, Gabriella Borter and Joseph Ax

LOS ANGELES/NEW YORK (Reuters) – U.S. nurses and doctors on the front lines of the battle against the new coronavirus that has infected tens of thousands of Americans and killed hundreds are shellshocked by the damage that the virus wreaks – on patients, their families and themselves.

Nurses and doctors describe their frustration at equipment shortages, fears of infecting their families, and their moments of tearful despair.

These are some of their stories:

NEW YORK CONFIRMED CASES: 53,324. DEATHS: 773

Dr. Arabia Mollette, an emergency medicine physician, has started praying during the cab ride to work in the morning. She needs those few minutes of peace – and some lighthearted banter with the cafeteria staff at Brookdale University Hospital Medical Center in Brooklyn at 6:45 a.m. – to ground her before she enters what she describes as a “medical warzone.” At the end of her shift, which often runs much longer than the scheduled 12 hours, she sometimes cannot hold back tears.

“We’re trying to keep our heads above water without drowning. We are scared. We’re trying to fight for everyone else’s life, but we also fight for our lives as well,” Mollette said.

The hospitals where she works, Brookdale and St. Barnabas Hospital in the Bronx, are short of oxygen tanks, ventilators and physical space. Seeing the patients suffer and knowing she might not have the resources to help them feels personal for Mollette, who grew up in the South Bronx and has family there and in Brooklyn.

“Every patient that comes in, they remind me of my own family,” she said.

At least one emergency nurse at a Northwell Health hospital in the New York City area is wondering how much longer she can take the strain.

After days of seeing patients deteriorate and healthcare workers and family members sob, she and her husband, who have a young son, are discussing whether she should leave the job she has done for more than a decade.

The emergency room, always a hotbed of frenetic activity, is now dominated by coronavirus cases. There are beds all over the waiting room. The nurse, who spoke on condition of anonymity, said she sees family members dropping off sick relatives and saying goodbye.

“You can’t really tell them they might be saying goodbye for the last time,” she said.

On Thursday, some nurses and doctors were brought to tears after days of physical and emotional fatigue.

“People were just breaking down,” she said. “Everyone is pretty much terrified of being infected … I feel like a lot of staff are feeling defeated.”

At first, she was not too worried about her safety since the coronavirus appeared to be deadliest among the elderly and those with underlying health conditions.

That confidence dissolved after seeing more and more younger patients in serious condition.

“At the beginning, my mentality was, ‘Even if I catch it, I’ll get a cold or a fever for a couple of days,'” she said. “Now the possibility of dying or being intubated makes it harder to go to work.”

There is no official data on the number of healthcare workers who have contracted the virus, but one New York doctor told Reuters that he knew of at least 20.

WASHINGTON STATE CONFIRMED CASES: 4,310. DEATHS: 189

A Seattle nurse has started screening patients for coronavirus at the door of her hospital, a different job from her usual work on various specialty procedures.

She doesn’t talk about her new job at home, because she doesn’t want to worry her school-aged children, she said. Her husband does not understand her work and tells her to decline tasks that could put her at risk.

“I’m like, ‘Well it’s already unsafe in my opinion,'” she said.

But she is nervous about having to separate from her family if she contracts the virus.

“I’ll live in my car if I have to. I’m not getting my family sick,” she said.

The nurse spoke on condition of anonymity because she is not allowed to speak to the media.

During her last shift, she was told to give symptomatic patients napkins to cover their faces instead of masks – and not to wear a mask herself. She ignored that and wore a surgical mask, but she worries less experienced staff heeded the guidance.

“We get right in their faces to take their temperatures because we do not have six-feet-away infrared thermometers,” she said. “The recommendations seem to change based on how many masks we have.”

Her hospital has put a box outside for the community to donate masks because they are so short of supplies.

She blames the government for not doing more to prepare and coordinate: “People should not have to die because of poor planning.”

MICHIGAN CONFIRMED CASES: 4,650. DEATHS: 111

Nurse Angela, 49, says the emergency room at her hospital near Flint, Michigan, is eerily quiet. “We’ve all been saying this is the calm before storm,” said Angela, who asked that only her first name be used.

The patients who trickle in are “very sick” with the COVID-19 respiratory illness, she said, “and they just decline really quickly.”

As they go from room to room, the nurses discuss how many things they are contaminating due to their limited protective equipment.

“You’d have to walk around with someone with Clorox wipes all night walking behind you,” she said. “The contamination is just so scary for me.”

She accepts that she and most of her colleagues may be infected. But she is worried about her daughter and her sister, who are both nurses, and she worries about infecting her 58-year-old husband.

Angela’s daughter has sent her three children, including an 18-month-old who suffers from asthma, to stay with their father to avoid possibly infecting them.

“I normally see my grandchildren twice a week and I haven’t seen them. It’s hard. I just cannot fathom what my daughter’s going through,” Angela said.

Many of her co-workers have done the same, packing off children to live with relatives because they are terrified, not so much of contracting the disease, but of passing it on.

Some of them are talking about quitting because they feel unprotected.

Angela would not judge them, she said, but she told a friend recently, “You have to remember, what if your kid gets sick or your mom gets sick, who’s going to take care of them when you take them to the hospital if all of us just leave?”

(Reporting by Gabriella Borter, Kristina Cooke and Joey Ax; Editing by Ross Colvin and Daniel Wallis)

Coronavirus rages on, putting strain on U.S. doctors, nurses

By Gabriella Borter and Nick Brown

NEW YORK (Reuters) – U.S. doctors and nurses on the front lines of the coronavirus outbreak came under increasing stress on Friday as the number of cases skyrocketed and hospital staff were forced to ration care for an overwhelming number of patients.

The United States surpassed two grim milestones on Thursday. The death toll soared past 1,000, reaching 1,261 by the end of the day, and the total number of infections topped 85,000, exceeding the national totals of China and Italy to make the United States the world leader in confirmed cases.

Worldwide, confirmed cases rose above 550,000 and deaths 25,000, the Johns Hopkins University & Medicine Coronavirus Resource Center reported on Friday.

“This is past a movie plot. Nobody could ever think of this, or be totally prepared for this. You’re going to have to wing it on the fly,” said Eric Neibart, infectious disease specialist and clinical assistant professor at Mount Sinai Hospital in New York. “The scale is unbelievable.”

After days of wrangling, the U.S. Congress may soon respond with a $2.2 trillion relief package, reinforcing an extraordinary array of economic measures that the U.S. Federal Reserve rolled out on Monday.

Leaders of the U.S. House of Representatives said they expected to pass the measure on Friday, sending the bill to President Donald Trump, who has promised to sign it.

In addition to aiding hospitals in hot spots such as New York and New Orleans, the package will bring welcome relief to businesses and unemployed workers. With much of the country on lockdown, a record 3.3 million Americans filed jobless claims last week, nearly five times the previous record set during the recession of 1982.

The counties surrounding Chicago and Detroit were also emerging as areas of concern, said Deborah Birx, coordinator of the White House Coronavirus Task Force.

One emergency room doctor in Michigan said he was using one paper face mask for an entire shift due to a shortage and that his hospital would soon run out of ventilators, the machines needed by sufferers of COVID-19, the respiratory disease caused by the virus, to help them breathe.

The doctor, Rob Davidson, urged Trump to use his executive authority to procure more test kits and ventilators.

“We have hospital systems here in the Detroit area in Michigan who are getting to the end of their supply of ventilators and have to start telling families that they can’t save their loved ones because they don’t have enough equipment,” Davidson said in a video he posted on Twitter.

New York Governor Andrew Cuomo has said any realistic scenario about the unfolding outbreak would overwhelm the healthcare system. His state, which has become the epicenter of the U.S. outbreak with more than 37,000 cases and 385 deaths, is scrambling to create more sick beds.

It is looking to convert hotel rooms, office space and other venues into healthcare centers, while setting up a convention center as a temporary hospital. Some hospitals are scrambling to convert cafeterias and atriums into hospital rooms to house intensive care patients.

Mount Sinai hospital had 215 inpatients with COVID-19 as of Thursday.

“The fear is next week we’ll have 400,” Neibart said, expecting a shortage of doctors and nurses.

In lighter moments, Neibart said he and his colleagues joke about claiming their own makeshift spots, for when they inevitably fall ill with the virus, although he said they routinely check on one another’s well being.

COVID-19 claimed the life of Kious Kelly, a Mount Sinai nurse manager whose death has led to an outpouring of remembrances from former colleagues.

“I remember him running crazy, checking on us and making sure we were OK,” Diana Torres, a nurse at Mount Sinai, told Reuters. “He would deliver our messages to administration if we weren’t happy. He wanted good things for us.”

Torres and other colleagues have also infused their tributes with angry messages about the shortage of personal protective equipment (PPE).

“It seems like we are fighting the government, (the hospital) administration and the virus,” Torres said. “We can tackle one, but not all at once.”

The New York Police Department also announced the first coronavirus death among its ranks on Thursday. Custodial Assistant Dennis Dickson was a 14-year veteran, NYPD said.

The Department of Veterans Affairs may be asked to help in New York, even as it struggles to provide enough staffing and equipment for armed forces veterans.

Maria Lobifaro, a New York intensive care unit (ICU) nurse treating veterans with COVID-19, said staff normally change masks after every patient interaction. Now, they are getting one N95 mask to use for an entire 12-hour shift.

The ratio of patients to nurses in the ICU is usually two-to-one. As of Monday it was four-to-one, she said.

“Right now we can barely handle the veterans that we have,” Lobifaro said.

(Reporting by Gabriella Borter, Nick Brown and Maria Caspani in New York and Doina Chiacu in Washington; Writing by Daniel Trotta)

U.S. states, cities desperate for coronavirus help, military prepares

By Stephanie Kelly and Doina Chiacu

NEW YORK/WASHINGTON (Reuters) – U.S. governors and mayors on Monday became more desperate in their pleas for help from the federal government to fight coronavirus as the military prepared to set up field hospitals in New York and Seattle to ease the strain on creaking health services.

New York City Mayor Bill de Blasio urged U.S. lawmakers to approve an economic relief package and appealed for ventilators and medical equipment, even asking for help from private citizens.

“Anyone out there who can help us get these supplies, we have only days to get them in place. That is the reality,” de Blasio told CNN. New York, the most populous U.S. city, is now at the epicenter of the outbreak in the United States.

Karine Raymond, a nurse at Jack D. Weiler Hospital in New York’s Bronx borough, said most nurses were unable to get specialized N95 masks and even simpler surgical masks were in short supply. Nurses are being told to wear them for as long as possible, she said.

“We are the be all and end all and lifeline to these patients, and yet we are being contaminated and cross contaminating,” Raymond said.

As health authorities struggled to cope with the rising number of sick people and the U.S. Senate failed to advance an economic stimulus package, Defense Secretary Mark Esper said the U.S. military is preparing to deploy field hospitals to New York and Seattle.

The planned hospitals, essentially tent facilities that can be rapidly set up, can only handle a limited number of patients and are less suited to treating highly infectious people who need to be isolated. But they can relieve pressure on hospitals by treating patients with illnesses other than COVID-19.

The Army Corps of Engineers is preparing to convert hotels and dormitories into treatment facilities for sick patients as the number of U.S. coronavirus cases nationwide topped 40,000 on Monday, more than 500 of whom have died.

New York’s de Blasio urged U.S. lawmakers to provide more help.

“I want to appeal to everyone in the House and Senate, you have got to help cities, towns, countries, states, public hospitals, private hospitals. You’ve got to get all of them direct relief,” he said.

A far-reaching economic package for the coronavirus crisis failed to advance in the Senate after Democrats said it contained too little money for hospitals and not enough restrictions on a fund to help big businesses. Democrats predicted a modified version would win passage soon.

Both Democrats and Republicans say they are aware that failure to agree on the bill could have a devastating effect on states, cities and businesses, and trigger further heavy losses in U.S. stock markets.

The U.S. Federal Reserve rolled out an unprecedented new array of programs aimed at blunting the “severe disruptions” to the economy caused by the coronarvirus outbreak.

The central bank will back the purchases of corporate bonds and direct loans to companies. It will expand its asset holding by as much as needed to stabilize financial markets and roll out a program to get credit to small and medium-sized business.

The steps briefly lifted U.S. stock index futures more than 3% but share prices quickly dropped back into the red, putting the S&P 500 <.SPX> on pace for its worst month since World War Two.

With the addition of Maryland, Indiana, Michigan and Massachusetts on Monday, 15 out of 50 U.S. states have now imposed restrictions on people’s movements to curtail the virus, putting the country on a track similar to those of the most devastated European countries such as Italy and Spain.

The population affected by the state lockdowns amounts to more than 150 million people out of a U.S. total of about 330 million.

STAY AT HOME

In what appeared to send a conflicting message about the federal government’s efforts to combat the coronavirus health crisis, a senior White House advisor said that President Donald Trump is considering measures to reopen the U.S. economy.

Trump issued guidelines a week ago that he said aimed to slow the spread of the disease over 15 days. Late on Sunday, he tweeted: “We cannot let the cure be worse than the problem itself,” adding that at the end of the 15-day shutdown period, “we will make a decision as to which way we want to go.”

Trump senior economic adviser Larry Kudlow followed up on Monday, telling Fox News: “The president is right … We’re going to have to make some difficult trade-offs.”

A lack of coordinated federal action was causing chaos for states and municipalities, and even putting them in competition with each other for resources, the governors of New York, New Jersey and Illinois said.

The states “are all out looking for the same thing,” New Jersey Governor Phil Murphy told CNN on Monday.

Leaving states to fend for themselves has put them in bidding wars with the Federal Emergency Management Agency, other U.S. states and even against other countries, Illinois Governor J.B. Pritzker said.

“We’re competing against each other on what should be a national crisis where we should be coming together and the federal government should be leading, helping us,” Pritzker told the “Today” program.

New York Governor Andrew Cuomo called on Washington to put in place the federal defense production act to eliminate this “ad hoc” system. Trump on Sunday defended his decision to hold off using this power, on the grounds that nationalizing businesses “is not a good concept.”

General Motors Co <GM.N> and medical equipment maker Ventec are speeding up efforts under a partnership code-named “Project V” to build ventilators at a GM plant in Kokomo, Indiana, to help combat the coronavirus outbreak.

(Reporting by Stephanie Kelly, Susan Heavey, Doina Chiacu, Dan Levine and Nathan Layne; Writing by Daniel Trotta and Sonya Hepinstall; Editing by Howard Goller and Alistair Bell)

After 11 days, Chicago teachers strike to end as union, mayor reach deal

After 11 days, Chicago teachers strike to end as union, mayor reach deal
By Brendan O’Brien

CHICAGO (Reuters) – Chicago teachers will end their 11-day strike against the third-largest U.S. school system after their union and district officials reached a tentative settlement on Thursday of a labor battle that canceled classes for 300,000 students.

The five-year contract includes funding for more than 400 additional social workers and nurses, spending that the union argued was necessary to allow teachers to focus on curriculum, according to the union.

It was the second-longest in a wave of U.S. teachers’ strikes that played out across West Virginia, Oklahoma, Arizona and California over the past few years, topped only by a three-week June strike in Union City, California.

Like the earlier walk-outs, Chicago teachers had pushed for more money to ease overcrowded classrooms and more support staff, in addition to seeking a wage increase for the district’s 25,000 teachers.

A tentative deal reached late on Wednesday fell apart when the two sides disagreed over how many missed school days for students – and days of pay for teachers – would be tacked onto the end of the school year. The agreement reached on Thursday calls for five, less than the 11 the union had sought, the union said.

It was an early test of first-term Democratic Mayor Lori Lightfoot, who campaigned on improving the city’s schools but said the school district could not afford the sharp increases in spending on counselors and nurses that teachers sought.

“It was important to me that we got our kids back in class. Enough is enough,” Lightfoot said during a news briefing after the deal was reached. “I think it was the right thing for our city and I am glad this phase is over.”

Union members expressed frustration that Lightfoot had been unwilling to extend the school year by 11 days to make up for the lost classes. Pressure for a settlement had ramped up in recent days as teachers braced for their first paychecks reduced by the strike, as well as the prospect of health insurance expiring on Friday.

“This fight is about black children and brown children in the city of Chicago getting the resources in their school community that they have been deprived of for generations,” union Vice President Stacy Davis Gates said during a news conference after the announcement.

The tentative agreement includes enforceable staffing increases of 209 social workers, amounting to one in each school, a case manager in each school and 250 additional nurses, the union said.

The district also committed to spending $35 million to reduce oversized classrooms and prioritizing schools that serve the most vulnerable students.

City officials did not immediately respond to questions about contract details. The union had sought a three-year contract.

Crowds of red T-shirted teachers took to Chicago’s streets during the strike’s two weeks, picketing some of the 500 schools across the city and holding rallies and marches in downtown Chicago.

Democratic presidential contender U.S. Senator Elizabeth Warren on Oct. 22 joined the striking teachers on the picket line, and strikers also joined in protests against Republican President Donald Trump during his visit on Monday to Chicago.

The work stoppage forced officials to cancel classes, but school buildings stayed open for children in need of a place to go during the strike.

The strike angered parents and students, particularly the families of student athletes, as the walkout coincided with state-wide play-offs, which teams have competed for months to attend, and where college talent scouts look for candidates for athletic scholarships.

The strike came seven years after Chicago teachers walked out for seven days over teacher evaluations and hiring practices. In 2016, teachers staged a one-day walkout to protest the lack of a contract and failure to stabilize the school system’s finances.

Chicago resident Jackie Rosa thanked teachers for their “fearless fight” and courage in holding out for a deal.

“You put your bodies on the line to bring TRUE EQUITY to our children,” Rosa said on Twitter. “Chicago owes you everything.”

(Reporting by Brendan O’Brien in Chicago, additional reporting by Andrew Hay in Taos, New Mexico; Editing by Scott Malone, Chizu Nomiyama, Bernadette Baum and Dan Grebler)

Counting the costs: U.S. hospitals feeling the pain of physician burnout

Counting the costs: U.S. hospitals feeling the pain of physician burnout

By Julie Steenhuysen

ANN ARBOR, Mich. (Reuters) – Dr. Brian Halloran, a vascular surgeon at St. Joseph Mercy Ann Arbor, starts planning his garden long before spring arrives in southeast Michigan.

His tiny plot, located in the shadow of the 537-bed teaching hospital, helps Halloran cope with burnout from long hours and the stress of surgery on gravely ill patients.

“You really have to find the balance to put it a little more in perspective,” he said.

Hospitals such as St. Joseph Mercy Ann Arbor have been investing in programs ranging from yoga classes to personal coaches designed to help doctors become more resilient. But national burnout rates keep rising, with up to 54 percent of doctors affected.

Some leading healthcare executives now say the way medicine is practiced in the United States is to blame, fueled in part by growing clerical demands that have doctors spending two hours on the computer for every one hour they spend seeing patients.

What’s more, burnout is not just bad for doctors; it’s bad for patients and bad for business, according to interviews with more than 20 healthcare executives, doctors and burnout experts.

“This really isn’t just about exercise and getting enough sleep and having a life outside the hospital,” said Dr. Tait Shanafelt, a former Mayo Clinic researcher who became Stanford Medicine’s first chief physician wellness officer in September.

“It has at least as much or more to do with the environment in which these folks are practicing,” he said.

Shanafelt and other researchers have shown that burnout erodes job performance, increases medical errors and leads doctors to leave a profession they once loved.

For a graphic, click http://tmsnrt.rs/2zMlmuy

Hospitals can ill afford these added expenses in an era of tight margins, costly nursing shortages and uncertainty over the fate of the Affordable Care Act, which has put capital projects and payment reform efforts on hold.

“Burnout decreases productivity and increases errors. It’s a big deal,” said Cleveland Clinic Chief Executive Dr. Toby Cosgrove, one of 10 U.S. healthcare CEOs who earlier this year declared physician burnout a public health crisis.

WHAT TO DO?

Hospitals are just beginning to recognize the toll of burnout on their operations.

Experts estimate, for example, that it can cost more than a $1 million to recruit and train a replacement for a doctor who leaves because of burnout.

But no broad calculation of burnout costs exists, Shanafelt said. Stanford, Harvard Business School, Mayo and the American Medical Association are working on that. They have put together a comprehensive estimate of the costs of burnout at the organizational and societal level, which has been submitted to a journal for review.

In July, the National Academy of Medicine (NAM) called on researchers to identify interventions that ease burnout. Meanwhile, some hospitals and health insurers are already trying to lighten the load.

Cleveland Clinic last year increased the number of nurse practitioners and other highly trained providers by 25 percent to 1,600 to handle more routine tasks for its 3,600 physicians. It hired eight pharmacists to help with prescription refills.

Atrius Health, Massachusetts’ largest independent physicians group, is diverting unnecessary email traffic away from doctors to other staffers and simplifying medical records, aiming to cut 1.5 million mouse “clicks” per year.

Insurer UnitedHealth Group, which operates physician practices for more than 20,000 doctors through its Optum subsidiary, launched a program to help doctors quickly determine whether drugs are covered by a patient’s insurance plan during the patient visit. It is also running a pilot program for Medicare plans in eight states to shrink the number of procedures that require prior authorization.

Similarly, Aetna Inc this year began a behavioral health program that eliminates prior authorization requirements for admission to some high-performing hospitals.

DOCTOR OVERLOAD

Experts define burnout as a syndrome marked by emotional exhaustion, cynicism and decreased effectiveness. Many burned out doctors cut back their hours to cope, and a disturbing number commit suicide.

A landmark 2015 Mayo Clinic study found that more than 7 percent of nearly 7,000 doctors had considered suicide within the prior 12 months, compared with 4 percent of other workers. About 400 a year go through with it.

Driving the burnout symptoms is the burden of data entry on clumsy electronic medical records systems that doctors must use to prove the quality of their care, said Dr. Christine Sinsky, vice president of professional satisfaction at the American Medical Association.

Sinsky recently conducted an experiment in her own internal medicine practice in Dubuque, Iowa. She asked a staff member how many mouse clicks it takes to order and record a single patient’s flu shot in their electronic medical record. The answer: 32.

She has visited some practices where a doctor had to record flu shots for more than 1,000 patients because only the doctor was allowed to enter the order.

Such mandates reflect an overly strict interpretation of federal health reforms designed to encourage doctors to use electronic medical records, such as the 2009 Health Information Technology for Economic and Clinical Health Act that required doctors to demonstrate “meaningful use” of the systems.

“We have to recognize the exacting toll that the first generation of electronic health records have had on physicians,” Sinsky said. “I would identify it as one of the most important drivers of physician burnout.”

Pre-approval requirements from health insurers for many services and quality metrics built into Obamacare have added to doctors’ administrative duties.

“We’ve got this measurement mania. We’ve got to back off of that,” said Dr. Paul Harkaway, chief accountable care officer for Michigan’s St. Joseph Mercy Health System, a part of Trinity Health, a national not-for-profit Catholic healthcare system.

As a result of these requirements, primary care physicians spend more than half of their 11.4 hour workday performing data entry and other tasks, according to a September AMA/University of Wisconsin study published in the Annals of Family Medicine.

To manage, doctors often finish work at home in the evening, a part of the day known as “pajama time.”

COSTS TO THE HEALTHCARE SYSTEM

Doctors’ suffering can take a direct toll on patients. In a 2010 study, Shanafelt and colleagues found that the more burned out a surgeon was, the more likely he or she was to report a major medical error. Other studies have shown that burnout drives up rates of unnecessary testing, referrals to specialists and hospital admissions.

When doctors quit, it costs an estimated $800,000 to $1.3 million in recruitment, training and productivity costs, depending on the specialty.

Even when physicians don’t leave, they can contribute thousands of dollars in costs each year “just as a matter of inefficient functioning,” said Dr. Colin West of the Mayo Clinic.

The trend has medical malpractice experts concerned. CRICO, the malpractice carrier for Harvard University’s two dozen affiliated hospitals, recently had to settle a handful of cases because doctors were too burned out to fight, even though CRICO believed it could win.

“The clinician just wanted it to go away,” said Dr. Luke Sato, CRICO’s chief medical officer. Sato estimates that an average breast or colorectal cancer malpractice case might cost $750,000 to $1 million to settle.

The crisis has Harkaway worried for his colleagues in Michigan, and for his profession.

“Working with doctors every day, you see it,” he said. “They are just beat down.”

(Reporting by Julie Steenhuysen; Editing by Michele Gershberg and Editing by Edward Tobin)