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Each night for the past two weeks, the routine has been the same. Pradeep Natarajan and Puja Kohli, both physicians at Massachusetts General Hospital, return home, and, from the safety of the garage, change out of their work clothes and throw them immediately into the washing machine, where they go through two cycles. They shower before feeding their four-year-old twins and putting them to bed.

Then they really get to work.

For the next two hours or so, the couple intensely cleans their Brookline house, hoping to eradicate any trace of the virus they might have carried home. They vacuum and mop every room, wipe down every surface — every countertop and appliance, toilet and doorknob.

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“Basically, what a household cleaner would do each week to clean a home,” said Natarajan, the director of preventive cardiology at MGH, “we’re doing on a daily basis.”

Massachusetts General Hospital doctor Puja Kohli removed her scrubs after arriving home from work.
Massachusetts General Hospital doctor Puja Kohli removed her scrubs after arriving home from work. Erin Clark/Globe Staff

As patients suffering from COVID-19 begin crowding hospitals, health care workers, those working directly with patients and many who simply work in the same facilities, are taking extreme measures to protect themselves and, especially, their families. The deaths of health care workers in China and Italy and the frightening ease with which the virus appears to be transmitted, shedding abundantly from patients and living on surfaces for days, has stoked fear among those on the front lines.

“There’s such anxiety right now in the general community, period,” said Maryanne Bombaugh, president of the Massachusetts Medical Society and a clinician at the Community Health Center of Cape Cod. “But certainly with health care workers, there’s an anxiety there because we don’t want to be bringing anything home to our families.”

In a matter of a few short weeks, the outbreak has transformed from a distant threat into a national crisis, and health care workers, often with little guidance, have been left to devise their own measures for keeping their spouses and children safe.

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Some have sent kids to stay with relatives. Some are sleeping on cots or in the hospitals where they work.

Justin Schrager, an emergency physician at Emory Healthcare in Atlanta, made the decision recently to move out of the house he shares with his wife and three children and into a garage apartment, despite having a four-week-old baby at home.

It’s "one of the toughest things we’ve gone through,” said Schrager, whose communication with his children has been limited almost solely to FaceTime.

Doctor Puja Kohli's belongings rested in a bin after she wiped them down.
Doctor Puja Kohli's belongings rested in a bin after she wiped them down.Erin Clark/Globe Staff

In the midst of a pandemic unlike any to hit the world in a century, nearly every health care worker in America is struggling to adjust to a new reality.

“I can’t even go home and hug my kids anymore,” said Jessica Zeidman, a physician at Massachusetts General Hospital, who has had to teach her two young children to keep their distance until she has showered.

Edward W. Boyer, an emergency physician at Brigham and Women’s Hospital, has begun bringing an extra pair of clothes with him to work each day, changing into them at the end of his shift. On the drive home, he keeps his windows down, despite the cold, hoping the air will extricate any virus that may remain in his clothing.

At the dinner table, he says, his family has always held hands during a pre-meal prayer.

“We no longer do that."

The Centers for Disease Control and Prevention offers a list of measures that health care providers can take to protect themselves within the confines of a hospital. Wear eye protection, a gown, gloves.

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Outside the hospital walls, however, the guidance grows increasingly vague.

At Tufts Medical Center, the “vast majority” of workers have developed personal contingency plans in the event they become ill, said Beth Lane, a registered nurse in the maternal/fetal medicine clinic.

More than a week ago, Lane and her husband, who have a 10-year-old son with asthma, agreed that she would quarantine herself in a room above the family garage if she becomes ill.

“Thank God our house can be separated if something happens,” she said.

Concerns have been compounded by what many doctors and medical personnel have described as a significant shortage of personal protective equipment and by the medical community’s evolving understanding of the virus.

Two weeks ago, it was believed that the virus spread only through respiratory droplets excreted through coughing or sneezing and contact with contaminated surfaces. But a new study published this week in the New England Journal of Medicine raised the possibility that it could remain suspended in air for 30 minutes.

“There’s a lot of uncertainty, there’s a lot of shifting, rapidly evolving guidelines, and there’s a limited amount of data," said Dan H. Barouch, professor of medicine at Beth Israel Deaconess Medical Center and the Ragon Institute.

Already, providers at MGH and Brigham and Women’s Hospital have tested positive for the virus. Bombaugh, the Massachusetts medical society president, also recently developed symptoms consistent with COVID-19. She underwent a test for the virus late last week and is awaiting results. She is concerned she could have exposed her son or grandchild.

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David Schildmeier, a spokesman for the Massachusetts Nurses Association, called on Tuesday for “aggressive” efforts by hospitals to partner with local hotels where nurses could quarantine themselves and avoid carrying the virus home.

Schrager, the physician who moved into the garage, has done his best to make it through his current situation.

From his new living quarters, he keeps in touch with his wife and three children as much as possible. They FaceTime daily, wave hello from afar. A couple of times, the family has gone for a walk, with Schrager trailing a safe distance behind.

But with coronavirus cases expected to rise exponentially in the coming weeks, and with hospitals bracing for an influx of new patients, he worries how much longer he can go without his family.

“I can endure for a while,” Schrager said, speaking this week from his self-quarantine quarters. “But it’s hard to know when this is going to end, and what the end is going to look like.”


Dugan Arnett can be reached at dugan.arnett@globe.com.