One morning in late March, after another fretful night at home, Dr. Elissa Perkins, an emergency medicine physician at Boston Medical Center, opened up Facebook and fired off a 1,060-word missive on her profile page about the subtle dangers that now terrify her at work: A stray cough. A burst of spittle. The growing roster of sicker — and younger — patients checking in at the emergency department.
The headlines in the news also alarm her — of critically ill health care workers felled by repeated exposure to the same deadly new virus infecting the patients they were trying to treat.
“We are all going down,” Perkins wrote, about halfway through her Facebook post. “Every one of us who works in the medical field.”
The long tentacles of the coronavirus pandemic have spared no one, least of all the medical personnel tasked with saving the sick and dying. In China, Italy, and Spain, thousands of health care workers have contracted COVID-19, the disease caused by the virus, and dozens have died. Last week, a 48-year-old nurse in New York City died after catching COVID-19. His colleagues had been complaining for weeks about insufficient protective gear, like masks and gowns. A viral photograph of nurses at the same hospital wearing black trash bags over their scrubs encapsulated their plight.
State governors, including Massachusetts’ Charlie Baker, say they are routinely outbid by the federal government for desperately needed medical supplies and personal protective equipment in the global marketplace. Massachusetts has also asked for supplies from the U.S. Department of Health and Human Service’s Strategic National Stockpile, but only a small fraction of the state’s requests have been fulfilled. Meanwhile, the Washington Post reports, the national stockpile’s reserves are nearly depleted.
The equipment shortages are so dire, hospitals, including Boston Medical Center and Brigham and Women’s, have resorted to begging for donations on social media, and medical workers, like Perkins, warn they are now forced to practice medicine in dangerous conditions to conserve their limited reserves. They’re reusing particulate-filtering N95 masks and plastic face shields that are meant to be tossed after each patient exam to reduce the risks of cross-contamination. At Boston Medical Center, where 51 employees have tested positive for the virus, an initial policy, intended to forestall an anticipated shortage, forbade doctors from wearing surgical masks unless their patients had suspected or confirmed COVID-19 infections.
But Perkins, who is 43 and an expert in infectious diseases, lobbied hard to change the rule so she and her colleagues could protect themselves at work.
“This is the worst I have ever seen health care," she said later, of the widespread shortages of personal protective equipment, or PPE. “We all went into health care because we want to do right by our patients, but this is not what we signed up for. We did not sign up to be unprotected while we’re taking care of them.”
So that morning in late March, at home in Milton, Perkins dusted off a copy of “Estate Planning for Dummies.” A few hours later, she asked her husband, Mike Perkins, a 39-year-old public building inspector, if he’d read what she’d written online. Yes, he said. What do you think? she asked. Mike agreed. I guess it’s time.
They had talked before about updating their will, but only as a chore on their endless to-do list, not an urgent demand. So before her next shift, Elissa compiled a list of her financial accounts and life-insurance policy and saved their information in a locked document on her laptop. She gave the password to her husband. Soon, she would share it with her brother, in case Mike got sick, too.
In recent weeks, Perkins has been returning home from shifts in the emergency department much darker than usual. Perkins is a natural optimist. She has learned through the years how to divorce the horrors of her job from her day-to-day life in the suburbs, with her husband and two kids, ages 8 and 10. Rarely does the line between her two worlds blur. The Boston marathon bombings in 2013 briefly eroded that divide, as do cases involving children. But now, the tenuous boundary separating her professional and personal lives has collapsed.
The atmosphere in the emergency department is thick with anxiety and dread. At home, the tension is as taut as a tripwire. The enemy that stalks Perkins and her coworkers is neither invisible nor silent. She sees it in the hazy ground-glass opacities on CT scans of her patients’ lungs. She hears it through her stethoscope, the crackles of patients gasping for air, drowning above water.
All Perkins can think about now is the incoming onslaught of sick patients, her vulnerable emergency department colleagues, and the growing scarcity of personal protective equipment and even cleaning supplies that in the coronavirus era are now as precious as gold.
The severity of the current shortages reminds Perkins of her time practicing emergency medicine in developing countries like Mali, Ghana, Peru, and Vietnam. The nurses wore hand-sewn masks, like the ones volunteers in the United States are making with craft-store fabric and Pinterest templates. The doctors reused the same N95 masks that hospitals here now ration to their employees and guard under lock and key.
Disinfectants, like hand-sanitizer and bleach wipes, also are as hard to find in hospitals as they are at grocery stores. During a recent shift, her emergency department ran out of the bleach wipes she and the other doctors use to decontaminate their stethoscopes, ID badges, and face shields after examining sick patients. They tried to salvage the leftover sanitizing liquid at the bottom of the last bleach wipes container, pouring drop after drop onto paper towels until the container was dry.
The question that keeps Elissa and her husband up at night is no longer if she gets sick, but when? They have a plan in place: Perkins will move into the guest bedroom which has its own bathroom and a doorway to the backyard. She’ll FaceTime with the kids.
But what if she’s hospitalized? Then what? Coronavirus patients are isolated. Not even visits from family are allowed. Those who eventually succumb to the disease die alone. Will he able to see her, Mike wonders? What about her parents in New York? And what if he’s infected, too? Who would take in their children? In his lowest moments, Mike sometimes thinks Elissa is choosing her duty to her patients over her family.
“I know that’s a horrible, selfish thing to say because she’s the one who can help these people, but at what cost?” he said.
So Mike does what he can. He’s called out family members on social media for posting photos of themselves enjoying their busy lives outside of quarantine. He’s argued with coworkers who chalked up the severity of the pandemic to media hysteria. He built his wife a custom face shield using supplies from the hardware store. He resists the urge to yell at strangers he sees, cavorting in large groups outside. He tells his son he can’t play basketball with the neighbor’s kid. He drove to Grafton last week to pick up a set of N95 masks from an old friend in the construction business. He and his wife have amassed a small stash of these masks in their garage, from friends who have dropped them off on their porch or sent them in the mail, awaiting the day Perkins’ hospital runs out.
Until then, Perkins has four used N95 masks, each in a paper lunch bag, carefully labeled with the date on which she wore them. She read a study that claims the viral particles die off in three to four days, so if her old masks are contaminated, she thinks she’ll be able to re-wear them safely again.
She’s not that desperate yet.