Covid-19, Health, Interviews, Labor

“We feel like cannon fodder” • Nurse Elizabeth Lalasz on fighting COVID-19 in a broken healthcare system

Elizabeth Lalasz is a Registered Nurse of 11 years working in Chicago’s largest public safety net hospital. As the busiest hospital in Illinois mainly serving working class people, the uninsured, and communities of color, her hospital is on the frontlines of the coronavirus crisis. Marx21 interviewed Elizabeth about what it’s like handling COVID-19 in our broken medical system, she and her co-workers’ fight for life-saving equipment, and how we can show solidarity with healthcare workers through this pandemic. 

CL: What is the current state of things at your hospital? Are you seeing an increase in people seeking medical care right now and are you prepared for that?  

EL: We’re just at the very beginning of seeing people seeking medical care for COVID-19. My hospital is the busiest in the state of Illinois and it sees around 300 people a day, which I believe is now increasing. 

Being a safety net hospital, we mainly serve patients of color: African Americans, Latinos, immigrants, undocumented people. We’re increasingly serving more young people without insurance. A lot of people don’t have a primary care doctor, so they come to the emergency room. There’s been a push telling people to talk to your primary care doctor before coming to a hospital if you have symptoms — but of course, they don’t have one. 

So yes, we have seen an increase in the hospital of COVID-19 patients. The most acute patients are being hospitalized and some are being tested and sent home if they’re able to self-quarantine. Still, the volume is high. 

CL: What steps has management taken to protect workers and provide care to coronavirus patients? Do you think it’s adequate? 

EL: As far as the plan: we have been a union hospital for a long time, I’m covered by National Nurses United — the largest Registered Nurses’ union in the country. Since at least early February, NNU has been pushing hospital management to make sure that we actually have proper protection, it’s called Personal Protective Equipment (PPE). 

We sent multiple, multiple emails about making sure we have N95 masks. That’s the highest level of protection we can have, not only for COVID-19 but also for things like tuberculosis. It took quite a bit of pushing to make sure that we have those masks. We have them in the hospital, but they’re not always readily available, especially in the emergency room, so that’s a problem in and of itself. ERs in hospitals are called “point of entry,” so that’s where a lot of people come in, they’re sick, they sit in the waiting room, they have to be screened, and then brought in. So it’s pretty paramount, especially given this pandemic, that we actually have that kind of protective equipment available. 

But management is now asking us to reuse the masks, which you’re not supposed to do. Even with a tuberculosis patient, they should be thrown away at the end of the day. These are heavy duty masks that catch airborne particulates. There’s discussion at the World Health Organization saying COVID-19 spreads by droplets. But it can also stay in the air, especially if we need to give patients respiratory treatments, which does happen, especially since it’s a respiratory illness, at least in part.

I don’t know when we’re going to get more PPE. For example, my union also represents one of the richest hospitals in the city of Chicago, University of Chicago Medical Center. The nurses there were on strike last September for staffing and wages, their first strike in a very long time. I’ve heard that this hospital is differentiating between staff — doctors can get N95 masks, but nurses only get surgical masks. 

But surgical masks do not provide the type of protection we need, given what the CDC and World Health Organization have said about the virus, which is that it’s not only spread by droplets, but it’s also potentially airborne. If you have a cold, a surgical mask prevents you from giving other people the cold. If you’re a healthcare worker, it’s not going to protect you from the particles in the air. 

They’re also locking up these masks, which is a huge problem. This has been happening in our ER, we don’t have ready access. We had a patient last weekend who needed to be intubated, which means putting a tube down their throat so they can breathe, and there weren’t masks readily available for the doctors, nurses, or the tech that was helping. It’s a bit difficult to call the supervisors to get an N95 mask and intubate somebody at the same time. I don’t know how you do that. In fact, you can’t. So, we’ve definitely had exposures, or possible exposures. It’s kind of stunning, the level of inefficiency.

CL: Aside from the restrictions on PPE, are there other gaps you see in COVID-19 care?

EL: It’s also been a lot to push management — and we’ve pushed them some — to move suspected and confirmed COVID-19 patients to a particular area, rather than have them all over the hospital. Up until last week they hadn’t been doing that. They had actually been mixing the COVID-19 patients in with other patients — including patients that are immunocompromised, who of course are on the list of high-risk patients if they get infected. This includes cancer patients, cardiac patients, patients with respiratory illnesses, chronic illnesses like asthma or emphysema. 

So thankfully we’ve moved them on that. But they only have one unit, plus they have a backup unit in my division, which is a big division (medical-surgical.) They’re going to need more. So the idea of them prepping? They’ve got things in place, but they have to be thinking many steps in advance and I just don’t feel like they are. 

We also have some patients in critical care, you might have seen on television or read in the news that some COVID-19 patients have to go on ventilators. That’s where those very serious cases go, critical care. We need to be able to expand that now, because Chicago has yet to really hit the surge that is hitting, for example, New York right now, which is the epicenter. 

CL: Are you, as frontline medical workers, being consulted on the policies being implemented?

It’s not completely transparent to me what the plan is, which is why we’ve been arguing to management that they have a task force around COVID-19. That task force needs to be made up of frontline doctors and nurses and health care workers. They need to get our input, because we’re the people who do this stuff every day.

Here, they’re bringing these patients into the hospital itself. In Italy they have tents set up with special areas for suspected COVID-19 patients. We don’t have that yet, but we’re going to need it. Our management is beyond step A, they made it to step B — but we need to be planning for C, D and E. 

As healthcare workers, we don’t know exactly how COVID-19 will manifest in every patient, but we do know the best way to care for them: isolation, one-on-one care (meaning one nurse or one doctor to one patient), typically volunteers would be the best option. That’s what happened around Ebola and that’s what we need to put into place now. We’re steps behind.

CL: Are there particular safety measures that your union is calling for, and how are management and the government responding to these? 

EL: National Nurses United is the largest RN union in the country and also probably one of the most left wing ones, and we have a whole list of demands. There are all sorts of things to be said about unions becoming more democratic for their members, but my union, being a member run, has been fighting this for over a month, if not longer. The immediate demands are for PPE. The optimum protection are N95 masks, contact isolation gowns, and surgical shields to put over your eyes. 

We need to up the production of N95s, about 80% of which are made in China. They’re made in China because of the cheap labor and therefore, in a capitalist system, it means we don’t have the immediate capacity to increase production here. So we’re demanding retrofitting of other factories that are not currently making anything because of the social distancing, so they can begin to make things like masks.

But we would prefer to even have higher protection. In Italy and other places in Europe they literally have respirators that you can put over your head. They have much better protection in Europe. You see what’s happening in Italy and it makes you really nervous to be a healthcare worker right now in the US. Because even when we demand and win the optimum protection available, it’s still not enough, we believe. 

We’re also demanding ventilators, because we have limited ventilators and limited critical care beds in the US. We need specific places to put COVID-19 patients, not just in the immediate, but for the longer term too. We don’t know how long this is going to go on, it could go into the fall. There could be a second wave and we need to be prepared for that. So we’re demanding an increase in ventilator production and for retrofitting closed hospitals to make more critical care beds. 

Those are some of our immediate demands. Then there’s a whole series of long range demands, which include things like increasing health care capacity. We know about social distancing, which is about flattening the curve by decreasing the numbers of infections. We want to slow down the spread, we don’t want the curve to go up quickly, and the main way to do that is social distancing. But we have to increase the capacity of our healthcare system to be able to deal with the infections. We’ve felt this for years, we need to increase staffing. But it’s run for profit, so it’s a “lean production” model — which is insane in healthcare right now. 

CF: Say more about the for-profit medical system, what impact does it have on patient care in the US?

EL: There’s been so much discussion about Medicare for All in the last year or two, and in the last couple of months especially around the presidential election and the Democratic primaries. Bernie Sanders has been raising the idea of Medicare for All, which was already becoming more and more popular among people. They see how people are denied care and have to go and produce GoFundMes to pay for medical bills. So that’s the external part, in the outside world. 

But sometimes it’s hard for people to fully see what happens on the inside of healthcare, outside of talking about astronomical drug prices and people getting denied insurance claims. When you’re a health care worker, it means incredibly limited staffing. There’s a federal mandate, a law, that nurses stay with acute care patients 24 hours. But they also consider us expensive, especially at my hospital where I’m a union nurse, so I get a raise every year, I get guaranteed vacation and sick leave. They’re always trying to reduce those costs as much as possible. 

The same goes for doctors. There’s certainly a difference, but they can legally work them for 24 hours without getting a rest. I’m talking about interns and residents, not attendings. But when I talk to attendings in my hospital, they get maybe three days off a month and that’s it. Otherwise they’re in the hospital constantly. So you have such a high level of staffing intensity. 

So much of healthcare is what they call “meaningful use,” these are markers that are all indicated electronically. Insurance reimbursement is based on what you put into the patient’s chart, if you click on this or that particular indicator. That takes everything away from you to actually be available for the patient. It doesn’t take into consideration all the things you need to be doing for them.

So people here are really run ragged. You’re short staffed. You have heavily acute patients who don’t come in sooner because they can’t afford healthcare, in my hospital in particular. You’re just completely exhausted at the end of the day. 

There have been recent studies showing an increase in the number of suicides among doctors and nurses. This is the profession we’ve chosen and there are certain things we expect to see and do on the job. But it has an emotional and psychological impact on you — being incapable of getting to all your patients, having to do all this extra charting, and not really taking care of the human being, not being able to make that the priority.

CL: How do you think this long term trend of austerity, performance indicators, and undermining patient care is impacting your ability to deal with COVID-19?

It’s all run on the cheap already. So when it comes to a pandemic we have no, so to speak, extra “fat” on the system. It’s a lean, “just-in-time” production model based on the auto industry. So when it comes down to critical supplies like N95 masks, of course you’re waiting for them to get shipped from China, rather than having a whole abundance of them readily available. The federal government has stockpiles, but not the numbers that we need in the middle of a pandemic.

We already have a crisis-ridden system for profit, that doesn’t put healthcare first for patients, that tries to squeeze out everything it possibly can from healthcare workers. And then you basically put a nuclear bomb on top of that, and now it’s just blowing apart.

In Spain, they have just nationalized healthcare right in the middle of this crisis. In Italy they have nationalized the medical system. National health systems have the structure to centralize our responses in a crisis like this. A private healthcare system is not capable of that. Everybody’s doing their own thing, quite literally. You may have CDC recommendations here, but the hospital may or may not choose to follow it. 

The whole idea of the “free market” means you can do whatever you want. Trump is saying hospitals should do whatever they want. The lack of coordination means the shortages of PPE are going to be more acute. All they’ll do is attempt to squeeze down harder on health care workers saying: you need to stay on the job as long as you possibly can so we can extract as much labor as we can out of you. Until you drop over sick, or possibly die.

CF: You mentioned Spain, where the government is pulling private facilities under state control, at least temporarily. Do you think some form of nationalization of healthcare is a model for the US medical system?

EL: It’s raising that question in a big way. Yes, it would help. But it’s a weird situation, because who in our country would be the people running a state health system? We already have such a level of incompetence. So it’s a question about Trump. He and Pence, and even the people within Health and Human Services, there just doesn’t seem to be a recognition that this is a real problem. They just want to make more money off of it.

It would help to at least bring people into some kind of clear plan about what you do in a situation like this. So, right now, there are CDC guidelines. You can follow them, you can not follow them. Hospitals can just loosen those guidelines. They’re like “Oh well you don’t need an N95, you can have a surgical mask, and as a last resort you can wear a bandana.” Well, I’m not going to work if you don’t provide proper protection.

This is the largest occupational safety disaster in this country’s history. If we could at least bring hospitals together to make a clear and defined plan, that could respond to the virus as it changes, that would allow us to be nimble — it would make a huge difference.

We’ve learned from Wuhan, China. There are things we’re learning from Italy, Hong Kong and South Korea. We could begin to look at some of those lessons. But we have an administration that doesn’t want to look at those things. 

It’s also about the possibility of propping up a health care system that needs to exist. I just read an article in the Washington Post that said a hospital in Washington state is talking about closing because they’ve shut down their elective surgeries. This is a big money maker for any hospital. But to close hospitals right now? It’s crazy. We need capacity. We don’t need to contract capacity. We don’t need to lay off healthcare workers. I’m sure they would be hired somewhere else in a heartbeat because we need people. But we need the hospitals to exist to allow us to do our work. 

So nationalizing healthcare is not a panacea, but it certainly would move in the right direction. I think it gets beyond Medicare for all. There are criticisms about Medicare for all. I am for Medicare for all, as somebody working in the healthcare industry for 11 years. We certainly need something different. But I think we get beyond that when we start talking about nationalization. We’ve skipped a step. I think that conversation is very much out there amongst people because of all of this, which is so inadequate. 

It’s terrifying to go to work. I don’t know if I’ll be safe. My employer has a legal responsibility to keep me safe, but we know under capitalism that they don’t care about us. So you feel like cannon fodder. Do I want to be cannon fodder, do my coworkers? It raises all those things about nationalization and people’s willingness to fight for something better. We haven’t gotten there and I’m not sure how we’ll get there with this administration. But it’s also a very fluid situation.

CL: Your hospital has a unit that serves incarcerated people. What are the risks right now for people in prisons? 

EL: The incarcerated people I see come here when they’re acutely ill. There is an actual hospital at the prison, but if they become so ill that they need a higher level of care, they come to me. 

What’s happening in prisons is terrifying. For example, Cook County jail is a large facility and it’s overcrowded. The people who run it — including elected officials like the Cook County Sheriff and the Cook County board president (who is essentially my boss) — they would say they’ve decreased the numbers of prisoners. But it’s still close to 5,000 people in a closed area. I can’t even imagine. 

A couple of weeks ago I asked some of the officers, who have to accompany the incarcerated people over from the jail, if they had a plan — and they said they didn’t. But this is a place where people are in close proximity, it’s overcrowded, and they don’t have enough healthcare to begin with. We have nurses who are unionized at the jail, as well as AFSCME representing Licensed Practical Nurses (LPNs), but there aren’t enough of them. So I’m not even sure what’s going to happen. I just read that Rikers Island jail in New York had several positive patients, so it’s going to spread very quickly in those situations.

CL: And is it the same situation in immigrant detention centers?

EL: Yes, the same happens in these immigrant detention centers. It’s the same idea. We’ve known for months and months since Trump and his administration insisted that we set up these camps that people were not getting basic healthcare, that they were dying from pneumonia and other diseases. The denial of health care is rampant throughout these detention centers. So I can’t even imagine what’s going to happen. It’s a disaster waiting to happen. 

We need to stop ICE raids. First of all, ICE agents should not be using masks that we need in hospitals to go and do raids on immigrants! And we have to stop the raids so undocumented people will actually feels safe to come into hospital so that we can take care of them.

We can talk about medically at risk patients, and we should — those who’ve got respiratory or cardiac cancer, immunocompromised patients, and the like. But we also have to talk about the inequality in our society. We know that COVID-19 will disproportionately affect prisoners, who are mainly people of color, as well as immigrants in these detention centers. 

CL: And what about homelessness? I’ve been thinking a lot about this, living in Los Angeles. The recommendations are to “stay home,” but the homeless population in LA County is enormous. 

EL: These are people who just don’t have any real access to healthcare. I’m sure there are plans for all of those groups of people, to some degree. Somebody’s talking about what to do about the homeless in Chicago, I know, but will it be enough? Whole groups of people can become sick and it just spreads exponentially in that kind of environment.

And, right, it’s a problem across California. I was in San Francisco last September and I was just stunned at how many people were homeless. But it’s because people can’t afford housing in the state of California. And we’re also talking about people who have all kinds of underlying health issues that we don’t even know about because they’re not able to access care. And this newer telemedicine stuff is great (well, we’ll see, I haven’t tested it yet.) Instead of going into the ER you’re supposed to just call your doctor now. But you can’t do that if you’re homeless. So where does that leave people?

All these vulnerable groups we’re talking about, if you live in any of these spaces, you’re denied rights. So are we just going to let those populations perish? This crisis is bringing all the stuff you read about the brutality of the history of capitalism to the fore. This pandemic just brings it to such a new level, right in front of you. It’s a very challenging situation, especially to try and organize to pressure the government around these issues when you’re doing social distancing. 

CL: Trump insists on calling this infection a “Chinese virus.” Does this come up in your work? How do you and your co-workers respond to this kind of racism? 

Trump is really riding that one. But most of my coworkers are women of color, so they’re not real big fans of his. My union put out a good statement about Trump calling this the “Chinese disease” and the “Chinese virus.” We really need to cut against this racism. In fact places like Wuhan in China, Taiwan, Hong Kong, South Korea — these are all Asian countries and they’ve all had a far better response to this than the US. As we go forward we need to talk about what China did. I’m not saying we could do all of it, but knowing how they helped to mitigate and decrease their numbers is important. 

I think it will get worse, because that’s the card that Trump wants to play. it’s incredibly destructive, because it undermines people’s ability to cooperate. For example, the Chinese went to Italy to help out with the situation. But the racism breaks the world down, it maintains this ongoing war between China and the US that Trump has waged his whole presidency. We need global cooperation. We need to get beyond nation states and imperial war. We need those resources. 

When you sit back and scapegoat people, and try to point a finger at Chinese people, or Asians in general, it’s actually a good way to get the attention away from the criminal irresponsibility of the Trump administration. The coming number of months are potentially very volatile as things get worse for people economically, and they’re going to be looking for those scapegoats. So we have to cut against any kind of anti-Asian racism that exists in this country. 

We have a long way to go with that fight. Trump has built his presidency on that sort of racism. Whether it’s anti-Asian, anti-immigrant, the Muslim travel ban, the escalation with Iran. It’s a very destructive and dangerous tool. Certainly unions have to take this on, although that’s not always been a strong point from unions. But we have to show solidarity. We’re going to need the left to really push that anti-racism. Whatever the future holds, we have to fight and say that’s unacceptable and to take it on. 

CF: What kind of solidarity can people outside the health sector offer frontline medical workers right now, especially in a world where so many people are stuck at home? 

That’s a very good question and I know people are grappling with that. It’s a very challenging situation to be social distancing and then trying to organize at the same time. How do you protest if you can’t gather externally in groups to try to pressure the government to actually listen to you? 

Our demands vary from place to place, but we’re calling for PPE first and foremost. The inadequacy around available PPE has been all over the media recently, so signing online petitions around these demands is a good start. People should look at NNU’s demands and at the demands from other unions. The New York State Nurses Association (NYSNA) has a whole set of demands, as does Washington Nurses Association

Another thing we’re discussing: can we actually pressure the federal government over the Defense Production Act that Trump has now declared, which hasn’t been used since the Korean War, to up production? We don’t think that that’s really going to be feasible. The petition to Congress is the right thing and we’re demanding that the money be used for the production we need. Whether or not it happens? We can’t wait around for that.

We’re now pushing at the state and local level, and also taking donations from other sectors. For example in Boston, construction workers who are now not working, they’re donating their equipment to us. So that’s one of the things you can do. It’s still a fight within our facilities, though. It’s quite funny, I just found out that they’re not allowing our nurses to bring that donated stuff in, because it’s a total embarrassment to management. But the way we’re looking at it is: too bad. It’s my life, so if you can’t provide the equipment, I’m going to get it from somewhere else. 

We also need to figure out how to pressure some places to retool. For example there’s a small distillery here in the city of Chicago that’s moving from making gin to making hand sanitizer. It’s called KOVAL Distillery, and they make really good gin and whiskey. 

People can also give social media support. A lot of health care workers have put photos up on social media saying “this is what it looks like to not have a mask” or “this is what my mask looks like. What do you think?” or “here’s my bandana.” Supporting those sorts of things is important. And then some of the creative stuff that people have been able to do: donations mostly through mutual aid networks that have been set up on social media.

We are trying to figure out how to get the rest of the labor movement on board to help us press more widely on the need for PPE and our other demands. I don’t know what that’s going to look like yet. The left and the labor movement are weaker than we would like them to be going into this. But we’re trying to build up capacity, build up those networks, and use the pressure that we can. It seems to be working in some part.

CF: This is such a new terrain for workers figuring out how to fight back, how is that shaping your response as healthcare workers?

New situations like this can yield a weird combination of things. Like asking small businesses to help. A lot of that is because we’ve been pounding the social media. My union also had an article in the Chicago Tribute, my chief steward was on the front of the page because she’d gone to the hardware store and bought herself coveralls, because she didn’t feel protected. That coverage has helped push things forward.

We’re trying to figure out how to leverage this moment. It’s very dire, but we also realize a lot of attention is on us right now and we need to take advantage of that. Also, we understand that we are needed right now. Are you going to fire us? Sure, okay. 

There’s certainly the possibility that people could support us with job actions. I know that may not seem so possible right now. But as things unfold, there may be ways for people — perhaps virtually — to support us in strike action. I would not put that kind of action outside the realm of possibility. If we continue not to have the protection we need to go care for our patients, this could happen pretty quickly.

We’re anxious and fearful going into work, we’re under a state of emergency, we can be forced to work overtime, and get relocated in the hospital. But it’s also making people bolder. In the ER some of the nurses have been denied masks, which they need in order to work with possible and confirmed COVID-19 patients. When they’re denied those things they say “okay, well once you get the mask, come find me in the break room. I’ll see ya.” And suddenly that mask appears! Or they’ll give the masks to the doctors and not the nurses and, again, the nurses will say “see ya.” That’s essentially a sitdown strike. So the idea of stopping work is coming up. The teachers in New York did it, and in Seattle. 

It’s a tenuous line. As nurses, we can’t abandon our patients. If you do, you can get fired and lose your licence. But it’s also possible that we’ll start seeing more of these actions. We’ve been doing actions outside of the hospitals, both in California and here in Chicago, where we’re 6 feet apart but we’re out in front of the hospital saying this PPE is not adequate. 

At the University of Chicago, for a couple of days running, we were going into the chief nursing offices and dropping off invitations asking the chief officers to come and join us as we’re screening COVID-19 patients. And you can just keep harassing them, because they’re very scared about getting it themselves. So fine, they’re nurses, they can come down and help. 

Things are rapidly changing and I think people’s consciousness is changing very quickly, given this situation. There’s both fear, but there are also things we would never have thought about doing a month ago, that people are doing now. We’re skipping over steps. We’re trying to figure out how to organize in a very challenging environment.

CF: Is there anything else you want readers to know about the situation? 

EL: People should know we’re out there fighting for them and any support they can give us is  greatly appreciated. We’re still trying to figure out what that support should look like more concretely. It’s a challenging situation, but we aren’t giving up. We aren’t done by any stretch of the imagination. Supporting us now means we have a better chance of actually slowing this disease down and allowing us to find a vaccine to cure it. 

Everything that people are doing around social distancing, please continue to do it. Realize it’s going to get really dire and we’re going to need to do more mutual aid networks and all these sorts of things. But also understand that this is a moment in healthcare where we’re learning that we’re the ones that actually do this stuff, we’re the people who work and heal patients. 

There’s a real question about how the healthcare system in this country is going to continue to operate because, frankly, a lot of us don’t think it can, not the way that it has been. We plan on changing that once we get through this.

Interviewed by Clare Lemlich on March 22, 2020