More than 3,600 U.S. health care workers perished in the first year of the pandemic, according to “Lost on the Frontline,” a 12-month investigation by The Guardian and Kaiser Health News to track such deaths.
Lost on the Frontline is the most complete accounting of U.S. health care worker deaths. The federal government has not comprehensively tracked this data. But calls are mounting for the Biden administration to undertake a count as the KHN/Guardian project comes to a close today.
The project, which tracked who died and why, provides a window into the workings — and failings — of the U.S. health system during the covid-19 pandemic. One key finding: Two-thirds of deceased health care workers for whom the project has data identified as people of color, revealing the deep inequities tied to race, ethnicity and economic status in America’s health care workforce. Lower-paid workers who handled everyday patient care, including nurses, support staff and nursing home employees, were far more likely to die in the pandemic than physicians were.
The yearlong series of investigative reports found that many of these deaths could have been prevented. Widespread shortages of masks and other personal protective gear, a lack of covid testing, weak contact tracing, inconsistent mask guidance by politicians, missteps by employers and lax enforcement of workplace safety rules by government regulators all contributed to the increased risk faced by health care workers. Studies show that health care workers were more than three times as likely to contract covid as the general public.
“We rightfully refer to these people without hyperbole — that they are true heroes and heroines,” said Dr. Anthony Fauci in an exclusive interview with The Guardian and KHN. The covid deaths of so many are “a reflection of what health care workers have done historically, by putting themselves in harm’s way, by living up to the oath they take when they become physicians and nurses,” he said.
Lost on the Frontline launched last April with the story of Frank Gabrin, the first known American emergency room doctor to die of covid-19. In the early days of the pandemic, Gabrin, 60, was on the front lines of the surge, treating covid patients in New York and New Jersey. Yet, like so many others, he was working without proper personal protective equipment, known as PPE. “Don’t have any PPE that has not been used,” he texted a friend. “No N95 masks — my own goggles — my own face shield.”
Gabrin’s untimely death was the first fatality entered into the Lost on the Frontline database. His story of working through a crisis to save lives shared similarities with the thousands that followed.
Brazilian nurses mourn Covid-related deaths of healthcare workers.
Maritza Beniquez, an emergency room nurse at Newark’s University Hospital in New Jersey, watched 11 colleagues die in the early months of the pandemic. Like the patients they had been treating, most were Black and Latino. “It literally decimated our staff,” she said.
Her hospital has placed 11 trees in the lobby, one for each employee who has died of covid; they have been adorned with remembrances and gifts from their colleagues.
More than 100 journalists contributed to the project in an effort to record every death and memorialize those who died. The project’s journalists filed public records requests, cross-connected governmental and private data sources, scoured obituaries and social media posts, and confirmed deaths through family members, workplaces and colleagues.
Among its key findings:
More than half of those who died were younger than 60. In the general population, the median age of death from covid is 78. Yet among health care workers in the database, it is only 59.
More than a third of the health care workers who died were born outside the United States. Those from the Philippines accounted for a disproportionate number of deaths.
Nurses and support staff members died in far higher numbers than physicians.
Twice as many workers died in nursing homes as in hospitals. Only 30% of deaths were among hospital workers, and relatively few were employed by well-funded academic medical centers. The rest worked in less prestigious residential facilities, outpatient clinics, hospices and prisons, among other places.
The death rate among health care workers has slowed dramatically since covid vaccines were made available to them in December. A study published in late March found that only four of 8,121 fully vaccinated employees at the University of Texas Southwestern Medical Center in Dallas became infected. But deaths lag behind infections, and KHN and The Guardian have tracked more than 400 health care worker deaths since the vaccine rollout began.
Many factors contributed to the high toll — but investigative reporting uncovered some consistent problems that heightened the risks faced by health workers.
The project found that Centers for Disease Control and Prevention guidance on masks — which encouraged hospitals to reserve high-performance N95 masks for intubation procedures and initially suggested surgical masks were adequate for everyday patient care — may have put thousands of health workers at risk.
The investigation exposed how the Labor Department, run by Donald Trump appointee Eugene Scalia in the early part of the pandemic, took a hands-off approach to workplace safety. It identified 4,100 safety complaints filed by health care workers to the Occupational Safety and Health Administration, the Labor Department’s workplace safety agency. Most were about PPE shortages, yet even after some complaints were investigated and closed by regulators, workers continued to die at the facilities in question.
The reporting also found that health care employers were failing to report worker deaths to OSHA. The data analysis found that more than a third of workplace covid deaths were not reported to regulators.
Among the most visceral findings of Lost on the Frontline was the devastating impact of PPE shortages.
Adeline Fagan, a 28-year-old OB-GYN resident in Texas, suffered from asthma and had a long history of respiratory ailments. Months into the pandemic, her family said, she was using the same N95 mask over and over, even during a high-risk rotation in the emergency room.
Her parents blame both the hospital administration and government missteps for the PPE shortages that may have contributed to Adeline’s death in September. Her mother, Mary Jane Abt-Fagan, said Adeline’s N95 had been reused so many times the fibers were beginning to disintegrate.
Not long before she fell ill — and after she’d been assigned to a high-risk ER rotation — Adeline talked to her parents about whether she should spend her own money on an expensive N95 with a filter that could be changed daily. The $79 mask was a significant expense on her $52,000 resident’s salary.
“We said, you buy this mask, you buy the filters, your father and I will pay for it. We didn’t care what it cost,” said Abt-Fagan.
She never had the opportunity to use it. By the time the mask arrived, Adeline was already on a ventilator in the hospital.
Adeline’s family feels let down by the U.S. government’s response to the pandemic.
“Nobody chooses to go to work and die,” said Abt-Fagan. “We need to be more prepared, and the government needs to be more responsible in terms of keeping health care workers safe.”
Adeline’s father, Brant Fagan, wants the government to begin tracking health care worker deaths and examining the data to understand what went wrong. “That’s how we’re going to prevent this in the future,” he said. “Know the data, follow where the science leads.”
Adeline’s parents said her death has been particularly painful because of her youth — and all the life milestones she never had the chance to experience. “Falling in love, buying a home, sharing your family and your life with your siblings,” said Mary Jane Abt-Fagan. “It’s all those things she missed that break a parent’s heart.”
KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
American nurses are becoming iconic images of hope as they receive the first SARS-CoV-2 vaccinations approved for emergency use. A gathering of reporters, officials, and healthcare providers applauded when they witnessed the first vaccination in Oklahoma, as Erica Arrocha, RN administered the state’s first Covid-19 vaccination to a colleague, RN Hanna White, at Integris Baptist Medical Center. White told reporters, “Hopefully this is the start of something better.”
ICU nurse and NP Helen Cordova was the first Californian to get a Covid shot.
New York ICU nurse Sandra Lindsay, the first US healthcare worker to receive a shot, told journalists, “I trust the science,” as her vaccination was recorded and livestreamed to millions of viewers.
The first in line for vaccination in Minnesota was Minneapolis frontline VA nurse Thera Witte, who declared, “I’m feeling hopeful that this is the beginning of the end” of the deadly pandemic that has so far taken over 377,000 lives in the US and 1.65 million lives worldwide.
Why I love my job @The_BMC ! Teams of people working to safely and equitably distribute vaccines to their front line colleagues getting cheered on by their friends celebrating the arrival of the vaccines! A great day, a great place. ❤️ pic.twitter.com/XfrIthFIY5
There were even impromptu parties. When the first shipment of the Pfizer BioNTech vaccine arrived in Boston, there was dancing in the streets (or the hospital parking lot)—on a chilly Massachusetts day in December-—that immediately went viral.
The first Californian to be vaccinated had initially been dubious. ICU nurse and NP Helen Cordova at Kaiser Permanente Los Angeles Medical Center changed her mind, but she still understands the mistrust. Her training, though, prompted her to research the science behind the new vaccines: “That’s probably the best thing to do, educate ourselves, get the information ourselves,” she told ABC7 in LA. “As I started to dig in a little more, I felt more at ease. I started changing my stance on it. I went from ‘absolutely not’ to ‘sure, here’s my arm, let’s do it!’”
“It’s important not just for me, but for all of those that I love.” In New Jersey, the first to roll up her sleeve was Maritza Beniquez, an emergency department nurse at University Hospital in Newark. As state governor Phil Murphy looked on with journalists and healthcare workers, Beniquez was exuberant after receiving the state’s first SARS-2 shot on her birthday: “I couldn’t wait for this moment to hit New Jersey. I couldn’t wait for it to hit the U.S!”
And as humans cannot resist an opportunity to thrill one another with foreboding rumors of sinister events, false social media posts started to appear almost as soon as states began to vaccinate healthcare workers. So, if patients, friends, or family cite the nonexistent “42-y/o nurse in Alabama found dead 8-10 hours” later from anaphylactic shock, well, what did you expect? Share a real social media event like the Boston MC flash mob, and tell them you’re keeping your mask on even after your second vaccination, as epidemiologists say we will probably have to wait until mid-late 2021 to gauge the efficacy of the vaccines.
Boston Medical Center workers went all out to celebrate the arrival of the vaccine.
In March, Claire Tripeny was watching her dream job fall apart. She’d been working as an intensive care nurse at St. Anthony Hospital in Lakewood, Colorado, and loved it, despite the mediocre pay typical for the region. But when COVID-19 hit, that calculation changed.
She remembers her employers telling her and her colleagues to “suck it up” as they struggled to care for six patients each and patched their protective gear with tape until it fully fell apart. The $800 or so a week she took home no longer felt worth it.
“I was not sleeping and having the most anxiety in my life,” said Tripeny. “I’m like, ‘I’m gonna go where my skills are needed and I can be guaranteed that I have the protection I need.’”
In April, she packed her bags for a two-month contract in then-COVID hot spot New Jersey, as part of what she called a “mass exodus” of nurses leaving the suburban Denver hospital to become traveling nurses. Her new pay? About $5,200 a week, and with a contract that required adequate protective gear.
Months later, the offerings — and the stakes — are even higher for nurses willing to move. In Sioux Falls, South Dakota, nurses can make more than $6,200 a week. A recent posting for a job in Fargo, North Dakota, offered more than $8,000 a week. Some can get as much as $10,000.
Early in the pandemic, hospitals were competing for ventilators, COVID tests and personal protective equipment. Now, sites across the country are competing for nurses. The fall surge in COVID cases has turned hospital staffing into a sort of national bidding war, with hospitals willing to pay exorbitant wages to secure the nurses they need. That threatens to shift the supply of nurses toward more affluent areas, leaving rural and urban public hospitals short-staffed as the pandemic worsens, and some hospitals unable to care for critically ill patients.
“That is a huge threat,” said Angelina Salazar, CEO of the Western Healthcare Alliance, a consortium of 29 small hospitals in rural Colorado and Utah. “There’s no way rural hospitals can afford to pay that kind of salary.”
Surge Capacity
Hospitals have long relied on traveling nurses to fill gaps in staffing without committing to long-term hiring. Early in the pandemic, doctors and nurses traveled from unaffected areas to hot spots like California, Washington state and New York to help with regional surges. But now, with virtually every part of the country experiencing a surge — infecting medical professionals in the process — the competition for the finite number of available nurses is becoming more intense.
“We all thought, ‘Well, when it’s Colorado’s turn, we’ll draw on the same resources; we’ll call our surrounding states and they’ll send help,’” said Julie Lonborg, a spokesperson for the Colorado Hospital Association. “Now it’s a national outbreak. It’s not just one or two spots, as it was in the spring. It’s really significant across the country, which means everybody is looking for those resources.”
In North Dakota, Tessa Johnson said she’s getting multiple messages a day on LinkedIn from headhunters. Johnson, president of the North Dakota Nurses Association, said the pandemic appears to be hastening a brain drain of nurses there. She suspects more nurses may choose to leave or retire early after North Dakota Gov. Doug Burgum told health care workers they could stay on the job even if they’ve tested positive for COVID-19.
All four of Utah’s major health care systems have seen nurses leave for traveling nurse positions, said Jordan Sorenson, a project manager for the Utah Hospital Association.
“Nurses quit, join traveling nursing companies and go work for a different hospital down the street, making two to three times the rate,” he said. “So, it’s really a kind of a rob-Peter-to-pay-Paul staffing situation.”
Hospitals not only pay the higher salaries offered to traveling nurses but also pay a commission to the traveling nurse agency, Sorenson said. Utah hospitals are trying to avoid hiring away nurses from other hospitals within the state. Hiring from a neighboring state like Colorado, though, could mean Colorado hospitals would poach from Utah.
“In the wake of the current spike in COVID hospitalizations, calling the labor market for registered nurses ‘cutthroat’ is an understatement,” said Adam Seth Litwin, an associate professor of industrial and labor relations at Cornell University. “Even if the health care sector can somehow find more beds, it cannot just go out and buy more front-line caregivers.”
Litwin said he’s glad to see the labor market rewarding essential workers — disproportionately women and people of color — with higher wages. Under normal circumstances, allowing markets to determine where people will work and for what pay is ideal.
“On the other hand, we are not operating under normal circumstances,” he said. “In the midst of a severe public health crisis, I worry that the individual incentives facing hospitals on the one side and individual RNs on the other conflict sharply with the needs of society as whole.”
Some hospitals are exploring ways to overcome staffing challenges without blowing the budget. That could include changing nurse-to-patient ratios, although that would likely affect patient care. In Utah, the hospital association has talked with the state nursing board about allowing nursing students in their final year of training to be certified early.
Growth Industry
Meanwhile business is booming for companies centered on health care staffing such as Wanderly and Krucial Staffing.
“When COVID first started and New York was an epicenter, we at Wanderly kind of looked at it and said, ‘OK, this is our time to shine,’” said David Deane, senior vice president of Wanderly, a website that allows health care professionals to compare offers from various agencies. “‘This is our time to help nurses get to these destinations as fast as possible. And help recruiters get those nurses.’”
Deane said the company has doubled its staff since the pandemic started. Demand is surging — with Rocky Mountain states appearing in up to 20 times as many job postings on the site as in January. And more people are meeting that demand.
In 2018, according to data from a national survey, about 31,000 traveling nurses worked nationwide. Now, Deane estimated, there are at least 50,000 travel nurses. Deane, who calls travel nurses “superheroes,” suspects a lot of them are postoperative nurses who were laid off when their hospitals stopped doing elective surgeries during the first lockdowns.
Competition for nurses, especially those with ICU experience, is stiff. After all, a hospital in South Dakota isn’t competing just with facilities in other states.
“We’ve sent nurses to Aruba, the Bahamas and Curacao because they’ve needed help with COVID,” said Deane. “You’re going down there, you’re making $5,000 a week and all your expenses are paid, right? Who’s not gonna say yes?”
Krucial Staffing specializes in sending health care workers to disaster locations, using military-style logistics. It filled hotels and rented dozens of buses to get nurses to hot spots in New York and Texas. CEO Brian Cleary said that, since the pandemic started, the company has grown its administrative staff from 12 to more than 200.
“Right now we’re at our highest volume we’ve been,” said Cleary, who added that over Halloween weekend alone about 1,000 nurses joined the roster of “reservists.”
With a base rate of $95 an hour, he said, some nurses working overtime end up coming away with $10,000 a week, though there are downsides, like the fact that the gig doesn’t come with health insurance and it’s an unstable, boom-and-bust market.
Hidden Costs
Amber Hazard, who lives in Texas, started as a traveling ICU nurse before the pandemic and said eye-catching sums like that come with a hidden fee, paid in sanity.
“How your soul is affected by this is nothing you can put a price on,” she said.
At a high-paying job caring for COVID patients during New York’s first wave, she remembers walking into the break room in a hospital in the Bronx and seeing a sign on the wall about how the usual staff nurses were on strike.
“It said, you know, ‘We’re not doing this. This is not safe,’” said Hazard. “And it wasn’t safe. But somebody had to do it.”
The highlight of her stint there was placing a wedding ring back on the finger of a recovered patient. But Hazard said she secured far more body bags than rings on patients.
Tripeny, the traveling nurse who left Colorado, is now working in Kentucky with heart surgery patients. When that contract wraps up, she said, she might dive back into COVID care.
Earlier, in New Jersey, she was scarred by the times she couldn’t give people the care they needed, not to mention the times she would take a deceased patient off a ventilator, staring down the damage the virus can do as she removed tubes filled with blackened blood from the lungs.
She has to pay for mental health therapy out-of-pocket now, unlike when she was on staff at a hospital. But as a so-called traveler, she knows each gig will be over in a matter of weeks.
At the end of each week in New Jersey, she said, “I would just look at my paycheck and be like, ‘OK. This is OK. I can do this.’”
Republished courtesy of Kaiser Health News.KHN (Kaiser Health News) is a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
The National League for Nursing (NLN) presented the New Jersey League with a Constituent League Excellence in Innovation Award on September 25, the final day of its virtual Education Summit.
Praising the New Jersey League for expanding its grants and scholarships program, NLN CEO Beverly Malone, PhD, RN, FAAN, said, “The National League for Nursing is enormously grateful to the New Jersey League for Nursing for its leadership in proactively boosting access to nursing education at a time when higher education is increasingly out of reach for so many deserving students.” The NJLN now offers direct material support to 25 students at all levels of educational progression. Each of the 25 students is eligible to receive up to $1,000, with one advanced degree candidate who pledges to join the state’s nursing workforce eligible for a $10,000 scholarship award.
“While we face the challenges of a pandemic, along with demonstrable health care disparities reflecting the social determinants of health, innovative programming, and other initiatives to support students and faculty are truly needed,” said NLN President Patricia S. Yoder-Wise, RN, EdD, NEA-BC, ANEF, FAONL, FAAN. “The New Jersey League for Nursing has been a role model in this regard, helping to spread the National League for Nursing’s message of sustained, inclusive, culturally sensitive educational excellence in the preparation of the next generation of nurses to deliver outstanding patient care, advancing, in particular, the health all New Jersey residents.”
The first nursing organization to be formed in the US, the National League for Nursing was founded in 1893 as the American Society of Superintendents of Training Schools for Nurses. Today, the NLN provides professional development, advocacy, and testing resources for 40,000 individual and 1,200 institutional members in nursing education programs at colleges and universities, health care organizations, and agencies. To learn more about the NLN and membership benefits, visit http://www.nln.org/.
The importance of board certification was a key theme when two clinical nurse educators—one from California, the other from New Jersey—received this year’s BCEN 2020 Distinguished Awards. Each year, the Board of Certification for Emergency Nursing (BCEN) honors an emergency nurse and a pediatric ED nurse for combining outstanding clinical work with successful advocacy on behalf of specialized board certification, and Lisa Chambers and Jude Lark do indeed stand out.
CPEN Lisa Chambers
The 2020 Distinguished CPEN Award winner is Lisa Chambers, MSN, MPS, RN, CEN, CPEN, TCRN, an emergency services/trauma clinical educator, and clinical nurse III at CHOC Children’s Hospital in Orange, California. Described as “One of CHOC Children’s finest,” who “passionately guides frontline staff in integrating knowledge, skill, and behaviors to improve nursing practice and patient care” by Melanie Patterson, DNP, MHA, RN, vice president of patient care services and chief nursing officer at CHOC Children’s, Chambers is proud of her staff’s determination to become board-certified during the pandemic. Far from being slowed down by COVID-19, she notes that “In fact, six of our nurses got certified as soon as the testing centers reopened. We had certification after certification. To me, that just showed they were using their time to push themselves.”
CEN Jude Lark
The 2020 Distinguished CEN Award winner is Jude Lark, BSN, RN, CEN, CCRN, an emergency services clinical nurse educator at Atlantic Health System’s Overlook Medical Center in Summit, New Jersey. Lark is “the consummate emergency department nurse—proficient, professional and compassionate—and is highly deserving of this national recognition,” said MaryPat Sullivan, MSN, RN, CNS, the chief nursing officer for Overlook Medical Center. Lark’s team was an inspiration during this eventful year: “In 42 years of critical care nursing, I have never seen anything like what we experienced in the emergency department and critical care units across New Jersey. Our board-certified nurses used their knowledge of best practices and the most updated skills to help facilitate and drive the innovative practices and adaptations we had to quickly develop for our COVID patients, and for each other, too.” She added, “Over the past six years, we have increased our certified nurses by 52%!”
Lark also remarked upon the way board-certified nurses took the lead during the pandemic, noting that “board-certified nurses really helped with that advanced level of thinking and effective utilization of CDC guidelines and ENA current COVID practice and trends, and in collaborating with our other sites. I actually have chills, because I think of all the emergency nurses and what they went through, while also taking care of each other.”
ED nurses seeking information on becoming board-certified should visit the BCEN site. Details on preparing for emergency nurse certification and other nursing certifications are available at Nurses Get Certified.
As Xinyi Christine Zhang watched the COVID-19 death toll among healthcare workers rise this spring, she wanted to find a way to give solace — and thanks — to their families.
The 15-year-old teen, of South Brunswick Township, New Jersey, joined her church in commemorating members who had died of COVID-19. But she was driven to try to do more, something personal. “I thought there could be something more meaningful I could do for the families of the doctors who lost their lives fighting the pandemic,” said Christine.
A gifted artist, Zhang resolved to draw the fallen U.S. healthcare workers in colorful memorial portraits, distribute them to their families and post them on her website. She wanted the relatives to know that people appreciated those who were trying to help Americans heal while putting their own lives in jeopardy.
Zhang frequently draws portraits for her friends and knew memorial portraits are usually rather expensive. She realized that drawing front-line workers could actually help families and was a better use of her time than drawing her friends — whom she said she’d drawn “like 10 times already.”
According to KHN and The Guardian’s “Lost on the Frontline” project, more than 900 healthcare workers in the United States have died after helping patients battle the coronavirus. The pandemic overburdened many hospitals and led to shortages in protective equipment such as masks and gowns that endangered many of those assisting patients.
Zhang found her subjects through that project. She set up a website to upload her portraits and to let families request drawings of their loved ones. Her portraits are free and easily accessible online, she said.
She has finished and posted 17 portraits since she started in late April. Each one takes six to eight hours, and Zhang spreads that work out over a few days so as not to interfere with her school assignments. Using a close-up image as a reference, she first digitally sketches the proportions of the person’s face with a pencil and then adds unique colors to “really bring life to the portrait.”
Her largest obstacle is getting in touch with the families. She hopes more families will request portraits through her website so she can work with them from the beginning.
One person Zhang featured is Sheena Miles, a semiretired nurse from Mississippi who died of COVID-19 on May 1. Christine tracked down her son, Tom Miles, who expressed his gratitude on Facebook.
“When you’re going through a loss like that, like the loss of a mom, to get the email from out of the blue just kind of gives you a profound feeling that there are some good people in this world,” Tom Miles said in an interview. “For her to have such talent at such a young age, and that she really cares about people she doesn’t even know — she is what makes America what it is today.”
This kind of response is exactly what Zhang aims for — she wants the families to know that she is thankful for the work of their loved ones.
“Someone they don’t know personally, even a stranger, appreciates what their loved one has done,” she said.
The portraits may be a source of brightness for grieving families, said Zhang’s mother, Helen Liu.
“I hope that families who receive these portraits will have a feeling of hope that better times will come,” Liu said. “A memorial is something meaningful and permanent, and I feel her portraits capture the happiness that will forever be with them.”
She hopes to get additional requests for the memorials from families.
In addition to drawing, Christine is a member of the South Brunswick High School’s Science Olympiad team and helps build projects for competitions. She’s interested in exploring engineering or product design as a career. Anything related to building or creating, she said.
She plans to either major or minor in art in college. For now, she wants to continue this project throughout high school — hopefully with help from others who know how to create digital art. She has a form on her website where others with art experience can sign up to help out. She said they can also add “other heroes in our society, such as war veterans or firefighters.”
“There are so many people that need to be honored, but I can’t do it by myself,” Zhang said.
Published courtesy ofKHN (Kaiser Health News), a nonprofit news service covering health issues. It is an editorially independent program of KFF (Kaiser Family Foundation), which is not affiliated with Kaiser Permanente.
