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On Pandemic’s Front Lines, Nurses From Half a World Away On Pandemic’s Front Lines, Nurses From Half a World Away
(14 days later)
MANILA — There were seven nurses in the Buendia family. One of them, Jhoanna Mariel Buendia, got a call from the Philippines on March 28, just before the start of her shift at an intensive care unit in a British hospital.MANILA — There were seven nurses in the Buendia family. One of them, Jhoanna Mariel Buendia, got a call from the Philippines on March 28, just before the start of her shift at an intensive care unit in a British hospital.
It was her father, with the news that her beloved aunt — an I.C.U. nurse, in Florida — had died of complications from Covid-19, the disease caused by the coronavirus.It was her father, with the news that her beloved aunt — an I.C.U. nurse, in Florida — had died of complications from Covid-19, the disease caused by the coronavirus.
Ms. Buendia, 27, went to work. She suited up, strapping on her N95 mask, face shield, gown and apron and taping down her gloves, too numb to process the fact that her aunt had lost her life doing what she was about to do. It wasn’t until a few hours later, as she tended to a patient suspected to have the virus, that it became real and she burst into tears.Ms. Buendia, 27, went to work. She suited up, strapping on her N95 mask, face shield, gown and apron and taping down her gloves, too numb to process the fact that her aunt had lost her life doing what she was about to do. It wasn’t until a few hours later, as she tended to a patient suspected to have the virus, that it became real and she burst into tears.
Nurses from the Philippines and other developing countries have long made up for shortages in wealthier Western nations. They now find themselves risking their lives on the front lines of a pandemic, thousands of miles from home.Nurses from the Philippines and other developing countries have long made up for shortages in wealthier Western nations. They now find themselves risking their lives on the front lines of a pandemic, thousands of miles from home.
Ms. Buendia’s aunt, Araceli Buendia Ilagan, 63, was an associate supervisor in the cardiac surgical intensive care unit at Jackson Memorial Hospital in Miami. She was remembered as a nurses’ nurse, turning down administrative promotions that would have taken her away from patients’ bedsides.Ms. Buendia’s aunt, Araceli Buendia Ilagan, 63, was an associate supervisor in the cardiac surgical intensive care unit at Jackson Memorial Hospital in Miami. She was remembered as a nurses’ nurse, turning down administrative promotions that would have taken her away from patients’ bedsides.
“I guarantee you. She was in every single room helping every single nurse with every single patient,” said Martha Baker, a registered nurse and president of Jackson Memorial’s union for doctors and nurses, who had known Ms. Ilagan since the 1980s.“I guarantee you. She was in every single room helping every single nurse with every single patient,” said Martha Baker, a registered nurse and president of Jackson Memorial’s union for doctors and nurses, who had known Ms. Ilagan since the 1980s.
“That was probably her doom,” Ms. Baker said. “To be such a good leader, and such a hands-on leader. She exposed herself, perhaps at that time to patients we didn’t even know were Covid-positive.”“That was probably her doom,” Ms. Baker said. “To be such a good leader, and such a hands-on leader. She exposed herself, perhaps at that time to patients we didn’t even know were Covid-positive.”
According to the World Health Organization, the world has six million fewer nurses than it needs. One result is that nurses in places like the Philippines have long gravitated toward wealthier countries for higher-paying opportunities.According to the World Health Organization, the world has six million fewer nurses than it needs. One result is that nurses in places like the Philippines have long gravitated toward wealthier countries for higher-paying opportunities.
Almost 16 percent of nurses in the United States are immigrants, and nearly a third of those — the largest share — are Filipinos. Many also come from Nigeria, India, Jamaica and Mexico, among other places. In Britain, Ms. Buendia is one of about 18,600 Filipino nurses working for the National Health Service, its second-largest contingent of migrant nurses, after Indians.Almost 16 percent of nurses in the United States are immigrants, and nearly a third of those — the largest share — are Filipinos. Many also come from Nigeria, India, Jamaica and Mexico, among other places. In Britain, Ms. Buendia is one of about 18,600 Filipino nurses working for the National Health Service, its second-largest contingent of migrant nurses, after Indians.
Like other medical professionals, they are at high risk of exposure. At least seven Filipino employees of the NHS, including nurses, porters and a nurse’s assistant, have died from Covid-19, according to news reports. In the United States, the virus has claimed the lives of at least five nurses and a doctor from the Philippines.Like other medical professionals, they are at high risk of exposure. At least seven Filipino employees of the NHS, including nurses, porters and a nurse’s assistant, have died from Covid-19, according to news reports. In the United States, the virus has claimed the lives of at least five nurses and a doctor from the Philippines.
“The common denominator is that we’re all scared,” Ms. Buendia said of herself and her three housemates, who are also Filipino nurses. They all work at the same hospital in York and have been in England since September.“The common denominator is that we’re all scared,” Ms. Buendia said of herself and her three housemates, who are also Filipino nurses. They all work at the same hospital in York and have been in England since September.
Howard Catton, chief executive of the International Council of Nurses, a federation of national nurse associations, said migrant nurses had been “massively important” in helping countries like Britain, Spain and Italy fight the virus.Howard Catton, chief executive of the International Council of Nurses, a federation of national nurse associations, said migrant nurses had been “massively important” in helping countries like Britain, Spain and Italy fight the virus.
But he said the crisis underscored the need for developed countries to train their own nurses rather than relying so heavily on migrants.But he said the crisis underscored the need for developed countries to train their own nurses rather than relying so heavily on migrants.
This month, the Philippines, which says it needs about 300,000 more health care workers than it has, barred them from leaving the country, citing the need to protect them from infection and to ensure they were available to fight the virus at home.This month, the Philippines, which says it needs about 300,000 more health care workers than it has, barred them from leaving the country, citing the need to protect them from infection and to ensure they were available to fight the virus at home.
Migration is woven into the Philippines’ culture. As much as 10 percent of the population works overseas, sending money home, and nursing is one of the most popular options. On average, 13,000 nurses go abroad each year. Nursing recruitment agencies pave the way for visas and certifications so they can find jobs overseas.Migration is woven into the Philippines’ culture. As much as 10 percent of the population works overseas, sending money home, and nursing is one of the most popular options. On average, 13,000 nurses go abroad each year. Nursing recruitment agencies pave the way for visas and certifications so they can find jobs overseas.
Even some Filipino migrants who work in other fields have had training in nursing. Last month in Madrid, the Filipino chief nurse at Hospital Hestia, Edzel Lopez, posted an urgent call on Facebook asking her compatriots to apply for nursing jobs there. Much of the hospital’s staff had been infected by the coronavirus, and bureaucratic obstacles to hiring new nurses were being swept away.Even some Filipino migrants who work in other fields have had training in nursing. Last month in Madrid, the Filipino chief nurse at Hospital Hestia, Edzel Lopez, posted an urgent call on Facebook asking her compatriots to apply for nursing jobs there. Much of the hospital’s staff had been infected by the coronavirus, and bureaucratic obstacles to hiring new nurses were being swept away.
The Spanish hospital hired John Matthew Eusebio Villapol, a 26-year-old from the city of Tagaytay, who was working as an English teacher but had experience training Philippine Army medics and working for private ambulance services. “It was a battlefield promotion, so to speak,” Mr. Villapol said.The Spanish hospital hired John Matthew Eusebio Villapol, a 26-year-old from the city of Tagaytay, who was working as an English teacher but had experience training Philippine Army medics and working for private ambulance services. “It was a battlefield promotion, so to speak,” Mr. Villapol said.
Updated July 7, 2020
The coronavirus can stay aloft for hours in tiny droplets in stagnant air, infecting people as they inhale, mounting scientific evidence suggests. This risk is highest in crowded indoor spaces with poor ventilation, and may help explain super-spreading events reported in meatpacking plants, churches and restaurants. It’s unclear how often the virus is spread via these tiny droplets, or aerosols, compared with larger droplets that are expelled when a sick person coughs or sneezes, or transmitted through contact with contaminated surfaces, said Linsey Marr, an aerosol expert at Virginia Tech. Aerosols are released even when a person without symptoms exhales, talks or sings, according to Dr. Marr and more than 200 other experts, who have outlined the evidence in an open letter to the World Health Organization.
Common symptoms include fever, a dry cough, fatigue and difficulty breathing or shortness of breath. Some of these symptoms overlap with those of the flu, making detection difficult, but runny noses and stuffy sinuses are less common. The C.D.C. has also added chills, muscle pain, sore throat, headache and a new loss of the sense of taste or smell as symptoms to look out for. Most people fall ill five to seven days after exposure, but symptoms may appear in as few as two days or as many as 14 days.
Scientists around the country have tried to identify everyday materials that do a good job of filtering microscopic particles. In recent tests, HEPA furnace filters scored high, as did vacuum cleaner bags, fabric similar to flannel pajamas and those of 600-count pillowcases. Other materials tested included layered coffee filters and scarves and bandannas. These scored lower, but still captured a small percentage of particles.
A commentary published this month on the website of the British Journal of Sports Medicine points out that covering your face during exercise “comes with issues of potential breathing restriction and discomfort” and requires “balancing benefits versus possible adverse events.” Masks do alter exercise, says Cedric X. Bryant, the president and chief science officer of the American Council on Exercise, a nonprofit organization that funds exercise research and certifies fitness professionals. “In my personal experience,” he says, “heart rates are higher at the same relative intensity when you wear a mask.” Some people also could experience lightheadedness during familiar workouts while masked, says Len Kravitz, a professor of exercise science at the University of New Mexico.
The steroid, dexamethasone, is the first treatment shown to reduce mortality in severely ill patients, according to scientists in Britain. The drug appears to reduce inflammation caused by the immune system, protecting the tissues. In the study, dexamethasone reduced deaths of patients on ventilators by one-third, and deaths of patients on oxygen by one-fifth.
The coronavirus emergency relief package gives many American workers paid leave if they need to take time off because of the virus. It gives qualified workers two weeks of paid sick leave if they are ill, quarantined or seeking diagnosis or preventive care for coronavirus, or if they are caring for sick family members. It gives 12 weeks of paid leave to people caring for children whose schools are closed or whose child care provider is unavailable because of the coronavirus. It is the first time the United States has had widespread federally mandated paid leave, and includes people who don’t typically get such benefits, like part-time and gig economy workers. But the measure excludes at least half of private-sector workers, including those at the country’s largest employers, and gives small employers significant leeway to deny leave.
So far, the evidence seems to show it does. A widely cited paper published in April suggests that people are most infectious about two days before the onset of coronavirus symptoms and estimated that 44 percent of new infections were a result of transmission from people who were not yet showing symptoms. Recently, a top expert at the World Health Organization stated that transmission of the coronavirus by people who did not have symptoms was “very rare,” but she later walked back that statement.
Touching contaminated objects and then infecting ourselves with the germs is not typically how the virus spreads. But it can happen. A number of studies of flu, rhinovirus, coronavirus and other microbes have shown that respiratory illnesses, including the new coronavirus, can spread by touching contaminated surfaces, particularly in places like day care centers, offices and hospitals. But a long chain of events has to happen for the disease to spread that way. The best way to protect yourself from coronavirus — whether it’s surface transmission or close human contact — is still social distancing, washing your hands, not touching your face and wearing masks.
A study by European scientists is the first to document a strong statistical link between genetic variations and Covid-19, the illness caused by the coronavirus. Having Type A blood was linked to a 50 percent increase in the likelihood that a patient would need to get oxygen or to go on a ventilator, according to the new study.
If air travel is unavoidable, there are some steps you can take to protect yourself. Most important: Wash your hands often, and stop touching your face. If possible, choose a window seat. A study from Emory University found that during flu season, the safest place to sit on a plane is by a window, as people sitting in window seats had less contact with potentially sick people. Disinfect hard surfaces. When you get to your seat and your hands are clean, use disinfecting wipes to clean the hard surfaces at your seat like the head and arm rest, the seatbelt buckle, the remote, screen, seat back pocket and the tray table. If the seat is hard and nonporous or leather or pleather, you can wipe that down, too. (Using wipes on upholstered seats could lead to a wet seat and spreading of germs rather than killing them.)
If you’ve been exposed to the coronavirus or think you have, and have a fever or symptoms like a cough or difficulty breathing, call a doctor. They should give you advice on whether you should be tested, how to get tested, and how to seek medical treatment without potentially infecting or exposing others.
After a day of training, Mr. Villapol said, he was assigned half a floor’s worth of patients. He planned to report for work on his second day off, knowing they would be short-staffed however many people showed up. “I’ll work if they’ll have me,” he said.After a day of training, Mr. Villapol said, he was assigned half a floor’s worth of patients. He planned to report for work on his second day off, knowing they would be short-staffed however many people showed up. “I’ll work if they’ll have me,” he said.
Ms. Buendia’s family, whose roots are in the northern Philippine city of Baguio, has sent nurses to hospitals in Florida, California, Britain and Saudi Arabia.Ms. Buendia’s family, whose roots are in the northern Philippine city of Baguio, has sent nurses to hospitals in Florida, California, Britain and Saudi Arabia.
Ms. Buendia joined the profession to follow in her aunt’s footsteps. Ms. Ilagan helped her through college, sending money and guiding her through tough times in nursing school. She mentored Ms. Buendia from a distance as the young nurse began her career in Saudi Arabia, later moving to Britain.Ms. Buendia joined the profession to follow in her aunt’s footsteps. Ms. Ilagan helped her through college, sending money and guiding her through tough times in nursing school. She mentored Ms. Buendia from a distance as the young nurse began her career in Saudi Arabia, later moving to Britain.
Ms. Ilagan called Ms. Buendia late last month, as the gravity of the pandemic was becoming apparent in both of the countries where they worked. Coronavirus cases had begun turning up at their hospitals.Ms. Ilagan called Ms. Buendia late last month, as the gravity of the pandemic was becoming apparent in both of the countries where they worked. Coronavirus cases had begun turning up at their hospitals.
It was a conversation of familial concern, couched in the language of their shared profession. They chatted about basic infection protocol; Ms. Ilagan gave her niece tips, like how to disconnect patients from tubing in a way that would keep fluids from spattering her. They reassured each other that they were fine.It was a conversation of familial concern, couched in the language of their shared profession. They chatted about basic infection protocol; Ms. Ilagan gave her niece tips, like how to disconnect patients from tubing in a way that would keep fluids from spattering her. They reassured each other that they were fine.
It was the last time they spoke. Soon afterward, Ms. Ilagan developed flu-like symptoms and began self-isolating at home. Four days later, her husband found her unconscious and struggling to breathe. He rushed her to the hospital, but she died before they could intubate her.It was the last time they spoke. Soon afterward, Ms. Ilagan developed flu-like symptoms and began self-isolating at home. Four days later, her husband found her unconscious and struggling to breathe. He rushed her to the hospital, but she died before they could intubate her.
“I was so shocked,” Ms. Buendia said. Since then, her uncle, a nurse in California, has tested positive for the virus and been hospitalized.“I was so shocked,” Ms. Buendia said. Since then, her uncle, a nurse in California, has tested positive for the virus and been hospitalized.
Ms. Buendia’s parents have been calling her from the Philippines every day, often in tears. “They can’t sleep at night,” she said. “I reassure them that I’m fine.”Ms. Buendia’s parents have been calling her from the Philippines every day, often in tears. “They can’t sleep at night,” she said. “I reassure them that I’m fine.”
In truth, she is afraid. But she has no thoughts of giving up the work. “That’s the reason why I’m here, to be a nurse,” she said.In truth, she is afraid. But she has no thoughts of giving up the work. “That’s the reason why I’m here, to be a nurse,” she said.