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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
(2 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.
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.
Updated June 5, 2020Updated June 5, 2020
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.
The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.The unemployment rate fell to 13.3 percent in May, the Labor Department said on June 5, an unexpected improvement in the nation’s job market as hiring rebounded faster than economists expected. Economists had forecast the unemployment rate to increase to as much as 20 percent, after it hit 14.7 percent in April, which was the highest since the government began keeping official statistics after World War II. But the unemployment rate dipped instead, with employers adding 2.5 million jobs, after more than 20 million jobs were lost in April.
Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.Mass protests against police brutality that have brought thousands of people onto the streets in cities across America are raising the specter of new coronavirus outbreaks, prompting political leaders, physicians and public health experts to warn that the crowds could cause a surge in cases. While many political leaders affirmed the right of protesters to express themselves, they urged the demonstrators to wear face masks and maintain social distancing, both to protect themselves and to prevent further community spread of the virus. Some infectious disease experts were reassured by the fact that the protests were held outdoors, saying the open air settings could mitigate the risk of transmission.
Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.Exercise researchers and physicians have some blunt advice for those of us aiming to return to regular exercise now: Start slowly and then rev up your workouts, also slowly. American adults tended to be about 12 percent less active after the stay-at-home mandates began in March than they were in January. But there are steps you can take to ease your way back into regular exercise safely. First, “start at no more than 50 percent of the exercise you were doing before Covid,” says Dr. Monica Rho, the chief of musculoskeletal medicine at the Shirley Ryan AbilityLab in Chicago. Thread in some preparatory squats, too, she advises. “When you haven’t been exercising, you lose muscle mass.” Expect some muscle twinges after these preliminary, post-lockdown sessions, especially a day or two later. But sudden or increasing pain during exercise is a clarion call to stop and return home.
States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.States are reopening bit by bit. This means that more public spaces are available for use and more and more businesses are being allowed to open again. The federal government is largely leaving the decision up to states, and some state leaders are leaving the decision up to local authorities. Even if you aren’t being told to stay at home, it’s still a good idea to limit trips outside and your interaction with other people.
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.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.
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.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.
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 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.)
Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.Taking one’s temperature to look for signs of fever is not as easy as it sounds, as “normal” temperature numbers can vary, but generally, keep an eye out for a temperature of 100.5 degrees Fahrenheit or higher. If you don’t have a thermometer (they can be pricey these days), there are other ways to figure out if you have a fever, or are at risk of Covid-19 complications.
The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.The C.D.C. has recommended that all Americans wear cloth masks if they go out in public. This is a shift in federal guidance reflecting new concerns that the coronavirus is being spread by infected people who have no symptoms. Until now, the C.D.C., like the W.H.O., has advised that ordinary people don’t need to wear masks unless they are sick and coughing. Part of the reason was to preserve medical-grade masks for health care workers who desperately need them at a time when they are in continuously short supply. Masks don’t replace hand washing and social distancing.
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.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.
If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.If you’re sick and you think you’ve been exposed to the new coronavirus, the C.D.C. recommends that you call your healthcare provider and explain your symptoms and fears. They will decide if you need to be tested. Keep in mind that there’s a chance — because of a lack of testing kits or because you’re asymptomatic, for instance — you won’t be able to get tested.
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.