As coronavirus cases near 83,000 across D.C., Maryland and Virginia, hospital workers say they’re facing hazardous conditions at work and are calling for increased pay and more personal protective gear while they take on the pandemic.

“Every day I wake up when I have to go to work, and you feel a little jittery,” nurse Debra Washington says. She works at United Medical Center in Southeast D.C., the District’s only public hospital, and the only one east of the Anacostia River.

Washington has worked at the hospital for more than 30 years. But like health care workers treating coronavirus patients across the country, she says her work days are full of unprecedented fears and stresses.

Washington and 146 other nurses at UMC sent a formal petition to the hospital’s management calling for hazard pay last week. In the document, nurses say they have to “ration and reuse” protective gear, assume additional administrative and environmental duties in the hospital, and care for up to six COVID-19 patients per shift.

“Many of the nurses have tested positive for COVID-19 because of caring for COVID-19 patients at UMC,” the nurses wrote. The petition ends with a statement in bold red letters: “We Demand Hazard Pay for the Nurses!”

Toya Carmichael, a spokeswoman for United Medical Center, said  the hospital “appreciates DCNA’s petition for hazard pay and UMC is evaluating the possibilities on how to recognize and support our team during these times. However, to date no medical facility in the District is offering hazard pay.”

Despite not receiving hazard pay, hospital employees say they are facing dangerous conditions doing their jobs during the pandemic. While regional hospitals haven’t seen the kind of surge of patients like in New York, many employees report continuing shortages of protective gear and long, grueling hours. These conditions, they argue, merit extra compensation. Hospitals say they acknowledge the increased risk involved with caring for patients during the pandemic, but that there are major economic factors at play when it comes to hazard pay, namely a drop in hospital revenue.

“If everything was just normal, then we wouldn’t have all of these deaths and dying that’s going on around us,” Washington says. “You’re doing everything you can right, but still, at the end of the day, people are still dying. And you can possibly be one of them. It is a hazard.”

Nationally, at least 9,000 health care workers have contracted the coronavirus The Centers for Disease Control and Prevention reports 27 health worker have died due to COVID-19, but said the true number is likely far higher because the data came from a relatively small number of reports.

Washington says giving hazard pay, which is extra pay on top of normal wages to compensate for more dangerous conditions at work, “would be a nice show of appreciation.”

And it’s not only nurses at UMC who are making the ask — other employees in the region, like janitors, unit secretaries and techs, who assist doctors and nurses with cleaning, moving, monitoring and treating patients, are also calling for hazard pay. Several hundred workers at Prince George’s Hospital Center submitted a similar petition to management last week, the text of which was provided to DCist.

“Prince George’s County currently has the highest rate of fatalities and confirmed cases of COVID-19 in Maryland,” the petition reads. “Yet, we work without consistent access to vital PPE, medical equipment, and enhanced compensation.”

Both petitions don’t specify a certain amount of hazard pay, but say workers are due financial recognition for the risks they’re taking on in performing their jobs during the pandemic.

A ‘Universal Shortage’ Of Protective Gear 

Hospital workers describe a number of stresses facing them at work these days. Chief among them are the ongoing shortages of personal protective gear, like masks and gowns. Those shortages are a focal point of worker demands for hazard pay.

“We demand personal protective equipment (PPE) that offers maximum protection and incentive pay that rises to the level of this pandemic,” the Prince George’s Hospital Center petition says.

All of the workers DCist spoke to for this story reported being asked to reuse surgical masks and N95 masks. Several said they received one N95 mask for a whole week of work — sometimes one that was already used and then sterilized for reuse.

DCist is not revealing the names of several workers interviewed for this story after they expressed fear over reprisals in the workplace. DCist confirmed the workers’ jobs with the union and by reviewing photos of employee badges.

One nurse who works with patients before and after their operations at Prince George’s Hospital Center said she was receiving one surgical mask for a week of work, unless she dropped it on the ground or got it wet. That single mask, she told DCist, becomes damp over the course of a day of wearing it, and the material sags into her mouth when she speaks from behind it. She worries that the moisture on the mask will attract bacteria; she hangs the mask up every night after work to try to air it out before her next shift.

And while she wasn’t directly caring for COVID-19 patients, she says she was exposed to colleagues who did. She wishes she could have a new surgical mask at least twice a week.

Washington, the UMC nurse, says she dons an additional surgical mask to cover her N95 mask when she goes in to treat a patient with a confirmed or suspected case of COVID-19. “Because that N95 mask that I have on is the one that I have to have on all day long,” she says.

Some workers say they’ve paid for their own respirator devices and filters, in hopes of better protecting themselves. One Prince George’s Hospital Center patient support worker says she bought a respirator from another colleague, who had taken orders for several other hospital workers and bought a number of the devices for around $30 each.

That same aide, who works in a variety of units throughout the hospital, including the ICU, says she receives one surgical mask once every two weeks, which she is required to sign out.

An ICU nurse at Prince George’s Hospital Center says he doesn’t switch gowns between patients. If a patient is bleeding badly, he covers his regular gown with a trash bag to try to protect it from bodily fluids. He’s also bringing in his own head and shoe coverings.

Lisa Brown, the executive vice president of union SEIU 1199, which represents hospital workers in the District and Maryland, says that area hospitals are feeling the effects of a “universal shortage” of PPE supplies. But she worries about how those limited supplies are being distributed.

Brown says the union has raised concerns that facilities like Prince George’s Hospital Center aren’t getting adequate stocks of PPE in comparison with other hospitals in the University of Maryland system, which runs several hospitals in the Baltimore area, Anne Arundel County and Prince George’s County in addition to Prince George’s Hospital Center.

The situation has improved since the union raised those concerns, Brown says, though she doesn’t feel that the problem had been entirely fixed.

“As the hardest-hit county in Maryland, Prince George’s Hospital Center should always be stacked with PPE,” Brown told DCist in an email. “Unfortunately, it’s still a struggle.”

As of Wednesday, Prince George’s County has more than 12,400 cases of COVID-19, and 432 confirmed deaths. Last week, the county said 70 of its 113 ICU beds were filled with COVID-19 patients.

The University of Maryland Medical System wrote in an emailed statement to DCist that while there is a national shortage of PPE, its patients and workforce “remain optimally protected.” It also said claims about inequitable distribution of PPE across the system were “inaccurate.”

“UMMS has embraced assertive, system-wide PPE conservation strategies, consistent with Centers for Disease Control and Prevention protocols,” said the hospital system’s statement.

The system “comprehensively sources and equitably distributes PPE to ensure staff and patient safety,” the hospital later said.

UMC in D.C. requires all staff in the hospital to wear a face covering. According to a protocol document shared with DCist, the hospital has strict rules governing the distribution of protective equipment. Staff are required to either request the gear from the hospital storeroom or get it from “PPE cages,” which can only be unlocked by management.

UMC spokeswoman Toya Carmichael emphasized the gear supply the hospital has received from the local community.

“We have received an enormous amount of support from the community and local businesses in the format of donated meals and PPE which is distributed to our staff on almost a daily basis,” she wrote in an email. “We have begun providing staff with UMC logo face covers as well as N95 masks to use when they leave the hospital.”

Edward J. Smith, executive director of the D.C. Nurses Association (DCNA) union, says his members are in a “pretty good place” with personal protective equipment at the moment, adding that donations have helped; A donor gave nurses at St. Elizabeths hospital in the District 1,000 new N95 masks last week, for example.

But Smith says the union “has made clear” it does not support the reuse of N95 masks from patient-to-patient, a common practice in area hospitals as they confront widespread equipment shortages.

DCNA represents nurses at Howard University Hospital, Children’s National Hospital, UMC and D.C. government facilities like St. Elizabeths Hospital, but Smith says only Howard University Hospital is allowing nurses to get a new N95 mask for each patient they treat. Howard University Hospital declined to answer questions from DCist about its policies on personal protective equipment and hazard pay.

Children’s National and Saint Elizabeths hospitals say they are both following guidance from the Centers for Disease Control and Prevention governing mask use and re-use.

“Staff can get a new N95 mask any time throughout the shift/day when it is indicated according to hospital protocol,” a spokeswoman for Children’s National wrote in an email.

CDC guidance advises health care workers to discard N95 respirators immediately in certain cases, including after “aerosol generating procedures” and contamination with bodily fluids. But in many cases says it is acceptable to wear the same N95 mask “for repeated close contact encounters with several patients.”

But the CDC says while extended use and reuse of respirators can help stretch limited supplies, there are risks. For example, if you touch the surface of a contaminated respirator, you can spread disease. “One study found that nurses averaged 25 touches per shift to their face, eyes, or N95 respirator during extended use,” reads the CDC’s guidance.

Staffing In A Pandemic

Beyond shortages of personal protective equipment, some hospital workers describe intense shifts and heightened fear and anxiety about coming into work.

The ICU nurse at Prince George’s Hospital says he’s not working overtime, even though it’s been offered. He’s too exhausted. His unit is all COVID-19 patients, many of them with other health conditions that make them vulnerable to the disease. Sometimes they “crash,” he says, and suddenly need to be intubated or put on oxygen.

“I do three 12-hour shifts, and it takes me 48 hours to recover,” he says.

And sometimes, his patients don’t make it. When they pass away, he says, ICU nurses are now responsible for putting the bodies in body bags and wiping the bags down before they are taken out of the unit.

Lisa Brown of SEIU 1199 says few local union members have been hospitalized, but some have gotten sick.

United Medical Center’s Carmichael says few hospital staff have contracted the coronavirus.

“Less than 5% of our ENTIRE staff have tested positive for COVID-19 and there is no clear way to know whether these positives are work or community related infections,” she wrote in an email.

Noel Sinkiat, a nurse at Howard University Hospital, died of COVID-19 in late March, his family told the Washington Post. He was one year away from retirement. “He was the guy that everybody went to when they had an issue,” said Smith from the D.C. Nurses Association.

At St. Elizabeths, the District’s public psychiatric hospital, the city reports that one staff member had died from probable COVID-19, and more than 100 staff of the hospital have tested positive for the virus. When the hospital tested all of its staff last week in response to a court order, 17 asymptomatic employees tested positive. (Patients sued the hospital last month and alleged that the facility was not doing enough to prevent the spread of the coronavirus. As of Monday, the virus had killed 13 patients at the hospital.)

Staffing shortages also stretch the already-stretched hospital teams.

“Even before COVID-19, staffing shortages have been a wide-spread issue, particularly in such classifications as nursing and housekeeping,” says Brown of SEIU 1199. She noted that some hospitals in the region are adding staff to deal with the pandemic, while others are furloughing workers.

Adventist HealthCare, which runs three hospitals in Montgomery and Prince George’s counties, has added 265 temporary staff, two-thirds of them ICU or surgical care nurses, according to an emailed statement. Overtime hours are mostly holding steady.

UMC is “projecting additional surge staffing,” hiring additional nurses, respiratory therapists, and other staff, according to spokeswoman Toya Carmichael. The hospital recently moved out 75 residents of its skilled nursing facilities to make room for more COVID-19 patients.

Creating surge capacity has required overtime from non-medical staff at UMC, too.

“Certain departments including our Environmental Services and Facilities teams are working longer hours to conduct the necessary renovations and construction of additional surge beds and also to care for the additional patients we are seeing due to COVID,” Carmichael told DCist in an email.

“Additionally our food and nutrition staff have been working longer hours alongside me as we work to ensure that all staff including the late night and weekend teams receive the donated meals and PPE given to those who work during the typical M-F 9-5 timeframes,” she continued.

Some workers say much of the burden of the pandemic in hospitals falls disproportionately on workers who aren’t doctors or nurses — the techs, aides, janitorial workers and others who keep the hospital going. That includes some direct patient care, says Tony Powell, a union leader and unit secretary at UMC.

“Doctors spend maybe three to five minutes with a patient. A nurse spends maybe 10 to 15 minutes with a patient. A tech is in there for eight hours, pretty much,” Powell, a former surgical technician, says. “Because they actually are the ones to do all the baths, they do the vital signs. They do the feedings. If they have to be cleaned up, changed, whatever. So they’re in there much more than even the nurses.”

‘A Budget Issue’

The District is offering a $14 day per diem for government employees who physically report to work, up to $140 per pay period. The per diem applies to employees of St. Elizabeths hospital, but most other hospitals in D.C. and its suburbs are not offering such pay.

“It’s clearly a budget issue,” says Smith from the D.C. Nurses Association. “I haven’t heard anybody from management saying it’s not appropriate. Basically, it’s that they can’t afford it at this time.” Pausing elective surgeries during the public health crisis has decimated the finances of hospitals, who depend on them as a key source of revenue.

That’s the case at Adventist HealthCare System, according to an email from spokeswoman Lydia Parris.

“Like other healthcare systems in our area, Adventist HealthCare is navigating the uncertain financial climate from COVID-19,” Parris said in an email. “We have seen a surge in COVID-19 patients, but overall volumes at our hospitals are down and some services across our system have been on hold.”

“We will examine incentive pay once we have a better understanding of the full impact of the financial climate. We appreciate the extraordinary effort our employees have put forth in response to COVID-19 and will continue to look for ways to honor their service,” she wrote.

President Trump has voiced support for hazard pay for hospital workers, and so have Democratic leaders, but lawmakers have not included it in any coronavirus-related federal legislation so far.

The University of Maryland Medical System says it has instituted incentive programs that offer more pay for employees who take on additional shifts, as well as the opportunity to accrue more paid leave. SEIU 1199 says staff at UMMS hospitals have been offered an extra $100 for every additional four overtime hours they work.

Brown of SEIU 1199 says the hospitals haven’t been willing to offer hazard pay because they’re not overwhelmed yet.

“It’s really dependent on the numbers,” she says. “I guess that’s understandable, if in your facility you don’t have a huge caseload, then you don’t see the threat. The threat is in having to get up and go to work.”

Hospitals in New York, which saw some of the most intense weeks of COVID-19 patient surges in the country, did offer hazard pay to their employees. Northwell Health, the city’s largest hospital system, gave its frontline employees $2,500 lump sum bonuses and an extra week off. The New York Post reported that nurses at Mount Sinai received $250 dollars per week in hazard pay, which has since been scaled back as the surge in patients to the hospital slows.

Local hospital workers say hazard pay would be a recognition of the risks they’re taking in coming in to work, and could help them allay transportation and other costs they’re facing because of the pandemic.

But despite the shortages of PPE, long hours, and lack of hazard pay, hospital workers say they’re still committed to taking care of patients to the best of their ability.

The Prince George’s Hospital Center ICU nurse says he feels “responsible to make sure that those patients, regardless of color, race, religion, economic status get their treatment. I love what I do,” he says.