Confessions of a California Covid Nurse
(Bloomberg Opinion) -- The Humboldt County Public Health department in California is inside what used to be a juvenile jail. The offices are former prison cells. A few of the doors still have the small windows with the sliding panels that allowed guards to observe prisoners. The basement is a dungeon, the lab equipment is jammed into a small room never meant to be a lab, and the staff are on top of each other in ways that would have seemed unhealthy even before the pandemic. I asked the county’s head of infectious disease if she could help me identify the building’s architectural style. She had to think about it. “Old,” she finally said.
When Erica Dykehouse, one of the county’s two infectious-disease nurses, arrives at this building each morning, the first thing she does is search her databases for new positive Covid-19 tests. Up until the county confirmed its first coronavirus case, on Feb. 20, she’d spent her days tracking the odd case of measles or syphilis or one of the 80 other diseases people gave to each other. She worked an ordinary 40-hour week with the sense that basically no one outside her office had any idea what public health nurses did, or that they even existed. But she loved her job, thought of it as her calling. She’d traded a better-paying job as a primary care nurse, in which she found herself solving the same health problems over and over, for one where she felt she could help prevent those health problems from occurring in the first place. “The downside is you can’t quantify what you prevented,” she said.
Now she worked 16 hours a day trying to prevent the spread of the coronavirus. She started each day with three coronavirus testing databases: the big one compiled by the state of California; a new one from Optum Inc., a testing company working in partnership with the state; and the tiny one from the county’s small in-house lab. Some counties had lost their labs to budget cuts but Humboldt still had one, such as it was. It was never intended for more than a few chickenpox tests a week, and now it strained to pump out the results from 100 coronavirus tests every day. But the positives they found were a huge relief to Erica, because they’d processed the tests inside of 24 hours. That speed allowed her to locate contagious people and isolate them before they did damage.
Unfortunately, the vast majority of the tests were done at the big new Optum site, or inside local hospitals, and processed by Quest Diagnostics and LabCorp. Five months into the pandemic, the two giant private testing companies were taking more than a week to send back results. “If I look at Optum I always ask, ‘What am I going to do with this, because the result is eight to 10 days old?’” said Erica. “Your ability to contain is over.” By the time she got ahold of people to inform them that they had Covid-19, they no longer had Covid-19. There was no point in isolating them.
Still, she felt obliged to try to run to ground every single person the carrier might have infected over the previous two weeks — even as the lost time gnawed at her. Two weeks! The state of California was paying Quest Diagnostics $160 a test for results that were, in practice, useless, except as a make-work program for badly stressed public health nurses — while the county’s own little lab made nothing by processing the tests efficiently. This was one of several bizarre aspects of the pandemic that Erica Dykehouse was still getting her mind around.
She now kept a diary of sorts. The federal government required her to fill out a form for every case. She got to these around 9 at night. Rather than simply fill in the blanks, as she’d done before the pandemic, she wrote up everything that happened so she could go back and see how and when things had changed. Back in March, for instance, she’d been required to ask the new positives if they had shared food with others, or touched communal surfaces, or walked through rooms with other people in them, or — well, there’d been all kinds of theories about how the virus spread, and the guidance she received in the morning was sometimes obsolete by that night. By June she was asking people with Covid-19 a single question: Who have you been within 6 feet of for more than 15 minutes? Six feet, 15 minutes. “Food isn’t a carrier,” said Erica. “It’s not ‘They walked through a room and got it.’ It’s people who sat down at a party and spent time talking.”
Her diary also recorded the behavior of the citizens of Humboldt County. Early on, they’d been cooperative. Though no one was pleased to hear they had Covid-19, people respected her authority. They behaved much as people had before the pandemic, when she told them they needed to isolate themselves. “They go through all of the things they were supposed to be doing,” she said. “Everyone just goes to their mental calendar. ‘How am I supposed to stay home? I was supposed to go to my girlfriend’s baby shower.’” Erica always tried to help them sort out their problems. “I have to make sure I’m offering something to them, so they give something back,” she said. What she now wanted from them was a list of everyone who had come within 6 feet of them, for 15 minutes, since they’d been infected.
And they did their best to comply — at least until the middle of May, just after the state’s shelter-in-place order was lifted. From that point on, her diary tells the story of a discomfiting change. People had less and less interest in what she had to say; they seemed to now think they knew everything they needed to know. “A lot of these people are getting their medical information off Facebook,” said Erica. People stopped returning her calls. People hung up on her. People even lashed out at her. “It’s the first time in this job I’m experiencing people hanging up on me — except with STDs,” said Erica. “Most of the time you call and say, ‘I’m a nurse from Public Health’ and they talk to you or call you back. We’re used to people trusting us. Now they don’t. That’s been very weird.”
Two cases stuck in Erica’s mind. One was a couple in their 70s, both possibly contagious. She’d found them, told them to quarantine, and they had turned right around and hosted a big Fourth of July BBQ. When she tried to contact guests who might have been infected, she found them either dismissive or outright rude. “You have these whole little social networks that are hostile,” she said. “Most of the time they are polite enough just to hang up. But I’m trying to develop a thick skin.”
The other case that stuck in her head was the meth dealer. The Public Health nurses had gotten to him soon after he’d been infected and, though he was dismissive of their advice, said he would isolate himself. Erica suspected he was still sneaking out at night, and her suspicion was confirmed when he infected a buddy of his, who in turn infected his daughter-in-law. The buddy’s daughter-in-law, who had no symptoms, went to her job at Alder Bay Assisted Living, a nursing home in Eureka. More than a dozen staff members and residents became infected. Four died.
That all this should happen in Humboldt County is a bit of a surprise. Its health officers had been quick to grab whatever help they could find — and use it. They’d been the first in the entire state to get their act together and set up an Optum testing site after the state offered all 58 counties funding for testing. They’d been enterprising, and they also enjoyed some natural tactical advantages. Surrounded on three sides by oceans of evergreen trees and on the fourth by the actual ocean, Humboldt County is about as close as you come in California to an island in the middle of nowhere. If any county was going to defend itself from the virus, Humboldt might be it. But by late June, Erica and her colleagues sensed that everything was moving in the wrong direction. “We feel like we’re losing control of the situation,” one of the county health officers said. “People are getting it and we don’t know where.”
Consider Erica Dykehouse and the situation in which she finds herself. She has many good reasons to throw her hands in the air and tell society to shove it. Big companies are collecting huge sums of money for useless test results. People are breaking rules and turning what might be single infections into networks of possible infections. Each new positive is taking longer than the last to trace. Her efforts to prevent the spread of disease are now as likely to be met with abuse and derision as with gratitude and cooperation. On top of it all, she and her colleagues are spent. At one point, Erica went 20 days without a break, until she collapsed.
And then there’s the bigger picture — which she can still glimpse through the window of her cell-like office. From her desk, she stares right into the side of a building that’s more or less glued onto the ancient juvenile jail but is clearly newer and more expensive. The bioterrorism lab, it’s called. The county built it after the anthrax attacks on Capitol Hill, back in 2001. Since those attacks, American public health officials quickly learned, equipment to defend against bioterrorism was the one thing that you could get money for. Not staff, not space, not training, not the ability to plan for infectious disease; if you wanted resources, you had to use it to prepare for the coming attack against the society. “We had all this equipment just sitting there,” said Erica. “We never use it, so if there is an event, we don’t know how to use it.” The health department’s lab guy had impressed her by realizing this, and finding clever ways to operate the machines, so that in the event some bioterrorist appeared in Humboldt County, they’d know how to test for whatever he brought with him.
Yet when the attack finally came, it came from within. “Can I just say one thing?” Erica asked, after I’d finished asking her questions. “I’ve never had an interest in serving in the military. But this is the closest I’ve ever been. There’s nobody to replace us. If we don’t show up, there’s nobody to show up.” Her job, as she now sees it, is to keep the door to the Public Health office open, until the American public is ready to be saved from itself. “There will come a time when their minds will be changed,” she said. “Once the reality hits them — when they see a friend of theirs die. Or someone young die. I don’t want them to feel confrontational. I want them to know I’ll be here for you. I’ll take your call even though you treated me like dirt.”
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Michael Lewis is a Bloomberg Opinion columnist. His books include “Flash Boys: A Wall Street Revolt,” “Moneyball: The Art of Winning an Unfair Game,” “Liar’s Poker” and “The Fifth Risk.” He also has a podcast called “Against the Rules.”
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