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She Had to Choose: Her Epileptic Patient or Her 7-Year-Old Daughter She Had to Choose: Her Epileptic Patient or Her 7-Year-Old Daughter
(about 11 hours later)
When New York City closed its public schools, Cindy Urena, a home health aide for Sunnyside Community Services in Queens, faced a choice: stop seeing a client with severe epilepsy or leave her 7-year-old daughter alone at home.When New York City closed its public schools, Cindy Urena, a home health aide for Sunnyside Community Services in Queens, faced a choice: stop seeing a client with severe epilepsy or leave her 7-year-old daughter alone at home.
Ms. Urena, 39, earns $15 an hour, and like half of New York City’s direct care workers, relies on food stamps even when she is working.Ms. Urena, 39, earns $15 an hour, and like half of New York City’s direct care workers, relies on food stamps even when she is working.
She made her choice. Now she has no income at all.She made her choice. Now she has no income at all.
Kelly Takemura faced a different problem: as the pandemic spreads, who gets care and whose care becomes inessential? Ms. Takemura is the director of nursing at SelectCare Home Care Services in Manhattan, whose 156 aides have been working and riding the subways without masks or hand sanitizer because of shortages.Kelly Takemura faced a different problem: as the pandemic spreads, who gets care and whose care becomes inessential? Ms. Takemura is the director of nursing at SelectCare Home Care Services in Manhattan, whose 156 aides have been working and riding the subways without masks or hand sanitizer because of shortages.
The most acute cases are still getting care; for others, the agency has pulled back on visits for the safety of both aides and clients.The most acute cases are still getting care; for others, the agency has pulled back on visits for the safety of both aides and clients.
“It’s like times of war,” Ms. Takemura said. “You have to prioritize.”“It’s like times of war,” Ms. Takemura said. “You have to prioritize.”
No city in America has been hit harder by the coronavirus than New York, which surpassed 9,000 confirmed cases as of Sunday, and no part of the city’s vast health care system is more fragile than the loose corps of low-wage home care providers, overwhelmingly women of color.No city in America has been hit harder by the coronavirus than New York, which surpassed 9,000 confirmed cases as of Sunday, and no part of the city’s vast health care system is more fragile than the loose corps of low-wage home care providers, overwhelmingly women of color.
While other New Yorkers heed the governor’s call to remain inside, more than a quarter-million home care workers travel the subways and crowded apartment blocks to bathe, dress, feed and spend time with the city’s most vulnerable residents — those who, when hospital beds become scarce, may be passed over in favor of younger patients.While other New Yorkers heed the governor’s call to remain inside, more than a quarter-million home care workers travel the subways and crowded apartment blocks to bathe, dress, feed and spend time with the city’s most vulnerable residents — those who, when hospital beds become scarce, may be passed over in favor of younger patients.
Covid-19 is especially lethal for older adults and people with serious underlying health conditions. For some, their home attendant is both their best protection and their most likely source of infection.Covid-19 is especially lethal for older adults and people with serious underlying health conditions. For some, their home attendant is both their best protection and their most likely source of infection.
Nearly half of all home aides in New York City live in poverty or near it, according to a study from PHI. In 2018, the average hourly wage for a home caregiver was $13.50. Even if they wanted to stay home from work, few could afford to.Nearly half of all home aides in New York City live in poverty or near it, according to a study from PHI. In 2018, the average hourly wage for a home caregiver was $13.50. Even if they wanted to stay home from work, few could afford to.
They are a vulnerable lifeline to some of the city’s most vulnerable residents, managing their own child care and financial stress, their clients’ fears and their own.They are a vulnerable lifeline to some of the city’s most vulnerable residents, managing their own child care and financial stress, their clients’ fears and their own.
The risks in their daily work are not only to themselves, but to their clients and their own partners and children. The care they give is also a potential opening for infection.The risks in their daily work are not only to themselves, but to their clients and their own partners and children. The care they give is also a potential opening for infection.
Statewide, two-thirds say they do not have access to adequate personal protective equipment, like masks and hand sanitizer, according to the Home Care Association of New York State.Statewide, two-thirds say they do not have access to adequate personal protective equipment, like masks and hand sanitizer, according to the Home Care Association of New York State.
Delva Walker lost her income when her patient’s family decided it was too risky to have aides coming in and out of the home — they wanted live-in care to minimize the dangers.Delva Walker lost her income when her patient’s family decided it was too risky to have aides coming in and out of the home — they wanted live-in care to minimize the dangers.
“I have bills to pay, rent to pay, but it’s something beyond my control,” Ms. Walker said. After 30 years as an aide, she said, she accepted the risks involved.“I have bills to pay, rent to pay, but it’s something beyond my control,” Ms. Walker said. After 30 years as an aide, she said, she accepted the risks involved.
“In my line of work, you have to do everything possible to give them care,” she said. “It’s in the contract. It’s the work I chose because I love to help people. My care for people is beyond. When they have a blizzard, I go.”“In my line of work, you have to do everything possible to give them care,” she said. “It’s in the contract. It’s the work I chose because I love to help people. My care for people is beyond. When they have a blizzard, I go.”
Deidre Armstrong, 39, who provides live-in care for an 89-year-old woman, said her life has also been upended. She has not been home to her fiancé and teenage niece since Sunday. “But when I do,” she said, “I have to keep a distance from them. No hugging. No kissing.”Deidre Armstrong, 39, who provides live-in care for an 89-year-old woman, said her life has also been upended. She has not been home to her fiancé and teenage niece since Sunday. “But when I do,” she said, “I have to keep a distance from them. No hugging. No kissing.”
Like ride-share drivers, aides often work for multiple agencies, following different safety protocols. Clients, too, might have a night aide from one agency, a morning aide from another, weekend aides from a third and family members filling the gaps.Like ride-share drivers, aides often work for multiple agencies, following different safety protocols. Clients, too, might have a night aide from one agency, a morning aide from another, weekend aides from a third and family members filling the gaps.
So risks pass between aides and clients, but also among aides and other aides, family members and fellow subway riders. For the homebound, any health setback might mean a trip to the emergency room, which for the aide means a marathon wait in the place where the virus is most clustered.So risks pass between aides and clients, but also among aides and other aides, family members and fellow subway riders. For the homebound, any health setback might mean a trip to the emergency room, which for the aide means a marathon wait in the place where the virus is most clustered.
At RiseBoro Community Partnership, which sends 1,100 home care workers into 700 homes in Brooklyn and Queens, Glenmore Matthews, the vice president of home care, said he was trying to stagger travel times and to change routes to reduce risk on the subways.At RiseBoro Community Partnership, which sends 1,100 home care workers into 700 homes in Brooklyn and Queens, Glenmore Matthews, the vice president of home care, said he was trying to stagger travel times and to change routes to reduce risk on the subways.
He talked about the financial toll on agencies like his. Any missed visits means lost revenue. “If we don’t provide services, we cannot bill Medicaid,” he said. “It’s a domino effect.”He talked about the financial toll on agencies like his. Any missed visits means lost revenue. “If we don’t provide services, we cannot bill Medicaid,” he said. “It’s a domino effect.”
James Reynolds, a physical therapist who works for the New Jewish Home, said he tried to maintain social distancing when visiting clients, but it was not always possible. Many of his patients were recovering from falls, learning to regain balance. “So I have to stand close enough to assist,” he said.James Reynolds, a physical therapist who works for the New Jewish Home, said he tried to maintain social distancing when visiting clients, but it was not always possible. Many of his patients were recovering from falls, learning to regain balance. “So I have to stand close enough to assist,” he said.
Updated June 16, 2020Updated June 16, 2020
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.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.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.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.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.
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.
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.
Mr. Reynolds grasped a cruel irony: his care might be the thing that kills a patient. “I am looking at the risk and reward,” he said. “If a patient is a fall risk but has family around them, I might not seek more visits, because those visits put them at risk.”Mr. Reynolds grasped a cruel irony: his care might be the thing that kills a patient. “I am looking at the risk and reward,” he said. “If a patient is a fall risk but has family around them, I might not seek more visits, because those visits put them at risk.”
Meals on Wheels deliverers have also cut back on personal interactions, ordinarily a key benefit of their service, especially for clients who have few other human contacts. Instead of entering apartments, now the deliverers place food at the door and step back six feet.Meals on Wheels deliverers have also cut back on personal interactions, ordinarily a key benefit of their service, especially for clients who have few other human contacts. Instead of entering apartments, now the deliverers place food at the door and step back six feet.
“We’re trying to have distance but get a visual idea of what’s happening,” said Tania Collazo, who runs the food delivery program in Queens for the Jewish Association Serving the Aging, or JASA, which serves 430 homebound people.“We’re trying to have distance but get a visual idea of what’s happening,” said Tania Collazo, who runs the food delivery program in Queens for the Jewish Association Serving the Aging, or JASA, which serves 430 homebound people.
“How are they doing mentally through this? They’re wondering if the meals are safe to eat. There’s a feeling that they may be forgotten — that if they get sick they’ll be neglected by the medical system in favor of someone who is more likely to survive.”“How are they doing mentally through this? They’re wondering if the meals are safe to eat. There’s a feeling that they may be forgotten — that if they get sick they’ll be neglected by the medical system in favor of someone who is more likely to survive.”
Other stressors: in a work force that is 78 percent foreign-born, aides with East Asian features have encountered racist taunts because the virus originated in China.Other stressors: in a work force that is 78 percent foreign-born, aides with East Asian features have encountered racist taunts because the virus originated in China.
In abundant sunshine on Wednesday, Gloria Providence and her client, Harold Richman, 97, sat on a bench on Riverside Drive, a few feet apart, both wearing latex gloves provided by Mr. Richman’s family.In abundant sunshine on Wednesday, Gloria Providence and her client, Harold Richman, 97, sat on a bench on Riverside Drive, a few feet apart, both wearing latex gloves provided by Mr. Richman’s family.
The current precautions were nothing new for her, Ms. Providence said. She was 59 and was acutely aware of the dangers facing her as well. “We have to act as if everyone and everything is contagious,” she said. “That’s how we’re trained.”The current precautions were nothing new for her, Ms. Providence said. She was 59 and was acutely aware of the dangers facing her as well. “We have to act as if everyone and everything is contagious,” she said. “That’s how we’re trained.”
The interview was conducted outdoors because for journalists, now, that is the best practice. For Ms. Providence and Mr. Richman, that was not an option. They would be going home.The interview was conducted outdoors because for journalists, now, that is the best practice. For Ms. Providence and Mr. Richman, that was not an option. They would be going home.
But not before a song. “You have to keep their brains stimulated,” Ms. Providence said. “The one thing you don’t want is a sense of isolation, especially now. So we sing. Don’t we sing, Mr. Richman?”But not before a song. “You have to keep their brains stimulated,” Ms. Providence said. “The one thing you don’t want is a sense of isolation, especially now. So we sing. Don’t we sing, Mr. Richman?”
Mr. Richman suggested an aria from La Bohème but then could not get started; Ms. Providence suggested “Porgy and Bess.”Mr. Richman suggested an aria from La Bohème but then could not get started; Ms. Providence suggested “Porgy and Bess.”
And for a moment in this mad week in March, it was summertime, and the living was easy.And for a moment in this mad week in March, it was summertime, and the living was easy.