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The Pathologist: She Confronts the Virus From Inside Nursing Homes The Pathologist: She Confronts the Virus From Inside Nursing Homes
(32 minutes later)
— Lubab al-Quraishi, a pathology assistant in New Jersey— Lubab al-Quraishi, a pathology assistant in New Jersey
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This piece is a collaboration between The New York Times and The Fuller Project.This piece is a collaboration between The New York Times and The Fuller Project.
A few days a week, Lubab al-Quraishi, 47, wakes up before sunrise and drives to the diagnostics lab where she works as a pathology assistant, in northern New Jersey. There, she picks up the gloves, gowns, face masks and face shields she needs to do her job in relative safety. Then she’s back on the road, crossing the Hudson River into New York City, sometimes alone, staving off exhaustion, and sometimes dozing in the passenger seat while a colleague drives.A few days a week, Lubab al-Quraishi, 47, wakes up before sunrise and drives to the diagnostics lab where she works as a pathology assistant, in northern New Jersey. There, she picks up the gloves, gowns, face masks and face shields she needs to do her job in relative safety. Then she’s back on the road, crossing the Hudson River into New York City, sometimes alone, staving off exhaustion, and sometimes dozing in the passenger seat while a colleague drives.
Months ago, when the coronavirus was just starting to spread through the U.S., the director of the lab asked employees to help test for the virus in nursing homes. Many of al-Quraishi’s colleagues were nervous about the work. One of the first major outbreaks in the U.S. had taken place in a Seattle-area nursing home, and now it seemed elderly Americans across the country were vectors of a little understood but frightening disease. The director explained that testing for the disease could expose his staff members’ families. “He didn’t think anyone would do it,” she said. “I said, ‘I am ready.’”Months ago, when the coronavirus was just starting to spread through the U.S., the director of the lab asked employees to help test for the virus in nursing homes. Many of al-Quraishi’s colleagues were nervous about the work. One of the first major outbreaks in the U.S. had taken place in a Seattle-area nursing home, and now it seemed elderly Americans across the country were vectors of a little understood but frightening disease. The director explained that testing for the disease could expose his staff members’ families. “He didn’t think anyone would do it,” she said. “I said, ‘I am ready.’”
Now al-Quraishi spends half her week visiting nursing homes across Staten Island, Queens and Brooklyn. Some of the homes are fine, like a cross between a hospital and a decent hotel. Others leave her in despair for the residents and workers.Now al-Quraishi spends half her week visiting nursing homes across Staten Island, Queens and Brooklyn. Some of the homes are fine, like a cross between a hospital and a decent hotel. Others leave her in despair for the residents and workers.
One home she visits is dark and filthy. It smells of urine. Residents, gathered together in the basement for testing, seem to al-Quraishi stuck in a lonely and uniquely American tragedy, one exposed and exacerbated by the pandemic. In her native Iraq, al-Quraishi didn’t know anyone who sent their mother or father to a nursing home. It was never a question that her mother, who is 78, would live with al-Quraishi. “I prepare her food, I take her to the restroom, clean her, put her back to bed, give her the medication,” she said. “She’s a little disoriented. But I would never put her in a nursing home. That’s another thing I learned in Baghdad.”One home she visits is dark and filthy. It smells of urine. Residents, gathered together in the basement for testing, seem to al-Quraishi stuck in a lonely and uniquely American tragedy, one exposed and exacerbated by the pandemic. In her native Iraq, al-Quraishi didn’t know anyone who sent their mother or father to a nursing home. It was never a question that her mother, who is 78, would live with al-Quraishi. “I prepare her food, I take her to the restroom, clean her, put her back to bed, give her the medication,” she said. “She’s a little disoriented. But I would never put her in a nursing home. That’s another thing I learned in Baghdad.”
The nasal swabs are painful, and if residents test positive they have to be retested again that week.The nasal swabs are painful, and if residents test positive they have to be retested again that week.
“I feel guilty when I swab them,” she said. “They’re at the end of their lives. They are in a different world.” The tests take less than a minute to administer, but the mornings are long as al-Quraishi talks the residents through their discomfort and confusion, trying to connect with them.“I feel guilty when I swab them,” she said. “They’re at the end of their lives. They are in a different world.” The tests take less than a minute to administer, but the mornings are long as al-Quraishi talks the residents through their discomfort and confusion, trying to connect with them.
Al-Quraishi, who graduated ninth in a class of 300 from the College of Medicine at Baghdad University and went on to specialize in surgical pathology, is one of a large number of immigrants and refugees being asked to lend their expertise to America’s coronavirus response. Their sacrifices come during an administration that has passed legislation severely limiting refugee resettlement, that has used the health crisis to further deny asylum to migrants at the U.S. border with Mexico, and that has made it more difficult for foreign doctors to work in the U.S.Al-Quraishi, who graduated ninth in a class of 300 from the College of Medicine at Baghdad University and went on to specialize in surgical pathology, is one of a large number of immigrants and refugees being asked to lend their expertise to America’s coronavirus response. Their sacrifices come during an administration that has passed legislation severely limiting refugee resettlement, that has used the health crisis to further deny asylum to migrants at the U.S. border with Mexico, and that has made it more difficult for foreign doctors to work in the U.S.
In Iraq, al-Quraishi was expected, like most of her colleagues, to take a turn in the E.R. The conditions were appalling, brought on by years of war and years of sanctions preceding it, she said. “Kids were dying of the simple flu, a simple GI infection, because we had no medicine,” she said. “I worked in a hospital where we had no IV fluid, and when we did, no line to run the fluid through.”In Iraq, al-Quraishi was expected, like most of her colleagues, to take a turn in the E.R. The conditions were appalling, brought on by years of war and years of sanctions preceding it, she said. “Kids were dying of the simple flu, a simple GI infection, because we had no medicine,” she said. “I worked in a hospital where we had no IV fluid, and when we did, no line to run the fluid through.”
For reasons she still doesn’t know, al-Quraishi and her husband, who also trained as a doctor, were targeted by the insurgency in Iraq. “We kept moving from one area to another,” she said. “Trying to keep my children safe. We were one family of thousands who experienced the same thing.”For reasons she still doesn’t know, al-Quraishi and her husband, who also trained as a doctor, were targeted by the insurgency in Iraq. “We kept moving from one area to another,” she said. “Trying to keep my children safe. We were one family of thousands who experienced the same thing.”
Eleven years after the U.S. invasion, after a lengthy and often bewildering application process, al-Quraishi and her young family were resettled as refugees in Texas, where she tried without success to resume her life as a doctor.Eleven years after the U.S. invasion, after a lengthy and often bewildering application process, al-Quraishi and her young family were resettled as refugees in Texas, where she tried without success to resume her life as a doctor.
“I made an appointment with the head of the pathology department at a huge local hospital,” she told me. “I said, ‘I am a pathologist from Iraq and I am interested in volunteering.’ I just wanted them to know me.”“I made an appointment with the head of the pathology department at a huge local hospital,” she told me. “I said, ‘I am a pathologist from Iraq and I am interested in volunteering.’ I just wanted them to know me.”
Recertifying in the U.S., though, is notoriously costly and time-consuming; in 2020 there were, by one estimate, about 263,000 immigrants and refugees living in America who, despite being trained internationally in health and medicine, are unable to work. Instead, al-Quraishi took jobs at CVS and Popeyes and tried to stay current in her field, eventually moving her family to New Jersey for the job as a pathology assistant, for which she was initially paid so little she struggled to make rent. Working, once again, in the medical field, was both a relief and a heartbreak. “Doctors don’t take you seriously,” she said. “That’s the most painful part.”Recertifying in the U.S., though, is notoriously costly and time-consuming; in 2020 there were, by one estimate, about 263,000 immigrants and refugees living in America who, despite being trained internationally in health and medicine, are unable to work. Instead, al-Quraishi took jobs at CVS and Popeyes and tried to stay current in her field, eventually moving her family to New Jersey for the job as a pathology assistant, for which she was initially paid so little she struggled to make rent. Working, once again, in the medical field, was both a relief and a heartbreak. “Doctors don’t take you seriously,” she said. “That’s the most painful part.”
When Covid-19 hit the U.S., exposing systemic flaws in medical care, al-Quraishi felt uniquely prepared by her experience in Iraq. Not only did she understand how to work in extreme situations, she found the Iraqi medical education to be more well-rounded than the American one. “Not necessarily better,” she said. “But the system is different.” The fact that doctors were required to work in E.R.s strained by crisis felt particularly relevant now. “Iraq went through a lot,” she said. “There was always a need.”When Covid-19 hit the U.S., exposing systemic flaws in medical care, al-Quraishi felt uniquely prepared by her experience in Iraq. Not only did she understand how to work in extreme situations, she found the Iraqi medical education to be more well-rounded than the American one. “Not necessarily better,” she said. “But the system is different.” The fact that doctors were required to work in E.R.s strained by crisis felt particularly relevant now. “Iraq went through a lot,” she said. “There was always a need.”
After Gov. Phil Murphy of New Jersey wrote an executive order granting temporary licenses to internationally trained medical professionals to help respond to Covid, al-Quraishi and her husband put on their own scrubs and masks and showed up at a hospital. “I said, ‘We are from Baghdad,” she said. “We know how to handle difficult situations. Just give us the chance.”After Gov. Phil Murphy of New Jersey wrote an executive order granting temporary licenses to internationally trained medical professionals to help respond to Covid, al-Quraishi and her husband put on their own scrubs and masks and showed up at a hospital. “I said, ‘We are from Baghdad,” she said. “We know how to handle difficult situations. Just give us the chance.”
She reached out to the governor on Twitter. “I wanted to say ‘Thank you, Mr. Governor, we will help you as much as we can. But we have been here for years. What happens when this is all over?’”She reached out to the governor on Twitter. “I wanted to say ‘Thank you, Mr. Governor, we will help you as much as we can. But we have been here for years. What happens when this is all over?’”
Updated July 15, 2020Updated July 15, 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.
“Maybe it wasn’t the right time to tell him this, but I felt a little bit upset,” she said.“Maybe it wasn’t the right time to tell him this, but I felt a little bit upset,” she said.
The staff members at the nursing homes where al-Quraishi works are primarily women of color and also vulnerable.The staff members at the nursing homes where al-Quraishi works are primarily women of color and also vulnerable.
Al-Quraishi thinks frequently about their compassion for the residents, and their devotion to the work. Staff members sit with residents, holding their hands through the eye-watering swab. They painstakingly explain to the residents why they have to undergo testing. They explain it again a few days later when al-Quraishi returns. And they explain it again a few days after that, when residents have forgotten al-Quraishi was there in the first place.Al-Quraishi thinks frequently about their compassion for the residents, and their devotion to the work. Staff members sit with residents, holding their hands through the eye-watering swab. They painstakingly explain to the residents why they have to undergo testing. They explain it again a few days later when al-Quraishi returns. And they explain it again a few days after that, when residents have forgotten al-Quraishi was there in the first place.
At first, nursing homes seemed foreign to al-Quraishi. But, soon she began to imagine an older version of herself in place of one of the residents.At first, nursing homes seemed foreign to al-Quraishi. But, soon she began to imagine an older version of herself in place of one of the residents.
More than 70 percent of Americans using long-term care like nursing homes are women, according to a recent CDC study. “My daughter said, ‘This is how Americans do it,’” al-Quraishi said. “But I was raised in Iraq. To end up in a nursing home is really sad.”More than 70 percent of Americans using long-term care like nursing homes are women, according to a recent CDC study. “My daughter said, ‘This is how Americans do it,’” al-Quraishi said. “But I was raised in Iraq. To end up in a nursing home is really sad.”
Months into the pandemic, more than 40% of deaths in the U.S. can be linked to nursing homes.Months into the pandemic, more than 40% of deaths in the U.S. can be linked to nursing homes.
Al-Quraishi will work in nursing homes as long as she is needed. She tries to tune out, or even to understand, the continuing pressures on immigrants and refugees coming out of the White House, but it can be difficult. “If you ask me to go back home, I would collapse,” she said. In November she filed an application for citizenship, but while the country is overwhelmed by Covid, she has been left waiting for the next step.Al-Quraishi will work in nursing homes as long as she is needed. She tries to tune out, or even to understand, the continuing pressures on immigrants and refugees coming out of the White House, but it can be difficult. “If you ask me to go back home, I would collapse,” she said. In November she filed an application for citizenship, but while the country is overwhelmed by Covid, she has been left waiting for the next step.
“I think we need to start a campaign,” she said. “We need to talk about our rights as refugees and international doctors. We need to talk about a system that needs to be thoroughly changed.”“I think we need to start a campaign,” she said. “We need to talk about our rights as refugees and international doctors. We need to talk about a system that needs to be thoroughly changed.”
In Her Words is available as a newsletter. Sign up here to get it delivered to your inbox. Write to us at inherwords@nytimes.com.In Her Words is available as a newsletter. Sign up here to get it delivered to your inbox. Write to us at inherwords@nytimes.com.