Registered nurse Sandra Old field died of Covid-19 in May. Since March, she and fellow nurses had been sounding the pandemic alarm about dangerous conditions at the Kaiser Permanente Fresno Medical Center, the California hospital where she worked for nearly 20 years.
After California declared a Covid-19 state of emergency on March 4, Oldfield didn’t feel safe working in just the surgical mask issued to her by the hospital. She joined co-workers who complained to management, demanding access to N95 respirators.
That same month, one of Oldfield’s patients, initially admitted with gastrointestinal symptoms, became acutely ill with a respiratory infection and tested positive for Covid-19. Oldfield went home to isolate March 26. Within two months, Oldfield, 53, was dead.
Other hospital staff scrambled to uncover who else might have been exposed to the virus. By March 28, nurses were frantically texting Rachel Spray, a coworker of Oldfield’s in the telemetry unit, asking what they should do. Hospital management had no clear answer, according to Spray, who also serves as a union representative at the hospital for the California Nurses Association (CNA). News of more confirmed cases circulated by word of mouth.
Ultimately, 50 workers at the hospital were exposed to Covid-19 by that first case. Ten people tested positive and three of those developed a serious illness, according to CNA, which documented the outbreak.
The Fresno nurses staged two demonstrations outside the hospital in April and early May, demanding access to adequate personal protective equipment (PPE). The protests also alerted the public to the risk, which Kaiser Permanente had not disclosed to patients or the wider community. On May 27, the nurses held a third demonstration, to mourn Oldfield. They believe hospital management should have prevented Oldfield’s death.
“Losing a nurse, it really destroyed the morale,” Spray says. “Having to go to work the day after your coworker — your friend — dies from Covid, and not having any resources to help you to deal with that.”
Because of the protests, the circumstances of Oldfield’s death were widely reported in local media. But many healthcare workers who have died of Covid-19 remain anonymous. In fact, no one knows exactly how many workers in hospitals, nursing homes and healthcare facilities have died of Covid-19. No public agency reliably tracks the data, and healthcare facilities are reluctant to volunteer it, sometimes withholding information about the extent of outbreaks until they become too severe to ignore.
In the absence of official numbers, much of what we know about Covid-19’s toll on healthcare workers comes from whistleblowers like those at Fresno Medical Center. Poor working conditions — as well as long-standing concerns about patient safety issues, which have been exacerbated by the pandemic — have prompted healthcare workers to launch a series of dramatic on-the-job actions.
In These Times spoke with more than a dozen healthcare workers who have participated in strikes and protests, as well as field organizers with national and local healthcare unions. We also reviewed data from the National Labor Relations Board (NLRB) on union elections and charges of unfair labor practices at private-sector healthcare employers (over which the NLRB has jurisdiction).
While traditional unionization has slowed in 2020, including in the healthcare sector, there are indicators of growing interest in organizing within hospitals, nursing homes and other frontline healthcare facilities. Thousands of workers have gone on strike. And while it’s difficult to estimate how many workers have taken part in smaller on-the-job protests and pickets, healthcare workers are filing more NLRB complaints alleging retaliation for workplace organizing than in previous years.Meanwhile, several healthcare unions report they are making inroads with non-union workers. They especially see potential to improve the ratio of patients to staff, which has steadily deteriorated in the context of consolidated corporate healthcare systems.“Our phones are ringing in a way they haven’t in the past,” says Matthew Yarnell, president of SEIU Healthcare Pennsylvania, which represents healthcare workers at three new facilities following successful union drives during the pandemic. Virtually every facility shares the same core issues, Yarnell says: “chronic short staffing, low wages, not being prepared for a highly contagious airborne pandemic virus.” The tragic situation has become a crucible for “enhanced workplace action and organizing.”
Undercounts & Outbreaks
In a September report, National Nurses United (NNU) — the largest U.S. union of registered nurses — estimated at least 1,718 healthcare workers had died of Covid-19 and related complications. That figure is more than twice as high as the 767 healthcare worker deaths reported by the Centers for Disease Control and Prevention (CDC) as of publication. NNU suggests its estimate — which relied on obituaries, union memorials, GoFundMe campaigns, social media posts and news reports — is an undercount.
Most of the CDC’s data does not collect occupational status, creating an undercount of cases irreconcilable even with other federal data. The Centers for Medicare & Medicaid Services, for example, reports higher fatalities for nursing home workers alone — more than 800 deaths as of August 30 — than the CDC’s figure of 767 cases for all healthcare workers to date.
Many state agencies are not tracking the data any better. As of mid-September, California’s health department reported 167 total deaths of healthcare workers, including 146 deaths of healthcare workers in nursing homes — suggesting just 21 healthcare workers had died outside of nursing homes. Meanwhile, NNU said it had confirmed at least 44 healthcare worker deaths outside of nursing homes as of mid-September, including Oldfield.
The lack of adequate protective gear is a clear contributor to these deaths. In the first month of the pandemic, frontline healthcare workers’ risk of infection was at least three times higher than the general population’s, according to a study published this summer in The Lancet. Inadequate PPE further increased the risk. Non-white healthcare workers had a risk at least five times higher and were also more likely than their white counterparts to report inadequate or reused PPE.
And the PPE shortages, detrimental at the outbreak of the pandemic, have not improved in many areas. “In many ways, things have only gotten worse,” American Medical Association President Susan Bailey said in an August statement.
The federal government missed numerous opportunities to prevent the severe PPE shortage. Well before the World Health Organization declared Covid-19 a pandemic on March 11, public health experts warned inadequate stockpiles and critical supply-chain shortages of PPE poses a threat to frontline workers.
In early March, U.S. healthcare workers watched catastrophe unfold for their counterparts in Italy, where an estimated 2,500 doctors, nurses and hospital staff tested positive for Covid-19 in one six-day span in March. The Trump administration compounded nonexistent preparation with deliberate misinformation, leaving healthcare workers exposed as U.S. cases climbed. But healthcare unions say the government isn’t the only actor at fault. “The healthcare industry is also guilty of grievous misconduct,” according to the NNU report.
The report contends that hospitals and nursing homes have widely failed to report workplace deaths from Covid-19. They are not required by law to do so, and they rarely self-report.
Hospitals facing Covid-19 outbreaks in their facilities often fail to warn staff members who may have been exposed, sometimes citing federal privacy laws restricting the release of medical information as a pretext for not disclosing crucial information. NNU alleges that healthcare employers may instead be reluctant to acknowledge workplace deaths because of liability for workers’ compensation claims.
Instead of counting on their employer to warn workers of possible infections, hospital staff say they often rely on informal communication to track the spread.
Tinny Abogado, a nurse at Kaiser Permanente Los Angeles Medical Center, says nurses have relied on each other to track Covid-19 in the facility since March. “We have a messenger group, just the nurses in our unit,” says Abogado. “And we [use it] to say, ‘Hey, I got Covid.’ … That’s how we find out.”
In multiple Kaiser Permanente facilities, nurses have reported that key supplies, including N95 masks, are locked away and available only by request. Only if the requester can satisfy a particular list of criteria will they receive a mask from the hospital.
Kaiser Permanente did not respond to In These Times’ request for comment. In a statement following Oldfield’s death in May, Senior Vice President and Area Manager of Kaiser Permanente Fresno Wade Nogy expressed condolences and said that staff and patient safety remained the top priority.
Sympathy & Solidarity
In the context of declining union membership in the United States, healthcare represents a highly organized sector — but the overwhelming majority of healthcare workers still do not belong to a union. In 2019, the healthcare sector saw the greatest increase in union membership of any U.S. industry. Union density in the industry overall, however, remained relatively stagnant, given the simultaneous expansion of nonunion healthcare jobs.
Between March and September, the most recent month for which NLRB election data was available, healthcare workers had voted in 58 elections for union certification, winning 41 of them. That’s a decrease from the number of union elections held by healthcare workers over the same period in 2019 — not surprising given an overall drop in unionization efforts during the pandemic. Restrictive rules from the Trump administration’s NLRB, currently filled with a majority of Trump appointees, did not help matters. Overall, the labor board has received fewer than 800 petitions for union elections since mid-March, compared to more than 1,100 over the same period in each of the four previous years.
But this data does not necessarily capture the full picture of on-the-job organizing. Matthew Yarnell, president of SEIU Healthcare Pennsylvania, reports an uptick in worker interest, citing internal data that SEIU organizers in 18 states have been receiving more calls from healthcare workers during the pandemic than prior to it.
Yarnell says one union drive in particular, in Millersburg, Pa., illustrates the urgency of collective action in this moment. At Premier at Susquehanna, a nursing home named after the river that passes through the town, a Covid-19 outbreak had infected at least 16 workers by mid-June. Trudy Klinger, a restorative nurse in the facility, died of Covid-19.
“Workers organized [in] the course of three days,” Yarnell says. On June 10, the facility agreed to recognize their bargaining unit.
That experience tracks with national data on how the pandemic has affected essential workers’ attitudes towards unionization. This spring, the Roosevelt Institute and YouGov Blue surveyed more than 2,500 respondents in essential occupations — ranging from healthcare to food service and transportation — about their working conditions and willingness to take part in collective action at work. As concern about contracting Covid-19 at work increased, so did workers’ interest in protesting conditions and forming unions to improve them.
“The pandemic may be shifting workers’ understanding of the benefits of workplace collective action, presenting new opportunities for labor organization and action,” reads the report. According to data provided to In These Times by the survey’s Adam Reich, the healthcare workers who responded reflected this trend — particularly in areas hardest hit by the virus. “Covid has actually been this kind of mobilizing moment,” Reich says.
Unionized healthcare workers have also been going on the offense in new ways. In three southern California hospitals owned by healthcare giant Hospital Corporation of America (HCA), union nurses launched radio ads this summer calling for adequate PPE and patient staffing. They are also fighting for pandemic safety measures to be included in their next union contracts.
In April, HCA suspended registered nurse Jhonna Porter without pay after she used social media to warn colleagues at Los Angeles’ West Hills Hospital that their floor would begin accepting Covid-19 patients without adequate protections in place. Porter was reinstated after an outpouring of support, but dozens of similar stories have surfaced. NLRB records show that, since mid-March, healthcare workers have filed more than 200 unfair labor practice charges alleging violations of Section 8(a)(1) of the National Labor Relations Act, which prohibits employers from retaliating against or otherwise interfering in legally protected organizing. In 2019, healthcare workers filed just 46 such charges over the same period; they filed 141 and 109 over the same periods in 2018 and 2017, respectively.
The ongoing surge of Covid-19 cases has given one union campaign renewed energy. In early March, hasty preparations for Covid-19 brought a union drive by nurses at a mid-size acute care hospital in Wisconsin to a grinding halt. As staff attention shifted to pandemic preparation, administrators implied that a union fight would be selfish and unfair under the circumstances. The nurses, who were spurred to organize because of chronic understaffing, have since restarted their campaign. One spoke to In These Times about the renewed push on the condition of anonymity. To protect employees from retaliation, In These Times is also withholding the name of the hospital.
“We routinely are short if not one, two, then three nurses a shift … and the hospital really isn’t doing a whole heck of a lot to change that,” said the nurse. “I think people are realizing that things aren’t going to change. And that maybe we need to amp it up.”
Where workers have gone on strike against unsafe working conditions this year, public support has helped secure important wins.
In September, 4,000 unionized workers related to the University of Illinois-Chicago (UIC) Medical Center — including workers in technical, building and maintenance, and clerical positions—went on strike after filing 20 complaints with the city of Chicago. The complaints allege the hospital had been paying workers less than minimum wage. In the same week, more than 800 nurses represented by the Illinois Nurses Association went on strike amid contract negotiations that had stalled around the issue of staffing. At least four workers at the hospital have died of Covid-19 to date.
Workers at the UIC hospital pushed their employer to agree to raise wages for hospital staff and increase staffing by 160 nurse positions.
Vee Steward, represented by SEIU Local 73 as a clerical worker for the UIC hospital, says the pandemic has highlighted the necessity of fair wages throughout the hospital.
“I work with the front desk staff, and I work with these people who put their lives on the line every day, coming to work without the proper equipment,” Steward says. “And we demanded that UIC consider the fact that … we are coming here, doing our job, but then we are going home, exposing our families, and so they had to do better so that we can protect our families. No one should work and still not be able to afford to pay their rent or to buy food.”
At Fresno Medical Center, union nurses still shaken from Oldfield’s death are bracing for another wave of Covid-19 infections. Their protests this spring prompted small improvements, but they are still fighting for adequate PPE.
Amid the prolonged crisis, Fresno nurse and CNA representative Amy Arlund says that collective action is crucial to enlisting public support and sending a message about the importance of safe workplaces for healthcare providers.
“When you risk your nurses’ lives and you don’t protect them,” Arlund asks, “who’s going to be around to take care of you when it’s your turn to be sick?”
This article was supported by a grant from the Leonard C. Goodman Institute for Investigative Reporting. Fact-checking was provided by Hannah Faris and Janea Wilson.
Alice Herman is a 2020-2021 Leonard C. Goodman Institute for Investigative Reporting Fellow with In These Times.