Unsung Heroes Fight the COVID-19 Pandemic

Ruben Castaneda

With 600 beds, the Los Angeles County-USC Medical Center is a crucial provider of health care for the city's poorest residents and is one of the largest public hospitals in the country. Beginning in March, LAC+USC Medical Center began treating patients with COVID-19, the deadly disease caused by the novel coronavirus. The doctors, nurses, respiratory therapists and other health care professionals responding to the COVID-19 crisis are supported by an array of non-medical staff members who, though they aren't clinicians, are hospital heroes of the coronavirus pandemic. Here, U.S. News profiles three of them: The hospital chaplain who serves as a bridge between the dying and the living; the custodian who overcame her fears to clean COVID-19 rooms; and the veteran carpenter whose staff devised a safer way to insert a tube into the trachea of patients to help them breath, a procedure called intubation.

Name: Chris Ponnet
Age: 62
Role: Hospital chaplain

As he gently renders comfort to dying COVID-19 patients at LAC+USC Medical Center, the Rev. Chris Ponnet is on high alert, taking mental notes of every detail, for the benefit of the living.

"My role is to be a bridge between the family and the patient," Ponnet says. "I want to capture as much of what is happening in the room as possible, to report to the family. Did their loved one say any last words, did they mouth the 'Our Father' prayer or respond by grabbing my hand?"

Since early March, Ponnet, the director of the department of spiritual care at LAC+USC Medical Center, has anointed about 20 dying COVID-19 patients in their final moments on earth. The Catholic ritual is commonly known as "last rites," though Catholic clergy prefer to use the official name, "the anointing of the sick." With family members prohibited from entering the rooms of COVID-19 patients, Ponnet and other clergy members are often the last person a dying patient sees and hears from.

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To minister to these patients, he dons goggles, an N95 mask, a plastic face shield and a disposable gown and gloves.

Typically, Ponnet would dip a finger in oil and gently touch a dying patient's forehead, hand or foot to anoint them. But the virulence of the deadly coronavirus calls for an adjustment: Before going to a dying COVID-19 patient's room, Ponnet dips a small towel or cotton swab with oil. He'll use the towel or the swab to touch the patient's forehead, hand or toe, to avoid directly touching the person and risking infection.

The first COVID-19 patient he anointed, a woman in her 60s, grabbed Ponnet's hand and made slight eye movements. Many family members are consoled when they learn how their loved one responded in his or her final moments.

During the anointing, Ponnet recites a prayer and tries to comfort the patient. "I want to make sure the message is clean and simple," he says. "I talk about mercy and hope and pass along messages from the family. I let them know their wife will be OK, their kids will take care of each other."

Sometimes, Ponnet will bring out his smartphone and play the patient's favorite song or type of music. Other times he'll use his smartphone or a tablet to let family members see their loved one a final time.

Ponnet and the other clergy members who minister to LAC+USC patients and staff members have adjusted to the coronavirus pandemic in other ways.

For example, each Wednesday morning, Ponnet and about 10 other chaplains gather outside the hospital to pray for patients, their family members and hospital staff. The clergy members recite a prayer in English, and in Spanish. Often, they carry signs in both languages telling the people in the hospital they're praying for them. The clergy members move on and repeat the prayers to each of the four sides of the eight-floor hospital.

Hospital staff members often acknowledge the chaplains by waving from inside or putting their hands together, as if in prayer.

Name: Esbeda Refugio
Age: 39
Role: Custodian

Esbeda Refugio, a member of the cleaning staff at LAC+USC, takes pride in providing a safe, clean environment for patients and health care workers. But in March, as COVID-19 patients began to steadily stream into the hospital, she became fearful at the prospect of cleaning their rooms.

"I had to think about it twice," Refugio says. "A lot of questions come to your mind when you go inside a room that held a COVID patient."

Refugio, a Mexican immigrant who was brought to the U.S. by her parents when she was 5, says she was primarily nervous about becoming infected and bringing the virus home to her four children. Refugio is a single mom with children who range in age from 1 to 21.

[Read: Meet Rana Awdish, a Critical Care Doctor on the Coronavirus Front Lines.]

For a day or two, Refugio thought about the dangers to herself and her family. Ultimately, Refugio's faith in God, in her fellow hospital workers and her sense of mission prompted her to volunteer to clean the rooms of COVID-19 patients. Hospital officials say Refugio and countless other non-medical hospital professionals are unsung heroes of the pandemic.

"It's my responsibility to protect others, not only when it comes to patient care, but also the doctors, the nurses and the respiratory techs who go into the room," she says. "I want everybody to be safe, so I clean to the best of my ability."

Like the health care professionals who treat COVID-19 patients, Refugio gears up before she cleans a room where a COVID-19 patient stayed. She dons two hairnets, goggles, an N95 respiratory mask, a clear plastic face shield, a full gown and plastic booties over her shoes. She wears two pairs of disposable gloves. Inside a COVID-19 room, Refugio wipes down every surface someone could touch, like bed rails, light fixtures and door knobs. She mops, and places used linens in plastic bags. In an anteroom designed specifically for doffing gear, she places her booties, gown and respiratory mask into a bag. Such gear is meant to be used one time, and will be incinerated. She cleans her face shield and goggles.

Some of Refugio's co-workers have expressed worry about working in a COVID-19 room. "They come up to me and ask a bunch of questions," she says. "I tell them to cover up properly, wear all the protective equipment you need to wear. Whatever makes you safe, do what you have to do."

During a typical shift, Refugio might clean two or three COVID-19 rooms, as well as several others. It takes an hour to an hour and 20 minutes to clean a COVID-19 room, compared to her pre-COVID regimen of 30 to 45 minutes.

"Now, cleaning COVID-19 rooms is part of my routine," she says. "I treat every room as if were a COVID-19 room. A patient who tests negative (for COVID-19) could become positive later."

Refugio feels a sense of pride at the reaction she often gets from doctors, nurses and other health care professionals during her shift. "When they see me, I can tell they're happy that I'm there."

Name: Patrick O'Connor
Age: 60
Role: Supervisor of L.A. County-USC's carpentry shop

Many of the nurses at LAC+USC Medical Center were tense about the prospect of helping intubate the growing number of COVID-19 patients coming into the hospital. They were worried about becoming infected. They were particularly terrified at the prospect of bringing the virulent virus home to their families.

During intubation, clinicians stand right over the patient's mouth and insert a tube into the windpipe to allow a ventilator to pump air in and out of the patient's lungs. Placing the tube in the windpipe often causes patients to cough, sending droplets hurtling toward health care workers, putting them at risk for infection.

Before COVID-19, health care workers at LAC+USC didn't typically use intubation boxes, says Stephen Scott, facilities administrator at the hospital. They would typically wear masks and face shields for these procedures, but the virulence and lethality of the coronavirus call for the use of intubation boxes. The boxes, made of plexiglass, are about 2 1/2 feet by 2 feet in size, and fit over the patient's head down to his or her rib cage. The intubation box includes sleeves that allow clinicians to place the tube into the patient's trachea.

In mid-April, Patrick O'Connor, supervisor of LAC+USC's carpentry shop, devised a solution with his team: an extra-thick intubation box that provides greater protection for health care workers from aerosolized virus particles that patients may emit.

To do so, O'Connor's team -- which included a carpenter who used to work with museums to develop display cases -- consulted with a doctor to develop a sturdier, more stable intubation box, with modifications to thicken the walls.

Enhanced stability means it's less likely that there would be an inadvertent release of aerosol from the patient outside the box into the room, which could put health care workers at greater risk of infection.

As soon as O'Connor and a colleague wheeled the new device into the nursing unit on a cart, about 15 nurses gathered as the nursing manager briefly described the modifications the carpentry staff had made to improve safety.

"When she finished talking, the nurses started clapping," O'Connor says. "The staff here, there's no question they're stepping up, this is their time, no matter how extreme the danger. They accept that. When they applauded us, I felt so honored."

Modifying intubation boxes isn't the only way O'Connor and his staff have helped boost safety for hospital health care professionals who treat COVID-19 patients and other staff members. The carpentry staff has also created an anteroom where doctors, nurses, members of the cleaning staff and others can don and doff their protective gear in a safe environment.

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O'Connor says working at the hospital is more than a job. "We're in the background, doing things to make things safer for the doctors, nurses and other health care workers and staffers," he says. "That's why we're here."