A10 eZ re THE WASHINGTON POST.THURSDAy, MARCH 19 , 2020
go to pharmacies for her family’s
medications and grocery stores
for their food. The baby needs
formula. She now wears a mask
when she l eaves t he h ouse a nd has
tried to limit excursions to those
absolutely n ecessary.
“There are things that we have
to do as a family, to start preparing
for the possibility of being locked
down for two weeks to a month,”
she s aid.
If she develops a fever or other
virus symptoms, Lenoir said, she
will figure out how to isolate her-
self. As o f Tuesday, s he felt fine.
“Until I spike a temperature or
show some real signs of having a
virus or having an upper respira-
tory infection, there is really no
need to go and isolate like that,”
she said. “There is no need, be-
cause I’m not s ick.”
She added: “I understand that
society i s frightened. I understand
that very acutely, because I am
frightened.”
But life d oes not stop. Her fami-
ly’s needs have not disappeared.
She is eager to go back to work,
helping some of the District’s
poorest and sickest patients —
people she fears could be hit espe-
cially hard.
After struggling for decades
with mismanagement and finan-
cial problems, United medical
Center is scheduled to close in- But in some ways, Lenoir
said, it was well prepared for this
moment. The hospital still has
unused supplies acquired during
the 2014 Ebola outbreak, includ-
ing an adequate stock of the N
masks that have become scarce at
other medical facilities.
one thing it does not have: test
kits that can deliver rapid results.
few medical f acilities in the Wash-
ington region have the capacity
been home for several days in
oxon Hill, md., mingling with
loved ones who could b e especially
vulnerable to the coronavirus.
There was her m other, an 89-year-
old kidney transplant patient; her
disabled sister; her daughter, re-
covering from a Caesarean sec-
tion; and the 2-week-old baby. Le-
noir herself has the autoimmune
disease lupus.
“I had already been around
them three days,” Lenoir said. “So
it was like, ‘We already got it, if I
got it.’ ”
She had reasons to remain
hopeful. Lenoir had shown no
symptoms, and h er family already
practiced stringent hand-washing
and other hygiene measures be-
cause of her mom’s compromised
immune system and the presence
of the newborn. Called into the
hospital, s he r eceived a nasal swab
to test for t he presence of the virus,
alongside others who had worked
with the i nfected d octor.
Now she is waiting for the re-
sults, unable to return to work
until she is c leared.
Because she is t he b readwinner
and c aretaker to a crowded house-
hold, self-quarantine is not an op-
tion. Nor is isolation from the
outside world. Lenoir continues tohe moved to the hospital, once for
just a few seconds. She follows his
movements on a GPS app to make
sure he is o kay.
on Tuesday night, she watched
“ferris Bueller’s Day off” w ith h er
kids — them in the living room
and her, alone, in the master bed-
room. The kids had their TV, and
she h ad hers, all of them with their
own b owls of popcorn.
By then, roberta Lenoir had
already waited three days, at t imes
in fleeting terror, to find out
whether the pandemic would
change her life more than it al-
ready had.
She was with her family on
Saturday when the news came. At
the time, Lenoir, a 61-year-old
emergency department nurse at
United medical Center in South-
east Washington, was trying to
avoid an attack of seasonal aller-
gies by staying inside with the
relatives who share her home.
Then her phone rang. on the line,
she heard the voice of a manager
from the hospital.
A doctor Lenoir worked with
had t ested p ositive f or the corona-
virus.
for anyone, the news would
have been sobering. But it was
especially so for Lenoir, who hadthe coronavirus outbreak
for r apid on-site testing, and UmC
is no exception. Lenoir’s swab
sample w as sent off to a lab.
As she remains in limbo, she
rues what she believes were the
squandered weeks and months in
which the U.S. government could
have forestalled the pandemic’s
spread.
“We could have been so far
ahead of the 8-ball,” she said, “in-
stead of now having to wake up
and e verybody is scrambling.”
She thinks about all the people
walking around who, unlike her,
will not have a definitive test re-
sult anytime soon. How many
could be s preading t he v irus with-
out knowing it? Even with an am-
ple stock of hand sanitizer and
disciplined “social distancing,”
there is no way to fully remove t he
risk of contagion.
“The only thing I can do is hope
and pray that I am not the reason
my family members get sick. And
if we do get sick, I only pray that
we get out of it and overcome it,”
she said. “But there’s nowhere to
run. There’s n owhere to hide.”
In ohio, Heather Tubbs Cooley,
a pediatric nurse, and her hus-
band, a physician, accepted that
reality two weeks ago, when they
saw how the virus had begun to
ravage I taly.
“If you’re going to start seeing
these patients,” s he a sked h er hus-
band, “how are you going to come
home?”
He works mostly with patients
who come through his hospital’s
emergency room but are not im-
mediately admitted i nto the i nten-
sive care unit. Because the couple
has t hree kids — r anging from 5 to
12 — he has long taken extra pre-
cautions not to bring home bugs
he’s exposed to at work. When he
arrives, he removes his clothes in
the garage and packs them into a
garbage bag before changing into
a fresh w ardrobe and g oing i nside
the house. Now, in addition, he
touches nothing and heads
straight for the s hower.
He has not yet self-isolated, in
part because Tubbs Cooley, a re-
searcher not currently seeing pa-
tients, needs help educating their
kids, whose schools have closed.
He will quarantine, though, if he
develops any symptoms.
Tubbs Cooley knows her hus-
band is treating people presumed
to be infected, but he has not told
her how many, both because of
patient confidentiality and be-
cause he is trying t o protect her.
“He doesn’t want me to freak
out,” s he said.
Their kids have handled the
upheaval well, but Tubbs Cooley
can sense their concern. They ask,
often, about their parents’ work
schedules and have begun sleep-
ing in the couple’s bedroom. They
watch their father closely, glanc-
ing at him after every cough or
throat clearing.
“Dad, are you okay?”
Tubbs Cooley and her husband
have tried to be honest w ith them,
explaining what the virus is and
what it does, b ut making clear t hat
the vast majority of people who
catch it survive.
Still, the two of them decided
that they could not ignore the
most dire possibility, and they
needed to plan for it. They came
up with a shortlist of relatives w ho
could care for the kids, in case of
an emergency — o r worse.
one recent evening, the family
gathered to talk about it.
If mom and Dad got sick, or
died, the couple asked their chil-
dren, where would they want to
live?
[email protected]
[email protected]
[email protected]health workers who caught the
virus ended up in severe or critical
condition. In the United States,
where everyday activities have a l-
most skidded to a halt, the virus
has upended the lives of doctors
and n urses m ore than anyone else.
many are working in hospitals
and clinics where the supply of
protective gear is quickly dwin-
dling. And yet, they often do not
know which of their patients are
sick, because testing kits nation-
wide are in such s hort supply.
Dozens of U.S. health-care
workers have already fallen ill in
the early days of the pandemic,
some seriously. This week, the
American College of Emergency
Physicians announced two mem-
ber doctors were in critical condi-
tion after contracting the corona-
virus: a W ashington state Er doc-
tor in his 40s and a 70-year-old
physician in New Jersey.
As physicians contend with a
burgeoning angst that, for some,
has begun to manifest in night-
mares, many of them have drawn
up wills or placed themselves into
makeshift quarantines, sleeping
in hotel rooms, garages and base-
ments in hopes that they will not
infect their families.
“Nobody has any idea what
health-care workers are going
through,” said a maryland doctor,
who spoke on the condition of
anonymity because she did not
have permission from h er hospital
to talk to the news media. “It’s
unreal.”
Last week, she grew concerned
after suspecting a patient had in-
fected her. The woman’s husband,
a fellow doctor who was about to
begin a month-long rotation t reat-
ing coronavirus patients, i mmedi-
ately moved to the basement. The
family closed the vents and shut
off the heat to prevent the circula-
tion of contaminated a ir. from her
bedroom two floors above, she
talked to her husband over face-
Time about how to protect their
three c hildren. They a re all at l east
middle-school aged but suffer
from a chronic medical condition
that made them more susceptible
to the disease.
“We approached it like any oth-
er medical or scientific decision,”
said the woman. Her husband
considered checking into a hotel
room but decided not t o because i t
could put staff and other guests at
risk. E ventually, h e moved into his
office, at work. His family has not
seen him in nearly a week, and
they will not for at least another
month — maybe longer, if he gets
sick.
“If he does, it’ll be 14 days after
he gets i nfected, unless he’s a dmit-
ted, intubated or dies,” s he said.
The woman now works remote-
ly from h ome, w here she conducts
telehealth consultations. She
sleeps only a few hours a night,
emerging from her room each
morning to cook. After carefully
washing her hands, she leaves her
kids’ meals on the table, then t akes
her o wn up to her r oom.
Since last week, she has not
come within six feet of any of
them. No back rubs. No brushes
through their hair. No h ugs.
“We can’t risk our kids’ health
for t his,” s he s aid. “It is one thing to
say that we took a n oath to do t his,
but o ur kids d idn’t t ake an oath.”
Though she monitors herself
for signs of infection, she worries
most about h er husband, who, like
many physicians, continues to
work even as protective gear runs
out.
He has been so busy treating
coronavirus patients that they
have only faceTimed twice since
front line from A
‘Dad, are you okay?’ Doctors, nurses fear infecting families.
WHItney CurtIs For tHe WAsHIngton Post
ABoVe: neal Patel, an er
physician, holds his 3-month-
old daughter, lucy, as he talks
to his wife, Katie Patel, at their
Missouri home. Katie is going
back to work as an urgent care
nurse to fill in for a
quarantined co-worker.
left: Physician Jack iwashyna
has chosen to live in his
Michigan basement apart from
his wife and three kids.M Ax WAyneBY ARIANA EUNJUNG CHAIn the nightmare of the novel
coronavirus pandemic that is
unfolding around the world, par-
ents have been able to take
comfort in one thing: early re-
ports that the virus mysteriously
spares children even as it often
causes critical illness in the el-
derly.
A paper released this week in
the journal Pediatrics, based on
2,143 young people in China,
provides the most extensive evi-
dence on the spread of the virus
in children, and there is bad
news and good news.
The study provides confirma-
tion that coronavirus infections
are generally less severe in
youngsters, with more than
90 percent having mild to moder-
ate illness or even being asymp-
tomatic. But it contains worri-
some i nformation about one sub-
set — i nfants — a nd suggests that
children may be a critical factor
in the disease’s rapid spread.
The first thing to know is that
children are being infected
across all ages and genders.
Among the patients studied, half
were from Hubei province, the
epicenter of the outbreak, while
the others were from bordering
areas. They ranged from new-
borns to 18, with the median age
being 7.
So what does the coronavirus
look like in children?
According to the analysis by
Shanghai Children’s medical
Center researchers Yuanyuan
Dong, Xi mo and co-authors,
mild cases (52 percent) were
marked by the typical symptoms
of a cold — fever, fatigue, cough,
sore throat, runny nose and
sneezing. Some patients had no
fever and only digestive symp-
toms such as nausea, abdominalpain and diarrhea.
Those with m oderate infection
(39 percent) had pneumonia
with fever and cough, mostly dry
cough, followed by a wetter
cough. Some had wheezing but
no obvious shortness of breath.
Severe cases were rare (5 per-
cent), as were those who re-
quired critical care (0.4 percent.)
The severe cases began with
early respiratory symptoms,
which were sometimes accompa-
nied by gastrointestinal trouble.
Around one week, the children
had increased difficulty breath-
ing. Those cases sometimes
quickly progressed to critical ill-
ness, with acute respiratory dis-
tress or failure, which in turn
sometimes led to organ involve-
ment — heart failure or kidney
injury.
one 14-year-old boy died on
feb. 7. Additional information
about him was not revealed in
the study.
of special interest to pediatri-
cians is a group of seven infants
(11 percent of the total number ofinfants in the study) and two
children in the 1-to-5 group (
percent), w ho progressed to criti-
cal condition. The study sug-
gests, the authors wrote, that
“young children, particularly in-
fants, were vulnerable.”
The luckiest group — 4 percent
— had no symptoms, even
though nasal or throat swabs
showed they were positive for
coronavirus infection.
“Why most of the children’s
CoVID-19 cases were less severe
than adults’ [cases] is puzzling,”
Dong and mo wrote. “This may
be related to both exposure and
host factors.”
The researchers wrote that
children may have been more
isolated at home after the out-
break began, and therefore had
fewer opportunities to be ex-
posed to the pathogens. They
also suggested that there was
something in the children’s biol-
ogy — a cell receptor that binds
to the virus — that might be less
sensitive. Another theory is that
children often experience coldsand other respiratory infections
in winter, so they may have come
into the season with levels of
protective antibodies higher
than those of adults.
The Pediatrics editors wrote
that they were releasing the pa-
per early, within days of it having
been peer-reviewed but before
official publication, because of
the topic’s importance. In a com-
mentary accompanying the
study, associate editors Andrea
Cruz and Steve Zeichner, both
physicians, say the study sug-
gests that “children may play a
major role in community-based
viral transmission.”
The information indicates that
youngsters may have more s ymp-
toms t hat make them contagious,
such as runny noses, and that
they may have more gastrointes-
tinal symptoms, which raises
concerns about the virus being in
feces for several weeks after
infection.
“Prolonged shedding in nasal
secretions and stool has substan-
tial implications for communityspread in day-care centers,
schools, and in the home,” C ruz, a
pediatrician from the Baylor Col-
lege of medicine, and Zeichner,
an immunologist from the Uni-
versity of Virginia, wrote.
Adam ratner, a doctor in pedi-
atric infectious diseases at New
York University’s Langone
Health, said the outbreak in
China represents only a small
percentage of those who will
eventually become infected, and
when the group gets larger “we’ll
see more serious cases on the
fringes.”
He said the clear takeaway
from t he study is that the corona-
virus “is still something that has
the ability to cause s evere disease
across the age spectrum.” He said
his hospital and his colleagues
around the United States were
“taking the idea of covid-19 in
children very seriously.”
“We’re learning more and
more about this disease every
day, for better or for worse,” he
said. “It’s still very early days.”
[email protected]Study of children confirms less severity but suggests easier transmission
Researchers examine
Chinese youngsters’
response to infection“There are things that
we have to do as a
family, to start
preparing for the
possibility of being
locked down for two
weeks to a month.”
Roberta Lenoir, emergency
department nurse at united Medical
Center in southeast Washington. A
doctor Lenoir worked with has tested
positive for the coronavirus.