Los Angeles Times - 04.04.2020

B2 SATURDAY, APRIL 4, 2020 S LATIMES.COM

covering from COVID-19.
With that tentative diag-
nosis, the Yeates family
faced a dilemma that haunts
parents around the world in
these uncertain days of the
coronavirus outbreak: What
will happen if we’re too sick
to take care of our child?
A single mother who has
contracted the virus, and
probably passed it to her
child, cannot turn to family
or friends during a pan-
demic without putting them
in harm’s way. She cannot
drop her child off at day care.
Two-parent families, many
accustomed to the reliable
support that a partnership
provides, face the same grim
possibility.
And even though there
will be thousands, maybe
millions, of other parents in
the same dire position, there
are no easy solutions. New
York Times correspondent
Dana Goldstein, who bat-
tled COVID-19 along with
her husband and young
daughter, put it this way in a
Twitter thread: “This virus
turns every household into
an island.”
That was certainly true
for the Yeateses.
They were young, both 36
and healthy, and leaned on
the belief that things would
stay that way. But within a
few days, Michael Yeates fell
increasingly ill. When he
stood, his limbs seized with
pain. He felt as if his skull
was being clamped by a
trash compactor. Each
breath was like trying to
draw water from a dry well.
“It felt like there was
nothing there in my chest,”
he said.
All the while, the couple
avoided confronting the pos-
sibility that if both of them
suddenly took a turn for the
worse, it would be incredibly
difficult, if not impossible, to
look after Zoe. “We talked
about the fact that we had
no plan,” Yeates said, “and
could not conceive of a plan.”
Yeates went to an urgent
care clinic when his breath-
ing became dangerously la-
bored. He was given a shot of
prednisone to treat his in-
flamed lungs. Within the
hour, a paper maskgiven to
him by a nurse was damp
and torn from the force of his
constant coughing.
The day after, Yeates
drifted in and out of con-
sciousness. Meanwhile, his
wife was still recovering —
she would wrestle with a
sore throat and fatigue for
weeks — but she had to care
for little Zoe. Over the next
few days, Yeates and his wife,
who usually went to bed
around 11 p.m., would crash
right after Zoe went to bed at
7 p.m. They napped while
she napped.
Yeates’ wife returned to
work when her symptoms
subsided, and Yeates was
alone with Zoe. He could
barely get off the couch. He
counted the steps to the
kitchen: 20. He gave Zoe food
that didn’t require prepara-
tion, snacks usually re-
served for road trips.
Yeates put the toddler in
the backyard with her toys
and “let her go wild.” He gave
her paints and paper. “If it
meant she wasn’t crying, she
was allowed to do it,” he said.
She tore the house apart.
Zoe, accustomed to re-
ceiving lots of attention from
her dad, whined and tugged
on Yeates’ beard.
“I was being distant, but I
couldn’t help it,” Yeates re-
called. “I cried a few times. I
felt like I was failing.”
The Yeateses usually de-
pend on their parents, who
live nearby, for child care.
But his mom and his
mother-in-law are in the

high-risk category — older

than 65 and with underlying

health conditions. The

Yeateses knew Zoe could be

an asymptomatic carrier of

the virus. And they couldn’t

pinpoint anyone else — heal-

thy or not — whom they

would be willing to poten-

tially endanger.

“We chose not to think

about it,” Yeates said. “What

the hell are you going to do?”

Cullin and Audrey Wible,

parents to three young chil-

dren in the small New Jersey

town of Oceanport, faced

this dilemma in late March.

Both had presumptive cases

of COVID-19 but, like the

Yeateses, were unable to get

tested. Cullin, 41, got sick

first. He had a 103-degree fe-

ver for three days.

“I had aches and pains in

places where I’ve never hurt

before — the joints of my

toes, my kidneys,” said

Cullin, a construction execu-

tive. He fluctuated between

shivering and profuse sweat-

ing as he lay in bed under

several layers of blankets.

Cullin’s mind raced:

“What would we do if both of

us got really sick? What if we

both developed respiratory

symptoms?”

His parents in New

Hampshire volunteered to

drive down and watch the

kids if worst came to worst.

“No, that’s crazy,” he told

them. His mom is a cancer

survivor in her 60s. Audrey’s

parents in Ohio were also

out of the question. “We

really never concluded what

we would do,” Cullin said.

Audrey, 37, had a rela-

tively mild case and didn’t

feel truly sick until it was

clear Cullin was turning a

corner. She chalks that up to

her body knowing that she

needed to be there for her

kids.

Cullin felt like his family

had dodged a bullet. “I’ll be

honest, it’s hard to think

about,” he said, choking up.

The Wibles know that in-

evitably, others in their com-

munity will find themselves

in a similar bind but might

not be as lucky. They told

their church leaders that

they’re able to help those in

need, assuming that they

have gained immunity, even

if it’s temporary.

Peter Arcese, a father of

three in Brooklyn, began to

seriously ponder this issue

when his wife, Angela, began

experiencing severe

COVID-19 symptoms.

Arcese, a trusts and es-

tates lawyer, has helped

many clients set up

“standby guardianships,” a

legal tool developed during

the AIDS crisis that ensures

the care of minor children if

parents become incapaci-

tated. But that safeguard

wasn’t built with a pandemic

of this sort in mind, he said.

HIV, which causes AIDS,

can be transmitted only

through sex, blood or breast

milk, so there was no danger

to people taking in the child

of someone with the disease.

As Angela’s sore throat

progressed to chest aches

and ragged breathing,

Arcese realized that their

standby guardians were all

in high-risk segments of the

population.

“This goes beyond a

problem that law can solve,”

Arcese said.

As he feared what would

happen if he, too, got sick,

the 55-year-old imagined

communities building mu-

tual aid networks — run by

churches and nonprofits —

that could help fill the child-

care void. The network

would be manned primarily

by those who have already

been sickened by the virus.

He couldn’t think of any

other solution.

PARENTSAngela and Peter Arcese wondered how
they’d cope if both were incapacitated by illness.

Arcese family

Ill parents face

the dilemma

of child care

[Parents,from B1]

heightened concern around

the need to do more in our

congregate facilities to iso-

late people into shelters like

this and provide those basic

essential services as we work

through this crisis.”

Across the state, there

were alarming new signs of

the virus’ spread as well as a

few encouraging notes.

Orange County reported

57 new coronavirus infec-

tions Friday, raising its num-

ber of known cases to 711 —

more than double what it

was a week earlier.

The county’s death toll

remained unchanged at 13 —

the first time in four days

that more COVID-19-related

fatalities haven’t been re-

ported in the region.

In Riverside County, a

second sheriff ’s deputy died

of the virus.

Twenty-seven people at a

skilled nursing facility in the

East Bay city of Orinda have

tested positive for the co-

ronavirus. Of those, 24 are

residents and three are staff

members. The county has

tested all the residents and

is testing all staff. Most of the

residents are older than 65

and about half are older

than 80. Fourteen people at

the facility tested negative,

and results for others are

still pending.

“We are very, very con-

cerned,” said Dr. Chris Far-

nitano, Contra Costa Coun-

ty’s health officer. “This is a

virus without a vaccine. This

is a virus without a medical

treatment.”

L.A. County confirmed 11

new coronavirus-related

deaths Friday, bringing its

toll to 91, and 521 new cases

overall, bringing that total to

more than 4,500. The num-

ber of new cases increased

by more than 1,000 in 48

hours. About 541 residents

are hospitalized because of

COVID-19, officials said.

The county is seeing a

rapid increase in co-

ronavirus cases, with hun-

dreds of new cases reported

over a two-day period, as

testing ramps up and more

infections are identified.

Ferrer said that when

L.A. County initially in-

creased lab testing a couple

of weeks ago, its coronavirus

case count was tripling every

three to four days. For the

last two weeks, that rate has

slowed to a doubling of cases

every six days, which she

called “good news.”

But as lab testing contin-

ues to increase, she said,

people need to be prepared

to see an even bigger in-

crease in cases.

“If we assume that we’re

getting to where we’re striv-

ing to be, which is that we’re

able to test 10,000 people a

day, and about 10% of the

people we test continue to be

positive, you can see why we

need to prepare ourselves

for having 1,000 new cases of

people with COVID-19 every

day,” she said.

Almost 26,000 people had

been tested in L.A. County

as of Friday, more than dou-

ble the number reported a

week before, when just 11,

people had been tested.

The testing numbers still

lag behind those of New York

City, where more than 49,

positive cases had been

identified as of Friday morn-

ing.

On Friday, three new

drive-up coronavirus testing

locations opened in L.A.

County, at the Pomona Fair-

plex, the South Bay Galleria

in Redondo Beach and the

Antelope Valley Mall in

Palmdale. Testing also is

available at High Desert

Medical Group in Lancaster

and Glendale Memorial

Hospital, the county said.

Testing is by appoint-

ment only and limited to

residents who are showing

symptoms and are at least

age 65 or have underlying

health conditions.

The increase in L.A.

County cases may also be

the result of a surge in cases

reported in institutional set-

tings, including nursing

homes, assisted-living facili-

ties, shelters, treatment cen-

ters, jails and prisons. These

facilities tend to house a

large number of vulnerable

people who are older or have

underlying health condi-

tions, and residents often

live in close quarters, mak-

ing it difficult to curb the

virus’ spread.

The Department of Pub-

lic Health was investigating

321 cases among staff, resi-

dents and guests of 67 insti-

tutions as of Friday. Of

those, 166 were among resi-

dents and 155 among staff

members, Ferrer said. On

Monday, cases were being

investigated at just 18 facili-

ties. Of those who have died

of COVID-19, 11 have lived in

either a skilled nursing or as-

sisted-living facility, Ferrer

said.

Atotal of 25 cases have

been reported across L.A.

County’s correctional sys-

tem — 18 staffers and seven

detainees.

In addition, there were

seven cases reported among

L.A.’s homeless community;

down two from the day be-

fore because those cases

were determined to be

among people who were not

homeless, Ferrer said.

There have been 14 cases

of COVID-19 in the homeless

population across the state,

Newsom said Friday.

The state hopes to lease

as many as 15,000 rooms for

homeless people, and so far

counties have gotten 869

homeless people who are

vulnerable to the virus into

shelters. So far, 6,867 hotel

and motel rooms have been

committed to this effort.

AWORKER with the L.A. County transportation authority disinfects high-touch areas such as handrails,

benches, elevator call buttons and ticket vending machines at the Mariachi Plaza station in Boyle Heights.

Gary CoronadoLos Angeles Times

New signs of virus’ spread

[County, from B1]

change within hours of you

getting to the hospital,” said

Erica Chidi Cohen, co-

founder and CEO of Loom, a

boutique reproductive

health and education center

in Mid-City. “You just don’t

know.”

Already, hospitals across

L.A. have banned anyone

not giving birth from the ob-

stetric triage area, leaving

expectant Angelenos to la-

bor alone — possibly for

hours — while their partners

wait in the car. Recovery,

too, is off limits: Once the

baby is born, new families

have just minutes together

before the father or partner

is asked to leave.

“We understand this is

not how people want to be

giving birth — it’s not how we

want them to give birth,”

said Dr. Rashmi Rao, a ma-

ternal fetal medicine spe-

cialist and an assistant clini-

cal professor of obstetrics

and gynecology at UCLA.

“All of us physicians, we took

an oath, and we are sticking

to it. We are going to do our

best to keep our patients

safe.”

Changes go far beyond

restricting visitors. One of

California’s largest hospital

networks, Permanente Med-

ical Group, has begunoffer-

ing to induce labor as early

as 39 weeks, the earliest

point at which a pregnancy

is considered full term.

Kaiser Southern Califor-

nia has delayed such induc-

tions, as well as planned

caesareans due to the co-

ronavirus. Many providers

are telling patients not to

come in until they’re at least

five centimeters dilated, or

halfway through labor — by

which point the overwhelm-

ing majority of American

women would normally have

received an epidural.

But the most controver-

sial edict so far comes from

the Centers for Disease Con-

trol and Prevention, which

currently recommends a

mother be quarantined from

her newborn if she shows

symptoms of COVID-19, the

disease caused by the novel

coronavirus.

“The CDC is recom-

mending a seven-day sepa-

ration, but it’s a tough one,

and it keeps changing,” said

Dr. Sarah Kilpatrick, chair of

obstetrics and gynecology at

Cedars-Sinai and an expert

in maternal fetal medicine.

“The patient can refuse, but

we are hoping to encourage

her to accept.”

Healthcare workers em-

phasized the importance of

quarantine after an infant in

Illinois died from the virus

over the weekend.

“There is still much we

don’t know about how

COVID-19 spreads to

babies,” said Marianna Volo-

darskiy, regional maternal-

child health director for Kai-

ser Permanente in Southern

California. “When making

that decision, we have to rec-

ognize the importance of

mom and baby bonding and

protecting the baby from the

virus.”

Such stringent new rules

are temporary, experts said.

But many in medicine be-

lieve more subtle changes

are likely to become stand-

ard. Inventions born out of

necessity — fewer prenatal

visits, faster postpartum

discharge and a surge in

home births — could persist

long after this crisis is over.

“Some of the interven-

tions and testing and moni-

toring that used to be recom-

mended are not being done

anymore because of the risk

of coming to the hospital,”

said UCLA nurse midwife

Shadman Habibi. “Our cli-

ents are very appreciative.

They’re happy not to come

to [the] clinic.”

Low-risk patients like

Shaikley have begun moni-

toring their own weight and

blood pressure from home

instead of visiting the doctor

for frequent third-trimester

checks.

For higher-risk patients,

including those with pre-

existing conditions that may

make them more vulnerable

to COVID-19, the American

College of Obstetricians and

Gynecologists has recom-

mended consolidating care

into fewer visits and replac-

ing fetal monitoring with

kick counts and ultrasounds

with blood tests.

In L.A., many obstetri-

cians are replacing a com-

mon early fetal ultrasound

with a blood test that can be

taken weeks earlier and is far

more sensitive at detecting

the same chromosomal ab-

normalities.

“Now we’re saying, just

get the blood test,”

Kilpatrick said. “We still are

doing the 18- to 20-week

ultrasound, but we’re taking

out that middle visit, which

frankly probably wasn’t

really necessary anyway.”

Chidi Cohen, the educa-

tor, has moved Loom’s birth

classes online and revised its

curriculum to include “tacti-

cal skills” for laboring alone.

UCLA lactation and breast-

feeding specialist Genevieve

Colvin-Thomas now as-

sesses potentially fatal

breast infections via video,

while Rao, the obstetrician,

manages anxious patients

over the phone.

“My version has always

been, ‘If you are worried,

come in,’” Rao said. “Now I

say, ‘If you are worried, call

anytime.’”

But the pandemic has

pushed some mothers-to-be

out of hospitals altogether.

“I’ve been getting at least

five inquiries a day” about

home births, said Beth Can-

non, a licensed midwife in

Sherman Oaks. “People

want to have their team, and

they don’t want to be around

the extra germs.”

Ashley Ackerman, 32, an

advertising executive at

Netflix, is among those look-

ing to opt out.

“The plan was to give

birth at Cedars with a doc-

tor, my husband and a

doula,” Ackerman said. “But

if going to the hospital

means that I’m alone, I

might choose a birth center.”

Shaikley, on the other

hand, said she is ready to

labor alone if she has to.

“I love my husband; it’s a

very important moment in

our lives, but this is a crisis,”

she said. “I feel very fortu-

nate I had such a wonderful

birth experience the last

time, but I’m ready to give it

up if that has to happen.”

Women forced to rethink birth plans

‘We understand

this is not how

people want to be

giving birth — it’s

not how we want

them to give

birth. ... We are

going to do our

best to keep our

patients safe.’

—Dr. Rashmi Rao,

UCLA Health

[Pregnant,from B1]