L ATIMES.COM MONDAY, APRIL 6, 2020A
The surgeons in training
puzzled over a machine that
looks like an overly compli-
cated landline phone
plugged into aquarium tub-
ing. They’d seen it hooked up
to numerous patients, but
its workings were a mystery.
Normally, operating that
intravenous infusion pump
would be none of their busi-
ness.
The circumstances are
not normal. Not for these
surgical residents at Keck
Medicine of USC, and not for
any of the nation’s health-
care professionals, who are
on the front lines of fighting
the coronavirus outbreak,
which has killed more than
9,600 Americans.
California’s already trou-
bled healthcare system is
mobilizing for an unprece-
dented expansion. More
than 15,000 cases have been
confirmed in the state,
stressing California hospi-
tals’ capacity, and the state
is adding as many as 50,
beds— in wards as well as in
makeshift spaces, such as
convention centers and
sports arenas — to prepare
for an expected wave of criti-
cally sick people.
That urgency has forced
the healthcare industry to
radically reshuffle and ex-
pand its niched and hierar-
chical workforce, matching
specialists, nurses, aides,
technicians and family doc-
tors with new responsibili-
ties, or old ones they may
have forgotten.
That’s why the USC resi-
dents last month were learn-
ing the actual keystrokes of a
machine they normally
would glance at but seldom
touch. And it has been hum-
bling.
“None of us had any clue
on how to actually use that
machine,” said chief resi-
dent Dr. Christopher Foran,
- “I think everyone walked
away with a lot of valuable
knowledge.” Similar scenes
are playing out across
Southern California and
nationwide as known U.S.
cases of COVID-19 soar
above 337,000, taxing a
healthcare system bur-
dened withstaff shortages
and spiraling costs.
Hospitals have three
broad strategies, health
workforce experts say: re-
position existing staffers,
keep their staffs intact by
keeping the workers healthy,
and hire reinforcements.
But each sets off a com-
plicated chain reaction that
ripples through the organi-
zation.
If a physician who man-
ages general care on a ward
moves to intensive care, who
supervises the ward? Can
outpatient staffers, or the fa-
cilities themselves, be repur-
posed? Who supervises
those taking on new skills or
refreshing old ones? Who is
qualified to draw blood?
Take vitals? Who knows how
to triage patients?
“The challenge is that the
surge [of new patients] is
happening very quickly in
some spots,” said Edward
Salsberg, director of health
workforce studies at the
Fitzhugh Mullan Institute
for Health Workforce Equity
at George Washington Uni-
versity Milken Institute
School of Public Health. “It’s
not something that we have
the luxury of weeks ormonths to prepare for.
Those decisions at the front
line are really critical, and
that’s where I think some of
the task-shifting, if you’re a
large delivery system, makes
a lot of sense.”
Gov. Gavin Newsom last
week issued an emergency
order and created the Cali-
fornia Health Corpsto enlist
the help of more medical
professionals to provide
needed care. He also di-
rected the Department of
Consumer Affairs and other
agencies to work with the
state’s health-profession
credentialing boards to
waive some license require-
ments and loosen restric-
tions on tasks those profes-
sionals can perform. Many of
those “scope-of-practice”
rules are among the most
rigid in the country, with
proposed changes in the
state Legislature over the
years drawing considerable
debate and little action.
“I think we’re flying the
plane while we’re building
it,” said Joanne Spetz, a pro-
fessor at the Philip R. Lee In-
stitute for Health Policy
Studies at UC San Francisco
who helped craft the recom-
mendations that resulted in
Newsom’s order. “Everystate has different regula-
tions around the scope of
practice of health profes-
sionals, and those scope-of-
practice regulations dictate
essentially who can do what
and under what circum-
stances.”
In some states, voca-
tional nurses may adminis-
ter drugs via an intravenous
tube. In California, they
can’t, Spetz said. Loosening
that rule would free up regis-
tered nurses to perform
more urgent tasks.
Among those who will
have to figure out the scope-
of-practice puzzle is Dr.
Kenji Inaba, chief of trauma,
emergency surgery and sur-
gical critical care at Keck
Medicine of USC, who or-
ganized the surgical resi-
dents’ training session.
“Our nursing staff can get
wiped out” if too many
nurses get sick, Inaba said.
“And if that happens, we
wanted to make sure that all
of our residents, all of our
surgeons would be cross-
trained in all of the basic
things ... so that they could
step into any of those roles.”
Drastic steps are being
taken to allocate resources
and manpower to support
the healthcare system.More than 40,000 medical
professionals, including re-
tirees, have answered a call
to beef up New York’s medi-
cal workforce. The U.S.
Army made a similar plea,
and New York University an-
nounced it will let senior
medical students graduate
early and begin working in
NYU’s internal medicine or
emergency medicine de-
partments.
The U.S. Navy, mean-
while, positioned two hospi-
tal ships in New York and
Los Angeles to treat cases
unrelated to the pandemic.
The Los Angeles Conven-
tion Center is being trans-
formed into a field hospital
with help from the National
Guard.
There appears to be no
shortage of will or flexibility
among the medical field’s
rank-and-file. General prac-
titioners whose private
practices have shut are of-
fering their help at hospitals,
said California Medical
Assn. spokesman Anthony
York.
“I’m a primary care phy-
sician, and I was trained to
be able to work on the hospi-
tal floors, but when I left my
training program I went into
primary care,” said Leah Za-llman, a Cambridge Health
Alliance physician who di-
rects research at the Insti-
tute for Community Health,
anonprofit in the Boston
area. “I essentially haven’t
been on the hospital ward in
close to a decade. But I know
what to do, generally. I know
how to function on one, gen-
erally.”
Some medical students
have said that if they can’t
practice, they want to run
hospital errands or take care
of nurses’ children, said
Andy Ortiz, senior vice pres-
ident of human resources at
Cedars-Sinai Medical Cen-
ter.
Salsberg said there is a
pool of 28,000 students at
medical and osteopathic
schools who have just a little
coursework to complete be-
fore graduation. Many of
them can simply stay in their
current clinical rotation and
work on COVID-19 response,
he said.
It’s unclear when Los An-
geles will see its peak of
COVID-19 cases, and hospi-
tal executives have ex-
pressed guarded optimism
that they can move quickly
and adeptly to meet the ex-
pected surge. They have
closed elective surgeries and
discouraged people from go-
ing to emergency rooms for
routine treatments.
But California had trou-
bles before the surge, includ-
ing a shortage of nurses and
other health professionals.
More than one-third of the
state’s doctors and nurse
practitioners are nearing re-
tirement age, according to
the California Future Health
Workforce Commission, a
coalition of healthcare, edu-
cation and business leaders.
Nearly 1 in 5 of the na-
tion’s registered nurses who
work in hospitals, and a
quarter of those employed
elsewhere, are 55 to 64 years
old — a demographic at
greater risk of complications
and death from COVID-
than younger people, Doug-
las O. Staiger, a Dartmouth
College economics profes-
sor, wrote in the Journal of
the American Medical Assn.
Deploying them on the front
lines during a pandemic pre-
sents a risk, he warned.
“This is not to suggest
that these older nurses and
physicians should necessar-
ily be precluded from provid-
ing clinical care or should be
isolated, but rather to con-
sider if their direct clinician
duties can be shifted to em-
phasize roles with less risk of
exposure,” Staiger wrote.
Kaiser neurologist Jeff-
rey Klingman, 61, is working
from his home in Contra
Costa County on what he
called “COVID triage,” issu-
ing recommendations on
who can be tested for the
virus amid a shortage of
tests. The messages come to
him by text.
A nurse was showing
COVID-19 symptoms and
had been exposed, one mes-
sage showed.
“Absolutely,” he said, as
he texted back the recom-
mendation to test.
If history is any lesson,
medical professionals will
get ill and die. Hundreds of
U.S. nurses and home health
workers did in the 1918 flu ep-
idemic.
That number was almost
miraculously low, consider-
ing what they faced in teem-
ing slums and isolated
farms, where the dead
shared beds with the living.
Then, too, there was a short-
age of protective equipment
and of nurses, because they
had been shipped to Europe-
an battlefields for World War
I, said University of Virginia
nursing professor and histo-
rian Arlene Keeling.
“It seems to me the paral-
lels are amazingly appropri-
ate,” said Keeling, who was
teaching a class on disaster
nursing when the virus
broke out in Wuhan, China.
The flu bore the “Spanish”
descriptor only because
Spain, neutral in World War
I, was the first to report a
pandemic that combatant
nations hid from adver-
saries. The delay contrib-
uted to the heavy casualties
— 50 million people died
worldwide, 675,000 of them
in the U.S., according to the
Centers for Disease Control
and Prevention.
“The federal government
has had over a hundred
years to prepare,” Keeling
said. “Now its response may
be too little, too late.”Times staff writer Maura
Dolan in Orinda, Calif.,
contributed to this report.Picking up skills to prepare for crisis
NOFAL KAHWAJI, a registered nurse at Keck Medicine of USC, shows surgical residents how to use an IV
infusion pump. Healthcare workers are learning and shifting skills to prepare for a surge of virus cases.Keck Medicine of USCStaffers rise to the
challenge as hospitals
cross-train and work
out complex logistics.
By Emmanuel Morgan
and Geoffrey Mohan
BUSINESS
The economic gut punch
of the COVID-19 pandemic is
being felt by retirees. Even
those who have savings and
other resources now fear
that the financial stability
they had envisioned for their
post-working years is gone.
With the U.S. economy
staring at a recession and
the stock market having
plunged more than 25%
from its peak in February, re-
tirees have seen the value of
their retirement funds badly
eroded and are looking for
ways to generate cash for
their living expenses.
Three retirees explain
how they’re coping with the
crisis:
‘I’ve never seen
something this big’
Randy Smythe, 60, re-
tired last September after a
career in e-commerce sales
and soon took off to spend a
year visiting the national
parks while renting out his
home in Lake Arrowhead.
Now, he’s stuck at home
in Lake Arrowhead because
of the pandemic. Still two
years from eligibility for So-
cial Security, Smythe is hop-
ing income from his six-fig-
ure investment portfolio
and lower living costs can
see him through.
“I’m a single guy so I typi-
cally eat out, but I’m not eat-
ing out now” with all the
restaurants closed, Smythe
said. “So, I’m saving money
there.” He also no longer has
his traveling costs.
Smythe said he also pays
his bills as soon as they ar-
rive.
“I’ve always used that as
my first line of defense
against being laid off or
something else,” he said.
“I’m good until the first of
May.”
As for his investments,
Smythe said he actively
trades stocks but when the
market began gyrating
wildly several weeks ago,
“the first week I just didn’t
look at it” as prices plunged
into a bear market, he said.
“I’ve been doing this a
while, so I’ve been through
multiple downturns, but not
this big. I’ve never seen
something this big,” Smythe
added.
So far, he hasn’t sold
stocks heavily to raise cash.
Smythe said the value of
his portfolio — which is 90%
individual stocks and 10%
cash — has dropped only 5%
since February, thanks in
part to the market’s rebound
from its recent lows.
“I do like risk, but not this
much risk,” he said. “I know
the market has always gone
up over time.”
And if it doesn’t again
anytime soon?
“I could still work until
I’m 67 or 68, if I need to,” he
said.‘I’m blessed to have
this apartment’At 64, Marty Foster was
in the process of moving to
Las Vegas from San Fran-
cisco a month ago when the
pandemic hit the United
States.
Living in Nevada is sav-
ing him money because the
cost of housing is lower, as is
being holed up in his one-
bedroom apartment that
rents for $944 a month.
“There’s nothing to do,
there are no places open,”
Foster said.
Born and raised in Los
Angeles, Foster said he was a
prop maker in the movie
business for 25 years, then
spent 11 years as a cabinet in-
staller. A back injury sent
him into retirement seven
years ago with Social Securi-
ty Disability Insurance,
which provides him “a de-
cent fixed income,” he said.
“There’s nothing to
spend money on,” he said. “I
used to love to go to the mov-ies because I worked on
them. But now, anything
other than a grocery store is
out. I wouldn’t want to go out
right now if they were open.”
Foster also is looking for
ways to trim expenses. When
his car battery died recently,
he didn’t replace it, and in-
stead left the car parked and
suspended his car insur-
ance. “That saved me anoth-
er $50 a month,” he said.
Foster said he did splurge
$130 for an exercise bike to
stay active. He hasn’t yet
canceled some cruises that
he’d already paid for, despite
harrowing stories of infected
passengers on some ships, in
part because the cruise lines
are offering him credits
toward items he buys on the
ships when he’s finally able
to travel.
For now, though, “I see
the horror” of the pandemic
and “I read the stories about
the people it’s affected,” he
said. “I’m not that religious,
but I’m blessed to have this
apartment, and I’m not go-ing out of it.”Retirement account
has plummeted 25%
Two weeks ago, Charles
V. (he did not want his last
name used) arrived at his
apartment in San Juan,
Puerto Rico, to stay while his
new house is being built in
Rehoboth Beach, Del. Now
the 56-year-old doesn’t know
when he’ll return to the
mainland.
Charles was a marketing
executive with “a major con-
sumer-products company,”
which he declined to iden-
tify, for 29 years until he was
laid off two years ago. He
said he received a “generous
severance” of a continued
salary that, coincidentally,
ended just as the co-
ronavirus crisis hit.
Now, he’s making
changes to his seven-figure
investment portfolio to raise
cash and cut his exposure to
the stock market while also
looking to reduce his living
expenses.
“The value of my retire-
ment account has dropped
by 25%,” Charles said. “The
only thing I could control at
this moment was to perhaps
get a little bit more safety in
my financial situation. And
immediately you start to
think of things you can cut
back on, whatever they
might be.
“Let me be clear, I fully
recognize I’m in a better sit-
uation than the majority of
retirees,” he said. “But if
there’s one thing we all
share, it’s a sense of concern
and worry that the prospec-
ts of a comfortable retire-
ment are in jeopardy.
“There is an incredible
sense of fear about your fu-
ture,” he said. “Hopefully the
market will rebound more
than I’m having to deplete
[my investments] on a
monthly basis.”When well-laid retirement plans are upended
RETIREEShave seen the value of their retirement savings funds, such as 401(k)
accounts, crumble and are looking for ways to generate income for living expenses.Getty Images/iStockphotoBy James F. Peltz