On The Front Lines

Tales and medical on explanations on the inner workings of COVID-19 upon the body by medical experts in the LGBTQ community.

WORDS BY JOHN SOTOMAYOR PHOTOS BY CONAN SEGREST

A registered nurse, Donna Davis jumped at the chance to travel to New York City to assist the COVID-19 pandemic crisis when she read a post on Facebook about a call for help. A friend in the medical field posted the notice from Krucial Staffing which sought nurses with ICU experience. The only information available was that nurses had to be certified and available to leave overnight. Donna would only go if her wife Norma Anderson would travel with her. She needed her support if she was to be able to endure the hardship that awaited. Norma had doubts. She suffered from hypertension and diabetes. Her wife, Donna, suffered from asthma. Both would be in the high-risk group if exposed. They would probably face the harshest effects of COVID-19. Armed with their unshakeable faith over fear, the couple who led by example to their family, friends, and fellow parishioners at the Center for Spiritual Living Ocala decided they had to assist wherever called, and this was a calling.

On March 22, 2020, Donna and Norma left behind the security of their home in Ocala, Fla. toward the hotbed of the COVID-19 pandemic, and the unknown.

Chaos in the City

Upon arrival, the pace from airport to hotel to hospital was whirlwind. All the nurses recruited by Krucial Staffing were housed at the New Yorker Hotel on 8 th Avenue, near Penn Station. At the time, the organization did not state that spouses were prohibited, and with each nurse given their own room as a precaution, Norma’s presence did not disturb the process or integrity of the operation. They hugged goodbye then Donna boarded her bus and was whisked to her assigned hospital. Not knowing where she would go or what she would be asked to do, Donna could not possibly prepare for what awaited her.

Donna was assigned to Elmhurst Hospital in Queens; one of the hardest hit hospitals facing the novel coronavirus.

“When we arrived at the hospital, they conducted a preliminary orientation and the seriousness of the medical

requirements became apparent,” said Donna. “When we arrived on the floor, it was obvious this was a crisis situation. Machines were beeping all around us. Everyone was running around responding to codes. There was no final orientation. We were thrown right in.”

Everyone was in full personal protective equipment (PPE), the gear that includes protective clothing, helmets, googles, and other equipment designed to protect the wearer’s body from injury, illness, and infection, even the nurses’ station. PPE is normally worn inside the most critical patients’ rooms, not at every station of the hospital. The scene looked like a triage center during war time. To Donna and the other nurses, it looked like the Apocalypse, and was often described as such.

It was reported that medical staff did not have enough or the proper gear at first.

According to Donna, normally doctors and nurses switch off their N95 mask and respirator that filters out small particles in the air every time they enter a patient’s room. They are usually in a negative pressure room because the air cannot be compromised in the other part of the hospital.

After leaving the patient’s room, they take off all the gear and it is thrown away. This is to prevent contamination from one patient to the next. Unfortunately, the staff were not fully stocked for the number of patients seen in NYC.

“We began placing surgical masks over the N95, since the surgical masks were more readily available,” said Donna. “This was an unheard-of practice before, but done out of necessity.”

Working 12 hours shifts with one day off every 21 days, the nurses were exhausted. Normally, they work three full days then are off for a day. That’s where Norma’s training as a massage

Norma performed massages on the nurses’ backs and feet, using proper mask coverage and frequent hand sanitizer.

“They needed that in order to perform their daily physical tasks,” said Norma. Everyone was experiencing overload. They were being tested to their limits. Then on June 1, 2020, the unthinkable occurred.

Armageddon

Elmhurst is a primarily Asian and Hispanic working-class community that added cultural clash and language barriers when it came to understanding the danger of COVID-19, and applying the simple but often ignored solutions of social distancing, wearing masks, and frequently washing hands or using hand sanitizer. Coupled with overcrowded housing, often with 10 or more family members living in poorly ventilated apartments, it became a recipe for disaster.

“If one person got sick and lived with 10 other people, then they all got sick,” said Donna. “Many of them did not have insurance, so they were reluctant to seek treatment.”

The infection rates skyrocketed in the apartment buildings and places of employment that these sick people lived and worked.

People were crashing and coding then dying every day. On June 1, 2020, the mortality rate peaked. They were running out of space in the morgue, so they set up refrigeration trucks outside to handle the

largest number of deaths on a given day. The scene made national news.

Donna and Norma did everything in their power to assist the New York crisis, up onto the end of Donna’s contracted three-month assignment. On June 13, 2020, they returned to Ocala. They were quarantined for two weeks as required upon return to Florida. Neither were exposed to the virus, and both are fine.

Norma became more concerned about exposure from others in Ocala than in New York. In New York, everyone was required to wear masks. No one wore masks In Ocala upon their return in June. Having seen what she did, she recognized the importance.

“I did not survive New York only to be exposed in Ocala,” said Norma. “Ocala/Marion County is the fastest growing city and county in Florida based emergency room on new cases. People are nurse for almost taking it seriously, but they are not taking it personally.”

“When you talk to a patient and they say, ‘I can’t breathe,’ then it becomes all too real,” added Donna.

Their devotion to assist in the crisis continues. They are currently in Key West assisting on the front lines once again.

“THE FENWAY INSTITUTE’S MARCH 2020 REPORT NOTES THAT LGBTQ ADULTS EXPERIENCE HIGHER RATES OF CHRONIC CONDITIONS, SUCH

AS CARDIOVASCULAR DISEASE, OBESITY, CANCER, AND HIV/

AIDS, AND ARE MORE LIKELY TO ENGAGE IN RISK BEHAVIORS

LIKE SMOKING, VAPING, AND OTHER SUBSTANCE USE THAN THEIR STRAIGHT AND CISGENDER PEERS. CONDITIONS AND BEHAVIORS INCREASE VULNERABILITY TO THIS NOVEL CORONAVIRUS.”

–BOSTON UNIVERSITY STUDY

Sylvia McNeal, a nurse at a small emergency room in Ocala has the same concerns as Donna and Norma over the growing number of cases in Ocala/Marion County.

Her emergency room is equipped with only 12 rooms; four of which are segregated in the back and used for COVID-19 patients she refers to as PUIs or Patients Under Investigation.

“Prior to the spike, we may have seen one person per night in those rooms,” said Sylvie. “For the past 5 weeks as of mid-August, we see those four rooms occupied at all times.”

A trauma and emergency room nurse for almost 20 years, Sylvie says the most important part of working the front line is triage, which means determining who needs to be segregated out from incoming patients in order to keep others from contamination. That she says, comes with a heavy emotional burden.

“Another nurse does the temperature checks and screening to see if the patient has a fever, cough, sore throat, or other symptoms,” said Sylvie. “If they do, then I have to take them out through the back so they are secluded from everyone else.”

The difficulty is that incoming patients may have a fever or a sore throat but it does not mean they have COVID-19. It is unknown until they are tested.

“If you go to the hospital with these symptoms, you can be secluded into a space with others who do have the virus and get exposed there,” said Sylvie. Many come in absolute fear. Sylvie recalls one of her most emotional cases. It involved a young man in his late 20s who was HIV positive, thus in a highrisk group.

“I knew he was gay because when the screening nurse asked him “who brought you here?” and “how are you getting home?” he replied “my boyfriend.”

“As the screening continued, he revealed he was HIV positive,” said Sylvie. “You could see the concern on his face; he knew he was in a high-risk group, because he has a compromised immunity system.”

Some routine testing revealed he had a mild fever, and his x-ray revealed he had a slight pneumonia. He was informed that these were symptoms that required him to be tested for COVID-19. He was taken into one of the four back rooms.

He fidgeted as he waited. His eyes darted around the room for clues of what would happen next. As Sylvie entered, she wore her N95 mask, space shield, gloves, and plastic gown. The sight was more than he could handle. He started to break down.

“When he saw me, I could see the look in his eyes,” said Sylvie. He was overwhelmed with fear. He was convinced he was going to die. Sylvie’s years of experience came into

Nurses examine a newly arrived patient for COVID-19. New York, NY. play. Most important is demeanor. Her tone would calm him down.

“I told him there are things he can do to lessen the danger,” said Sylvie. “I asked him if he was taking his meds? Are you clean, meaning not using drugs? I emphasized that now is the time to start if he was not.”Sylvie put him on antibiotics to treat his pneumonia, because they did not know if it was viral or bacterial, whether it was COVID or was he just a bit under the weather complicated by his HIV.

He was sent home; he was not admitted. Other than HIV, he was a very healthy young man.

“We tell them to take Tylenol, drink lots of fluids to stay hydrated and avoid ibuprofen,” added Sylvie stressing, “Ibuprofen triggers COVID-19 to get worse.”

Like Donna and Norma, Sylvie worries over the risk of passing COVID-19 to her family.

“If we come down with so much as a little cough, we worry that we are bringing this home to our families,” said Sylvie. “If we have a cough or sore throat, then our immediate thought is that I have this because I took care of these patients. It is an everyday struggle.”

Sylvie lives with her fiancé, TJ, and their 11-year-old daughter. They have known each other for 11 years, and been a couple for 6 years. Sylvie is the biological mother. The father is still involved. He lives in Ocala. Sylvie has sole custody. TJ and Sylvie raise her.

TJ is on disability. She has some medical conditions whereby if Sylvie did bring it home, it would affect her more than Sylvie or her daughter.

Despite the risks, Sylvie conducts her job with diligence and care. Her primary concern is for the health of the community, and she will stand her post for as long as necessary.

COVID-19 and the LGBTQ Community

A study conducted by Boston University reports, “What we know and do not know of COVID-19 impact on the LGBTQ community … raises a significant concern. The Fenway Institute’s March 2020 Report notes that LGBTQ adults experience higher rates of chronic conditions, such as cardiovascular disease, obesity, cancer, and HIV/AIDS, and are more likely to engage in risk behaviors like smoking, vaping, and other substance use than their straight and cisgender peers. Conditions and behaviors increase vulnerability to this novel coronavirus.”

Donna agrees. “If it started with our self-worth, and how we are connected with our community, some people fall into unhealthy behavior and addictions,” said Donna. “The virus attacks those with respiratory and cardiovascular weakness. Many of the behaviors that we abuse in the LGBTQ community makes us easy targets.”

Another study conducted by Ithaca College revealed, “LGBTQ communities may be particularly vulnerable. LGBTQ people experience health disparities. Barriers to care cause us to be less likely to get medical care, and means we are more likely to have compromised health in general.

Health disparities magnify the impact that COVID-19 can have on us. These are among the factors that can increase our risk:

• COVID-19 is a respiratory illness, and LGBTQ people smoke tobacco at much higher levels than our heterosexual cisgender peers.

• LGBTQ people experience higher rates of HIV and cancer. This means more of us have weakened immune systems that can make us more vulnerable to COVID-19.

• LGBTQ people regularly experience discrimination and lack of cultural competence when seeking health care. As a result, many avoid or delay seeking health care, even in emergency situations.”

According to Donna, this is especially true of the transgender community. “When your ID says one gender, yet your appearance is that of another gender, the patient is subjected to numerous questions about their identity in public spaces that could be embarrassing for the patient,” said Donna.

Donna and Sylvie agree emphatically with what Boston University and Ithaca College say about the effects of smoking and vaping have on the severity of COVID-19.

According to Donna, when the virus gets into the system, it uses prongs to attach itself to the lungs. When someone vapes or smokes, they are causing the lungs to work hard to filter out the nicotine and

chemicals inhaled from smoking and vaping. throughout the body into the vital organs. If the lungs take in something that is not oxygen, it now has to filter out that substance before oxygenating the blood prior to distribution to the vital organs. If the vital organs do not get enough oxygenated blood, they will begin to shut down.

Add anything to the bloodstream that doesn’t help the body and causes the heart and lungs to work harder to oxygenate the blood, like excessive alcohol, drugs, or other stimulants like inhalants used to enhance sexual pleasure like “poppers” combined with Viagra, and the vital organs will compete for oxygenated blood and begin to shut down.

‘It is like Russian roulette,” said Donna. “At any moment, something will shut down. The body can only take so much and if we are not treating it right, then we are making ourselves easy targets for foreign invaders like COVID-19.”

According to Sylvie, the virus settles in the throat at the beginning. Then it settles into the lungs. Once it settles in the lungs, as a virus, it cannot be treated like an infection with antibiotics.

In the lungs there are little alveoli, which are the tiny air sacs where the exchange of oxygen and carbon dioxide takes place as the blood passes through.

Those alveoli are being attacked by the COVID-19. The blood is passing through the alveoli but does not feel any oxygen present so does not pick up oxygen as it moves forward. So, the blood does not oxygenate the body.

“Those who have survived extreme cases are still suffering lasting issues with their lungs because there are literally scars on the alveoli,” said Sylvie. “In the long term, they have a more difficult time oxygenating the vital organs of the body. The scar tissue in the lungs means they would have to wear oxygen, or they constantly have a cough and constantly get sick because their immune system is pretty much shot.”

Whether you are vaping or smoking, you are putting foreign chemicals in your lungs. Whether it is an oil from the vape or smoke from a cigarette. You are already compromising your lungs by doing that.

“Your lungs are not designed to carry smoke and oils’” said Sylvie. “The compromised lungs from smoking and vaping are more susceptible to a virus that requires scarring to latch on. Both the smoking or vaping and the COVID-19 deprive the lungs from producing oxygenated blood, thus a double whammy.”

An additional concern for the LGBTQ community is social distancing.

Many people in the LGBTQ community meet others for hookups, whether at a social establishment like a bar, or meeting online. They are being promiscuous. That is a big issue, because the virus travels from close contact.

“Even if you are hooking up with one person per week, I am sure you are not keeping your mask on and keeping a sixfoot distance,” said Sylvie.

The virus is especially hard on those with HIV. Their immunity system is already compromised. If infected, they will not be able to fight off the COVID-19 and will endure the worst effects.

“The one thing I am absolutely certain of is, if you have a compromised immune system, you will have a very difficult time fighting this virus,” said Sylvie.

Ultimately, how we endure this pandemic depends upon our use of safeguards, such as wearing a mask, frequently sanitizing or washing our hands, and social distancing, coupled with an honest awareness of our own risk level.