In late February, nurses at PeaceHealth Southwest Medical Center started noticing more patients with fevers, coughs and shortness of breath, but they couldn’t be sure any carried the novel coronavirus.

Worried about an outbreak like the one at a senior care facility in Kirkland, Washington, they called for more precautions. The nurses sent an email requesting new policies for visitors and staff to slow the spread, more space to properly isolate contagious patients, and tests administered by management to ensure staff knew how to properly use safety equipment like masks.

Around March 10, a flyer appeared at nurse stations at the hospital. At the top it read in bold, black font: “COVID-19 is similar to a severe seasonal flu.” It added the virus likely had a “lower mortality.”

The nurses’ concerns about the virus’ threat have proven merited. Of counties in the Portland metro area, Clark County has been hit particularly hard. As of Wednesday evening, the county had confirmed 190 positive cases and 13 deaths. The virus has killed more people there than in any county in Oregon.

Four nurses who spoke to OPB about their time working during the pandemic pointed to the flyer as an example of the ways the PeaceHealth Southwest hospital failed to address the concerns of frontline workers most endangered by the virus.

They said the flyer was dismissive, leading them to feel unsafe at work, especially as the first virus-related deaths began to appear in the United States. Though they say communication has improved, the nurses who spoke to OPB said the hospital seemed unprepared for the outbreak.

“There was a growing frustration among the nurses and a lack of communication with our leadership,” said Emily Calabro, an intensive care unit nurse at the hospital for the past five years.

It is not clear where the flyer came from. Debra Carnes, a PeaceHealth spokesperson, said the hospital didn’t create it, but she said talking points used in daily huddles at the hospital maintain the virus is a bad seasonal flu.

“This statement remains true, it is behaving like a bad seasonal flu, which can have, and have had large devastating impacts in our history,” Carnes said in a written statement. “At that point, that was the information being shared by scientific experts. As you know, what we know and what experts are learning about this virus evolves almost daily.”

Most nurses declined to have their names published out of fear of losing their jobs. PeaceHealth, a health care system spanning Alaska, Washington and Oregon, recently fired a physician who used Facebook to air concerns over his safety working at their hospital in Bellingham, Washington.

Richard DeCarlo, the PeaceHealth system’s chief operating officer, last week told a popular medical channel on YouTube that the doctor’s posts spread misinformation. He likened the messages to “yelling a fire in a theater when there’s not a fire.”

PeaceHealth Southwest staff talk in front of newly erected triage tents outside the emergency room in Vancouver, Wash. Hospitals are taking steps to prepare for a surge in patients from the novel coronavirus.

PeaceHealth Southwest staff talk in front of newly erected triage tents outside the emergency room in Vancouver, Wash. Hospitals are taking steps to prepare for a surge in patients from the novel coronavirus.

Troy Brynelson/OPB

The local nurses said since the pandemic reached the Northwest, they have worried about supplies and protocols. They wondered what the hospital would do if nurses and doctors started getting sick. A March 2 email to four PeaceHealth Southwest managers and an executive laid out their unease.

“There are a lot of questions, concerns and suggestions that have been raised by caregivers regarding the COVID-19 outbreak. There is a lot of anxiety among employees, as well as the community, that would likely be eased by clear, consistent information regarding policies, practices and plans,” a group of PeaceHealth nurses wrote. “To add to the stress, we are receiving mixed messages and different answers from different people.”

By that point, no one in Clark County had yet tested positive. But the virus proved lethal enough for Gov. Jay Inslee to declare a state of emergency.

A top PeaceHealth official reassured the nurses about supplies.

“From a system level, I can tell you that our PPE supplies are adequate given the projected use rates,” said Catherine Kroll, director of infection prevention. She noted the system had 50,000 respirators and 250,000 surgical masks in stock. “The good thing about being a system is we can easily transfer supplies between hospitals.”

Calabro, who helped write the email, said she and her peers felt dismissed.

“They weren’t addressing our concerns about what was the plan for the pandemic. How are we going to conserve PPE? What was the plan to triage these patients?” she said. “None of these concerns were being addressed.”

Emily Calabro lifts her daughter, Magnolia, 1, from the sink after dusting flour off her pants while baking at home in Vancouver, Wash., Thursday, April 2, 2020. Calabro and her husband, a firefighter, chose to send their daughter to stay with family in Kansas as fears grew about first responders' exposure to COVID-19.

Emily Calabro lifts her daughter, Magnolia, 1, from the sink after dusting flour off her pants while baking at home in Vancouver, Wash., Thursday, April 2, 2020. Calabro and her husband, a firefighter, chose to send their daughter to stay with family in Kansas as fears grew about first responders’ exposure to COVID-19.

Bradley W. Parks/OPB

Hospitals all over the world, including PeaceHealth facilities, have since dealt with significant shortages of personal protective equipment or PPE.

By March 11, the hospital told nurses to start removing outdated “service by” stickers on masks and motor-powered respirators, according to a workplace safety complaint filed by the Washington State Nurses Association. The mechanical respirators offer greater protection than N95 masks, but some of the equipment hadn’t been serviced in two years.

Carnes, the PeaceHealth spokesperson, said the masks and respirators are sanitized and inspected each time they’re used.

“We found that stickers should not have been placed on the [respirators] in the first place, because they do not expire,” Carnes said. “Stickers are used on equipment when it typically requires annual calibration. With the accelerated use of [respirators] throughout the hospital, all of them were inspected and cleaned.”

According to records provided by Clark County, PeaceHealth Southwest started requesting resupplies of PPE March 15. The first shipments didn’t arrive until March 26.

Carnes said the hospital used community donations to keep frontline staff supplied, receiving 8,000 masks and 18,000 gloves in addition to the government resupplies.

“Adequate COVID-19 preparedness and PPE conservation planning are a nationwide concern,” Carnes said, when asked to comment on nurses’ safety concerns. “We are taking every precaution necessary both to ensure our caregivers’ safety now and to ensure we have sufficient PPE in the future.”

Internally, Calabro and other nurses have filed 11 complaints about workplace safety with the union since February. The union would not provide copies of the complaints but said nurses have been vocal about issues.

“We are hearing much more from individual emails or phone calls to our nurse reps simply because filling out an [assignment despite objection complaint] is an additional step and any nurse fearful that management will see them as complainers is unlikely to fill out [a complaint],” said Ruth Schubert, a union spokesperson.

Schubert did note things seem to have improved recently. While the union remains concerned about reusing PPE, she said the union does feel the hospital has “improved on the testing and availability” of equipment.

Carnes told OPB the hospital continues to follow guidelines from the Centers for Disease Control, World Health Organization and the state Department of Health.

“These guidelines too continue to change, as the scientific community learns more about this novel virus,” she wrote.

She also said they are making changes when needed based upon feedback from front line care workers. 

“We are listening and have made a number of adjustments to process and procedures during this unprecedented time to ensure everyone’s safety,” Carnes said.

Besides equipment, nurses are also worrying about their proximity to the virus. Five workers at the hospital and nearby clinics had tested positive as of Wednesday, Carnes said.

At the start of one shift, one nurse told Calabro that the stock of small-sized N95 masks were almost gone. She immediately thought of her husband, a firefighter who also is at risk of contracting the virus. Then she thought about their 20-month-old daughter.

“To come home and worry about exposing my family is — it’s terrifying,” said Calabro, who has worked at the hospital for five years. She added she plans to make her own masks. “I don’t know what else to do.”

Sarah Collins keys into her Airbnb in Portland, Ore., after her shift Tuesday, April 7, 2020. Collins, an intensive care unit nurse at PeaceHealth Southwest, chose to live in an Airbnb during the COVID-19 pandemic to isolate from her family.

Sarah Collins keys into her Airbnb in Portland, Ore., after her shift Tuesday, April 7, 2020. Collins, an intensive care unit nurse at PeaceHealth Southwest, chose to live in an Airbnb during the COVID-19 pandemic to isolate from her family.

Bradley W. Parks/OPB

Another nurse, Sarah Collins, said she asked the hospital to rent hotel rooms in bulk for staff, in order to keep them away from family while they are on the front lines dealing with the virus. Collins worried she could infect her husband and two kids.

When the hospital declined, Collins took to social media. Eventually she found a neighbor with an unused Airbnb in her basement who offered her the space.

“My hospital was not able to provide me with an isolation space, and so I reached out to my community,” Collins said.

Recently, PeaceHealth has found rooms for staff, but they will prioritize people who already have symptoms or have family members who have tested positive. They are offering 14 rooms, Carnes said, and hope to get 13 more apartments available soon.

Around 1,150 nurses work at the hospital, according to the union.

“These [rooms] are made available to those with the greatest needs,” Carnes said. “With the top priority going to those who have a person at home with active COVID-19 or is under quarantine for the illness.”

The hospital also takes workers’ temperatures each day they enter the hospital, “to make sure that we’re minimizing the risks they could become infected by a fellow caregiver,” Carnes said.

Carnes added that a trauma psychologist is available to nurses. There is also a team to help nurses connect with resources like counselors or visit a chaplain.

Emily Calabro, middle, and her daughter, Magnolia, 1, say goodbye to Magnolia's father, Brandon, at Portland International Airport in Portland, Ore., Thursday, April 9, 2020. Calabro is a nurse and her husband is a firefighter. They chose to send their daughter to family in Kansas to shield her from the worst of COVID-19.

Emily Calabro, middle, and her daughter, Magnolia, 1, say goodbye to Magnolia’s father, Brandon, at Portland International Airport in Portland, Ore., Thursday, April 9, 2020. Calabro is a nurse and her husband is a firefighter. They chose to send their daughter to family in Kansas to shield her from the worst of COVID-19.

Bradley W. Parks/OPB

Still, Calabro plans to fly her daughter to Kansas to stay with her parents. But finding a flight has proven difficult as airline workers test positive for the virus and flights have been canceled. Calabro said she feels like her daughter would be safer at a distance.

“It’s heartbreaking to think about being away from my daughter,” Calabro said. “But the sooner we can probably bring her out there the better.”