Women of the Pandemic

by Lauren McKeon

  She pressed send. “I’m not one for candy-coating everything,” she told me. “And, it certainly provoked strong reactions in all directions.” Some of her staff felt grateful that she had broached the subject in such a direct, open manner. Others wished they’d been given a warning that they, and their own staff, were about to have a frank conversation about what might be ahead. Knowing would have allowed them to better support the staff that was already freaked out, they told Risdon. She thanked them for their feedback—it was a fair point. But she doesn’t regret sending the email; she needed to acknowledge the gravity of the situation. And it was grave. Throughout March and April, Risdon’s days felt soaked in terror. Months later, when I speak to her during the summer of 2020 as Canada’s daily case counts dipped, she almost laughs at that word, terror. Removed from those early weeks, it feels like such a dramatic choice. But she also can’t deny that’s what it was. She worried that the healthcare system in Canada might make the same mistakes as elsewhere: namely, sending every sick person to the hospital, neglecting both primary and at-home care, and creating accidental hotspots. She worried that both COVID tents and testing centres would enable the virus to cluster and spread. One wrong step could wreck every good, careful intention. She worried that hospitals, public health agencies, and other medical experts wouldn’t get it right.

  “I feared that our actions would make us have a COVID tsunami,” Risdon said. “It was this actual terror that we would be the inadvertent authors of our own demise.”

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  In the early months of the pandemic, Cora Mojica learned a lot about feeling terror. Mojica immigrated to Canada from the Philippines in 1987, leaving behind both her training as a secretary and most of her extended family. For the first two years, she was employed as a nanny. After she was granted permanent residency, she moved over to shipping and receiving, working at the same company for thirteen years before being laid off. In 2004, she applied for a job at the company that staffs hospitality workers at Vancouver General Hospital. Mojica got the job and has been there ever since. Her hospital is the city’s biggest, and on any given day she and her co-workers may have to prepare specialized meals for over one thousand patients. They’re not a team of superwomen, and sometimes they have to talk to their supervisor about whether they can make all those meals, fill all those trays. But, on a good shift, there’s a certain kind of regularity to the job—a coordinated dance to the clinking of cutlery, the fast-paced knock-clunk of dishes. Each day, there are about sixty food staff working, including cooks, bakers, and those prepping and placing food in the tray line. For each meal, Mojica’s team has two tray lines running at the same time, with ten people working each one. Some people fill the tray and the others move the food around the hospital, chugging metal wagons. Mojica is responsible for placing the milk and juice. Another person ladles the soup, snatches the crackers, chooses the dessert. One grabs the right pieces of each entrée. A symphony of breakfast, lunch, and dinner.

  When we think of healthcare workers, we often imagine physicians, nurses, technicians, specialists, surgeons—people who’ve dedicated their lives to helping the sick, the injured, and the dying. We think of clipboards and scalpels, scrubs and prestige. For the vast hospital enterprise to work, however, it also needs an army of cleaners and sanitizers, people to feed all those patients trying to get better, security guards to make people feel safe. In the uncomfortable hierarchy of health care, these key workers are often near the forgotten bottom and they are often, uncoincidentally, members of vulnerable populations. Many of them make not much more than minimum wage. Mojica estimates that 90 per cent of her co-workers are women of colour, and that the vast majority are from the Philippines, like her. In fact, across the system, immigrants play a vital role in Canadian health care, accounting for one out of four workers. A virus doesn’t have feelings; it doesn’t make a distinction between the person who intubates a rapidly declining patient and the person who wipes down their room after that last-ditch effort fails. Its one goal is to invade, replicate, take over. In those early months, every single person who walked into a hospital was also trekking into the virus’s hostile breeding grounds. All of them could get sick. And disproportionately, they did.

  By mid-May, in Ontario, healthcare workers comprised 17 per cent of all COVID-19 cases in the province, up from 10 per cent the month before. The vast majority of them were workers like Mojica: non-medical staff who showed up every day for their shifts, many of them because they couldn’t afford not to. (The first healthcare worker who died in the province was a hospital cleaner.) Mojica herself told me, more than once, that as scared as she was—as scared as she knew everyone on her shift was—she was also grateful to still have a job during the pandemic. This gratitude kept her going through the fear; not having an income was worse. “Even though it’s hard,” she said, “we still have to be grateful we have a job because others don’t.” Even those on CERB, she added, could be suffering more than those on the precarious front lines. “They have a family, they have a mortgage, they have to put food on the table,” she added. “Just do the job,” she told herself and her worried colleagues, not unkindly. “Just do the job.”

  Elsewhere in the world, a Lancet study published in late July confirmed that healthcare workers in the U.S. and the U.K. were at a far higher risk of contracting the virus than the generalized population. More alarmingly, it also showed that Black, Asian, and other people of colour in the healthcare field were at an even higher risk—five times more so than the (white) generalized population. A joint Guardian and Kaiser Health News project, Lost on the Frontline, identifies healthcare workers who died from COVID-19. In August, it estimated 62 per cent of the healthcare workers it catalogued were people of colour. The cause of the jaw-dropping disparity, the Lancet authors found, is multi-pronged failure. Many racialized healthcare workers were more likely to work in settings with greater exposure to patients with COVID-19, whether it be a designated ward, a busier hospital, or a long-term care centre. They were also more likely to receive inadequate PPE, or none at all, or to be asked to reuse what they did have. More research into the inequality, added the authors, was “urgently needed.”

  Mojica didn’t need a study to know the risks. She felt them in her own fluttering fear, saw them etched in the faces of her scared colleagues. It wasn’t only the hospital setting itself that could seem like a losing gamble. Mojica doesn’t have a car and so rides the bus every morning for her 10:30 shift. Before Vancouver declared a state of emergency, it would take her about an hour to get to work. During the lockdown, it took at least two hours. Sometimes, she’d watch one, two, three crowded buses go by before it was safe enough for her to board. Other times, she’d have to call a taxi. The worst was when she found a seat on the bus only to face racist vitriol. Twice, with her mask on Mojica was mistaken for a Chinese woman. One Canadian poll, released in June by Angus Reid and the University of Alberta, showed that half of those within Asian communities had experienced racial slurs or insults because of the pandemic’s geographic origin. Another 43 per cent said they had faced threats or intimidation. Racist graffiti blared from tunnels and underpasses, boarded-up shops, street signs. It filled our social media feeds and escaped the mouths of world leaders. Strangers blamed Mojica for bringing the virus to the city; they told her to go back home. Normally, she’s an outspoken person, but this time she bit her tongue, asking the Lord to forgive the racists. “Even though I’m not Chinese, it hurts,” she said. “Because why, why, why would anyone say that to people?”

  At work, her manager updated the team on the increasing COVID-19 case counts before every shift. Workers who were dropping off food had to wear full PPE. In COVID-19 wards, they were no longer allowed to enter the patients’ rooms. Once they arrived outside the ward that separated them from hopeful safety and definite danger, they had to phone a nurse who would don their own PPE and enter the room. The tray, plates, cups, and cut
lery were all now paper or plastic, completely disposable. But the food cart would have to go back down, sanitized once before it travelled through the corridors and on the elevators, and then again when it arrived back in the kitchens. During her breaks, she ate alone, following the new protocol. Even with all the extra cleaning and precautions, even with all her gratitude, Mojica still felt afraid sometimes. Her routine became work–home, work–home, work–groceries–home, repeat. Mojica is a widow and lives by herself, and during those wiped-out nights at home she would often FaceTime her mother and siblings in the Philippines, who were fifteen hours ahead. She’d tell them to wear a mask, not to socialize, and to keep the required six feet of distance. It was impossible to tell who could be a carrier, she told them. You could be walking around with no symptoms, never even knowing you were orchestrating death. She worried about them, constantly.

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  One of the most frightening things about SARS-CoV-2 is its often puzzling stealth. The virus’s predecessor is more like a blustery relative, loudly announcing itself—a characteristic that, in many ways, provided the strategy for its defeat. SARS-CoV was, and remains, deadly and highly contagious, traits it shares with the virus that causes COVID-19. Unlike its fellow coronavirus, however, SARS-CoV by and large makes people obviously very sick. It’s also only contagious when a person has symptoms. The virus weasels its way into a victim’s lungs and triggers horrible coughing, thus rowdily launching itself out of said person’s mucus-ways and onto the next victim. The resulting droplets are relatively heavy and do not travel far. During the height of the SARS outbreak, all of this made it easy to identify when a person was infectious and, in turn, easy to isolate them, then contact potential next victims and isolate them too. Little of that is true for SARS-CoV-2. During the first wave, it was still unclear how easily pre-symptomatic and asymptomatic people could transmit the virus. It was also unclear just how many of those people existed. But what was clear was that they did exist. As some people died startling, sudden deaths after becoming infected with SARS-CoV-2, others went on living, feeling no different at all.

  After half a year of research, scientists were still recording wildly different answers on the prevalence of asymptomatic cases. The WHO reported that the share of true asymptomatic cases ranged anywhere from 6 to 41 per cent. The huge variance can partly be blamed on another difference in the virus’s transmission and presentation: pre-symptomatic carriers who display no symptoms but who will go on to. This population can also spread the virus, walking around for days and feeling fine as it invades their body and sends out minuscule scouts. The U.S. Centers for Disease Control and Prevention (CDC) has estimated that 40 per cent of SARS-CoV-2 transmission has happened before people even feel ill. In other words, when it comes to the virus, the traditional wisdom about disease spread and control no longer applies. It has seemed to evade patterns just as easily as it does detection. It lodges high levels of particles in the nose and mouth, making it particularly easy for the replicating viral soldiers to escape into the environment—a process called viral shedding. The simplest way for the virus to do this is when a person coughs or sneezes, but studies have also shown the virus can shed when a person talks, shouts, or sings. What’s less certain is how long the virus can survive suspended in air or on surfaces (creating what’s called a fomite). When it comes to the latter, research during the first wave showed the virus can survive for hours or days, depending on both the environment and the material of the surface or object.

  “There are so many unknowns,” confessed Maria Van Kerkhove, the WHO’s technical lead for coronavirus response and head of its emerging diseases and zoonoses unit, in June. And in the absence of a scientific answer on where the virus skulked, or just how dangerous it could be to find it, another answer emerged: clean everything. By spring 2020, we were all experts in handwashing, dutifully singing the entirety of “Happy Birthday” as we scrubbed between our raw, cracked fingers. We plowed through Lysol wipes and sloshed bleach on everything. We zealously washed our groceries, the bottoms of our shoes, our jackets, takeout containers, plastic bags, our dogs. News stories emerged of third-party sellers charging $184.99 for bottles of hand sanitizer on Amazon.ca and $40 for bottles of travel-sized Purell on eBay. Even brick-and-mortar stores upped their prices to cover costs after shortages forced them to seek out new, more expensive suppliers. The astronomical inflation didn’t stop shoppers from stocking up; whole shelves went empty as people became desperate to acquire what scant protection they could. In hospital settings, where sick patients were already vulnerable to infection, janitorial and housekeeping work took on new weight. Doctors and nurses could follow distancing protocol and blue-green-red lines on the floor, but the deeper, daily work of keeping everyone safe fell to lower-paid cleaners.

  Precy Miguel has been employed as a housekeeper at St. Paul’s Hospital in Vancouver since 2006. By 2020, she’d been working in the emergency department for two years. When COVID-19 patients arrived at her hospital, she was scared, just like everybody else. She’d see patients intubated in their rooms and know that, at some point, she’d have to enter that same room to clean it. She tried to fill her heart with positivity and optimism. We can fight this, she’d tell herself, donning her N95 mask, face shield, goggles, and gown. We can do it. She was skilled and she had the gear and there was no way she could get infected if she followed proper protocols. She willed herself to believe it every time she read a sign on a patient’s door telling her how sick they were, how high her risk was, what she had to put on before heading in, everything she had to spray and wipe and mop. All around the world, people were dying and if she really loved her neighbours—and she did—then she had to clean the rooms where the virus waited. “We have to clean,” she told me. “We have to sanitize so that we can get rid of this crisis.” The thought of saving just one person kept her going through the fear.

  In March and April, both extra duties and staffing shortages meant Miguel would often have to work a double shift—her seven and a quarter hours stretching to nearly fifteen. Sometimes, she worked every day of the week, reminding herself that she was doing what needed to be done. Certain days were tougher than others. Miguel lives with her elderly parents and two brothers, and has been sleeping in the living room during the pandemic, behind a partition, to add extra distance. Her mother is unwell and during the pandemic was admitted to Miguel’s hospital for more than a week, luckily not with COVID-19. Nurses let Miguel visit once, but she mostly stuck to phoning her mom, following the hospital’s safety measures. Her mother worried that nobody visited her, wondered why she was alone in her hospital room, cut off from the comfort of family. Miguel tried to explain that it was for her own good, but was relieved when her mother was released. She remained meticulous about her cleaning routine. After every shift, she put her uniform in a plastic bag and changed into fresh scrubs. Once through the doors of her building, she sanitized everything in her path, as well as herself. Sometimes, after working a double shift, she’d be too exhausted to begin her next cleaning ritual and would spend the night sleeping in her car. She’d seen the patients in the COVID-19 rooms and didn’t want anybody in her family to end up like that, silent and unconscious as she killed the virus around them.

  Miguel is also the chair of her union local, and spent much of her time in that role adopting a brave face and fielding others’ concerns. Between focusing on her work duties, her family, and her co-workers, she barely had time to think about how she herself was faring during the pandemic. Her brothers are also essential workers, and Miguel insisted on not deviating from her usual grocery-shopping routine for the family. She also takes care of the building in which they live, and spent hours cleaning the railings, doorknobs, everything—you might as well add the tenants to her list of responsibilities. Her mind circled around those she cared for and about, looping the questions, What else can I do for them? What more is there? How can I still help? Often, she’d ad
d another lap to her concerns by worrying about her family back home in the Philippines. The more scraped thin her energy became, the more she reminded herself: If nobody will clean the hospital, how can we save those people? Yes, she needed her paycheque, but that wasn’t why she stayed. She stayed because she knew she had an important role to play in controlling the pandemic. It was her job to stop it from getting anyone else sick. Once it was in the body, well, then it was already beyond her control.

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  First, the nanny quit. Dr. Kanna Vela had hired her to look after her young children, ages five and two and a half, while she worked the emergency departments at three different hospitals in the Greater Toronto Area (GTA). She used to run a busy family practice, too, for seven years, back before her second daughter was born. She loved it, but she quickly realized it left her with little time to see her children and made the difficult decision to move full-time to emergency medicine. Even her most chaotic shifts were regimented in strict slots during the evening, night, and early morning, leaving her precious hours with her kids while they were both still awake. Vela and her husband, who runs a software company, were making it work—until March and the pandemic and their nanny’s understandable need to be at home with her own children. Vela wasn’t sure it was even safe for her to be in her own house. She’d surely be working with COVID-19 patients, and the last thing she wanted was for her family to become some of them. So, along with her parents, she devised an elegant, heartbreaking solution: she’d move into their home, and they’d move into hers. Her daughters would be cared for and Vela would be alone.