Reg­is­tered nurse San­dra Old field died of Covid-19 in May. Since March, she and fel­low nurs­es had been sound­ing the pan­dem­ic alarm about dan­ger­ous con­di­tions at the Kaiser Per­ma­nente Fres­no Med­ical Cen­ter, the Cal­i­for­nia hos­pi­tal where she worked for near­ly 20 years.

After Cal­i­for­nia declared a Covid-19 state of emer­gency on March 4, Old­field didn’t feel safe work­ing in just the sur­gi­cal mask issued to her by the hos­pi­tal. She joined co-work­ers who com­plained to man­age­ment, demand­ing access to N95 respirators.

That same month, one of Oldfield’s patients, ini­tial­ly admit­ted with gas­troin­testi­nal symp­toms, became acute­ly ill with a res­pi­ra­to­ry infec­tion and test­ed pos­i­tive for Covid-19. Old­field went home to iso­late March 26. With­in two months, Old­field, 53, was dead.

Oth­er hos­pi­tal staff scram­bled to uncov­er who else might have been exposed to the virus. By March 28, nurs­es were fran­ti­cal­ly tex­ting Rachel Spray, a cowork­er of Oldfield’s in the teleme­try unit, ask­ing what they should do. Hos­pi­tal man­age­ment had no clear answer, accord­ing to Spray, who also serves as a union rep­re­sen­ta­tive at the hos­pi­tal for the Cal­i­for­nia Nurs­es Asso­ci­a­tion (CNA). News of more con­firmed cas­es cir­cu­lat­ed by word of mouth.

Ulti­mate­ly, 50 work­ers at the hos­pi­tal were exposed to Covid-19 by that first case. Ten peo­ple test­ed pos­i­tive and three of those devel­oped a seri­ous ill­ness, accord­ing to CNA, which doc­u­ment­ed the outbreak.

The Fres­no nurs­es staged two demon­stra­tions out­side the hos­pi­tal in April and ear­ly May, demand­ing access to ade­quate per­son­al pro­tec­tive equip­ment (PPE). The protests also alert­ed the pub­lic to the risk, which Kaiser Per­ma­nente had not dis­closed to patients or the wider com­mu­ni­ty. On May 27, the nurs­es held a third demon­stra­tion, to mourn Old­field. They believe hos­pi­tal man­age­ment should have pre­vent­ed Oldfield’s death.

​“Los­ing a nurse, it real­ly destroyed the morale,” Spray says. ​“Hav­ing to go to work the day after your cowork­er — your friend — dies from Covid, and not hav­ing any resources to help you to deal with that.”

Because of the protests, the cir­cum­stances of Oldfield’s death were wide­ly report­ed in local media. But many health­care work­ers who have died of Covid-19 remain anony­mous. In fact, no one knows exact­ly how many work­ers in hos­pi­tals, nurs­ing homes and health­care facil­i­ties have died of Covid-19. No pub­lic agency reli­ably tracks the data, and health­care facil­i­ties are reluc­tant to vol­un­teer it, some­times with­hold­ing infor­ma­tion about the extent of out­breaks until they become too severe to ignore.

In the absence of offi­cial num­bers, much of what we know about Covid-19’s toll on health­care work­ers comes from whistle­blow­ers like those at Fres­no Med­ical Cen­ter. Poor work­ing con­di­tions — as well as long-stand­ing con­cerns about patient safe­ty issues, which have been exac­er­bat­ed by the pan­dem­ic — have prompt­ed health­care work­ers to launch a series of dra­mat­ic on-the-job actions.

In These Times spoke with more than a dozen health­care work­ers who have par­tic­i­pat­ed in strikes and protests, as well as field orga­niz­ers with nation­al and local health­care unions. We also reviewed data from the Nation­al Labor Rela­tions Board (NLRB) on union elec­tions and charges of unfair labor prac­tices at pri­vate-sec­tor health­care employ­ers (over which the NLRB has jurisdiction).

While tra­di­tion­al union­iza­tion has slowed in 2020, includ­ing in the health­care sec­tor, there are indi­ca­tors of grow­ing inter­est in orga­niz­ing with­in hos­pi­tals, nurs­ing homes and oth­er front­line health­care facil­i­ties. Thou­sands of work­ers have gone on strike. And while it’s dif­fi­cult to esti­mate how many work­ers have tak­en part in small­er on-the-job protests and pick­ets, health­care work­ers are fil­ing more NLRB com­plaints alleg­ing retal­i­a­tion for work­place orga­niz­ing than in pre­vi­ous years.Meanwhile, sev­er­al health­care unions report they are mak­ing inroads with non-union work­ers. They espe­cial­ly see poten­tial to improve the ratio of patients to staff, which has steadi­ly dete­ri­o­rat­ed in the con­text of con­sol­i­dat­ed cor­po­rate health­care systems.“Our phones are ring­ing in a way they haven’t in the past,” says Matthew Yarnell, pres­i­dent of SEIU Health­care Penn­syl­va­nia, which rep­re­sents health­care work­ers at three new facil­i­ties fol­low­ing suc­cess­ful union dri­ves dur­ing the pan­dem­ic. Vir­tu­al­ly every facil­i­ty shares the same core issues, Yarnell says: ​“chron­ic short staffing, low wages, not being pre­pared for a high­ly con­ta­gious air­borne pan­dem­ic virus.” The trag­ic sit­u­a­tion has become a cru­cible for ​“enhanced work­place action and organizing.”

Under­counts & Outbreaks

In a Sep­tem­ber report, Nation­al Nurs­es Unit­ed (NNU) — the largest U.S. union of reg­is­tered nurs­es — esti­mat­ed at least 1,718 health­care work­ers had died of Covid-19 and relat­ed com­pli­ca­tions. That fig­ure is more than twice as high as the 767 health­care work­er deaths report­ed by the Cen­ters for Dis­ease Con­trol and Pre­ven­tion (CDC) as of pub­li­ca­tion. NNU sug­gests its esti­mate — which relied on obit­u­ar­ies, union memo­ri­als, GoFundMe cam­paigns, social media posts and news reports — is an undercount.

Most of the CDC’s data does not col­lect occu­pa­tion­al sta­tus, cre­at­ing an under­count of cas­es irrec­on­cil­able even with oth­er fed­er­al data. The Cen­ters for Medicare & Med­ic­aid Ser­vices, for exam­ple, reports high­er fatal­i­ties for nurs­ing home work­ers alone — more than 800 deaths as of August 30 — than the CDC’s fig­ure of 767 cas­es for all health­care work­ers to date.

Many state agen­cies are not track­ing the data any bet­ter. As of mid-Sep­tem­ber, California’s health depart­ment report­ed 167 total deaths of health­care work­ers, includ­ing 146 deaths of health­care work­ers in nurs­ing homes — sug­gest­ing just 21 health­care work­ers had died out­side of nurs­ing homes. Mean­while, NNU said it had con­firmed at least 44 health­care work­er deaths out­side of nurs­ing homes as of mid-Sep­tem­ber, includ­ing Oldfield.

The lack of ade­quate pro­tec­tive gear is a clear con­trib­u­tor to these deaths. In the first month of the pan­dem­ic, front­line health­care work­ers’ risk of infec­tion was at least three times high­er than the gen­er­al population’s, accord­ing to a study pub­lished this sum­mer in The Lancet. Inad­e­quate PPE fur­ther increased the risk. Non-white health­care work­ers had a risk at least five times high­er and were also more like­ly than their white coun­ter­parts to report inad­e­quate or reused PPE.

And the PPE short­ages, detri­men­tal at the out­break of the pan­dem­ic, have not improved in many areas. ​“In many ways, things have only got­ten worse,” Amer­i­can Med­ical Asso­ci­a­tion Pres­i­dent Susan Bai­ley said in an August statement.

The fed­er­al gov­ern­ment missed numer­ous oppor­tu­ni­ties to pre­vent the severe PPE short­age. Well before the World Health Orga­ni­za­tion declared Covid-19 a pan­dem­ic on March 11, pub­lic health experts warned inad­e­quate stock­piles and crit­i­cal sup­ply-chain short­ages of PPE pos­es a threat to front­line workers.

In ear­ly March, U.S. health­care work­ers watched cat­a­stro­phe unfold for their coun­ter­parts in Italy, where an esti­mat­ed 2,500 doc­tors, nurs­es and hos­pi­tal staff test­ed pos­i­tive for Covid-19 in one six-day span in March. The Trump admin­is­tra­tion com­pound­ed nonex­is­tent prepa­ra­tion with delib­er­ate mis­in­for­ma­tion, leav­ing health­care work­ers exposed as U.S. cas­es climbed. But health­care unions say the gov­ern­ment isn’t the only actor at fault. ​“The health­care indus­try is also guilty of griev­ous mis­con­duct,” accord­ing to the NNU report.

The report con­tends that hos­pi­tals and nurs­ing homes have wide­ly failed to report work­place deaths from Covid-19. They are not required by law to do so, and they rarely self-report.

Hos­pi­tals fac­ing Covid-19 out­breaks in their facil­i­ties often fail to warn staff mem­bers who may have been exposed, some­times cit­ing fed­er­al pri­va­cy laws restrict­ing the release of med­ical infor­ma­tion as a pre­text for not dis­clos­ing cru­cial infor­ma­tion. NNU alleges that health­care employ­ers may instead be reluc­tant to acknowl­edge work­place deaths because of lia­bil­i­ty for work­ers’ com­pen­sa­tion claims.

Instead of count­ing on their employ­er to warn work­ers of pos­si­ble infec­tions, hos­pi­tal staff say they often rely on infor­mal com­mu­ni­ca­tion to track the spread.

Tin­ny Abo­ga­do, a nurse at Kaiser Per­ma­nente Los Ange­les Med­ical Cen­ter, says nurs­es have relied on each oth­er to track Covid-19 in the facil­i­ty since March. ​“We have a mes­sen­ger group, just the nurs­es in our unit,” says Abo­ga­do. ​“And we [use it] to say, ​‘Hey, I got Covid.’ … That’s how we find out.”

In mul­ti­ple Kaiser Per­ma­nente facil­i­ties, nurs­es have report­ed that key sup­plies, includ­ing N95 masks, are locked away and avail­able only by request. Only if the requester can sat­is­fy a par­tic­u­lar list of cri­te­ria will they receive a mask from the hospital.

Kaiser Per­ma­nente did not respond to In These Times’ request for com­ment. In a state­ment fol­low­ing Oldfield’s death in May, Senior Vice Pres­i­dent and Area Man­ag­er of Kaiser Per­ma­nente Fres­no Wade Nogy expressed con­do­lences and said that staff and patient safe­ty remained the top priority.

Sym­pa­thy & Solidarity

In the con­text of declin­ing union mem­ber­ship in the Unit­ed States, health­care rep­re­sents a high­ly orga­nized sec­tor — but the over­whelm­ing major­i­ty of health­care work­ers still do not belong to a union. In 2019, the health­care sec­tor saw the great­est increase in union mem­ber­ship of any U.S. indus­try. Union den­si­ty in the indus­try over­all, how­ev­er, remained rel­a­tive­ly stag­nant, giv­en the simul­ta­ne­ous expan­sion of nonunion health­care jobs.

Between March and Sep­tem­ber, the most recent month for which NLRB elec­tion data was avail­able, health­care work­ers had vot­ed in 58 elec­tions for union cer­ti­fi­ca­tion, win­ning 41 of them. That’s a decrease from the num­ber of union elec­tions held by health­care work­ers over the same peri­od in 2019 — not sur­pris­ing giv­en an over­all drop in union­iza­tion efforts dur­ing the pan­dem­ic. Restric­tive rules from the Trump administration’s NLRB, cur­rent­ly filled with a major­i­ty of Trump appointees, did not help mat­ters. Over­all, the labor board has received few­er than 800 peti­tions for union elec­tions since mid-March, com­pared to more than 1,100 over the same peri­od in each of the four pre­vi­ous years.

But this data does not nec­es­sar­i­ly cap­ture the full pic­ture of on-the-job orga­niz­ing. Matthew Yarnell, pres­i­dent of SEIU Health­care Penn­syl­va­nia, reports an uptick in work­er inter­est, cit­ing inter­nal data that SEIU orga­niz­ers in 18 states have been receiv­ing more calls from health­care work­ers dur­ing the pan­dem­ic than pri­or to it.

Yarnell says one union dri­ve in par­tic­u­lar, in Millers­burg, Pa., illus­trates the urgency of col­lec­tive action in this moment. At Pre­mier at Susque­han­na, a nurs­ing home named after the riv­er that pass­es through the town, a Covid-19 out­break had infect­ed at least 16 work­ers by mid-June. Trudy Klinger, a restora­tive nurse in the facil­i­ty, died of Covid-19.

​“Work­ers orga­nized [in] the course of three days,” Yarnell says. On June 10, the facil­i­ty agreed to rec­og­nize their bar­gain­ing unit.

That expe­ri­ence tracks with nation­al data on how the pan­dem­ic has affect­ed essen­tial work­ers’ atti­tudes towards union­iza­tion. This spring, the Roo­sevelt Insti­tute and YouGov Blue sur­veyed more than 2,500 respon­dents in essen­tial occu­pa­tions — rang­ing from health­care to food ser­vice and trans­porta­tion — about their work­ing con­di­tions and will­ing­ness to take part in col­lec­tive action at work. As con­cern about con­tract­ing Covid-19 at work increased, so did work­ers’ inter­est in protest­ing con­di­tions and form­ing unions to improve them.

​“The pan­dem­ic may be shift­ing work­ers’ under­stand­ing of the ben­e­fits of work­place col­lec­tive action, pre­sent­ing new oppor­tu­ni­ties for labor orga­ni­za­tion and action,” reads the report. Accord­ing to data pro­vid­ed to In These Times by the survey’s Adam Reich, the health­care work­ers who respond­ed reflect­ed this trend — par­tic­u­lar­ly in areas hard­est hit by the virus. ​“Covid has actu­al­ly been this kind of mobi­liz­ing moment,” Reich says.

Union­ized health­care work­ers have also been going on the offense in new ways. In three south­ern Cal­i­for­nia hos­pi­tals owned by health­care giant Hos­pi­tal Cor­po­ra­tion of Amer­i­ca (HCA), union nurs­es launched radio ads this sum­mer call­ing for ade­quate PPE and patient staffing. They are also fight­ing for pan­dem­ic safe­ty mea­sures to be includ­ed in their next union contracts.

In April, HCA sus­pend­ed reg­is­tered nurse Jhon­na Porter with­out pay after she used social media to warn col­leagues at Los Ange­les’ West Hills Hos­pi­tal that their floor would begin accept­ing Covid-19 patients with­out ade­quate pro­tec­tions in place. Porter was rein­stat­ed after an out­pour­ing of sup­port, but dozens of sim­i­lar sto­ries have sur­faced. NLRB records show that, since mid-March, health­care work­ers have filed more than 200 unfair labor prac­tice charges alleg­ing vio­la­tions of Sec­tion 8(a)(1) of the Nation­al Labor Rela­tions Act, which pro­hibits employ­ers from retal­i­at­ing against or oth­er­wise inter­fer­ing in legal­ly pro­tect­ed orga­niz­ing. In 2019, health­care work­ers filed just 46 such charges over the same peri­od; they filed 141 and 109 over the same peri­ods in 2018 and 2017, respectively.

The ongo­ing surge of Covid-19 cas­es has giv­en one union cam­paign renewed ener­gy. In ear­ly March, hasty prepa­ra­tions for Covid-19 brought a union dri­ve by nurs­es at a mid-size acute care hos­pi­tal in Wis­con­sin to a grind­ing halt. As staff atten­tion shift­ed to pan­dem­ic prepa­ra­tion, admin­is­tra­tors implied that a union fight would be self­ish and unfair under the cir­cum­stances. The nurs­es, who were spurred to orga­nize because of chron­ic under­staffing, have since restart­ed their cam­paign. One spoke to In These Times about the renewed push on the con­di­tion of anonymi­ty. To pro­tect employ­ees from retal­i­a­tion, In These Times is also with­hold­ing the name of the hospital.

​“We rou­tine­ly are short if not one, two, then three nurs­es a shift … and the hos­pi­tal real­ly isn’t doing a whole heck of a lot to change that,” said the nurse. ​“I think peo­ple are real­iz­ing that things aren’t going to change. And that maybe we need to amp it up.”

Where work­ers have gone on strike against unsafe work­ing con­di­tions this year, pub­lic sup­port has helped secure impor­tant wins.

In Sep­tem­ber, 4,000 union­ized work­ers relat­ed to the Uni­ver­si­ty of Illi­nois-Chica­go (UIC) Med­ical Cen­ter — includ­ing work­ers in tech­ni­cal, build­ing and main­te­nance, and cler­i­cal posi­tions—went on strike after fil­ing 20 com­plaints with the city of Chica­go. The com­plaints allege the hos­pi­tal had been pay­ing work­ers less than min­i­mum wage. In the same week, more than 800 nurs­es rep­re­sent­ed by the Illi­nois Nurs­es Asso­ci­a­tion went on strike amid con­tract nego­ti­a­tions that had stalled around the issue of staffing. At least four work­ers at the hos­pi­tal have died of Covid-19 to date.

Work­ers at the UIC hos­pi­tal pushed their employ­er to agree to raise wages for hos­pi­tal staff and increase staffing by 160 nurse positions.

Vee Stew­ard, rep­re­sent­ed by SEIU Local 73 as a cler­i­cal work­er for the UIC hos­pi­tal, says the pan­dem­ic has high­light­ed the neces­si­ty of fair wages through­out the hospital.

“I work with the front desk staff, and I work with these peo­ple who put their lives on the line every day, com­ing to work with­out the prop­er equip­ment,” Stew­ard says. ​“And we demand­ed that UIC con­sid­er the fact that … we are com­ing here, doing our job, but then we are going home, expos­ing our fam­i­lies, and so they had to do bet­ter so that we can pro­tect our fam­i­lies. No one should work and still not be able to afford to pay their rent or to buy food.”

At Fres­no Med­ical Cen­ter, union nurs­es still shak­en from Oldfield’s death are brac­ing for anoth­er wave of Covid-19 infec­tions. Their protests this spring prompt­ed small improve­ments, but they are still fight­ing for ade­quate PPE.

Amid the pro­longed cri­sis, Fres­no nurse and CNA rep­re­sen­ta­tive Amy Arlund says that col­lec­tive action is cru­cial to enlist­ing pub­lic sup­port and send­ing a mes­sage about the impor­tance of safe work­places for health­care providers.

“When you risk your nurs­es’ lives and you don’t pro­tect them,” Arlund asks, ​“who’s going to be around to take care of you when it’s your turn to be sick?”

This arti­cle was sup­port­ed by a grant from the Leonard C. Good­man Insti­tute for Inves­tiga­tive Report­ing. Fact-check­ing was pro­vid­ed by Han­nah Faris and Janea Wilson.