The Department of Veterans Affairs was unprepared for the country's novel coronavirus (COVID-19) outbreak, and VA employees say the nation’s largest integrated healthcare system continues to struggle with how to respond as hundreds of employees and veterans test positive for the virus.
Multiple VA hospitals lack personal protective equipment like masks, according to employees, who say they are frustrated over the department’s policy not to test non-veteran employees and worry that they could be overwhelmed should their medical centers be tasked with assisting overburdened local hospitals.
Globally, there are more than 1.3 million confirmed coronavirus cases — the United States now has the highest number of confirmed cases, at roughly 350,000, with more than 10,000 deaths. Within the Veterans Health Administration — the VA’s medical arm — 650 employees had tested positive for COVID-19 as of Friday evening, according to data provided to Task & Purpose by the House Veterans Affairs Committee.
This article is based on interviews with VA officials, lawmakers, and five VA healthcare workers who spoke to Task & Purpose on condition of anonymity for fear of reprisal in order to detail the department’s response to the spread of the virus.
“You don't know if all that training and policy things that you did are gonna work until you actually have to execute the plan, to see if it does,” said Rep. Phil Roe (R-Tenn.), the ranking Republican on the House Veterans Affairs Committee and a doctor himself. “If you've got 10 acute care beds and now all of a sudden you need 20 in one day, how are you going to plan for that? So you can be overwhelmed.”
“Let's plan for a train wreck and hopefully go on a train ride,” Roe said.
It’s against this backdrop — “train wreck” or “train ride” — that VA health care providers continue to go to work each and every day.
The department offered a sober assessment of what might be in store in its March 23 coronavirus response plan, which said the pandemic could come in multiple waves and last 18 months or more, adding that up to a third of the VA’s workforce could be rendered unavailable due to illness or sudden home-care responsibilities.
On the ground, the perspectives from Veterans Affairs employees who spoke with Task & Purpose were as varied as the clinics where they worked: from Portland, Oregon; to Tampa, Florida; Houston, Texas; Albany, New York; and Washington, D.C, where all but the VA Medical Center in Albany have confirmed COVID-19 cases, according to VA data.
Adjusting to the virus' spread
After the VA Medical Center in Washington, D.C. advised veterans to avoid coming in unless it was absolutely necessary, the clinic became “a ghost town,” a nurse practitioner there told Task & Purpose, adding that the hospital loosened restrictions on using apps like FaceTime so that doctors and nurses could more easily get in touch with their patients.
Care providers who spoke with Task & Purpose said they saw the number of patient visits plummet as their hospitals cancelled elective surgeries and remarked on seeing an uptick in the number of mailed prescriptions, while others noted that tents had been set up for employees and patients to undergo mandatory screening for COVID-19 symptoms.
Even so, there were some common concerns, including a lack of personal protective equipment, particularly N95 masks which filter out 95% of airborne particles, unlike the looser-fitting surgical masks.
Neither the surgical masks or the N95s are designed for continuous use, though VA employees told Task & Purpose that they’ve been directed to reuse their masks for up to a week at a time, as a way to conserve supplies.
'I'm wearing the same mask three days in a row'
A social worker at the Michael E. DeBakey VA Medical Center in Houston, Texas, told Task & Purpose that employees were given unclear, and at times conflicting guidance about PPE protocol, and who could work remotely, and who could not.
“The lack of communication is bad but the tone is far worse,” said the employee, who like other care providers there has been working in the clinic’s COVID-19 unit.
“Individuals who are at higher risk of complications should they get ill are still mandated to come in, without access to proper PPE. I have a coworker who lives with and cares for her elderly father. If she becomes ill or carries the virus home, her father could die.”
The mixed messaging extends far beyond the employee's immediate chain of command, she said.
“I would watch [VA Secretary Robert] Wilkie on TV and I would get so angry because he's saying, ‘Oh, we have plenty of masks and equipment,’” the employee said, “Meanwhile, I'm wearing the same mask three days in a row and it's not even a mask that's effective for COVID.”
She and her colleagues have even taken to resewing masks and bringing them home each night to sanitize them, she added.
Another employee, a nurse at the VA Medical Center in Portland, Oregon, told Task & Purpose that staff were informed they only had two weeks worth of personal protective equipment, like masks, if they continued to use them at their current rate — that was the third week in March.
As of Monday, that nurse told Task & Purpose that they were “down to one surgical mask per person per day,” adding that the N95 masks are “hard to come by.”
When asked about the hospital’s supplies, VA spokesman Damian McGee told Task & Purpose that “during emergencies such as this, hospitals routinely shift resources, staff, and supplies as needed to meet demands wherever they arise. VA Portland Health Care System is no different.”
McGee added that the VA is “equipped with essential items and supplies to handle coronavirus cases, and we are continually monitoring the status of those items to ensure a robust supply chain.”
A staff nurse at the James A. Haley Veterans Hospital in Tampa, Florida, said that medical staff were being issued one surgical mask a week as a way to ration protective equipment.
“If you’re going to do something with a patient, and have direct care, then this is your mask and you need to reuse it throughout the week,” said the nurse, who provided Task & Purpose with a photo of an internal message advising staff that N95 masks can be reused up to five times.
The VA employees who spoke with Task & Purpose are far from the only ones who have raised alarm over a lack of masks. On Saturday, National Nurses United, a national union of registered nurses, called for a protest at the VA Medical Center in Brooklyn, New York, to draw attention to staffing and PPE shortages, reported Military Times.
Previously, a March VA inspector general report revealed that only half of the 54 medical centers inspected had adequate supplies, with the remainder anticipating shortages of hand sanitizer, masks, gloves, and other essential equipment, and “acknowledged low inventory of personal protective equipment for staff.”
When asked about employees’ complaints over the availability of masks and other protective equipment, VA press secretary Christina Mandreucci told Task & Purpose that “all VA facilities are equipped with essential items and supplies, and we are continually monitoring the status of those items to ensure a robust supply chain.”
“VA facilities are using PPE in accordance with CDC guidelines, and all employees have the appropriate Personal Protective Equipment (PPE), as per those guidelines, she said, adding that N95 masks “are used when necessary.”
Lack of testing
The concerns among employees extend beyond just protective equipment and include a lack of available testing for non-veteran employees.
The second largest federal agency in the United States, the VA employed more than 390,000 personnel as of December, with the vast majority of them working within the Veterans Health Administration. Those employees are charged with manning the VA’s sprawling network of healthcare facilities and medical centers, which provide care to some 9 million veterans, many of whom are older, and have underlying health issues related to their military service.
As Task & Purpose previously reported, the VA has said that it will not provide COVID-19 testing to non-veteran employees — including medical staff who show symptoms of the virus. Instead, those employees are advised to follow guidance from the Centers for Disease Control and Prevention, and reach out to their private care provider to get tested, and treated, as they self-quarantine.
Roughly 123,000 of VA employees are veterans, according to an infographic from 2019, which means that the majority of the department's workforce is made up of civilian employees who are not eligible to be tested for COVID-19 at the hospitals and clinics where they work.
“This is the doctor in me, look, I've said this from day one, the thing that we needed, that is just now getting stood up, is robust testing, I said this two months ago,” Congressman Roe told Task & Purpose.
“I think the VA ought to test anybody that wants a test, who works there, that's me personally,” he added. “Right now, they probably don't have the capacity to do it. And they're saying, okay, test our veteran employees, but to me, robust testing needs to be done.”
According to figures provided to Task & Purpose by the VA on March 27, the department had 130,000 test kits. As of Monday, the VA has administered roughly 25,500 tests nationwide.
'It’s what you do, it’s what you signed up for'
Beyond the worries over testing and access to protective gear, care providers at the VA are bracing for the prospect that things could get worse across the country before they get better. And if that happens, then those same VA employees may be called upon to act as a final line of defense against the pandemic.
In the event of a national crisis, the VA can be tasked with backing up the civilian healthcare system as part of its “fourth mission,” and there are signs that it’s already starting to happen. As Stars and Stripes reported on Thursday, VA Secretary Wilkie opened 50 beds in Manhattan and Brooklyn to provide care to non-coronavirus civilian patients.
“It's the same thing as a battle,” Roe told Task & Purpose. “If you're on the line and it gets overrun, you need some reinforcements to come shore up that line, and that's exactly what that fourth mission is for.”
For Veterans Affairs care providers, it’s a daunting prospect. Even before the pandemic began, the VA faced a personnel shortage, with more than 44,000 vacancies on the healthcare side — a challenge not unique to the VA, but one that affects private healthcare systems as well. On March 24, the VA announced a new initiative aimed at hiring recently retired clinicians to help during the pandemic.
"It's one of the things we're thinking about,” a nurse at the VA Medical Center in Albany, New York told Task & Purpose.
"We know it's coming," she said, adding that staffing at the facility "really depends on the day," though she added that they have enough PPE and equipment, for now.
A stone's throw from the clinic where she works is a local hospital that's now receiving overflow patients from New York City.
"More and more cases are going over there, and we have some providers working in both facilities, so now we're realizing it's moving closer to home for us," she said.
While there’s certainly apprehension over how well the VA will be able to care for an influx of patients, none of the care providers who spoke with Task & Purpose voiced opposition to opening the VA’s doors to non-veteran patients.
As the nurse in Albany put it: “It’s what you do, it’s what you signed up for.”
If you are a medical care professional at the Department of Veterans Affairs and would like to discuss the VA's response to the COVID-19 pandemic, you can reach out to the author of this story at: James@taskandpurpose.com