California nurses union plans holiday strike over PPE | Hacker News Reader

California nurses union plans holiday strike over PPE

californiaglobe.com

109 pointsnimbius90 comments

I can confirm the "used PPE" thing from personal experience. My partner (a nurse at a VA hospital) was given a Tupperware container with holes poked in the lid as "overnight storage" for her N95 mask and was asked to reuse it for up to a month at a time. As far as I know this is still ongoing.

I know the cynical take is "you need to stop letting yourself be surprised / disappointed by this kind of thing" but we should be able to do better, especially in a federally run hospital in the USA.

My coworkers from mainland China were concerned about our well-being and started shipping us KN95 masks, even fairly early on in the pandemic. feelsbadman.jpg

I can also confirm as a student doctor we've had "used" N95s for weeks at a time (that we might not even be sized for). Often being chastised for using an N95 instead of a surgical mask in efforts to "save PPE". It's difficult as a student seeing patients with covid daily as we're given even less than staff. Some students even offered to buy their own PPE but we're not allowed to use outside equipment. So, here I am with my surgical mask seeing patients that possibly have covid but haven't been swabbed yet until I take a history.

Edit: Similarly to your partner, we are given paper bags for our face shields and kidney bean shaped plastic bins to hold our N95. They installed coat hooks to hang our masks at the end of a shift.

Was the Defense Production Act successful at ramping up production of PPE? It's been 8 months since I've seen a proper N95 mask on store shelves. Hearing that someone close was going through the same thing as your partner, bringing home used masks and having to hit the black market/eBay for respirators with cartridges so they wouldn't become lightheaded when transporting patients all day was shocking. I think what's even more sad is how few tech companies opened their hearts, wallets, innovations, or resources to tackling this PPE situation.

My understanding from earlier reading of HN was that it takes months (closer to 1 year than 1 month from what I remember) to standup a new production line for N95 masks. With the supply chain constraints & presumable demand for such things that could possibly take even longer to set up, I think it is understandable that we haven't seen an increased supply on store shelves.

I just don’t see how this can be the reality that we’re living in. These things were $1/per at retail before the pandemic. People are ready to pay many multiples ($10/day? Sure. $20/day? Yeah) of that now, how are the economic incentives not aligned to make these things be extremely common and easy for everyone to buy.

This is where the fine print in economics comes in, things will eventually be balanced by the invisible hand but that's only in the long-term. In the short-term an untold amount of human suffering can occur.

Economics doesn't solve for reduced human misery. To avoid this we would have needed adequate central plans for this event (or rather, a set of people that decided to fund the plans we did have).

That is a massive hole that is often looked over by many. Oh, the market will take care of it. When? After we're all dying from pollution or missing fingers from faulty equipment? How can you in good faith believe the market will take care of everything?

I don't know enough about material science / manufacturing engineering. Obviously, the specific item being talked about here matters. If this was a purely aesthetic item that is trendy the QC matters a lot less. I would assume companies don't want to rush a new line and then be sending out masks with defects - send that to a few hospitals and your business will be done.

It wasn't used for PPE, just ventilators.

> It wasn't used for PPE, just ventilators.

And meat packing.

The DPA was not employed to ramp up production of PPE.

We used it for ventilators, which we later found out we wouldn't need because they usually do more harm than good.

As an outsider this is basically exactly what I would expect to happen in US healthcare.

As an American, it has been incredibly demoralizing seeing one institution after another fail miserably. I didn’t have high expectations, but oh boy did we fall way short.

CDC was muzzled by Trump admin. and a lot of that cascaded downwards.

But still, horrible to see.

Muzzled, what an apt term in this situation

Not sure why you're being downvoted (other than by angry Trump supporters). This is a factually true statement.

"Americans will always do the right thing - after exhausting all the alternatives."

-- Churchill

3 vaccines in record time.. I know J&J is still pending. I want the Healthcare/CDC/FDA pipeline to be improved.. Without American ingenuity the world is a much bleaker place.

The Pfizer vaccine was developed in Germany. The Oxford vaccine was developed in the UK. Of the approved vaccines, only the Moderna vaccine was developed in the US (and it's actually being manufactured in Switzerland). The J&J vaccine is being developed in Belgium.

That's not to say that the US hasn't been playing important roles, both now and in the research that enabled this. But "without American ingenuity" we'd be using vaccines from several other countries (including several more that are currently in development, as well as China and Russia, who have approved vaccines already in use).

Did you get vaccinated?

I will, as soon as I can. As a healthy middle aged person I'm not high up on the list.

That’s completely unrelated to the question at hand. Your assertion was that American ingenuity brought us three vaccines, which was demonstrably disproven.

If you want to make the point “but we’ll do a great job distributing it”, an argument I’m not feeling positive about, then make that argument explicitly.

You realize Russia and China had ones quicker?

I never claimed US was fastest in spite of my skepticism about Russia and China, but it's the US vaccines that would get wide spread use in ending this pandemic.

3 is a good number and perhaps more will come from USA.

Especially since I (the general public) can get an N95 online. If companies aren't protecting their workers they're not trying hard enough.

There's a lot of counterfeit product in the supply chain at the moment so that "N95" may well not meet many of the required standards.

It's not a supply issue.

The way certain emergency regulations are written, if you don't have enough gear, you can reuse. If you have enough gear, you cannot. It's normal, awful business practices in hospitals.

Where can it be bought from a reputable/reliable retailer? I’d love a link.

Not the person you asked, but these are the ones I've been buying from Amazon for the past two months: https://smile.amazon.com/gp/product/B08CGZFSZ9

I've cut one open out of every box I've ordered, and so far they've all been legitimate, 5-layer masks. Actual 3M masks are still impossible to find, but I've been happy enough with these.

Not to discount that product at all, I’ve got no experience judging those things.

But Amazon is not a reputable retailer. there’s no way for the end user of this to validate its effectiveness so that’s why I’d prefer at least a retailer who’s merchant had to sign off and order a product vs a completely unknown company selling through Amazon.

I guess this is where we are when all our institutions fail us collectively.

I don't blame you one bit. I'm not happy about feeling I genuinely need to destructively test one of the filters in every box, believe me. I am just reporting that so far, this particular listing has proven to be the real deal. It could also change tomorrow, and Amazon wouldn't update the listing.

It blows my mind that these supply issues are happening in CA of all places. Where I can go to Koreatown in LA and buy 10 kn95s for $10 from about a dozen stores.

> My coworkers from mainland China were concerned about our well-being and started shipping us KN95 masks

My partner’s friend with family in China did the same thing for us. His dad was getting chemo and they had their family send a couple boxes of KN95s over to help protect him. Depressing, given how much America looks like a failed state relative to the two countries pandemic response, but good that interpersonal relationships trump all the BS “new Cold War” rhetoric.

You can just order KN95s quite easily in the United States and have been able to for a long time, and actually I have for personal use (especially during the CA fires), and they have almost identical nominal requirements to N95, but:

https://www.ecri.org/press/up-to-70-of-chinese-kn95-masks-te...

The reason we don’t have masks is because we’ve gone all in on China and lost our manufacturing base. If you think this happened in the past 3 years, you have to ignore all data and pretend history doesn’t exist.

Yes, it's not like I have any connection via heritage or anything either, but our Chinese friends and coworkers have been extremely kind to us. They seem mystified / embarrassed to ask about the way our country is managing.

> a federally run hospital

I mean, of course it's going to be a hellhole.

In 2006, CA Gov. Schwarzenegger spent $200 Million dollars on stockpiling PPE and ventilators. This was on the heel of the Swine Flu in order to leave the state better prepared in case of another pandemic.

The stockpile took about $5 Million a year to maintain after the initial $200M purchase.

In 2011, CA Gov. Brown got rid of the program to save that $5M/yr.

https://revealnews.org/article/california-created-a-massive-...

https://www.politico.com/states/california/story/2020/03/31/...

Swine flu pandemic was in 2009. Your timeline is off.

Sorry, it was "avian flu". From the article...

> In 2006, citing the threat of avian flu, then-Gov. Arnold Schwarzenegger announced the state would invest hundreds of millions of dollars in a powerful set of medical weapons to deploy in the case of large-scale emergencies and natural disasters such as earthquakes, fires and pandemics.

Thanks! Just letting you know (no big deal clearly).

Article says avian flu. Not important to OP's point.

Damn Orange man and his failed policies.

It is absurd that there aren’t n95, and similarly effective, masks easily available 9 months into this thing.

What's absurd is CA abandoning its $200M stockpile of PPE in order to save $5M a year about 9 years ago. That stockpiles purpose was to help alleviate another pandemic after the scare from the Swine Flu.

https://www.latimes.com/california/story/2020-03-27/coronavi...

Kn95 and kf94 are readily available and cheap in Los Angeles. I cannot believe healthcare authorities would rather have workers use a month old n95 that degrades after 72hours of use than a kn95 that is readily available in the area and costs $1.

This was a huge failure on the federal government.

All they had to do was guarantee to buy up a minimum number of masks at a reasonable price, which would have been the reasonable thing to do anyway (even if there was overproduction, they can start a new stockpile). A lot of new manufacturers were willing to dump costs into tooling up production if they knew there would be demand in a year or two for the product.

But because the government waffled so long, and kept casting doubt even on the length of the pandemic, barely anyone was willing to dump the money into production.

As I understand it, the current situation is that the majority of manufacturers for N95 masks today were the same ones that existed in 2019.

If I were a medical worker, and they gave me shit PPE and told me that I'm not allowed to use my own - I'd simply ignore them until I was fired.

It's gonna suck dying if I need to go to the hospital, but I don't blame the nurses at all for this

> If I were a medical worker, and they gave me shit PPE and told me that I'm not allowed to use my own - I'd simply ignore them until I was fired.

You'd not only be risking your job, but your license as well (as in, future employment in your field).

Yeah, but you'd (probably) be alive. It's an optimization problem, where at some point in the curve it becomes more expensive to follow the guidelines (and die) than be blacklisted from the profession.

We'll know next year how much worse the odds of actually dying from Covid-19 were as a nurse in unsafe conditions vs. as an unemployed ex-nurse.

I'm far from certain that deciding to stay on the job isn't a rational choice. It depends on how much losing your job actually lets you lower your odds of getting Covid-19, and whether, once sick, Covid-19 survival rates are different for healthcare workers.

This can easily be solved with a tiny bit of sense. The state of California has large stockpiles. Now would be the time to distribute some.

EDIT: shows the state of Hacker News readership that this is downvoted when the article states this. Furthermore, here is a second source: https://www.gov.ca.gov/2020/07/22/governor-newsom-announces-...

hitting the downvoted button because it offends their sensibility without reading articles or doing their own research.

Citation please? I find this incredibly hard to believe.

The article literally mentions it. While it may not be a large stockpile, there’s ppe to be had.

1/2 a billion.

Didn’t read the article did you?

The article seems bogus. The state is in the process of getting masks out to people:

""" As of Dec. 7, the state's PPE stockpile included:

    178.7 million N95 respirators
    339 million surgical masks
    63.8 million procedure gowns
    19.5 million face shields
    152.2 million sets of protective gloves

https://www.desertsun.com/story/money/business/2020/12/09/fr... """

That ain't half a billion N95 masks.

Didn't read the hn guidelines did you?

I'm normally onboard with that guideline, but c'mon, when you're demanding a citation for a fact that's in the second paragraph of TFA, you've got a little "didn't read the article, did you?" coming your way.

>If true, why hasn’t the state delivered

Wouldn't really call that a fact. Not a good argument for didnt-u-read comments anyhow. Your own

>in the second paragraph of TFA

is much better.

Good link.

> ... Battelle Critical Care Decontamination systems to decontaminate N-95 respirators, allowing for their reuse ...

Hospital management will do all sorts of stuff to undermine unions. The conflicts vary from pay to operational practice. One of the issues I heard about is that some hospitals are accused of keeping PPE supplies tight so that they can reuse them and save money. If supplies aren't tight, they cannot reuse.

In a local city in the northeast, a hospital working to break a nascent nurses union took the step of shipping in scabs from Georgia and Florida, housing and feeding them in a hotel, transporting in shared vans, etc in the middle of a pandemic.

Does anyone have a link to more context about the strike? I found this on the union website— http://www.seiu121rn.org/2020/11/29/press-release-nurses-hea...

This is the critical bottleneck to supply:

https://www.cbsnews.com/news/n95-mask-shortage-melt-blown-fi...

I don’t think this is a good idea, and it would be disaster out for the Union if people start dying. I hope there are smarter people out there who will break the strike line.

California was prepared for this a decade ago but squandered it.

  When the state budget swelled 14 years ago, Schwarzenegger launched a surge capacity stockpile that included mobile hospitals and medical gear intended to prepare California for a situation like it is facing today.

https://www.politico.com/states/california/story/2020/03/31/...

Arnold was elected in a special election after a career politician was recalled.

That is completely immaterial to the discussion

In defence of the OP, at risk of also getting downvoted :)

I think what the OP is trying to say is that it is hard to imagine a career politician instituting such a program.

George W. Bush was a career politician and as President he instituted a pandemic response plan.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1283304/

You mean, career politicians like GW Bush, who launched comprehensive pandemic preparation programs in 2005?

You mean, career politicians like the Bush administration, that stood up the Pandemic Response Team, that was subsequently dissolved by the Trump administration?

That kind of career politician?

Edit: Named the wrong admin, my memory was off.

Only the politicians we don't like are "career politicians", my friend. ;)

Is it? Career politicians have political debts to be paid, which override what's best for their constituents.

Tangential diatribes about career politicians are not relevant to a potential holiday nursing strike, regardless of the animosity we may feel towards them.

Edit: changed 'is not' to 'are not'

You can thank those politicians and those electors that voted for them that made it cost effective for textile manufacturers to move to China.

This is a good example of why labor unions are important and necessary. A single nurse can be ignored because of the massive power imbalance between an individual and the management collective of a large organization. Nurses banding together to create their own collective creates a level playing field for negotiations.

The nurses in CA have been unionized for quite a while now. At the point that a strike is happening I’m not sure the union is having much success negotiating with the hospital over something that should be basic, obvious and mutually beneficial. One of the big complaints that people have about Unions (under US law) is that they do not really care so much about employee welfare as much as some specific set of bargaining points. The union just adds another large bureaucracy that you personally have minimal bargaining power with. (Last unionized job I had actually negotiated a salary decrease for us but claimed some ideological win over facilities). I feel like something closer to employee ownership/cooperative business models are a better approach to providing for human needs, and to that effect the NLRA should really be reworked.

You don't need to rework existing labor law for organized labor and employee ownership to coexist. ESOPs with unions were more popular prior to the Reagan era, but I don't believe they've been made illegal.

True. My last statement should have been split into two separate proposals: 1.) Better legal/financial support for cooperative business models (the laws on the books are prohibitive for capital intensive projects). 2.) Revising the NLRA to allow competition among multiple unions for representation. Right to work laws are too far on this issue but unions should not simply exist as a monopoly, they should have to have some incentive to earn their members.

I'm not sure I understand #2. Today, workers can switch unions with a vote, right? If the argument is that the workforce at any given company should be represented by an arbitrary number of unions... I'd have to give that some thought, but it sounds like something that would occur in a post-scarcity science fiction world (a dystopia, or perhaps just an anti-union parody) wherein the future workforce consists almost entirely of lawyers. Maybe it wouldn't be that bad.

And note that this is not "just" for the good of nurses, although that would be a sufficient reason to do something about it (or strike if refused).

We are talking about primary caregivers during a pandemic. This labor action is good for everyone.

Nurses, doctors, and other healthcare workers in the US are being taken advantage of right now and threatening a strike is one of the few ways they can maintain a balance of power in the system.

I support the strike and I hope the folks ignoring covid precautions understand there is a limited supply of goodwill and of people who can save your ass if you get a bad case.

Doctors arguably have it worse right now because due to how they're employed, a good number of them have no legal ability to unionize or engage in collective bargaining.

Average med school debt at graduation is roughly $200k. Now imagine you are a recent graduate from residency or medical school, and you have a comorbidity or risk factor for severe covid. Unless you have some outside funding source to pay your debt, you have no choice not to work, likely in a hospital that has little incentive to keep you safe.

Even ignoring tuition, there is a massive opportunity cost to training a doctor, and these are the folks we're relying on to keep us healthy for decades into the future. Situation's pretty shit. Least we could do is lock down until every healthcare worker has been vaccinated.

Unpopular opinion: Unions should not be allowed to strike during an emergency.

The US has been in a continuous state of national emergency (usually multiple overlapping ones) since the 1970s, and that's without “during an emergency” automatically voiding labor rights.

If an emergency justifies conscription, then the necessary personnel should be conscripted; if it doesn't, there is no cause to waive labor rights, which exist specifically to assure that labor is genuinely consensual and not a matter of economic coercion.

Perhaps if hospitals actually gave the slightest damn about their employees' safety, said employees wouldn't feel the need to strike during an emergency?

Doesn't the California Nurses Union strike almost regularly, anyway? Assuming that nurses have a better understanding of the virus than average laypeople, and given the facts of the number of positive cases, plus the facts which undermine the claims (California seems to actually have a stockpile), it seems unprofessional and unethical in the extreme to strike at this time.

Somebody will always tell you that you are unprofessional and unethical if you strike, in my experience.

Source: years as a workplace rep in UK school under austerity government cutting public sector pay and pensions, plus 3 years as a branch secretary.

You would think that standing up against practises that are endangering health-worker's health, and in tow the health of their patients, would be the most professional thing to do.

I have family who work as nurses on the front lines. One of them just got back from her third shift in a week in the covid unit, and has had a grand total of one reused N95 mask to use, in flagrant violation of what is considered acceptable barrier practice. And this is at one of the biggest hospitals in California. The way the staff are being treated is despicable, and I 100% support any striking action by the Nurses' union.

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