How sloppy coronavirus measures pushed healthcare workers to the brink of death

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Hajni Nagyné, a nurse of the St. Elizabeth Hospital in Tata, had a fever while working on May 18. A week later, she was fighting for her life on a ventilator. After a series of blood transfusions, dialyses and 68 days of medically induced coma, she lost 26 kilograms of weight. She was treated in a hospital for four months. Now, with her legs still paralyzed, she is struggling to regain the strength of her muscles with daily physiotherapy. “I can’t even hear about Covid… I still cannot read my own medical records. I don’t want to think about what I’ve been through,” she said about her trauma in the recent months.

Hajni is just one of more than a dozen employees at Tata Hospital who have fallen ill of coronavirus. Her case is the most serious, but several of her other colleagues were in a serious condition during the first wave of the pandemic in April and May. Direkt36 has managed to uncover the events in Tata using internal hospital documents and the help of sources from within the institution.

At the end of April, the hospital of the nearby town of Tatabánya was shut down due to a serious internal epidemic. During April and May, patients were regularly transported from Tatabánya, the city, that was struggling with the spread of the infection, to Tata, an affiliate of the Tatabánya hospital. Soon, a number of cases emerged in Tata as well.

According to management’s plan, the goal of the transports was to ease the burden on the struggling hospital in Tatabánya. The patients arriving to Tata were supposed to be “clean”, not having contracted the virus. Because of this, the staff in Tata cared for the patients wearing no effective protective equipment. But the patients weren’t tested properly before their transports. Due to the lack of PCR tests at the time, only blood tests were used. These, however, are unable to show an ongoing infection. The results of these tests were negative, yet during April and May, a number of staff members became infected in Tata, including nurses, cleaners, a janitor, a doctor and one of the hospital’s chief nurses. Many of them started to show symptoms after getting in touch with patients from Tatabánya.

After more than twenty patients had tested positive, the hospital of Tata was shut down. Hajni and one of her colleagues spent weeks in intensive care. Some of the infected staff members quit their jobs since, others can’t wait for their retirement.

There was no public discourse about what happened in Tata. Hospital management merely stated that the high number of infections were the result of their careful and thorough testing procedures. However, internal documents and the background information provided by hospital staff show that shortages in protective equipment and tests contributed to the epidemic. In addition, the hospital struggled with severe shortage of staff, with many workers working 12-hour shifts without rest and change.

Direkt36 asked both the hospital management and the Hungarian National Public Health Center (NNK) whether it was subsequently investigated if there was a direct link between the epidemic that developed in Tatabánya, and later in Tata. NNK ignored our questions while János Lőke, the director general of Tata hospital, refused to answer claiming he was in quarantine.

The events in Tata show what can happen when a health care institution loses control of an epidemic within its own walls.

68 days of ventilation, 46 days of dialysis

On 27 May, a nurse at Tata Hospital posted a desperate message on her Facebook page. “Please move together now […], clasp your hands for prayer for my two colleagues. Their condition is critical.” The next day, the son of Hajni (one of the aforementioned patients) posted on Facebook, “I ask everyone to help. My mother needs blood right away!”

Hajni fell ill ten days earlier on 18 May, when she had a fever during her workshift. She was sent home. Her GP prescribed antibiotics to her but she didn’t get any better. A few days later, she started choking. Hajni called the ambulance and by the time they arrived, she lost conscience. She was first taken to the county hospital in Székesfehérvár, then to the National Korányi Institute of Pulmonology in Budapest and had to be put on ventilator on 26 May.

Hajni does not remember the subsequent weeks as she spent the next period in medically induced coma. For 42 days, she was put on ECMO, a machine to provide respiratory support instead of her own lungs. She received a series of blood transfusions, blood plasma as immune booster and plenty of muscle relaxants to help effective ventilation. She said that her underlying illnesses as well as her job may have exacerbated her condition: “I’ve been a nurse since 1985 and I have thyroid disease, diabetes, asthma.” In Korányi, she was on ventilator for 68 days and her blood was cleaned with dialysis for 46 days.

When she finally woke up she could not move at all.

“I was terribly tired and weak, lying in bed just like a a piece of wood,”

Hajni said. Her voice showed her reluctance to think back on what had happened. She lost 26 kilograms of weight (57 pounds) and her muscles still need to recover. She cannot move her feet yet, for example. “Luckily, the blackness goes off my fingers. I got microembolia, which resulted in the skin tissue dying,” she said, describing another side effect of her condition. “It can be said that Covid does not exist but I think my colleagues and I are living examples of how dangerous this disease is,” she added.

Like Hajni, one of the chief nurses at Tata Hospital became seriously ill due to the coronavirus infection. She, too, was treated at the intensive care unit of the Korányi Institute for weeks. At least a dozen other Tata hospital workers also caught the virus, according to information gathered by Direkt36.

“It probably comes from work,” Hajni replied to the question about the possible origin of her infection. At Tata hospital, workers were tested for coronavirus several times in May, but – while a number of positive cases occurred – she repeatedly tested negative until the symptoms appeared overnight. Hajni would rather not tell more, and although she also told her story on a live TV show last week, the events at Tata hospital weren’t mentioned. However, according to Direkt36’s research, the problems started well before May.

They shut us down, for some reason

The parent institution of Tata Hospital, St. Borbála’s Hospital in Tatabánya, was appointed by the government as a designated Covid19 hospital in early April. It was at the time of the first wave of the epidemic. Schools were closed, people were staying at home.

Hospital management was in a rush to organize the transition so that the infected can be accommodated properly. One phase of the reorganization took place on Easter weekend, April 11-12, when four departments were relocated to Tata, which is an affiliate hospital of the central institution at Tatabánya. Normally, there are only rehabilitation departments in Tata, where Hajni and her colleagues work. But after Easter, they were accommodating the hematology, oncology, chronic internal medicine as well as the nursing departments, the director general of St. Borbála’s Hospital himself, János Lőke, informed on local TV.

“The idea was that there would be no coronavirus patients in Tata, only ‘clean’ patients were supposed to arrive,”

a Tata hospital worker told Direkt36.

But back in Tatabánya, events soon escalated as the virus started spreading inside the building. The first cases occurred at the gastroenterology and kidney departments, which had to be shut down on 22 April. Staff members contracted the virus and were quarantined in growing numbers. Replacing them was not easy. According to letters seen by Direkt36, hospital director general János Lőke asked for nurses and doctors from health minister Miklós Kásler and National Chief Medical Officer Cecília Müller at least three times. In a 21 April letter to Kásler, for example, he wrote about a “critical human resources situation” and asked for 61 doctors and 105 trained staff members (the hospital has about 1,500 employees altogether). On April 26, he wrote to Müller that 71 of his employees had dropped out of work due to infection or quarantining, and that even a 70-year-old doctor, being at a particularly vulnerable age group, had to be involved in taking care of patients. “Our current situation is threatening the care of both coronavirus and non-coronavirus patients and cannot be sustained in the long run,” the hospital director warned.

But Cecília Müller decided not to comply with Lőke’s requests. Instead, she ordered a hospital lockdown. Patient admission stopped on 28 April. “For some reason, they didn’t send us staff, they shut us down,” Lőke told local TV afterwards, expressing how much the decision surprised him. He also noted that the lockdown was decided based on telephone conversations and information provided by the hospital, but no one from the authority had actually visited the site in person.

From then on, patients living in the county were brought to other hospitals. The document of Müller’s ruling reveals that, in addition to staff shortages, a number of mistakes were made in the hospital. For example, some staff members kept on working for days after showing the first symptoms. Infected or suspected patients were not always properly isolated but placed in wards with multiple beds. Tatabánya was the only hospital that had to be closed during the first wave. Müller’s decision did not specify who was responsible for the situation in the hospital. Director General János Lőke remained in his position.

2 nurses for 40 patients

In the same time, patients who had been transported from Tatabánya were taken care of in Tata under the illusion that there were no infected ones among them. A Tata hospital worker asking for anonymity claimed that staff members wore only rubber gloves and surgical masks, which only provide partial protection against the virus. The worker fell ill two weeks after they took part in receiving many patients from Tatabánya in Easter. According to information provided by hospital staff, they were the first worker in Tata to test positive for the coronavirus. The source originates their illness from the fact that they came into contact with patients from Tatabánya, as the incubation period of the disease is up to two weeks.

Similar to the case in Mór, previously uncovered by Direkt36, patients were not properly tested for the virus prior to their transfer to Tata. According to one Tata hospital worker, their medical records showed that only blood tests were conducted, which were negative. But these types of tests are only capable of showing previous exposure to the virus but do not reveal ongoing infection. However, PCR tests, suitable for detecting active infection, were not available in Szent Borbála Hospital at the time. The hospital management did not answer our questions regarding the testing of transported patients.

Patients were brought on a daily basis from Tatabánya to Tata during most part of both April and May, even when it was already clear that the virus had been spreading in the Tatabánya hospital buildings, according to one Tata hospital worker. Even then, transported patients were still not tested with PCR tests. According to regulations at the time, PCR-testing was only compulsory when patients were released from hospital care. Because of this, several patients’ infection was only detected when they were about to be released home.

In April, several of the relocated patients in Tata had fever, but at first, this was not seen suspicious. “They were helpless patients in serious conditions who needed to be fed and cleaned. It is relatively difficult to determine whether such symptoms are indicative of coronavirus in such patients. For example, a fever can be caused by bedsores. In addition, many of them were not in a state that they could communicate to describe their symptoms,” said a worker who later became infected herself.

In April and in the most part of May, Tata hospital lacked the proper protective equipment suitable for the treatment of infected patients, making it easier for the virus to spread. Nurses were only wearing surgical masks, capes, rubber gloves, and caps. According to workers talking to Direkt36, one of the chief nurses repeatedly asked hospital management in Tatabánya to send them protective equipment, but the requests were denied because Tata did not have an official Covid ward. In addition, half of the Tata nurses were ordered to work in Tatabánya on April 20, leaving only a total of six nurses to care for patients in need of continuous care. (One of them told Direkt36 that three of the staff members who were relocated soon became ill.)

Under these circumstances,

“that we went to work every day for 12 hours, day or night, and that two nurses had to treat 40 seriously ill people… whether or not we had protective equipment would not have mattered. Taking a break or changing clothes… this was impossible, it would have required three times the staff, ”

said the worker, who later fell ill.

The fall of Tata

Regular PCR testing of Tata staff only began on 5 May. Samples were taken once a week, and each week, someone tested positive and dropped out of work. By 19 May, a string of nurses, cleaners, administrators, physiotherapists, and almost the entire cardiology rehabilitation department had contracted the virus. There were infected workers on the other floor of the building, at the musculoskeletal rehabilitation department too. Based on our interviews with several hospital sources, at least three workers were hospitalized with the rest overcoming their illness in their homes. “I’ve never seen my wife so sick before,” the husband of an older worker recalled.

Our “Tata heroes” must be acknowledged, wrote a former hospital employee on 19 May on Facebook. “They are the doctors, nurses, cleaners, administrators, chief nurse and, last but not least, the physiotherapists of the Cardiology Rehabilitation Department of the St. Elisabeth Hospital! They were involved in the treatment of non-coronavirus patients transported here from Tatabánya.”

“By now, almost all of them have fallen,”

his post reads.

When workers produced a series of positive tests, patient screening started and positive cases were found in almost every ward. Moreover, the doctor collecting their samples got infected as well. Care collapsed, patient admission was stopped, positive patients were transferred to other hospitals.

An internal document originating from hospital management on 19 May reported on the events in Tata: “The Nursing Director and the Chief Physician are visiting the site today. The outbreak erupted at the site over the weekend. (…) At the cardiological rehabilitation, 15 patients became positive, all of them asymptomatic. 5 employees have positive results. 7 employees are already quarantined due to earlier positive results. (…) Workers are properly equipped, disinfectants are available. The second sampling of workers will take place today and tomorrow.”

A day later, Tatabánya hospital reopened. The hospital did not provide detailed public information about what was happening in Tata in the meantime. The management’s statement only informed that 23 patients and 11 workers tested positive, and only 2 workers showed “mild symptoms”.

“The large number of positive tests does not reflect irresponsible human negligence, but is the result of responsible, comprehensive screening for the safety of workers, patients and local citizens. We did all this even though we are aware that it is an extra burden on both patients and workers, and that more of our colleagues may be out of work,”

the statement read.

The exact origin of the disease has not been investigated later, at least workers are unaware of it and Direkt36 has not found any public information to suggest this. We asked the Hungarian National Public Health Center and the St. Borbála Hospital whether an internal investigation had been conducted after what had happened, but we did not receive a response from either institution. The hospital argued that Director General János Lőke could not comment because he was currently in quarantine.

Full sick pay is still at stake for nurses

Some of the staff members returned to work after their recovery in the end of summer, but two of them decided to leave their jobs. The two workers who were in intensive care still have health issues, muscle weakness among them. Another recovered staff member has traces of the disease on her lungs and experiences shortages of breath and coughs from time to time. One worker cannot wait her soon-to-come retirement from work.

Workers interviewed by Direkt36 complained that even after five months of their illness, they were still not paid a 100 per cent salary for the duration of their sick leave. They were told that the decision depended on the Ministry of Human Resources. In order to be fully paid, it must be determined that their infection comes from work, otherwise they only get two-thirds of their salary.

“I don’t know what’s there to decide. It’s clearly a work infection. I didn’t contract it in the Maldives,”

one of them said. Delayed payment has put many in a difficult financial situation. (Neither the hospital nor the Hungarian National Public Health Center replied our inquiries regarding the workers’ payment.)

Hajni Nagyné could only leave the rehabilitation department of the Kisbér hospital in October. Many of her colleagues and friends prayed for her recovery and some also visited her. In September, she was elected a “Hero of Everyday Life in Tata” on a vote of a local civic initiative.

Today, Hajni still works hard to be able to walk again. As for now, without a wheelchair or walking frame, she cannot. She feels that she owes her doctors and nurses at Korányi Pulmonology Institution who treated her to do everything on her part for a full recovery. “They have put a lot of efforts in me,” she said. The head of Korányi’s chronic respiration department has repeatedly told her that she is “a miracle” because not only did she survive but she did it with “her whole spirit.” “I returned to Earth on the wings of angels,” Hajni said.

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