The night Miguel Moran died from complications of the coronavirus, his 23-year-old son and four other family members put on their face masks and rushed to a suburban New York hospital to be at his bedside.
One by one, they donned a hospital-issued plastic gown, a head covering and gloves. They spent a few minutes each saying an emotional farewell to the lifeless body of the 56-year-old immigrant from El Salvador, a Pentecostal churchgoer who washed trucks to provide for his family.
His only son, Daniel Moran, said a bedside prayer at St. Joseph Hospital on Long Island. He squeezed his dead father’s hand.
“One day we’ll join you in heaven,” he cried.
Sixteen days later, father and son were buried together.
Miguel Moran died of acute respiratory failure from Covid-19 on April 16, according to his death certificate. Eight days after praying over his father’s body, Daniel himself was dead from the disease.
The elder Moran’s wife and daughter, who also lived with him and visited the hospital the night he died, later tested positive for the coronavirus — as did two other family members who were also in the room that night.
The family’s plight highlights the pandemic’s many challenges. The wrenching separations of dying patients and loved ones who would normally be at their side as they drew their last breaths. Overburdened health care systems balancing that with mandates to protect visitors and staff. Hospitalsstruggling with access to personal protective equipment (PPE).
“It’s incredibly heartbreaking this happened in the first place,” said Dr. Cassandra Pierre, medical director of public health programs at Boston Medical Center. “But also that you have to hold your family member or you won’t even get the opportunity to do that without having PPE in place is just so unnatural. This is where we are right now to continue to keep people safe.”
The extraordinary measures to stop the contagion have touched the seriously ill, their vulnerable families and overtaxed hospital personnel.
“I really feel for that family,” Pierre said. “I feel for the health care center who’s trying to accommodate them. It’s such a weird time where you can’t even grieve appropriately for your family members.”
The situation is ‘painful for all concerned’
Hospitals across the country have suspended most visits. Many critically ill patients have been deprived the comfort of a familiar face in their final moments. Grieving happens from afar. Visitation policies are left to hospital administrators.
“I feel like everyone makes it up as we go along,” Pierre said of visitor protocols. “Certainly, at the bare minimum, everyone should be wearing a surgical mask in almost all hospital spaces. But other than that I think it’s kind of left at the discretion of the institution.”
The New York Health Department has halted hospital visits statewide except for imminent end-of-life situations, labor and delivery and pediatric cases. For confirmed or suspected Covid-19 patients, visitors must don masks, gowns and gloves, practice “scrupulous” hand hygiene, and use eye protection if available.
This is in line with US Centers for Disease Control and Prevention guidance, which also includes training visitors on the proper PPE use and discouraging older adults and people with underlying medical conditions from visiting.
Catholic Health Services, which runs St. Joseph in Bethpage and other Long Island hospitals, declined comment beyond referencing its Covid-19 visitor policy. It, too, has suspended all but end-of-life, newborn delivery and pediatrics visits.
“Exceptions for visitation will be made on a case-by-case-basis by hospital and (skilled nursing facilities) leadership in conjunction with Infection Prevention leadership and will follow appropriate CDC guidelines for screening for COVID-19 infection BEFORE entry is allowed,” the policy says.
Nancy Foster, vice president of quality and patient safety policy at the American Hospital Association, said health care centers have had to make tough choices.
“The extraordinary reality of COVID-19 has forced many hospitals and health systems to take extraordinary measures to keep patients and communities safe,” she said in a statement.
“It is necessary for everyone’s sake that we restrict visitors, and it is painful for all concerned, including the staff who have to insist on it. We do not take lightly the sacrifices we are asking individuals and their loved ones to make. We would not do so unless it was absolutely necessary.”
Miguel Moran walked himself to ambulance and died two days later
Miguel Moran started to feel ill the week before his April 16 death. His boss at a company that washes fleets of trucks and ambulances sent him home one day with a fever. His daughter said she took him to a physician. Her father wasn’t tested but the doctor was “100% certain” Moran had the coronavirus.
He self quarantined at home — not coming out of his room, according to his daughter, Mercedes Moran, 31, and his wife, Reina Garay, 53.
“We were taking all the precautionary steps we heard on the news,” Mercedes Moran said in Spanish from the family’s Farmingdale home. “We didn’t come near him. Dad was isolated. We left food at his door. My brother was always in his own room.”
Two days before his death, Moran was sweating heavily, his fever increasing. His breathing was labored and he had trouble moving. Still, he walked himself to the ambulance that took him to the hospital, his family said.
The next day, he told his wife on the phone, “I’m going to die. The doctor says I’m not going to make it.”
‘Papi, wake up. Let’s go home’
Moran died just after 10 p.m. on April 16. The hospital allowed five family members to individually say their goodbyes. They shared a plastic gown and head covering provided by the hospital.
Moran’s wife went first. “I touched his head, his feet, his hands,” she recalled.
Mercedes Moran was surprised her father had been intubated. After all, he had walked to the ambulance twodays earlier. He wore a hospital gown under a blanket that was pulled to his neck. She stroked his face. His eyes were shut. She snapped a final photo with her phone.
“‘Papi, wake up. Let’s go home,'” she told his lifeless body. “I was in shock. He had to be sleeping. I kept telling him to get up.”
Daniel Moran went next. He was obese, and the gown didn’t completely cover his body, according to his sister. He later told her he had prayed and held their father’s hand.
At the visit’s end, hospital staff instructed them to shower once they got home. A week later, all five family members would test positive for coronavirus, according to Mercedes Moran and her mother.
Daniel didn’t feel sick untiltwo or threedays after that hospital visit — shortness of breath, fever, headaches. He had stopped going to his job at a Kentucky Fried Chicken when his father first became ill. His sister took him to a doctor. A chest x-ray revealed pneumonia, she said. He also tested positive for coronavirus. Daniel vowed to recover at home. He reminded her the pandemic had hit nonwhite Americans especially hard.
“He didn’t want to end up intubated like our father,” Mercedes Moran said. “He said, ‘Most of the dead are Hispanics and African Americans. I don’t want to die far from you.'”
On the afternoon of April 24, his condition worsened. His mother, sister and another relative helped him to the car for the short drive to the hospital. On the way, Daniel struggled to breathe.
“He was dying in the car,” his mother recalled.
They stopped outside a local firehouse. When an ambulance arrived, Daniel climbed onto it himself, his mother and sister said. He fell face first — unconscious — onto the floor of the ambulance.
“My grandson was screaming, ‘Please, help us!'” Reina Garay said. “By the time they turned him around, my son had already turned blue. His arm dropped to his side. He was dead.”
At the hospital, where he was pronounced dead,family members were asked whether they wanted time alone with Daniel. Mercedes Moran declined, saying they had been with him when he died.
“I didn’t want to put my mother at risk,” she said. “We only have each other now.”
Father and son are buried in the same grave
Most infectious agents do not survive long in the human body after death, according to the World Health Organization.
But much about the novel coronavirus is still unknown.
“In our hospital, we’re very careful in the handling of people who have died from Covid to ensure there is minimal contact, especially contact without PPE,” Pierre said.
Dr. Krutika Kuppalli, an infectious diseases physician and fellow at the Johns Hopkins Center for Health Security, and other specialists said it’s unlikely the son became ill from touching his father’s body. He was more likely to be infected at work or at home or visiting a grocery store, they said.
Many hospitals have had PPE shortages. Some heath care systems limit end-of-life visits to one person. Others require face shields or goggles. Ideally gowns shouldn’t be shared, experts say.
“Nothing is ever foolproof,” Pierre said.
Saskia Popescu, a hospital epidemiologist and infection prevention expert with George Mason University, said most hospitals visitors are not properly trained to use PPE because there are so many other priorities.
“It’s very challenging right now,” she said. “We’re very stressed in health care. Whether it’s supplies or staffing or very critically ill patients. So then to really have to keep an eye on a family to make sure they’re trained and educated and being safe is one extra layer.”
Postmortem hospital visits have been uncommon during the pandemic, Popescu said.
“When they’re in the room is where I have seen that cross contamination happen,” she said of hospital visitors.
In the early afternoon of May 2, Miguel and Daniel Moran were buried in the same grave at Amityville Cemetery. A procession of cars, pickups and the hearses with their caskets drove by the Pentecostal church where they worshiped.
“Papi and Daniel are now saying goodbye to the church that brought them so much happiness,” Mercedes Moran cried in a video posted to social media.
“And they brought us so much happiness,” she said later.