In February, Jennie Castillo was completing her required clinical hours at the University of California Davis Medical Center to become a respiratory therapist when she came in contact with a patient who tested positive for the coronavirus soon after.
The patient, who hadn't interacted with someone with a known case of coronavirus or recently traveled to a foreign country, became the first known person in the U.S. to have potentially caught it through community contact.
The revelation was a sign the virus was spreading on American soil. But for Castillo, it meant she had to pause her clinical work and self-quarantine for 14 days to ensure she hadn't contracted the virus from the patient. She became restless over the two weeks, knowing she was falling behind in her clinical hours.
When she emerged from self-isolation, the world was different. Colleges were pulling students from clinical placements and moving instruction online.
The U.S. now has more confirmed COVID-19 cases than any other country, making it the new epicenter of the pandemic and putting the nation's healthcare system under immense strain as it struggles to treat the influx of patients.
The situation also made Castillo part of a legion of community college students in healthcare fields who've had their education placed on hold or significantly changed. In many cases, their programs require a specific number of clinical hours that students can't or are struggling to get because colleges and healthcare facilities have shut down their programs to help prevent the virus from spreading to more people.
Yet these tend to be the very workers needed to combat the pandemic. Respiratory therapists routinely operate ventilators and can come into closer contact with COVID-19 patients than doctors and nurses do. Their expertise will be critical for the scores of hospitals rerouting healthcare workers to the frontlines who have little experience operating such equipment.
Students studying respiratory therapy have company. Community colleges are struggling to help students fulfill clinical hours for other programs that produce workers needed to combat the virus, such as nurses and medical technicians, as well as those that aren't, like dental hygienists.
"I talked with other program directors about how (we are) going to fill their clinical hours," said Lisa Hunsaker Ilaga, who runs American River College's respiratory therapist program, where Castillo is enrolled, in an interview with Education Dive. "We can't stop their education."
Watching from the sidelines
For Castillo, respiratory care is personal. When her nephew was born premature and weighed less than 2 pounds, she watched as a respiratory therapist worked alongside the nurses and doctors to help him make it out of the neonatal intensive care unit.
"It's not a really talked-about profession," she said. "That (experience) had gotten me interested in it." A decade later, she expects to graduate from American River College's respiratory therapy program at the end of the calendar year.
Workers in the profession help patients who are struggling to breathe due to diseases such as asthma and pneumonia. Demand for respiratory therapists was projected to grow 21% in the decade ending in 2028, but their need has skyrocketed now that more than 2 million people worldwide have been confirmed to have contracted the virus.
In response, the Respiratory Care Board of California announced that hospitals can employ respiratory therapist students if they are supervised. American River's students perform clinical hours in the second year of their program.
The program's accreditor, Commission on Accreditation for Respiratory Care (CoARC), also notified schools earlier this month that students will be able to count this experience toward their clinical hours. All of American River's second-year students are interested in doing so, Hunsaker Ilaga said, adding that they would have a better chance of getting a job later if they were already working at a hospital.
Watching the pandemic unfold from the sidelines has been frustrating for some students. "It would have been a really great experience for us to learn and see how we can essentially help patients who are critically ill," said Olga Tkachev, a second-year student in the respiratory program who's applied to work as a respiratory therapist for California, in an interview with Education Dive.
In the meantime, CoARC is giving the program other freedoms on what counts as clinical hours so students can graduate on time. For American River, that includes having second-year students evaluate first-year students on how effectively they treated patients during mock scenarios, such as someone coming into the emergency room with shortness of breath.
"We've honestly just had to get very creative," Hunsaker Ilaga said.
Being the 'superheroes' of COVID-19
Students training to be on the frontlines aren't the only ones who have been impacted.
Medical laboratory technicians work behind the scenes to test patient samples for the coronavirus. Testing backlogs form when there are shortages of these workers, test kits or equipment they need to safely perform their job duties.
Diane Price Banks, the director of Bronx Community College's medical laboratory technician program, said her students must complete a 15-week internship at a lab to get licensed.
But many have had their placements canceled due to the pandemic, which has shut down much of the New York City metropolitan area as it attempts to control the spread of the virus. So far, more than 7,900 people in New York City have died of COVID-19 — more than any other jurisdiction in the U.S.
The job can be hazardous, Price Banks noted. Lab technicians are at risk of contracting the virus when they're handling infected samples. A shortage of personal protective equipment heightens the danger.
About half of the program's students have told Price Banks they are eager to get back to their internships if they get the opportunity. "They want to get in," she added. "They want to be the superheroes that they feel they are inside."
"They want to get in. They want to be the superheroes that they feel they are inside."
Diane Price Banks
Director, Bronx Community College's Medical Laboratory Technician program
Relaxed regulations may make it easier to do so. New York Gov. Andrew Cuomo announced in March that healthcare workers who aren't licensed as clinical lab technicians can perform coronavirus testing, so long as they "meet the federal requirements for high complexity testing."
Price Banks said her students could return to their internships if the facilities provide them with supervision and proper protective equipment. Students also must acknowledge in writing that they know the risks of COVID-19.
Some students are wary, however, either because they're worried about their own health and safety or that of their loved ones. Those students may have to make up clinical hours at a later date, potentially pushing back their graduation.
First-year students are also affected because much of their coursework has been moved online. Although lab simulations exist for some of the concepts they must learn, others can't be covered so easily, such as teaching students how to operate equipment used to detect heart diseases.
"This will greatly impact the students' grades and their ability to proceed through the program," Price Banks said.
Adjusting the timeline
Other community college programs are being held to their usual licensing requirements.
Sunny Anderson, director of Spokane Falls Community College's occupational therapy assistant program, said its accreditor hasn't budged on its standards. The program's second-year students must complete a 16-week clinical placement to get their licenses.
With Washington state under shelter-in-place orders, around three-fourths of the facilities where students work have sent them home, Anderson said. "They cannot actually do anything," she said, adding that students won't be able to take their board exams until they complete their program.
Anderson is determined to have students finish their clinical hours as soon as possible, even if it means moving them to the summer. "Our faculty, the academic fieldwork coordinator and myself don't get paid for the summer," she added. "But I will do anything in order to get these students graduated."
Theresa Grady, the director of the dental hygiene program at the Community College of Philadelphia, is in a similar situation. Although 28 students were expected to complete their clinical hours at the college's on-site facility, they can't do so because it is shut down.
Because those students finish their programs in the summer — not the spring — they hadn't made as much headway finishing their clinical hours as others had before the coronavirus pandemic shuttered campuses.
However, Grady is confident the students will make up the time. "They're going to graduate, it just might not be on the timeline they were thinking."