When Jake, a respiratory therapist (RT), answers the phone, he is coughing. He explains that he caught COVID-19 from patients in his hospital. While he has mostly recovered, the cough is lingering.

“I spent five days in a hospital. I was sick for three weeks, and I’m still on a leave of absence because my lungs aren’t great,” says Jake. (All interviewees in this piece appear under pseudonyms, to enable them to speak openly about working conditions in hospitals.) “And now, with the wildfires, they’re really not great.”

Trained in cardiopulmonary medicine, RTs tend to any patient with breathing issues or lung problems. They say they are lower on the hospital hierarchy than doctors and nurses, pointing to lower pay and inadequate personal protective equipment (PPE) as evidence of this hierarchy. According to the Bureau of Labor Statistics, in 2019, median wage for RTs was $61,330; for nurses, it was $73,300. Respiratory therapists held about 135,800 jobs in 2019, 82 percent of which are in hospitals (whereas registered nurses held about 3.1 million jobs, with 60 percent employed in hospitals). While some RTs are unionized, many are not — leaving them without worker-led bodies to bargain over issues like pay and PPE, much less safety protocols and staffing ratios, or to raise public awareness about their working conditions.

But when the COVID pandemic hit, their work briefly gained prominence. My dad is an RT (though I didn’t interview him for this article), and suddenly, he was on the front lines of responding to the respiratory illness. For a few crucial weeks, headlines covered politicians battling over ventilator production: Did the United States have enough? Where would we get more? Would the president order an increase in their production? It’s RTs who operate ventilators, putting in years of school and on-the-job experience to know “how much air you need, when you need it, and everything in between,” as one RT tells me.

Yet RTs say working conditions were, and remain, dire. They describe inadequate PPE, uneven protocols, impossible directives, and a lack of respect, or even understanding, from hospital management.

“We’re still surviving off scraps,” says Lisa, another RT. At first, RTs in her hospital were told to use a different mask for each patient. Given that they can have ten to twenty patients per shift, that meant ten to twenty N95 masks. Over time, however, standards were lowered.

“From there it became: you have one mask for everyone for the day, so just try to keep it clean,” she says. “Then it was one mask a week. Then we ran out of our highest-standard masks, so it became ‘here’s this new mask, which doesn’t fit some people’s faces, but we’re going to make do with it.’”

The new masks are reprocessed several times, and management at her hospital has told RTs that they are good for six weeks, or three rounds of reprocessing. But several RTs say that sometimes the new masks’ straps break before those six weeks are up, leaving them abruptly without a mask while in a COVID patient’s room.

“There’s a lot of fear, and a lot of anger and frustration,” says Lisa of the lax protections and inadequate PPE. While higher-grade PPE exists, she says it’s often reserved for doctors and nurses, leaving RTs to fend for themselves.

“Management has a lot of faith in the protective gear; among RTs, not so much,” says Alex, another RT. He says that while RTs in his hospital were told protocols had changed to limit the number of health-care workers in a COVID patient’s room, some doctors and nurses aren’t even aware of the change, making for uneven implementation. Other RTs echo this confusion over at-times-unworkable protocols, suggesting that the people determining the protocols aren’t involved in bedside care.

“RTs are the stepchild of the hospital: it’s a struggle to get funding for us, it’s hard to open new positions for us,” says Jake, who describes being issued gowns with packaging that reads “not for medical use.” “No one pays attention to RTs until they’re needed.”

As to whether their brief moment in the public eye might lead to pay increases or more protective equipment in the future, RTs aren’t holding their breath.

“The people who are supposed to advocate for us, and represent us — the NBRC (National Board for Respiratory Care), for example — let us down,” says Lisa. Given the dearth of unions in the field, bodies like the NBRC are RTs’ only advocates.

“Look,” says Jake when asked what he’d tell the NBRC, who he characterizes as having projected a message that RTs would make do with what PPE they had during the pandemic. “I appreciate your confidence in me but also, I’d appreciate a mask.” He coughs again.