Shannon Damo has been at the bedside of patients in distress at the most critical moments when they are unable to breathe.

The 40-year-old respiratory therapist at Kapiolani Medical Center for Women & Children is responsible for keeping ailing patients alive, at times manually pumping air into their lungs with a bag and managing breathing tubes and ventilators that have been a critical tool in saving COVID-19 patients.

Damo has been among the most exposed health care workers during the nearly year-old coronavirus pandemic. She is among 50 respiratory therapists at the hospital who have been working under increasingly dangerous circumstances, which they are trying to change as they negotiate their first union contract.

“They’ve been cutting us to a bare minimum. We’re working with a skeleton crew. It’s almost borderline unsafe. We work in all areas of the hospital just like a nurse, but there are not as many of us,” she said, adding that the hospital has reduced staffing for respiratory therapists to about six from the typical eight to 10 per 12-hour shift, “which is scary.” “(Respiratory therapist) is one of the most susceptible occupations to catching COVID because COVID is a respiratory virus.”

Damo has treated dozens of coronavirus patients over the past year, often worrying that she will bring the virus home to her two young children, ages 7 and 8.

“We live together. I take care of them,” she said. “It’s not like I can isolate myself from my kids. God forbid they catch it.”

The Hawaii Nurses Association, which expects to ratify a new contract soon for Kapiolani nurses who voted to authorize a strike, is still trying to bargain with the hospital for the smaller group of respiratory therapists who mostly go unnoticed. Another major concern for workers is the reuse of N95 masks, which are cleaned and disinfected and reused for at least five shifts.

“Any suggestion that our PPE practices are unsafe is misleading. Our practice to disinfect and reuse N95 masks complies with CDC and manufacturer guidelines, and we know it is effective because we haven’t had any Kapiolani employees test positive for COVID-19 due to an exposure from a patient when these practices have been followed,” said Kristen Bonilla, spokeswoman for parent company Hawaii Pacific Health. “Staffing for respiratory therapists is based on patient volumes, which can fluctuate.”

The group has been in collective bargaining for about a year and a half but has so far been unable to reach a contract. Negotiations were put on hold for four months due to COVID-19.

“They are around the higher-risk activities, more than any other job description,” said Daniel Ross, president of the Hawaii Nurses Association. The group organized about two years ago, but first-time contracts are “notoriously difficult to negotiate, and they tend to take longer.”

On Thursday, Hawaii health officials reported three new coronavirus- related deaths on Oahu — two men, one in his 60s, the other in his 80s, and a woman in her 90s, all with underlying medical conditions — and 119 new infections, bringing the state’s totals since the start of the pandemic to 328 fatalities and 24,739 cases.