I saw the news of young nurses (those who graduated well after 2000) impacted by the storm of COVID-19 patients. They never knew what it was like not to have Universal Precautions as part of daily ‘norms’ at work. They’re scared and angry, and that is so very understandable. In normal times, all of this would be absolutely unthinkable. But these are not normal times. This is a global situation that was not fully appreciated until it hit US. Many warnings had been issued over the last several decades. Mistakes were made. In the US, we tend to think that we’re immune to things that happen in other parts of the world. While 9/11 erased a bit of that, it has never hit us in a medical battle like this, for the vast majority of people alive now. Viruses don’t care about what country they’re in. Every country on the planet is trying to get equipment, from PPE (gloves, gowns, masks, face shields, etc) to ventilators. EVERY. COUNTRY. There is little in the way of inventory to purchase. Add that the US government is outbidding states’ governors, and it’s a total cluster. I’ve been an RN for 35 years, though have been disabled for many years now. I have the ‘luxury’ of watching this, but wish so much that I could be there helping. It goes against everything in me to not be of use during this time. So, I write. It’s all I have to offer. My mom’s grandma died in the Spanish Flu of 1918. Pandemics influenced my family in how my mom’s mom did NOT cope with the death of her mom. Her father died a year later. She stayed broken. She raised kids as a broken mom. None of this is “just” the current situation… there will be collateral damage. But we have to protect the caretakers AS BEST WE CAN with what PPE is available. Now.
Time speeds up as you get older, so this may sound like ages ago, but it’s really not. In the mid-80s, AIDS was still relatively new, not well understood, and another cause of fear and much discrimination. It was different, as there were higher risk groups. COVID-19 just needs a breathing body. We didn’t have Universal Precautions until 1987. There was typically one box of gloves at the nurses’ station, and those were only for “Code Browns” (a poop situation beyond the ability of one person to deal with) or massive bleeding- and that was at the discretion of the nurse. This is when I started nursing. It’s just how things were. We did have isolation carts for AIDS patients, with gowns and gloves. Masks were only used for suctioning, and face shields weren’t even imagined. I don’t remember ever having protective eyewear. We gave IM and IV meds with syringes that had needles. Not everybody had an IV pump… and Dial-a-Flows were rationed. We were expected to be careful. We also had up to 14 patients on an acute neurological/neurosurgical floor on the night shift PER NURSE. It wasn’t until 1996 that Universal Precautions became “standard precautions”, and were considered part of basic care. I taught infection control at a nursing home in the mid-90s. Back then menstrual blood wasn’t considered a risk, and the guidelines were “if it has not saturated the pad to the point of dripping, it can be disposed of in regular trash cans”, which stunned me back then. Now, I can’t imagine putting any sort of blood in the regular trash. Things change.
Governors are doing all they can to get enough PPE, but when it will arrive isn’t set in stone, especially with the “eBay” manner in which they are having to purchase supplies. The feds aren’t looking out for anybody on the frontlines. So it’s time for ingenuity and remembering that these are not normal situations. Normal rules are out the window in a crisis. This is more like M*A*S*H than 2020 hospitals. Mentality has to adjust. Some conservation now may mean even more critical availability later.
It troubles me a lot that so many people who are dealing with this crisis are going to develop (if they haven’t already) PTSD. The repeated stress and life-altering/life-threatening situations does something to a person. Please reach out to someone when (not if) you are overwhelmed. Remember that this will not last forever. The overall percentage of people in the US who have this now is still statistically insignificant (a bit over 331,000 positive cases right now… with a population of 330M in the US, that is %0.001). The folks who have this are not in any way insignificant, nor is their suffering or the loss felt by the family, friends, and coworkers of those who die from COVID-19… but from a pure numbers standpoint many, many more people are OK. With that same 331,000, 9441 have died- that’s %0.03 of those who are positive. That’s 33 times less than %1. Just of those who are positive. The death rate is %0.0000000003 of the total population. I know you’re still swamped and getting slammed. But feeling like ‘everybody’ is sick can be another stressor. For those in hotspots right now, I realize that how it feels is what is hard, because it seems so non-stop. It will get better. Not today and not this week, or maybe not even this month… but it will get better. We will know a time when this isn’t all over the news anymore. And hopefully, we’re better for it. This can’t happen in vain.
So, nurses who haven’t known a time without standard precautions, hang in there. Bring your ideas to your managers about how to conserve PPE. When all of the patients are positive for COVID-19, how many times do you need to change gowns? I know reusing some things sounds absolutely counter-intuitive. I’ve seen some creative things on the news from the nurses in the thick of things. You can change how this goes with your ideas. Hoping for more PPE is fine- just don’t expect it on a timetable that is “normal”. Nothing about this is normal. Including what you have to do as a nurse or other caretaker.
Would I want to work with less PPE? Absolutely not. But there IS no bounty of PPE now- it’s all rationed, when it’s available. And it’s because every corner of the country is going to see this virus hit close to home. The hotspots need things now. Until it gets there, what else can you use? How can you change the policies for a catastrophic influx of patients? How do you stay safe?