EMPOWERING. UNITING. ADVANCING All Nurses | PANDEMIC THE COVID-19 Crisis

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EMPOWERING. UNITING. ADVANCING. Spring 2020 allnurses.com PANDEMIC THE COVID-19 CRISISMembership has its privileges • FREE registration • FREE support • FREE magazine alerts for new issu... es • FREE content alerts • Networking • Job Search • Anonymous posting (real name optional) allnurses.com is all about anonymity. Anonymity allows nurses to share insights, to post questions freely without fear of losing their job, and to learn and gain from other’s experiences. Tap NOW to Become a Member Become a member today for FREE!Spring 2020 allnurses 3 Multiple Locations. One Mission. Live Your Best Life. Hundreds of Career Opportunities Tap Photos to Find Your New Career.4 Spring 2020 allnurses Dave Smits C.E.O. EMPOWERING. UNITING. ADVANCING. EDITORS / CONTRIBUTING WRITERS Mary Watts, BSN, RN Natalia Dabrowska, MSN-CNL, RN Dr. Kristi Miller, PhD Kathy Day, RN Brian Sorenson allnurses is published quarterly by allnurses.com, Inc., 7900 International Dr., Suite 300, Bloomington, MN 55425 All rights reserved. Reproduction in whole or part without written permission of the publisher is prohibited. The opinions of contributing writers to this publication do not necessarily reflect the views of allnurses.com, Inc. Copyright © 2020 by allnurses.com. All rights reserved. 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CHECK GRAMMAR, PUNCTUATION, AND SPELLING PRIOR TO SUBMISSION.Contents 36 Warm Weather Will Slow the Virus and Other Bad Advice By Dr. Kristi Miller The COVID-19 Battle Cry for Retired Nurses By Kathy Day, RN Shelter in Place, Stay at Home... What Does it Mean? A COVID-19 Dilemma: Where are all the PPEs? By Mary Watts, BSN, RN The Real War Against COVID-19 in America By Natalia Dabrowska, MSN-CNL, RN The Origins of COVID-19 46 7 16 10 326 Spring 2020 allnurses The COVID-19 pandemic is and likely will be the top story for not only nurses and medical professionals but the population as a whole for the forseeable future. With a pandemic like the one currently ravaging the globe, there are stories fron the front lines which need to be heard. Nurses treating patients in hallways, waiting rooms, and tents is now a common occurrence. Shortages of once commonplace equipment as seemingly basic as N95 masks have seen the concerned citizens of America take to their sewing machines to make masks for nurses, doctors, and other medical profesionals. The exponential growth in COVID-19 cases in “hot zones” in the states of New York, California, Washington, Louisiana, and Florida We welcome your story ideas. Reach us at magazine@allnurses.com Editor’s Note Contact us shows that the work of nurses in these and other locations is likely just beginning. Even more startling is how the COVID-19 pandemic is playing out in Italy, France, Spain, and other European countries. While phrases such as social distancing, shelter in place, and flattening the curve are becoming commonplace in conversations being heard across the country and around the globe, talk only goes so far. With all of that having been said, this issue of allnurses Magazine is all about what seems to be the only issue in the nursing universe today – COVID-19. We have insight and stories from all corners of the country. Data on the pandemic both in the United States and around the globe. Now, more than ever, we want to extend a huge THANK YOU to nurses both here and abroad. Stay safe and stay healthy. Connect allnursesrock allnursescom allnurses @allnurses @allnurses allnurses Brian Sorenson Editor, allnurses MagazineSpring 2020 allnurses 7 It started in California with Governor Gavin Newsom ordeering residents to “shelter in place”. New York Governor Andrew Cuomo quickly followed suit by requiring residents to stay indoors except for essential trips and services. Since those two orders came down, 16 states and a number of cities have announced stay-at-home orders. But what is the difference between “stay at home” and “shelter in place”? Here’s what we’ve been able to learn so far. Essentially, sheltering in place means staying at home, the order from San Francisco’s Department of Public Health says. “Widespread testing for COVID-19 is not yet available but is expected to increase in the coming days,” the mandate from San Francisco’s Department of Health says. “This order is necessary to slow the rate of spread.” “‘Shelter in place’ is a scary term for people,” New York Governor Andrew Cuomo said during a news conference on Thursday. “I believe communication is important, and I believe words are important. Say what you mean and don’t say what might alarm people.” What does a shelter-in-place order prohibit? In the San Francisco Bay Area, the mandate prohibits going outside, with certain exceptions for different groups of people. Vulnerable people, which include the elderly, minors and people with disabilities, should not go out at all, according to the order. Anyone who is at risk of severe illness from COVID-19 is also urged to stay inside. Who is exempt from a shelter-in-place order? People can leave their house for “essential activities,” which include getting medical supplies, going to the doctor or getting supplies needed to adequately work from home. They can also go out to get groceries. People can also go out to run, walk or hike as long Shelter in Place, Stay at Home What it means, where it’s happening, and how it can help8 Spring 2020 allnurses as they maintain the requirements of social distancing and stay at least six feet away from other individuals. Those whose work is considered “essential” are also permitted to leave the house to continue their work. Essential businesses include health care facilities, grocery stores and other food markets, banks, media services, hardware stores, laundromats and delivery services, among others. Where are these orders in effect? As of this writing, sixteen states including Washington, New Mexico, Hawaii, Wisconsin, West Virginia, Michigan, Indiana, New Jersey, Oregon, Illinois, New York, Connecticut, California, Louisiana, Ohio and Delaware have announce statewide stay-at-home orders. Non-essential businesses in Nevada, Maryland, Pennsylvania, Kentucky and Massachusetts have been ordered to close but these states have stopped short of issuing stay-at-home orders. A number of cities including Atlanta, Philadelphis, New Orleans, Kansas City and St. Louis have also issued stay-at-home orders. How does it help? While data is still in the very early stages, the San Francisco area has seem a leveling off of identified cases of COVID-19. Officials are hoping that these orders – while they vary in inclusiveness – serve to stem the tide of COVID-19 infections and, in turn, prevent a wave of individuals who require hospitalization. In short, staying at home or sheltering in place leads to another current phrase – flattening the curve. Are these measures helping? Possibly. The charts below show a comparison between New York and California. Judge for yourself. via https://www.sfchronicle.com/health/article/NY-has-10-times-the-coronavirus-cases-CA-has-Why-15154692.php Virus’ explosive growth in New York Case totals as of 6 PM Tuesday, March 24 Coronavirus cases have surged in New York compared with California. Early California public health responses, including shelter-in-place orders, may be one reason. New York has also tested for more people than California.Spring 2020 allnurses 9 ONLINE RN TO BSN Open doors. Expand your career. LEARN MORE10 Spring 2020 allnurses The Real War Against COVID-19 in America By Natalia Dabrowska, MSN-CNL, RNSpring 2020 allnurses 1112 Spring 2020 allnurses Change for the Future In all the craziness in the midst of COVID-19, it is easy to only focus on the present, but we cannot forget to elicit change for the future as well. If we don’t do it now, it may never be done. No more pushing it off or putting it on the back burner with, “Well this is how it’s always been.” That clearly does not work. Shortages of Staff and Equipment I am currently working across three different hospitals navigating this pandemic. Like everywhere else in the country, there is a shortage of masks, equipment, PPE, possibly ventilators and beds. There is also already a shortage of nurses and staff on a GOOD day, without these huge spikes of hospitalizations flooding in. Well here’s some news that nurses have always known: There is not actually a shortage of nurses—There is a shortage of nurses willing to work UNDER THESE CONDITIONS. Case and point: While we are being called to the front lines without proper gear, being rationed protective equipment, we ourselves are not being rationed. For instance, my main job is as a pediatric pulmonary nurse coordinator. I have two other nurses who share this same role with me. Usually one of us is in the office, one of us is with patients, and the third may work on the Cystic Fibrosis registry and research. In an effort to reduce exposure to patients, we cancelled all non-urgent appointSpring 2020 allnurses 13 ments, testing, research, etc. This put all THREE of us coordinators in the office the same day. One of our doctors was fuming. She said each of our chances of contracting COVID-19 is OVER 50% and if one falls down we ALL fall down. Still, administration and management did not budge. They continue to lead “updates” via zoom meetings, where they sit on camera in sweatshirts from the comfort of their own homes while we put ourselves at risk. A Time for Change This is the first sign that it is time for change. There is no room in healthcare for people who choose to sit at home rather than jump into the trenches when patients and entire communities need us. The reason our Healthcare System so often fails us is because there is NO room for it to be business-driven and for-profit for a small group of individuals ready to cash it all in. Why Weren’t We Ready? THAT is why we were not ready for something like this. We should have been ready. There is no excuse. Yet we weren’t because we have non-medical people making decisions along with medical people who somehow never even put hands on a patient. These are the people we let run the show and it is shown time and time again that this FAILS. We are one of the most developed first world countries on this planet and we continue to have one of the worst healthcare systems. We have high rates of maternal mortality, infant death, and others. There is NO excuse for this. We work shortstaffed or with unsafe assignments while “higher up” people don’t care. What they care about is apologizing to the patient who had a meltdown because the cafeteria put orange juice on their lunch tray instead of apple juice by mistake. They don’t support the patient’s nurse who gets blamed for this even though she kept a very sick patient alive that day while juggling 5 others for 12 or 16 hours. It is too often a thankless job. And yet, the nurse who does this day in and day out is the one who does NOT get listened to about making changes and improving workflow, patient care, and safety. Who Cares About Employees’ Health? We give all of ourselves for a system that does not even realize it would collapse without us. This is even better shown with this example during this pandemic: One of our CRNA’s worked side-byside a doctor during a five-hour surgery. This “We should have been ready. There is no excuse.”doctor later became symptomatic and tested positive for COVID-19. The hospital told the CRNA that he was exposed but could not get tested and that he should self-monitor—but come to work still. This group of CRNA’s later bought their own respirators because the hospital could not provide them with enough. Instead of applauding this, the hospital told them they cannot wear them because IT MIGHT MAKE PATIENTS AND VISITORS NERVOUS. So, who cares about our employees’ health as long as we minimize any concern for everyone else (who is in even more danger if our exposed employees are walking around unprotected)? We are at war during this time with COVID-19. We are at war and we are not properly equipping our soldiers. We are at war and our generals are sitting at home hoping that not all of us fall while fighting their battle for them. We are at war and having to sacrifice ourselves. Make no mistake- medicine is built off of the sacrifices of our soldiers. We give up bathroom breaks, lunch breaks, holidays with families, weekends, sleep, and more. We even risk ourselves when we know we shouldn’t. I once ripped my gloves off at a micro-preemie delivery when it was believed mom had an unknown infection. We had finally gotten the tiny endotracheal tube in the right spot, about 6cm at the lip, and I had to tape it in place, with what you can imagine was a tiny, tiny piece of tape. This is always a rush to ensure we do not lose the tube and get the baby stable as soon as possible. The tape kept sticking my gloves and I couldn’t peel it off, so I finally ripped off the gloves and thereby exposed myself to this baby covered in maternal fluid. I did this and do things like this, because we all do at some point in our careers, because in this game of life and death we try to win at life as much as possible. We do this because when we have a really hard shift or a death, part of what heals us is being able to look back on the situation and say, “I did everything I could have possibly done. I gave it my all. We all did our best.” My fear is that we may not be able to say this when we look back at COVID-19. We are already at a loss and drowning. We don’t have the equipment to do our best and we may get knocked out in the process. So we while we continue to try the best we can with what we have, we cannot forget that when this war “We are already at a loss and drowning”Spring 2020 allnurses 15 is over, our war on the healthcare system is just beginning. Enough is Enough We have to continue to come together and rise. We finally have to say enough is enough and not back down anymore. We have to storm the streets and government buildings the way we are storming the hospitals to fight this thing. We have to demand safe staffing ratios. We have to demand appropriate compensation. We have to demand a complete reform of the structure. We have to demand putting selfless, medically competent people in charge to pioneer our hospitals—those who come into the trenches with us when we need leadership and all hands on deck. We need to make our healthcare system something better than using drowning nurses as pillars and Press Ganey scores as the entire foundation while our “leaders” sit on top in the ivory tower. Now More Than Ever The time is now. No, actually, the time was yesterday, was years ago, but the next best time is now. We owe it to ourselves and we owe it to our patients. We owe it to our communities and to all those who will be joining this humbling workforce after us. These burdens we have been carrying on our backs can be eased with a paradigm shift. It is time to rebuild. This war may be our hardest and most challenging one yet, but it is the most necessary, now more than ever. Have something to say? Click here to comment!16 Spring 2020 allnurses A COVID-19 Dilemma: Where are all the PPEs? By Mary Watts, BSN, RNSpring 2020 allnurses 17 The deadly Coronavirus Pandemic has evolved into a much faster-growing monster than anticipated by many, infecting more than anyone could imagine. Hospitals are filling up with Coronavirus patients. ICU beds and ventilators are in short supply. As frightening as the virus is, the doctors and nurses on the front line of care are worried more about the lack of adequate personal protective equipment including N95 masks, surgical gowns, gloves, and eye gear. Without the proper protection, doctors and nurses are risking their lives daily as well as endangering their patients and their families as they care for those infected with the virus. Several healthcare professionals have already been infected; some have even succumbed to the disease. Recommended Protective Equipment The Centers for Disease Control and Prevention recommends health care workers should wear protective gowns, gloves, goggles and masks while treating potential and confirmed cases of Covid-19 to avoid exposure. But, to add to the frustration of doctors and nurses, there has been some disagreement over which masks are needed. Previously, the CDC advised this use of tight-fitting respirators like the N95 or powered air-purifying respirators (PAPRs) which cover the entire head. In early March, the CDC updated its recommendation by saying that regular surgical masks are an acceptable option when examining or treating a coronavirus patient. More than likely, this change was based primarily on the “mask shortage” rather Eye Protection Goggles or face shield Respirator or medical mask N95 respirator, if available Gown Closed securely at the back Gloves Pulled up over gown sleeves Current CDC recommendations for healthcare workers “N95 masks are being reused indefinitely. Since I worked PACU I hadn’t been sized, so I was given a one size fits all mask. We aren’t sanitizing them. The plan is to throw them in a paper bag, and put them somewhere safe so we can use them again during the next shift.”18 Spring 2020 allnurses than on healthcare professional and patient safety. Due to the shortage, many hospitals are requiring their staff to reuse their masks, whether it be surgical masks or N95 respirators many times, sometimes for up to 30 days, unless they become soiled. Homemade Masks?? The CDC also stated the following: “In settings where facemasks are not available, HCP might use homemade masks (e.g., bandana, scarf) for care of patients with COVID-19 as a last resort. However, homemade masks are not considered PPE, since their capability to protect HCP is unknown. Caution should be exercised when considering this option. Homemade masks should ideally be used in combination with a face shield that covers the entire front (that extends to the chin or below) and sides of the face.” [via] As a result of this statement, mask-making groups popped up all over the country, trying to do whey they could to help protect the healthcare providers. So what’s all the fuss about? Isn’t a mask a mask? The FDA website offers a comparison of N95 respirators and surgical masks, both of which are examples of PPEs that are used to protect the wearer from airborne particles and from liquid contaminating the face. Surgical masks • Loose-fitting; does not provide complete protection • Help block large-particle droplets, splashes, sprays, or splatter that may contain viruses and bacteria • Does not filter or block very small particles in the air that may be transmitted by coughs, sneezes, or certain medical procedures (COVID-19 is a small-particle) • Not intended to be used more than once. N95 Respirators • A respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles • Blocks at least 95 percent of very small (0.3 micron) test particles • The filtration capabilities of N95 respirators exceed those of surgical masks • Not intended for public use • Not intended to be reused From the lists, you can see that nurses and doctors should be using a tightly fitted N95 respirator designed to keep out more particles. “I feel like our government thinks this is adequate protection for us. And nothing will change until we die. And I don’t want to be one of the deaths.” “While I understand people’s wants and desires to help, I do not feel that these are acceptable alternatives. We might as well go in with no masks. I’d personally rather use my N95 for a week straight than a mask that offers virtually no protection.” “This shines a light on how the public truly has no understanding of virus transmission and how our medical protective gear works. What scares me is that the government feels these are going to be acceptable for us and that Americans are answering the need for our healthcare workers, when they are not.”Spring 2020 allnurses 19 Centers for Disease Control and Prevention National Institute for Occupational Safety and Health Surgical Mask N95 Respirator Testing and Approval Cleared by the U.S. Food and Drug Administration (FDA) Evaluated, tested, and approved by NIOSH as per the requirements in 42 CFR Part 84 Intended Use and Purpose Fluid resistant and provides the wearer protection against large droplets, splashes, or sprays of bodily or other hazardous fluids. Protects the patient from the wearer’s respiratory emissions. Reduces wearer’s exposure to particles including small particle aerosols and large droplets (only non-oil aerosols). Face Seal Fit Loose-fitting Tight-fitting Fit Testing Requirement No Yes User Seal Check Requirement No Yes. Required each time the respirator is donned (put on) Filtration Does NOT provide the wearer with a reliable level of protection from inhaling smaller airborne particles and is not considered respiratory protection Filters out at least 95% of airborne particles including large and small particles Leakage Leakage occurs around the edge of the mask when user inhales When properly fitted and donned, minimal leakage occurs around edges of the respirator when user inhales Use Limitations Disposable. Discard after each patient encounter. Ideally should be discarded after each patient encounter and after aerosolgenerating procedures. It should also be discarded when it becomes damaged or deformed; no longer forms an effective seal to the face; becomes wet or visibly dirty; breathing becomes difficult; or if it becomes contaminated with blood, respiratory or nasal secretions, or other bodily fluids from patients. Understanding the Difference ! WARNING Lorem ipsum dolor sit amet, consectetur adipiscing elit. Nullam scelerisque leo et eros convallis condimentum. Phasellus tincidunt, volutpat vitae.20 Spring 2020 allnurses What’s Being Done to Get More Masks and Other Equipment? Project Airbridge A planeload of health care supplies arrived in New York City on Sunday, March 29, from China. This is part of an effort the White House says will expedite the arrival of goods that are badly needed to fight the coronavirus pandemic. According to a White House statement, the shipment included 130,000 N95 masks, nearly 1.8 million other face masks and gowns, more than 10.3 million gloves and more than 70,000 thermometers. This is the first of about 20 flights through early April for a public-private partnership it’s calling Project Airbridge. Thank You Hopefully, all healthcare professionals and frontline responders will receive what they need to provide protection for themselves, their patients, and their families while continuing this battle against a deadly Coronavirus. Until then, nurses will continue to show up and provide compassionate care...because that’s what nurses do. They are indeed heroes, and for that we thank you! Your service and dedication does not go unnoticed. If you want to share your story, please go to allnurses.com. We have a special COVID-19 Disaster forum where you can safely and anonymously talk with other nurses. References https://www.nytimes.com/interactive/2020/03/11/us/virus-health-workers.html https://www.cdc.gov/coronavirus/2019-ncov/hcp/ppe-strategy/face-masks.html https://www.fda.gov/medical-devices/personal-protective-equipment-infection-control/n95-respirators-and-surgical-masks-face-masks https://www.npr.org/sections/coronavirus-live-updates/2020/03/29/823543513/project-airbridge-to-expeditearrival-of-needed-supplies-white-house-saysSpring 2020 allnurses 21 EASIER YOUR JOB HUNT JUST GOT Nurses are more in-demand than ever before and finding your new nursing career is easier than ever. allnurses Jobs has been rebuilt from the ground up and is easier to use than ever before. Don’t wait. Get started today! Search Smarter22 Spring 2020 allnurses January 31 Suspension of Entry as Immigrants and Nonimmigrants of Persons who Pose a Risk of Transmitting 2019 Novel Coronavirus COVID-19 cases in United States: 6 February 29 Suspension of Entry as Immigrants and Nonimmigrants of Certain Additional Persons Who Pose a Risk of Transmitting Coronavirus COVID-19 cases in United States: 60 March 1 Vice President Pence and Secretary Azar Add Key Administration Officials to the Coronavirus Task Force COVID-19 cases in United States: 65 March 6 President Trump at Signing of the Coronavirus Preparedness and Response Supplemental Appropriations Act COVID-19 cases in United States: 289 March 11 White House Coronavirus Task Force Announces Community Mitigation Strategies For Seattle, Santa Clara; President Trump addresses nation COVID-19 cases in United States: 1,248 The COVID-19 Response from the White HouseSpring 2020 allnurses 23 March 13 “The entry into the United States of all aliens who were physically present within the United Kingdom during the 14-day period preceding their entry or attempted entry into the United States is hereby suspended and limited” Source: WhiteHouse.gov / worldometers.info March 13 National Emergency Concerning the Novel Coronavirus Disease (COVID-19) Outbreak COVID-19 cases in United States: 2,157 March 16 Call to Action to the Tech Community on New Machine Readable COVID-19 Dataset “15 Days to Slow the Spread” COVID-19 cases in United States: 4,503 March 20 Cooperative action taken with Canada and Mexico to close borders in an effort to slow the spread of COVID-19; approval of New York disaster declaration COVID-19 cases in United States: 25,500 March 22 Presidential approval of Washington state disaster declaration March 29 Presidential approval of disaster declarations in five states COVID-19 cases in United States: 43,800 COVID-19 cases in United States: 142,46024 Spring 2020 allnurses COVID-19 by the numbers With science there are inevitably numbers. With the COVID-19 pandemic, the numbers are everywhere. What can be learned from the numbers, though? At their core, the infection rates seen in Italy and Spain are staggering. What would those numbers look like is the United States experienced the same rate of infection? What is the maximum rate of infection that the United States could experience before the healthcare system experiences a complete breakdown? How many ventilators are there in the United States? How many ICU beds are there in the United States? While those questions may seem overwhelming, let’s attempt to get some answers.Spring 2020 allnurses 2526 Spring 2020 allnurses December 31 Chinese Health officials inform the WHO about a cluster of 41 patients with a mysterious pneumonia. Most are connected to Huanan Seafood Wholesale Market. January 1 Huanan Seafood Wholesale Market closes. January 7 Chinese authorities identify a new type of coronavirus (called novel coronavirus or nCoV). January 11 China records its first death January 13 First coronavirus case outside of China is reported in Thailand. January 20 First US case is reported: a 35-year-old man in Snohomish County, Washington. Jan 23 Wuh plac quar Hub prov follo days The numbers are staggering. What began was identified in 41 patients in the city of Wuhan as a mysterious pneumonia on December 31, 2019 has become a global pandemic. The spread, though, didn’t happen overnight. It took 14 days before the first case outside of China was identified – this time in Thailand. A full 21 days after the initial December 31 report, the first case of what was then billed as Wuhan Coronavirus or Novel Coronavirus was identified in the United States. A single case in Washington state on January 30, 2020. Three days later, on January 23, the chinese city of Wuhan is placed under quarantine and the province of Hubei follows suit days later. As of this writing on April 22, 2020 the United States has identified over 840,000 COVID-19 cases – a virus which didn’t have that name until February 11. How did we arrive at this level of a global pandemic – a pandemic which has resulted in over 2,600,000 identified cases of COVID-19 and over 182,000 deaths from the virus? What is the outlook for COVID-19 around the globe and in the United States? Are American hospitals prepared for the onslaught of COVID-19 cases? COVID-19 epicenter in Italy Case totals as of 3 PM Wednesday, April 22 (statista.com) In Europe, the epicenter of the global COVID-19 pandemic has been in Italy where over 187,000 cases of the virus have been identified. The hardest hit region in Lombardy, in northern Italy. Lombardy has seen over 69,000 COVID-19 cases with over 12,740 deaths – a mortality rate of 18.4%. Lombardy region 69,092 cases 12,740 deaths 10,060,574 populationSpring 2020 allnurses 27 nuary 3 han is ced under rantine, bei vince ows within s. January 30 WHO declares a global public-health emergency. January 31 President Trump bans foreign nationals from entering the US if they were in China within the prior two weeks. February 2 First death outside China is recorded in the Philippines February 7 Chinese whistleblower Li Wenliang dies. February 9 Death toll in China surpasses that of the 2002-2003 SARS epidemic, with 811 deaths recorded. Hubei province 67,801 cases 3,186 deaths COVID-19 epicenter in China 57,237,740 population Case totals as of 2 PM Monday, March 30 While COVID-19 did spread outside of the Hubei province in China – where the city of Wuhan is located – the overwhelming majority of cases were contained near the assumed origin of the virus.28 Spring 2020 allnurses February 11 WHO announces that the new coronavirus disease will be called "COVID-19." February 12 Coronavirus cases start to spike in South Korea. February 19 Iran outbreak begins. February 21 Italy outbreak begins. February 29 US reports first death on American soil. March 8 Italy places all 60 million residents on lockdown. M 1 W d o p P Tr al 2 co Explosive spread Case totals as of 3 PM Monday, March 30 The first map (below) depicts global COVID-19 case totals on March 2, 2020. The map at left shows how COVID-19 cases have spread over the course of one month. Global COVID-19 Infections | March 2, 2020 Via https://www.healthmap.org/covid-19/Spring 2020 allnurses 29 March 11 WHO declared the outbreak a pandemic. President Trump bans ll travel from 26 European ountries. March 13 A US national emergency is declared over the novel coronavirus outbreak. March 17 A leaked federal plan warns the new coronavirus pandemic "will last 18 months or longer" and may come in "multiple waves" of infections. March 17 Italy reports 475 COVID-19 deaths, the highest single-day death toll for any country since the outbreak began. March 19 Nearly all US states declare a state of emergency. March 22 About 1 in 3 Americans are under lockdown as 12 states issue stay-at-home orders. March 23 New York City confirms 21,000 cases, making it the biggest epicenter of the outbreak in the US. Global COVID-19 Infections | March 30, 202030 Spring 2020 allnurses United States 839,836 cases 46,079 deaths 328,239,523 population If the United States experienced COVID-19 at the scale of Italy Population Infections Rate of Infection Percentage Requiring Mechanical Ventilation United States 328,239,523 1,017,542* .31% 125,157** Italy 60,317,546 187,327 .31% 19,620** Statistics from America’s COVID-19 Hot Spots COVID-19 Statistics: United States and Italy Population density calculated per square mile. Percentage tested reflects the percen Data from http://covidtracking.com/, https://www.arcg Positive Cases: 33,261 Deaths: 1268 Percentage Tested: .76% State Pop.: 39,512,223 Population Density: 251 Positive Cases: 27,495 Deaths: 856 Percentage Tested: 1.29% State Pop.: 21,477,737 Population Density: 375.9 Positive Cases: 33,059 Deaths: 1,468 Percentage Tested: 1.22% State Pop.: 12,671,821 Population Density: 231.4 Positive Cases: 24,854 Deaths: 1,405 Percentage Tested: 3.06% State Pop.: 4,648,794 Population Density: 107.2 CALIFORNIA FLORIDA ILLINOIS LOUISIANA *Infections in United States assumes an identified infection rate equal to that of Italy, .31% **Percentage requiring mechanical ventilation (12.3%) is from a study by Kenneth McIntosh, MD via https://www.uptodate.com/contents/coronavirus-disease-2019-covid-19Spring 2020 allnurses 31 Italy 187,327 cases 25,085 deaths 60,317,546 population ntage of each state’s total population. Case totals as of 3 PM Wednesday, April 22 gis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6 Positive Cases: 251,690 Deaths: 14,828 Percentage Tested: 3.34% State Pop.: 19,453,561 Population Density: 419.3 Positive Cases: 32,967 Deaths: 2,700 Percentage Tested: 1.17% State Pop.: 9,986,857 Population Density: 174.7 Is America prepared for a potential tidal wave of COVID-19 cases? The short answer, unfortunately, is no. If the United States were to experience infection levels at the rate which Italy has seen, our healthcare system would buckle under the pressure of such an influx of patients. With shortages of Personal Protective Equipment (PPE) and ventilators being seen in New York, many improvements need to be seen to improve what many view as a bleak outlook for caring for COVID-19 infected patients in America. Hospital beds per 1,000 people Median age Ventilators available Ventilators per 100,000 residents SOURCES: https://en.wikipedia.org/wiki/List_of_countries_by_hospital_beds https://en.wikipedia.org/wiki/List_of_countries_by_median_age https://meduza.io/en/feature/2020/03/21/the-ventilator-problem UNITED STATES 2.77 UNITED STATES 38.1 UNITED STATES 68k UNITED STATES 18.8 ITALY 3.18 ITALY 45.5 ITALY 5k ITALY 8.3 Italy began a quarantine of the country’s epicenter – Lombardy – in early March and soon extended the lockdown to the entire country. While the COVID-19 virus appears to still be spreading, the daily increase of cases has slowed. NEW YORK MICHIGAN32 Spring 2020 allnurses One of the original names which was tossed about – Novel Coronavirus – pinpoints just how we arrived at a world on lockdown. This is the first time that this particular strain – SARS-CoV-2 – has appeared in humans. Due to its recent appearance in the human population, there is no natural immunity to the virus. Its “newness” in the global population coupled with how easily it spreads, its lifespan on surfaces, and how mobile humans are makes for the perfect storm. A new virus. A mobile population. Simple transmission. Quick replication of viral cells. All of the ingredients were there. The question still remains, how did a virus new to the human population appear in humans? In a research paper published in the journal Nature Medicine, Kristin Anderson, PhD who is an associate professor of immunology at Scripps Research explained “By comparing the available genome sequence data for known coronavirus strains, we can firmly determine that SARS-CoV-2 originated through natural processes.” That statement alone should put to rest various conspiracy theories circulating online relating to the virus being a biological weapon developed by either the United States or Chinese governments. Natural evolution evidence The evidence for natural evolution was supported by data on SARS-CoV-2’s backbone -- its overall molecular structure. If someone were seeking to engineer a new coronavirus as a pathogen, they would have constructed it from the backbone of a virus known to cause illness. But the scientists found that the SARS-CoV-2 backbone differed Where and did the virus come from How did it spread so fast The Origins of COVID-19Spring 2020 allnurses 33 substantially from those of already known coronaviruses and mostly resembled related viruses found in bats and pangolins. Possible origins One scenario regarding the evolution of the virus to its current state is that nutural selection in a non-human host played a role before its jump to humans. This was the case with both SARS (civets) and MERS (camels). Researchers have propsed bats as the most likely reservoir for SARS-CoV-2 as it is very similar to a coronavirus found in bats. There are no documented cases of direct bat to human transmission, though, making an intermediate host a likely piece of the COVID-19 puzzle. The other proposed scenario is that a non-pathogenic version of the virus jumped from an animal host to humans, then evolved to its current state with a segment of the human population. One possibility is that pangolins, an armadillo-like mammal found in Asia and Africs, played a part in the transmission due to an RBD structure found to be very similar to that of SARS-CoV-2. A coronavirus from a pangolin could possibly have been transmitted to a human, either directly or through an intermediary host such as civets or ferrets. Causes of COVID-19’s rapid spread Discussed in a recent Scientific American podcast, editor W. Wayt Gibbs and Washington Governor Jay Inslee broke down examples of how COVID-19 was able to spread so rapidly. “Let me give you one example from here in Washington. On March 10, despite stern official warnings not to gather in groups, 56 people met for an event in Skagit County. All of them were apparently healthy at the time. But 10 days later, 43 of those 56 people have either been confirmed to have COVID-19 or are showing symptoms of the disease. Experts suspect that one or more people in the group was a so-called “supershedder,” someone who has yet to show symptoms but is transmitting lots of infectious virus.” An infection rate of over 76% from one ill-advised gathering. While the specific method of transmission is unknown, there are numerous possibilities. Respiratory and fomites “[Fomites] refers to transmission from surfaces. The average person touches their face 2- or 3,000 times a day—three to five times every waking minute. In between, we’re touching doorknobs, water fountains, elevator buttons and each other. Those things become fomites.” “The NIH researchers ... sprayed infectious droplets onto cardboard, stainless steel and plastic. Then they checked the spatter as time passed to see how quickly the viral particles dried out and fell apart.” CARDBOARD • 4 hours before live virus started to fall significantly • Quite infectious 8 hours later STAINLESS STEEL • Infectious after 24 hours The results from the National Institute of Health SOURCES: https://www.sciencedaily.com/releases/2020/03/200317175442.htm https://www.scientificamerican.com/podcast/episode/covid-19-how-and-why-the-virus-spreads-quickly/34 Spring 2020 allnurses tests show that infection without people immediately present can still occur. This is in addition to the confirmed spread via respiratory droplets. Silent transmission During a World Health Organization study of 94 COVID-19 patients in China, tests were performed to determine when they became infections and when they stopped shedding the virus. The results showed that patients tended to become less infectious as their symptoms progressed. Additional findings concluded that the largest amount of viral shedding occured two days before they felt ill. Those finding are what has led to social distancing, washing hands thoroughly for 20 seconds, and other campaigns to slow the spread of COVID-19. Germs from a cough or sneeze can travel 6 to 8 feet “Maintaining at least 6 feet of space between yourself and another person...they call it social distancing. I wasn’t even being social in the first place! I’m going to the grocery store to get some food, and they want me to adhere to “social distancing”. Call it what it really is! “Infection-prevention distance”, the “germ reduction zone”, the “safety zone”, the “I-don’t-want-toget sick zone”. You put the word “social” followed by a word that makes people feel restricted- as in “distancing”, you are bound to get a few rebels. They should’ve labeled it something else. This is more than just a social issue – for some it could mean life or death.” Calling social distancing what it really is...Spring 2020 allnurses 35 Be a part of what makes us great.36 Spring 2020 allnurses Warm Weather Will Slow the Virus and Other Bad Advice Look at a world map of where the coronavirus has spread and the answer seems obvious though these cases may be travel-related and not linked to seasonality. The World Health Organization states that from the evidence so far, COVID-19 can be transmitted in all areas, including those with hot and humid climates. Though the flu peaks in February along with RSV and the common cold, experts don’t know if the coronavirus will behave in the same way. The most recent article on this topic that I could find is from the New York Times, published on March 22, 2020. Experts state in this article that “Wherever the temperatures were colder, the number of the cases started increasing quickly,” In the US southern states like AZ, FL and TX are seeing slower growth of the outbreak. This is supported by two other studies (one from Spain and Finland, the other from China). The virus thrives in dry conditions between 28.3 and 49 degrees F. HOWEVER (and this is a big however for scientists like myself – none of these studies has been peer reviewed.) Even if warm temperatures make the virus less effective, it will still be transmitted. It might be tougher for the virus to survive in the air or on surfaces for long periods, but it will still be contagious for hours. It’s going to be 4-6 weeks before we have a clear picture of this situation. SO much is unknown, and even if the virus slows during warmer months it could return with ferocity in the fall. Other misconceptions about what will help prevent infection: 1. Gargling with warm water No evidence, though it may provide comfort 2. Drinking hot water frequently to flush the virus into the stomach No evidence: infections often begin after we’ve been exposed to thousands or millions of viral particles, so sweeping a few down the oesophagus is unlikely to have much of an impact. 3. Blasting hot air No evidence – you might kill a few, but there are millions. A steaming bowl of hot soup will provideSpring 2020 allnurses 37 There’s a lot of bad information out there. This article discusses some of the top false claims being spread on the internet. As nurses, it is crucial that we have the most accurate, up-to-date information for our patients, family and friends. They trust us to know what’s going on. comfort and may kill a few more, but aiming a hair dryer at your face isn’t going to help. 4. Ingesting colloidal silver No evidence 5. Getting some sun No evidence 6. Taking your vitamins (garlic, pepper, elderberry, mint, vitamin C) No evidence. This one will get me the most kickback, I know it, but I stand by it. My statement: If you take supplements you’ll get better in 7 days, if you don’t, it will take a week. You can help people understand that though one person may have personal experience with one of these tactics working for them, that is called “anecdotal” evidence and does not apply to the general population as a whole. Scientific evidence is based upon large data sets, not just one person’s experience. Remind folks that once the virus is in your blood stream, or in your respiratory system, most of these strategies will not work. There’s a video telling folks to raise the temperature of their nostrils to 130 degrees. That sounds great, except, how can you raise the temperature of your blood to 130 degrees? Boiling your blood will most certainly kill you much more quickly than coronavirus. What we do know: Coronavirus is also known as COVID-19. It is a virus which is a collection of proteins and lipids, so antibiotics won’t help treat it. There is no known cure. It passes person to person by physical contact and it can live on hard surfaces and in the cough of a sick person’s respiratory droplets. Anyone can get it and carry it, but people over 65 are more likely to die from it, as are folks in high risk categories. New studies suggest that though it is mainly transmitted as respiratory droplets, it can go airborne depending on heat and humidity, which means if someone carrying the virus sneezes in the Walmart, you might breathe in those particles up to two hours later. It has a long latency period (it may incubate for up to 14 days), so you might spread it to lots of people before you even know you38 Spring 2020 allnurses have it. We don’t have enough resources to deal with everyone getting sick at the same time, so we have to slow the spread of the virus (shoot, I can’t even find a thermometer). “Sound preparation base on scientific evidence is what is needed at this time.” – UNICEF 1. Wash your hands often 2. Stay home 3. Avoid touching your face 4. Stay home 5. Practice social distancing 6. Stay home 7. Cover your mouth when you cough 8. Stay home 9. Disinfect surfaces 10. Did I mention you should stay home? There is a spark of hope. Outbreaks in China and South Korea appear to be stabilizing, but that seems to be due to intervention by the authorities (lockdowns, travel restrictions), and not due to anything related to the virus itself. Finally – thank you to all the folks who cannot stay home. Those of you who go in to work every day to fight the good fight – I want you to know, I’m not buying or using gloves or masks because I am fully aware of how they work (and don’t work… those folks at the grocery store make me cry…) and if you know how I can send you some or donate to help get you what you need, post the link and I’ll do it. Nurses on the frontlines, you are my heroes. Thank you. Coronavirus situation in the US Total deaths as of 8:11am Apr 22 BST Graphic: Steven Bernard and Cale Tilford Sources: Johns Hopkins University, CSSE; Worldometers; FT research © FT Alabama 186 Alabama 186 Alaska 9 Alaska 9 Arizona 208 Arizona 208 Arkansas 43 Arkansas 43 California 1,268 California 1,268 Colorado 449 Colorado 449 Connecticut 1,423 Connecticut 1,423 Delaware 82 Delaware 82 DC 112 DC 112 Florida 884 Florida 884 Georgia 818 Georgia 818 Hawaii 12 Hawaii 12 Idaho 51 Idaho 51 Illinois 1,468 Illinois 1,468 Indiana 630 Indiana 630 Iowa 83 Iowa 83 Kansas 107 Kansas 107 Kentucky 171 Kentucky 171 Louisiana 1,405 Louisiana 1,405 Maine 36 Maine 36 Maryland 584 Maryland 584 Massachusetts 1,961 Massachusetts 1,961 Michigan 2,700 Michigan 2,700 Minnesota 160 Minnesota 160 Mississippi 183 Mississippi 183 Missouri 189 Missouri 189 Montana 12 Montana 12 Nebraska 38 Nebraska Nevada 38 163 Nevada 163 New Hampshire 42 New Hampshire 42 New Jersey 4,753 New Jersey 4,753 New Mexico 65 New Mexico 65 New York 14,828 New York 14,828 N Carolina 213 N Carolina 213 N Dakota 13 N Dakota 13 Ohio 557 Ohio 557 Oklahoma 164 Oklahoma 164 Oregon 78 Oregon 78 Pennsylvania 1,564 Pennsylvania 1,564 Rhode Island 171 Rhode Island 171 S Carolina 135 S Carolina 135 S Dakota 7 S Dakota 7 Tennessee 157 Tennessee 157 Texas 517 Texas 517 Utah 32 Utah 32 Vermont 40 Vermont 40 Virginia 324 Virginia 324 Washington 652 Washington 652 W Virginia 27 W Virginia 27 Wisconsin 242 Wisconsin Wyoming 242 6 Wyoming 6 Puerto Rico 64 Puerto Rico 64 Statewide ‘stay at home’ order* Advisory ‘stay at home’ order** *Includes 'shelter in place' orders **Includes Kentucky's ‘healthy at home’ order Dr. Kristi Miller, aka Safety Nurse is an Assistant Professor of nursing at USC-Upstate and a Certified Professional in Patient Safety. She is also a mother of four who loves to write so much that she would probably starve if her phone didn’t remind her to take a break. Her work experiences as a hospital nurse make it easy to skip using the bathroom to get in just a few more minutes on the computer. She is obsessed with patient safety. Please read her blog, Safety Rules! on allnurses. com. She is doing research into the relationship between participation in Root Cause Analysis and patient safety attitudes (contact her if you are interested). In the guise of Safety Nurse, she is sending a young Haitian woman to nursing school and you can learn more about that adventure: https://www.gofundme.com/rose-goes-to-nursing-school Have something to say? Click here to comment!Spring 2020 allnurses 39 Where do you see your nursing career going? The demand for nurse practitioners is on the rise, with no signs of slowing down. And as the demand grows, so does the pay — with median salaries already at $113,930*. That’s well above the median salary for those with their bachelor’s in nursing. Start preparing now with an online nursing degree from Maryville University. • Choose from 5 concentrations – FNP, AGPCNP, AGACNP, PNP, or PMHNP • 100% online – no campus visits required • Complete clinicals locally in your preferred setting • CCNE accredited • Ranked among “America’s Top Colleges” – Forbes, 2019 • Programs start in fall, spring, and summer GET PROGRAM DETAILS40 Spring 2020 allnurses Tweets from the Front Lines In the war against COVID-19, information is moving fast and conditions are changing by the minute. The social network Twitter has proven itself to be integral in bringing change and communicating the struggles nurses are facing both on and off the job. We’ve chosen to showcase some of the most impactful messages recently shared by nurses across the country.Spring 2020 allnurses 4142 Spring 2020 allnurses Good News! The battle against COVID-19 is real and it is ugly. But amongst all of the sadness, there is positivity. Americans and American companies are stepping up to aid in the fight against a seemingly invisible enemy. The Four Seasons Will Provide Free Rooms For NYC Hospital Workers On The Front Lines Of COVID-19 Brooklyn Distillers Turn Waste Alcohol Into Hand Sanitizer Sharing A Free Pair For Healthcare Governor Andrew Cuomo announced on Twitter yesterday that the Four Seasons Hotel on 57th Street will provide “FREE lodging to doctors, nurses & medical personnel currently working to respond to the COVID-19 pandemic.” Thanks to the ambitious work of two distillers at Brooklyn-based Kings County Distillery who researched World Health Organization and Centers for Disease Control guidelines for hand sanitizers, the distillery now has 1,000 bottles ready for the public. Crocs is now offering free pairs of shoes to health care workers fighting on the front lines against the coronavirus. Health care workers can place an order for their free Crocs on crocs.com. It’s part of the “A Free Pair for Healthcare” program, according to a release from Crocs.Spring 2020 allnurses 43 Aspen University offers an online RN to BSN completion program for registered nurses who have an associate degree or diploma in nursing and wish to pursue a baccalaureate degree. With a liberal arts foundation, our RN-to-BSN program builds on initial nursing preparation to prepare nurses for a broader scope of practice with a useful understanding of the cultural, political, economic, and social issues that affect patients and influence care delivery. It is designed for adult learners wishing to complete their undergraduate degree without the on-campus class requirement. Finish Fast – Complete in 12 months (8-week courses) Enjoy Flexibility – 10 courses with start dates every 2 weeks Accredited – CCNE accreditation Affordable – Tuition and fees only $10,550 Pay Monthly – Opt to pay $250 per month Achieve Educational Goals and Career Mobility • Network as you learn • Interact with respected nursing leaders and fellow professionals • 1-on-1 with instructors We understand trying to fit education into an already busy schedule. We created interactive, flexible, facilitated, online courses designed to fit around your lifestyle. Go from RN to BSN online at a remarkably low cost.44 Spring 2020 allnurses COVID-19 Breaking the Myths The Online Home of over 1,000,000 Nurses and Nursing Students. MYTH 1: COVID-19 will go away in the Summer months. WRONG. Previous pandemics didn’t follow weather patterns. Additionally, Summer in the northern hemisphere is Winter in the southern hemisphere. MYTH 2: COVID-19 will spread more in the Summer months due to mosquito bites. WRONG. COVID-19 spreads via respiratory droplets, not blood. MYTH 3: If you can hold your breath for 10 seconds, you don’t have COVID-19. WRONG. Most youg patients with Coronavirus will be able to hold their breath for longer than 10 seconds. And many elderly without the virus won’t be able to do it. MYTH 4: Since COVID-19 tests are difficult to find, we shuld donate blood and the blood bank will test for it. WRONG. No blood banks are testing for COVID-19. Blood donation is a selfless action. You should be mtivated for the right reasons. MYTH 5: Coronavirus lives in the throat. So drink lots of water so the virus is pushed into the stomach where the acid will kill it. WRONG. The virus may gain entry via throat but it penetrates into the host cells. You can’t wash it away. Excessive water will only make you run to the toilet. MYTH 6: All this social distancing is an over reaction. You’ll see that the virus won’t cause much damage. WRONG. A lower number of cases proves that social distancing is working. MYTH 7: Car accidents kill 30,000 people annually. What’s the big deal with COVID-19? WRONG. Car accidents are not contagious, their fatalities don’t double every three days, they don’t cause mass panic or a market crash. MYTH 8: Hand sanitizers are better than soap and water. WRONG. Soap and water actually kills and washes away the virus from skin (it can not penetrate our skin cells) plus it also cleans visible soiling of hands. Don’t worry if Purell was sold out at your supermarket. MYTH 9: One of the best strategies to prevent COVID-19 is to clean every door knob in your home with disinfectants. WRONG. Hand washing/maintaining 6ft distance is best practice. Unless you’re caring for a COVID patient at home, your home surfaces should not be a big risk. via @FaheemYounus – Faheem Younus, MD is Chief Quality Officer and Chief of Infectious Diseases, University of Maryland UCH.Spring 2020 allnurses 45 CONTAGION PREVENTION PERSONAL CONTACT AIR BY COUGH OR SNEEZE CONTAMINATED OBJECTS MAINTAIN A DISTANCE OF SIX FEET WITH PEOPLE WASH YOUR HANDS OFTEN AVOID CONTACT WITH SICK PEOPLE ALWAYS COVER YOUR COUGH OR SNEEZE CLEAN SURFACES REGULARLY NO GROUPS LARGER THAN 10 PEOPLE 11 Why is COVID-19 different? What makes the new coronavirus so dangerous to humans is simply that it’s “novel,” meaning it’s new to humans, so we don’t have any way to fight it. This is the first time it has ever circulated in humans. Additionally, there is no cure. While testing of both anti-viral medications and vaccines is underway, it’s unlikely that there will be a vaccine to prevent COVID-19 for at least a year. Regarding seasonal dissipation – much like the seasonal flu – there are no indications regarding a slowdown in the spread of COVID-19 as the weather warms in the northern hemisphere. There has been some evidence emerging from China that COVID-19 cases may be waning, but nobody is certain if or when that will happen. What can I do? Wash your hands frequently and thoroughly for at least 20 seconds using soap and water. Avoid touching your face – including eyes, nose, and mouth – with unwashed hands. Don’t openly cough into the air – even if you presume to be otherwise healthy. If you or a family member are sick, isolate at home for the recommended 14 days. If you can find a regular facemask for an ill person, that may prevent the spread of droplets. Lastly, clean surfaces frequently. A preliminary study showed that this virus could last three days – or longer – on surfaces. COVID-19 Health & Safety Tips The Online Home of over 1,000,000 Nurses and Nursing Students.46 Spring 2020 allnurses The COVID-19 Battle Cry for Retired Nurses The COVID-19 epidemic brought me back to work after 20 years of retirement By Kathy Day, RN Just a few weeks ago, I was helping with a list of classmates from my nursing school class of 1970. Yes, it was so we could plan our 50th class reunion. I was looking at the young fresh faces on my class photo, including my own. I have worked as a patient safety advocate for the past 10 years, as a volunteer. I have not worked clinically for 20 years. It is surreal for me to be out of school for 50 years. All of those anniversary festivities have been canceled.Spring 2020 allnurses 47 As those party planning emails came, the news on TV was getting more urgent about this new virus. COVID 19 had floated around for a few months. We heard stories about it when a bunch of people got sick on cruises. There were decisions being made about whether or not those people should be allowed back into the US. There were some pretty frightening images of the Chinese who were all wearing masks on the streets and many were dying. Some of the dying were doctors. The news got more and more scary The few nursing home patients in Washington State became the beginnings of an epicenter for this disease. Then New York City, then parts of California. Just a few weeks later, here we are. Every State is affected including Maine with our very small, but older population. The news is dire, every single day. Every day citizens are stocking up on face masks and hand sanitizers and clearing shelves of other necessities like toilet paper and food staples. There isn’t enough PPE for nurses, doctors and other frontline workers. There aren’t enough testing materials so that every single person who is exposed to COVID 19, or who has a risk factor or who may even have some symptoms, can be tested. We are all being trusted to socially distance ourselves, or to self-quarantine if we have a risk factor or symptoms. All of us are being asked to stay away from others and stay at home as much as possible. Basically we must consider every person around us to be infected…it helps us to socially distance. Businesses and borders are closed Still, irresponsible Spring breakers gathered in FL and other warm places, and COVID spread. Some large churches held big gatherings and services in spite of all of the warnings, and COVID spread. A few of our Senators and Representatives got it. Tom Hanks and his wife got it. This virus doesn’t care how famous, religious, rich or powerful you are….it will invade your body. It is a great opportunist. My son is out of work as of Friday. My husband and I have been spending most of our days at home, but we drive somewhere daily. Our little dog has been the star of our isolation show, and we take him everywhere with us. One day we enjoyed a short trip to the coast of Maine, and I am so luck to be so close to such beauty. And, this old nurse is going back to work I knew there was something I could do. I communicated with other healthcare workers and with my patient safety colleagues. The effort to keep patients away from crowded clinics and ERs meant that someone was going to have to keep telling them that it was the safest thing for them, unless they had life threatening symptoms. I called my local hospital. I asked if they had considered using retired nurses for some sort of telephone triage line. They hadn’t but they were very excited about my idea. Some of their staff was working on a phone tree and an algorithm. I offered to work from home, taking calls. I also offered to recruit other retired nurses to do the same. So, I have recruited 5 other nurses. 4 of us have had our physicals and background checks done already. We hope to be working within the week. We all can help ... We all can help, even those of us who are “older’, retired and at a higher risk of disease. Find a way. And for those nurses who are working with COVID 19 patients on the front lines, my hat off to you. Your courage and dedication just blows me away. I do hope that most of you will not face a shortage of needed PPE, and yes, I do know that some of you already have. We are all in this together. Doing what the experts are telling us is our social responsibility, but nurses young and old can do so much more. We all need to stand together albeit remotely. Have something to say? Click here to comment!48 Spring 2020 allnurses Worth a Thousand Words The written word is powerful but as the old adage goes, a picture is worth a thousand words. The pictures (or photos if you’re a stickler) from the front lines of the war against COVID-19 will forever be etched in the minds of millions. Here are some of them... A parking garage at Nashville, Tennessee’s Vanderbilt Hospital was converted to be used for patient overflow for the expected tidal wave of COVID-19 cases. Davis County – where Nashville is located – has seen nearly 300 COVID-19 cases.Spring 2020 allnurses 49 A plea from the nurses and doctors in the Emergency Department at Saolta Group University Hospital in Galway, Ireland. Kious Kelly, a nurse manager at a Manhattan hospital, has quickly become the face of the battle to obtain Personal Protective Equipment for nurses. The 48 year-old who worked at Mt. Sinai Hospital may have been the first nurse in New York to pass away from COVID-19.50 Spring 2020 allnurses [Show More]

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