Nursing was the most common occupation and residential care facilities were the most common reported job setting for healthcare professionals (HCPs) with COVID-19, CDC researchers found.
In a subset of six jurisdictions reporting occupational type or job setting for HCPs with COVID-19, 30% of infected HCPs were nurses — twice the proportion of nurses in the healthcare workforce (15%) — and two-thirds of cases were in nursing and residential care settings, reported Michelle Hughes, PhD, of the CDC, and colleagues in Morbidity and Mortality Weekly Report.
Similar to previously reported U.S. data, HCPs with COVID-19 who were male, age 65 or older, or nonwhite, or had underlying medical conditions, were particularly likely to have died.
The researchers cited workers in long-term care facilities as those most in need of attention during the pandemic.
“During the COVID-19 pandemic, multiple challenges in long-term care settings have been identified, including inadequate staffing and PPE, and insufficient training in infection prevention and control,” Hughes and colleagues wrote. “As the pandemic continues, it is essential to meet the health and safety needs of HCPs serving populations requiring long-term care.”
Even HCPs who do not provide direct patient care, such as administrative staff members and environmental service workers, were at risk, Hughes and colleagues also emphasized. About 19% of cases among HCPs had such jobs.
They added that their count probably underestimated the number of healthcare professionals with COVID-19, especially among asymptomatic individuals, given that job status was only available for 22% of COVID-19 cases reported to CDC. It was added to the CDC case report form in May.
The data — which covered Feb. 12 to July 16, 2020 — included 641 deaths in healthcare professionals with COVID-19. More recent statistics from the CDC indicates 162,328 cases of COVID-19 and 710 deaths as of Sept. 23 among U.S. healthcare professionals.
In the MMWR analysis, which covered about 100,000 COVID-affected HCPs who met inclusion criteria, median age was 41, and 79% were women. Of those with race/ethnicity data available, 47% were non-Hispanic white, 26% were Black, 12% were Hispanics or Latinos of any race, and 9% were Asian.
Among HCPs with data on underlying medical conditions, 44% had at least one of 10 underlying medical conditions. Cardiovascular disease (18%) was the most common, followed by chronic lung disease (16%) and diabetes (13%). Cardiovascular disease and diabetes mellitus were most common in those who died.
Hospitalization and intensive care unit admission status were available for only a portion of HCP cases; however, 8% of those with known status were hospitalized and 5% were admitted to an ICU.
By Molly Walker, Associate Editor, MedPage Today
The pandemic is forcing college students to make grave decisions that would have been inconceivable a year ago, and many are operating with minimal guidance.
Although people in their late teens and early twenties with COVID are less likely to contract severe cases and are often asymptomatic, college students around the country are testing positive after suffering from headache, chills, fever, and nausea. And, as they spread the virus amongst themselves, it is all too easy for them to transmit it to people in older, more vulnerable age groups such as campus employees and community residents. As the nation’s colleges and universities set widely varying policies and march to different drummers, students may feel like they are on their own. They’re struggling with their sense of personal responsibility, competing forms of peer pressure, and undoubtedly a sense of thwarted expectations. Sources of realistic advice are scarce, and school administrators are unwilling or unable to provide guidance for managing the “edgier” aspects of campus life.
Student-led COVID safety advice programs such as Oberlin College’s “ObieReal” are still getting off the ground, where they exist at all, but they have a sound philosophy. As Oberlin Vice President and Dean of Students Meredith Raimondo said, “Telling people only what not to do is not a strategy for long-term behavior change; you have to give people options.” With this in mind, we would like to offer some real-world college social-life tips for the 2020 “COVID-Ed:”
1. ALWAYS Wear Your Mask in Public Spaces
Surgical masks are still considered critical supplies, so you should have at least three cloth masks that you can launder after a day’s use. Find a mask that is as comfortable as possible and stays in place, so you are not tempted to remove it or touch it. Wear your mask whenever you go out: human nature being what it is, you can never assume that other people are going to practice social distancing, let alone maintain it consistently!
2. Protect Your Pod/Bubble
Your campus pod or “bubble” can help preserve your sanity, but if the virus enters your group, you could all get sick. Remind one another to always wear masks and social distance in public spaces, practice good hygiene at all times, and follow the Pod ground rules.
3. Don’t Go to Frat/Sorority Parties
Don’t even think about hitting a Frat or Sorority party. Greek life has served as an incubator for numerous college COVID outbreaks; in fact, the New York Times has identified at least 250 cases of COVID-19 originating in sororities and fraternity houses. Some universities have asked houses to shut down, but they often lack the power to enforce closings. As much as the Greek experience may enrich your life, by attending a gathering at a frat or sorority house you can catch and help spread an illness that has killed an average of 940 people each day in the US since January.
4. Be Smart About Where You Eat
The “freshman 14” used to refer to the weight you can put on during your first semester. In 2020, “freshman 14” may become a reference to the days you spent quarantined in a dorm-from-Hell because you got exposed to COVID. Some colleges have carry-out dining halls, while others continue to offer indoor seating. If your school is among the latter group, they almost certainly have “grab and go” dining options, which are far safer. Instead of dining out at a restaurant, order takeout meals, get deliveries, or use curbside pickup. Visiting a restaurant’s outdoor seating area increases the risk of exposure, but it is safer than eating inside. If you must take the risk of eating in an enclosed space, only do so in an establishment that maintains a six-foot distance between tables (staff should of course be masked).
5. Stay Out of Bars. Please!
Alcohol is always a temptation in college, but drinking during a pandemic—even in a bar that attempts to comply with six-foot distancing—is only a bit safer than playing Russian Roulette (but in a pandemic, you may hit not only yourself but anyone within reach, ranging from friends and family to complete strangers). Bars have been the locus of a number of serious outbreaks. As the night progresses, people talk more loudly (which spreads larger droplets faster and further) and are easily tempted to disregard even moderate social distancing. Infectious disease expert Dr. Sandra Kesh told C-Net that the disinhibiting effects of alcohol should rule out bar visits: “Bars are noisy, so you’re yelling your drink order at the bartender and other people are right by you—it’s really a perfect environment for that shared air space which we get so worried about.”
If you or your friends are reckless enough to give way to social pressure and go out drinking in a bar or a social gathering, there’s no call for being completely irresponsible: wear a mask, and insist on going to a place that serves in an open-air setting and adheres to social distancing. Set a conservative limit on the number of drinks you will have (definitely do not get drunk)! Keep your mask on when not drinking, and if people start shouting, and the management or hosts cannot stop guests from leaning in toward one another, leave immediately. In short, this is the time to embrace the joys of sobriety.
6. Learn to Enjoy the Great Outdoors
While the weather still permits, take your social gatherings outside. Meeting a group of friends to eat, walk, or exercise on campus grounds makes it easier to maintain social distancing, and at daytime gatherings, the ultraviolet light further reduces the danger of transmission and supports your body’s resistance by increasing your vitamin D intake.
7. Reach Out and Tele-Touch Someone
COVID does not have to crush your college social life. FaceTime, Zoom, Google Hangouts… you already know ways to get creative with technology. Meeting up with a study group on Zoom can help you hit the books together with fewer distractions. Video apps are great for meeting with friends, and they create a nice safe space for a budding romance: when you’re flirting with someone remotely, they can only ogle what you’re willing to display (and vice versa); you can get to know each other well enough to really be sure whether you’re ready for physical contact; and if things go sour, it’s easy to make a clean break. One Zoom dater’s favorite strategy for a date that’s heading south is, “Oh my gosh, my Wi-Fi went off!”
Seven in 10 professionals these days are working remotely to reduce the risk of spreading COVID-19. Thanks to an internet connection and teleconferencing software, nearly everyone can work from home. Why shouldn’t nurses and other medical professionals work remotely, too, when transitioning to telemedicine is an option?
Industry forecasts say that telemedicine is “set for a tsunami of growth.” If you’re a nurse (or currently studying to become one), embracing the tech evolution in the medical industry not only elevates nursing as a whole — but will ensure you’re not left behind. Consider the following points about telehealth and how it could improve the quality and longevity of your nursing career:
Working From Home
The nursing field can be extremely demanding on your time. Hospitals and medical facilities are strained from the coronavirus pandemic, requiring nurses to work longer and harder. A recent study found that nurses in hospital settings are being pressured to work longer than they’d like to, typically wearing uncomfortable protective gear which causes discomfort and fatigue.
Having the opportunity to work from home in a telemedicine position could be a good solution to having more control of your time. Stepping away from a high-pressure environment such as an emergency room or intensive care unit to work from home as a nurse could feel liberating. Additionally, nurses who are raising families may appreciate the flexibility of being more available for their kids. Some of the most sought-after work from home positions for a registered nurse include:
- Clinical appeals nurse: Reviews denied insurance claims and conduct the appeals reviews.
- Health informatics nurse: Gathers, stores, and manages patient data.
- Telephone or telehealth triage nurse: Consults with patients over video or phone call.
- Nursing instructor/educator: Teaches nursing students to prepare them for tests and their nursing careers.
Reductions in Stress
As mentioned, nurses are being pushed out of their comfort zones to work longer hours in challenging conditions. Nurses are often naturally empathic and care deeply for the well-being of the patients they’re helping. If feelings about every loss, death, or injury are not managed correctly, they may contribute to a sense of stress or worry. Many frontline nurses are already close to (or experiencing) burnout and mental health issues due to the rise in COVID-19 patients.
Self-care is critical for nurse practitioners at this time. It’s often difficult when working in a high-pressure setting, such as a hospital. Telehealth may be the ideal solution, giving some autonomy back to nurses so they can take charge of their mental health by setting their own schedules, controlling their work surroundings, and regulating the amount of stress they allow around them.
A Larger Client Base
Telemedicine has many benefits and is set to experience explosive growth. One of the most significant benefits is the opportunity to expand your business by taking on patients outside of your local area. All you need is a reliable internet connection, teleconferencing software (if you’d like to offer face-to-face video consultations), or a phone for audio calls.
Telehealth benefits go both ways — if you build a remote nursing practice and provide telemedicine services, you could increase your patient base by taking on clients during expanded hours and from varying locations. Additionally, patients who live in rural or underserved communities could get the quality care they need by opting for a phone or video consultation.
Expanded Work Opportunities
Most medical fields could benefit from expanded telemedicine services. Even the vision care industry can make use of telemedicine. A typical vision consultation may require a test or diagnostic you would need to be present for, but some exams have been adapted and made available through online web portals.
Consumers are receptive to the concept — 61% of patients reported that they received the same level of care from a vision telemedicine consultation, and 20% said: “the quality of telemedicine was better.” And as a telenurse, you may be able to expand into other medical fields of interest that you wouldn’t typically receive patients for in a specialized hospital or clinical setting.
A World of Possibilities
There will always be a market for in-person nurses. They’re needed to respond to emergencies in hospitals and to provide rehabilitation or care to seniors and recovering patients. The problem is, working in high-demand positions such as an emergency room or intensive care unit tends to be physically and emotionally taxing. Many nurses may experience fatigue or burnout, which could cut the longevity of their careers short.
Being open to working in telemedicine opens up a new world of possibilities. You could be more location independent, having the flexibility to set your own schedule and better balance your personal life. You may even decide after working in a hospital setting or clinic to transition into telemedicine. Having the option allows you to leverage your experience into nursing work with less proverbial “wear and tear” without entirely leaving a career you put so much energy and effort into.
Although health workers constitute about 3% of the population in most countries, they comprise 14% of COVID-19 cases reported to the World Health Organization (WHO), and in some countries account for up to 35% of COVID cases. WHO Director-General Tedros Adhanom Ghebreyesus noted this in a September 17 statement and added, “The COVID-19 pandemic has reminded all of us of the vital role health workers play to relieve suffering and save lives.” As “one of the keys to keeping patients safe is keeping health workers safe,” on Thursday the Director-General issued a 5-point charter on healthcare worker safety in conjunction with Patient Safety Day.
The 5-point WHO charter urges its partner countries to:
1. Develop and implement national programs for the occupational health and safety of health workers
WHO recommends that education and training programs for health workers at all levels include health and safety skills in personal and patient safety and that healthcare licensing and accreditation standards incorporate requirements for staff and patient safety. Member countries should also review and upgrade national regulations and laws for occupational health and safety to ensure that all staff members have regulatory protection of their health and safety at work.
2. Protect health workers from violence in the workplace
Promote a culture of zero tolerance to violence against health workers. Labor laws, policies, and regulations need to be strengthened, and all healthcare workers should have access to ombudspersons and helplines to enable free and confidential reporting and support for any health worker facing violence.
3. Improve the mental health and psychological well-being of healthcare workers
Healthcare facilities must establish and maintain safe staffing levels, and ensure fair duration of deployments, working hours, and rest breaks. Mental and social support services, including advice on work-life balance, risk assessment, and mitigation should be readily available to all staff.
4. Protect healthcare staff from physical and biological hazards
Health care systems must implement patient safety, infection prevention and control, and occupational safety standards in all health care facilities. Facilities need to ensure availability of personal protective equipment (PPE), adequate quantity, appropriate fit, and acceptable quality. All facilities should maintain an adequate, locally held, buffer stock of PPE and provide workers with adequate training on appropriate use and safety precautions. Further, at-risk healthcare staff should receive vaccinations against all vaccine-preventable infections, and in the context of emergency response, be given priority access to newly licensed and available vaccines.
5. Connect the dots between policies on patient safety and healthcare worker safety
Institutions should integrate staff safety and patient safety incident reporting and learning systems, and define the linkages between occupational health and safety, patient safety, quality improvement, and infection prevention and control programs.
Regarding the latter point, the charter states that “No country, hospital or clinic can keep its patients safe unless it keeps its health workers safe.”
For more details on the charter see the WHO announcement, “Keep Health Workers Safe to Keep Patients Safe.”
Many people, including nurses, have daily mantras or affirmations they use to set their intentions and motivate themselves throughout the day. Mantras can help you get through a tough time, but the ones you’ve always used before might not be enough to get you through the pandemic. If you’re looking for new mantras or affirmations, or you want to get started with them, here are 10 phrases tailored to COVID-19:
1. I will care for my patients to the best of my ability.
Nursing is also about patient care, so leading with a patient-centered affirmation is very fitting. Notice that the words focus on what’s possible—“care for my patients to the best of my ability”—instead of focusing on unrealistic expectations (i.e., “I will cure all my patients”). All mantras and affirmations should be equally realistic and within your abilities; otherwise, they will put unneeded pressure on you and stress you out.
2. This will not break me.
Caring for patients during the pandemic, especially patients who are severely sick with COVID-19, can be absolutely overwhelming. Tell yourself that you may bend under the pressure, but you are strong enough not to break. You will get through this in one piece, and you will live to fight another day (or rather, live to help your patients fight another day).
3. I have survived hard times before.
This relates to the previous mantra, and the two work well in tandem. As proof that this experience will not break you, consider all the times you thought you couldn’t overcome a challenge—and then did it anyway. Look to the past for evidence of how strong you are and how your resiliency will enable you to persevere in the midst of these incredibly tough times. Even when the last thing you wanted to do was put on your cotton scrubs and go to work, you still did it, and you can do it again.
4. Stay in the present.
With no real end to the pandemic in sight, it’s easy to get caught in a spiral, wondering about all the disasters the future might hold. This is an understandable impulse, but try not to give in to it. Instead, focus on the present moment and helping the patients right in front of you (or making the most of your day off, when you’re not on shift). Concentrate on what you can do this week, this day, this hour, this minute.
5. I can make a difference.
Within the scheme of the pandemic, it may not seem like the actions of a single nurse can make a difference either way. However, your actions matter to your patients, which in turn impacts their loved ones and their entire network. Maybe you can’t make a difference to the whole world, but you can (and will) make a difference to your patients. Your work is not futile.
6. This is temporary, and it will pass.
As the pandemic drags on, the hypothetical end point seems further and further away. Some days it feels like there has always been a pandemic, and will always be a pandemic. But even the worst situations eventually come to an end. Even though it may feel endless, COVID-19 will end and vaccines will become available. We don’t know how far away the light at the end of the tunnel is, but there is a light.
7. I cannot control everything.
This can be a tough one for nurses, who often joined the profession partly because they like to be in charge and have a lot of autonomy. But many things are still out of your control, and this is especially true in the healthcare field where you can do your best and still not achieve the patient outcomes you so desperately wanted. Rather than blame yourself, remind yourself that you cannot control everything and sometimes things happen.
8. I will focus on things that I can change.
Another mantra duo, “I will focus on things that I can change” is a good follow-up to “I cannot control everything.” Thinking about how you can’t control everything can sometimes lead to feelings of helplessness and powerlessness. But just because not everything is in your control doesn’t mean that nothing is. Concentrate on what you can do, even if it’s just taking the time to listen closely to a patient.
9. I have things to be grateful for.
In hard situations like coronavirus, it’s very easy to fixate on the negatives because there are so many bad things happening at once. While it can be difficult, try to find some small things to be grateful for–even if it’s as simple as a call with your loved ones or a nice soothing cup of tea. It sounds silly, but looking for the small things will help you find tiny sparks of positivity.
10. I am allowed to have negative feelings…but they won’t overwhelm me.
You are probably having a lot of emotions right now, many of them negative. You might be scared, sad, angry, confused or all of the above at once. Tell yourself that it’s okay not to be okay and that you are allowed to feel all your feelings, however negative they may be. Avoid “toxic positivity” which insists on projecting happiness and productivity at all times. However, you should also remind yourself that these feelings will pass. You don’t want to wallow in them so much that you tip into despair.
The right mantras and affirmations can help you center yourself, clear your head and reaffirm your priorities. If you’re in need of some mantras during the pandemic, try reciting these 10 phrases to yourself before donning your scrubs and heading to work. Thank you for all that you do!
Before COVID-19 hit New York City, Mount Sinai Morningside Hospital had a flexible, 24-hour visitor policy for patients in the intensive care unit (ICU).
People would visit their loved ones at any hour of the day, coming and going as they pleased. Doctors and nurses said the constant support of family members was beneficial to these gravely ill patients.
Now, per New York State Department of Health guidelines that apply to all areas of the hospital, visitors are limited to one 4-hour session per day, and only one person is allowed at the bedside at a time. At Morningside, that has to be done between the hours of 10 a.m. and 6 p.m. so visitors can undergo temperature and symptom checks before being permitted on the floors.
Morningside ICU physicians and nurses told MedPage Today those visitation policies are too restrictive, especially as staff have become more adept at managing COVID-19 transmission risk.
“It’s particularly challenging for this community because these families have a lot of restrictions,” said Mirna Mohanraj, MD, an ICU physician at Morningside (formerly St. Luke’s Hospital), which predominantly serves minority patients from Harlem and the Bronx. “Not everyone has a flexible job they can leave for 4 hours. They don’t have the financial resources to hire childcare.”
In an emailed statement, the New York State Department of Health said that hospitals “can authorize visits longer than four hours depending on a patient’s status and condition” and noted that labor & delivery patients, pediatric patients, and those with intellectual or developmental disabilities can have a support person at all times.
“This policy remains in place to safeguard and maintain the health and wellbeing of patients, staff and visitors while the need to contain the spread of COVID-19 continues,” the statement read.
The new visitation rules are a vast improvement from the disease peak, when visitors were barred from hospitals altogether and patients died alone. But while the policy may be sufficient for patients elsewhere in the hospital, it poses particular challenges for the ICU, Mohanraj said.
“The ICU is such a dynamic place, things change frequently and unexpectedly,” she said. “It’s traumatic for a family member not to be present when things are changing rapidly.”
Morningside ICU charge nurse Jessica Montanaro, MSN, RN, said while the visitation rules “make sense on regular floors, you have more grave situations [in the ICU]. You’re dealing with death and difficult decisions. In truly grave situations, people need more support. It should be a different situation for the ICU.”
Mohanraj said the literature “shows that having family at the bedside can be beneficial to patients” in the ICU, which is why many ICUs have adopted flexible visitor policies in recent years.
“Family members can provide emotional and psychological support,” she said. “Often, they’re the ones re-orienting patients, moving their legs, alerting the nurses to issues like pain control or a bedpan.”
“They’re also the constant reminder of the full lives that patients had before they got to the ICU,” she added. “And it helps the family develop trust in us as their healthcare team.”
Hospital administrators have allowed exceptions on a case-by-case basis, as called for by the state guidelines. But that means more time spent trying to cut through red tape, and the possibility of request denials.
Eric Gottesman, MD, medical director of the ICU at North Shore University Hospital in Manhasset, New York, which was also hit hard during the COVID-19 peak, said administrators there typically make exceptions to the visitor rule for end-of-life discussions.
“We follow the guidelines but if there’s an emergent issue, we do stray a little,” Gottesman told MedPage Today. “We try to bend, not break.”
Gottesman was similarly accustomed to a liberal visitation policy before COVID-19 hit. The new policy “puts more pressure on us by having to tell patients about the limitations,” he said. “Also, if we’re on rounds and no family member is present to take in the info, we have to come back and do it over.”
So what changes would ICU doctors and nurses like to see?
Family members should be able to stay for longer than 4 hours, Mohanraj said, especially if that person is the patient’s only visitor. That visitor should also be allowed to return to the bedside after they’ve left (right now, once a visitor leaves a hospital floor, they’re not allowed to return).
Finally, Mohanraj said nighttime visits would be especially helpful because ICU patients who experience delirium typically get worse at night, so the additional family support might alleviate related issues.
Safety is the first priority, she said, and thus far preventing transmission among visitors “has been perfectly manageable,” especially as very few patients with COVID-19 remain in the hospital, she said.
ICU providers in New York hospitals say the trauma of seeing families separated during the peak of the crisis has stuck with them, and makes their current push to have family members around more urgent.
In the beginning of the crisis, visitors weren’t allowed unless a patient was imminently dying — but that’s not always easy to call, Montanaro said.
“We had difficult cases where we would allow one family member to come up and stand in the patient’s doorway, say their goodbyes, and then the patient didn’t pass,” Montanaro said.
As policies eased over time, and patients could have two visitors, she recalled a case of a dying mother with three family members who wanted to say goodbye — her husband and two sons.
“That family had to choose which son would say goodbye to their mother,” she said. “So many things about that experience will haunt us for the rest of our lives.”