Covid survivors are at risk from a separate epidemic of opioid addiction, given the high rate of painkillers being prescribed to these patients, health experts say.
A new study in Nature found alarmingly high rates of opioid use among covid survivors with lingering symptoms at Veterans Health Administration facilities. About 10% of covid survivors develop “long covid,” struggling with often disabling health problems even six months or longer after a diagnosis.
For every 1,000 long-covid patients, known as “long haulers,” who were treated at a Veterans Affairs facility, doctors wrote nine more prescriptions for opioids than they otherwise would have, along with 22 additional prescriptions for benzodiazepines, which include Xanax and other addictive pills used to treat anxiety.
Although previous studies have found many covid survivors experience persistent health problems, the new article is the first to show they’re using more addictive medications, said Dr. Ziyad Al-Aly, the paper’s lead author.
He’s concerned that even an apparently small increase in the inappropriate use of addictive pain pills will lead to a resurgence of the prescription opioid crisis, given the large number of covid survivors. More than 3 million of the 31 million Americans infected with covid develop long-term symptoms, which can include fatigue, shortness of breath, depression, anxiety and memory problems known as “brain fog.”
The new study also found many patients have significant muscle and bone pain.
The frequent use of opioids was surprising, given concerns about their potential for addiction, said Al-Aly, chief of research and education service at the VA St. Louis Health Care System.
“Physicians now are supposed to shy away from prescribing opioids,” said Al-Aly, who studied more than 73,000 patients in the VA system. When Al-Aly saw the number of opioids prescriptions, he said, he thought to himself, “Is this really happening all over again?”
Doctors need to act now, before “it’s too late to do something,” Al-Aly said. “We must act now and ensure that people are getting the care they need. We do not want this to balloon into a suicide crisis or another opioid epidemic.”
As more doctors became aware of their addictive potential, new opioid prescriptions fell, by more than half since 2012. But U.S. doctors still prescribe far more of the drugs — which include OxyContin, Vicodin and codeine — than physicians in other countries, said Dr. Andrew Kolodny, medical director of opioid policy research at Brandeis University.
Some patients who became addicted to prescription painkillers switched to heroin, either because it was cheaper or because they could no longer obtain opioids from their doctors. Overdose deaths surged in recent years as drug dealers began spiking heroin with a powerful synthetic opioid called fentanyl.
More than 88,000 Americans died from overdoses during the 12 months ending in August 2020, according to the Centers for Disease Control and Prevention. Health experts now advise doctors to avoid prescribing opioids for long periods.
The new study “suggests to me that many clinicians still don’t get it,” Kolodny said. “Many clinicians are under the false impression that opioids are appropriate for chronic pain patients.”
Hospitalized covid patients often receive a lot of medication to control pain and anxiety, especially in intensive care units, said Dr. Greg Martin, president of the Society of Critical Care Medicine. Patients placed on ventilators, for example, are often sedated to make them more comfortable.
Martin said he’s concerned by the study’s findings, which suggest patients are unnecessarily continuing medications after leaving the hospital.
“I worry that covid-19 patients, especially those who are severely and critically ill, receive a lot of medications during the hospitalization, and because they have persistent symptoms, the medications are continued after hospital discharge,” Martin said.
While some covid patients are experiencing muscle and bone pain for the first time, others say the illness has intensified their preexisting pain.
Rachael Sunshine Burnett has suffered from chronic pain in her back and feet for 20 years, ever since an accident at a warehouse where she once worked. But Burnett, who first was diagnosed with covid in April 2020, said the pain soon became 10 times worse and spread to the area between her shoulders and spine. Although she was already taking long-acting OxyContin twice a day, her doctor prescribed an additional opioid called oxycodone, which relieves pain immediately. She was reinfected with covid in December.
“It’s been a horrible, horrible year,” said Burnett, 43, of Coxsackie, New York.
Doctors should recognize that pain can be a part of long covid, Martin said. “We need to find the proper non-narcotic treatment for it, just like we do with other forms of chronic pain,” he said.
The CDC recommends a number of alternatives to opioids — from physical therapy to biofeedback, over-the-counter anti-inflammatories, antidepressants and anti-seizure drugs that also relieve nerve pain.
The country also needs an overall strategy to cope with the wave of post-covid complications, Al-Aly said
“It’s better to be prepared than to be caught off guard years from now, when doctors realize … ‘Oh, we have a resurgence in opioids,’” Al-Aly said.
Al-Aly noted that his study may not capture the full complexity of post-covid patient needs. Although women make up the majority of long-covid patients in most studies, most patients in the VA system are men.
The study of VA patients makes it “abundantly clear that we are not prepared to meet the needs of 3 million Americans with long covid,” said Dr. Eric Topol, founder and director of the Scripps Research Translational Institute. “We desperately need an intervention that will effectively treat these individuals.”
Al-Aly said covid survivors may need care for years.
“That’s going to be a huge, significant burden on the health care system,” Al-Aly said. “Long covid will reverberate in the health system for years or even decades to come.”
The additional employment of virtual clinical technology, the extension of counseling services, and use of nursing students to administer COVID vaccines in rural areas are three findings from a pair of recent surveys administered by the National League for Nursing (NLN). The surveys of nursing school deans and directors were conducted in January and February of this year.
With schools restricted in providing in-person clinical experiences due to COVID, the use of virtual clinical experiences helped prepare nursing students. Some 72.2% of the surveyed nursing schools provided clinical experiences through virtual clinical simulation because of limited access to clinical settings.
Compared to other years, “that is a high number because, generally, students would be getting their clinical experiences in the clinical settings,” said Janice Brewington, PhD, RN, FAAN Chief Program Officer and Director, Center for Transformational Leadership at the NLN in an interview. Those clinical experiences, she noted, include both going into clinical practice in hospitals or other settings in the community, as well as skills development.
To address the psychological effects of COVID on students and/or faculty, many nursing schools (41.5%) either added or improved counseling services, the survey found. In addition, 15.1% of nursing schools introduced mental health services.
Whether the service provided was called counseling, mental health, or something else “the whole idea is that you’re there to support the student and the mental anguish that they’re having in this whole process,” said Beverly Malone, PhD, RN, FAAN, President and CEO, NLN.
Students giving shots
Although 55.7% of schools said that their students were not administering COVID vaccines in the community, of those schools that were having students administer vaccines, 40% served rural areas, compared with 32% in urban areas and 28% in both urban and rural areas. Some 60% of faculty, the survey found, were available to supervise students giving shots in the community.
As might be expected, most schools (67.4%) said that junior or senior nursing students were participating in administering vaccines; 28.8% said that only seniors were giving shots, according to an executive summary. And almost two-thirds of schools (63.2%) indicated that students received credit for community services for giving the vaccine.
Other findings included:
Some 178 full-time faculty resigned or retired early due specifically to COVID.
PPE was used in most schools by faculty and students in classrooms/labs and clinical settings.
Some 65% of schools said students giving the COVID vaccine in the community had received the vaccine; 73% said faculty supervising student administration of the vaccine had received the vaccine.
Of the survey results, Dr. Brewington says she found it interesting “how schools were mobilizing their students and faculty to provide vaccinations in the community.” The schools forged collaborative partnerships with hospitals, public health departments, community health centers and other community entities, she notes. Nursing, she says, is about “caring and providing services to patients, families and the community.”
I started my career as a nurse 35 years ago. Thirteen of those years I spent up in the air as a flight nurse, responding via helicopter to the most urgent calls. We responded to accidents, shootings, strokes, heart attacks, you name it.
Because we were outside the four walls of our hospital the majority of the time, hospital leaders didn’t have the same on-the-ground visibility into the work that we were doing. And while I’ve never known a nurse who got into the field for the recognition that comes along with the work, the fact that the work we were doing to save lives happened outside the hospital meant that when we pulled off something incredible, we were the only witnesses to it.
Then, one night, around 10 p.m., we responded to a terrible multi-vehicle wreck on a major highway. Traffic was backed up for miles on both sides while we came in and did our job – triaging patients in the dark to find the one in most emergent need (others went by ground), stabilizing him as quickly as possible with intubation, IVs, and packaging for transport before loading the patient hot (helicopter never shut down – blades still turning) into the helicopter, and transporting him to the hospital. There was nothing particularly strange about the accident itself, but as it turns out, the CEO of my hospital just happened to be caught up in that traffic, and he had a front-row seat to watch us do our job.
The next day, the CEO and my director came down to where we were and asked to see us. After seeing what we did in person, he wanted to come and personally thank us for the ‘effortless, yet life-saving’ work that he had witnessed. And now, decades later, that gesture still sticks with me. Just a simple act of recognition, especially coming from the leaders at the head of a hospital, can make a world of difference for an exhausted nurse.
And when we’re talking about our country’s nurses this year, “exhausted” is an understatement. As we mark Nurses Week amid the hopeful winding down of the worst international health crisis in memory, nurse and frontline staff recognition should be at the top of mind of every healthcare executive – not only because it’s the right thing to do, but because happy and engaged nurses reduce turnover and provide objectively better care.
So what can hospital leaders do about it? There are a few key tactics that are important not only during Nurses Week, but year-round:
Give time – and space – for self care. Nurses are often the last to take time to care for themselves. Reinforce that from the top to the bottom of your organization, staff members should take the time and resources they need to take care of their physical and mental needs. Allow them to take their well-deserved paid time off so they can recharge, and create an environment in which asking for help and asking for resources is not seen as a sign of weakness, but rather one of strength.
Give nurses the opportunity to lift each other up. By giving your nursing staff the ability to nominate each other for recognition – either for going above and beyond, for stepping in and helping whenever needed, or simply for being a positive presence in the unit – you foster a culture that celebrates achievement. Integrate the nomination process directly into ongoing staff rounding processes, making nominations quick and easy. And don’t forget how much recognition and encouragement from the ‘C Suite’ means to the staff.
Amplify good patient stories. When you receive positive feedback from a patient about the treatment they received from a member of your nursing staff, share it publicly with your entire staff. Talk about the interventions used, and how caregivers interacted with patients in a positive manner. This too can be integrated directly into patient rounding processes – build opportunities for recognition directly into rounding scripts.
Of course, Nurses Week this year will be marked by special events, meals, public displays of appreciation, nursing excellence awards, and more. But nurse recognition needs to be about so much more than a moment in time – it needs to go beyond a simple “thanks” or “good job.” When recognition is adopted as a cultural value, and when it’s codified into policies and processes, it becomes self-perpetuating and infectious, in the best sense of the word.
As nurses, we all know that the only thing to expect during our shifts is the unexpected. Especially with the outbreak of COVID-19, we’ve seen this to be especially true. As a result of my nursing career, I’ve learned to roll with the punches, which particularly came in handy as I transitioned to the business side of the field.
When I first became a nurse, I never dreamed of starting my own staffing agency. After several years of working as a long-term care nurse in assisted living facilities around the country, a few fellow nurses gave me the idea. I was told by colleagues and supervisors that I had a knack for managing the team, and those simple acts of encouragement gave me the push I needed. Ever since then, it’s been a rollercoaster ride and a ton of on-the-job training. In honor of Nurses Week, I’ve compiled six key learnings from my experience as a nurse turned business owner.
1. You won’t have much time to be a nurse
While I will always be a nurse at heart, I am now very much a businesswoman. At first, I continued to work as a traveling nurse as I was afraid to give all my time to this endeavor – I still had many bills to pay and picking up extra shifts gave me steady income. Eventually, I hit a tipping point as I was completely overwhelmed, which wasn’t healthy. Now I run the company’s operations and spend most of my time in an office. While I love it, it’s a huge transition from being a nurse but the core of providing care for others is still there and that passion is what keeps me going.
2. Fail quickly, but never give up
Going from a nurse to a business owner was a tough transition, and I almost quit on more than one occasion. But I knew I had to keep going for my community, and I realized I’m passionate about providing jobs for other nurses. Hearing from those nurses and seeing the bigger picture helped me put one foot in front of the other, no matter the barriers I hit. Once I took the leap of faith and gave my business 100%, I’ve never looked back.
3. You’ll have to make an investment to grow
Facilities usually have 30-60 days to pay their invoices, while most nurses are paid on a weekly basis. The startup money I had went quickly, which meant I had to get creative with funding solutions. I had trouble getting a traditional bank loan, but instead came across an alternative financing company called FundThrough, which I still use today to keep my nurses paid and help bridge the gap between invoices.
4. Keep track of your books
When I first started, one of the hardest things I had to learn was the financial side of the business. Because I’ve never run a company before starting Nurses at Heart, I didn’t know the best way to track my expenses and income. When it came time to file my taxes, I realized I needed help and enlisted an accountant who showed me how to use QuickBooks. Now we meet every three months to review the books together and ensure everything is on track. It’s important to know your strengths and weaknesses as a business leader and get the help you need from other professionals.
5. Surround yourself with the right people
I realized quickly that I can’t do everything on my own. Today, my agency employs more than 100 people spanning two states, which requires a lot of coordination and management on my part. I’ve been lucky to build an incredible team that I lean on daily, but I have to put trust in my team and let them do what I hired them to do.
6. Your nursing experience will always come in handy
From my experience, I’ve found that those running the business side of the staffing agencies often don’t have prior nursing experience. Because I started my career as a nurse, I know how to speak to administrators, other nurses, and patients. I can relate to nurses and understand their unique challenges, while my bedside manner helps me navigate difficult conversations with ease. I’ve found that both my clients and employees respect me because I know how the healthcare system operates. This experience is what helped make my staffing agency stand out from the competition.
As a proud nurse and newfound business owner, I can tell you that making a paradigm shift wasn’t easy. But along the way, I found success and happiness by following my gut and persisting through the tough times. Similar to the characteristics that make a great nurse, business owners also need to stay calm, level-headed and trust their team. You never know what life is going to throw at you, but with your experience and skills as a nurse, you’ve been given training for so many other situations. You can overcome any challenge with perseverance and trust, and by remembering you have an army of supportive nurses behind you.
Kids at Yreka High School in Siskiyou, California know that one teacher is really looking out for their health. Our Nurse of the Week, BSN Amy Gaither, is a nurse-educator who tends to a very important patient demographic: Yreka High’s teens.
Since early 2020, of course, her purview has broadened well beyond the usual adolescent cases of asthma, gym injuries, and Pop Quiz Flu. Gaither still handles those things, naturally, but she has also been disseminating pandemic safety policies and planning logistics with the Siskiyou Department of Health and Board of Education. Then, somehow, she teaches four Health Occupations classes each day (kids probably knock on her classroom door at odd moments). And, she sometimes exercises her persuasive powers to recruit students to help out at the vaccination clinics at the local fairgrounds.
Gaither herself is quick to laud her colleagues, telling the Siskiyou Daily, “I couldn’t have done this without them,” but acknowledged, “It’s a challenging year for nurses. In my 32 years as a nurse, this has been my most difficult year yet.”
Yreka High is well aware of her value. Assistant Principal Rhoda Dawes says, “Amy is amazing,” and reflected that their school nurse’s leadership qualities helped sustain them during the long Covid ordeal: “[Amy] still comes to work with a smile on her face. This has been a tough year for her because of Covid, but she has been such a trooper, and I can’t say enough about how blessed we are to have her on staff.”
Dawes is far from being the only one to hold Amy Gaither in high esteem. In fact, last week, staff members bearing tributes crashed what Gaither had been told would be a student meeting. Tributaries from the Yreka High staff then presented gifts to the teary-eyed nurse:
The Yreka High Horticulture class created a floral bouquet in her honor
Yreka’s Shop teacher made a pen for the BSN
Staff brought personal notes
All of Gaither’s co-workers also pitched in to give her a much-needed vacation on the Oregon coast.
Colleagues were eager to show their appreciation for the responsibilities she has shouldered so well over the past year—and for her graceful management of the accompanying stress. As Vice Principal Dawes remarked, “Her job has been difficult. People don’t always want to hear they have to quarantine, but again she is so kind, she is genuine, and she truly cares about every staff member and student.” A deeply moved Gaither told a reporter, “They are the best here. I just cried. It meant so much to me.”
(DailyNurse respectfully suggests that ALL schools pay their nurses a similar tribute this year. It would be the right thing to do : ).
For more on Yreka High’s Amy Gaither and what we might call the Amy Gaither Appreciation Day Event, visit the Siskiyou Daily.
Researchers looked at 236,379 British patients diagnosed with COVID-19 over six months, analyzing neurologic and psychiatric complications during that time period. They compared those individuals to others who had experienced similar respiratory illnesses that were not COVID-19.
They found a significant increase in several medical conditions among the COVID-19 group, including memory loss, nerve disorders, anxiety, depression, substance abuse and insomnia. Additionally, the symptoms were present among all age groups and in patients who were asymptomatic, isolating in home quarantine, and those admitted to hospitals.
The results of this study speak to the seriousness of long-term consequences of COVID-19 infection. Numerous reports of brain fog, post-traumatic stress disorder, heart disease, lung disease and gastrointestinal disease have peppered the media and puzzled scientists over the past 12 months, begging the question: What effect does COVID-19 have on the body long after the acute symptoms have resolved?
I am an assistant professor of neurology and neurosurgery and can’t help but wonder what we have learned from past experience with other viruses. One thing in particular stands out: COVID-19 consequences will be with us for quite some time.
Several other viruses, including a large majority of those that cause common upper and lower respiratory infections, have been shown to produce such chronic symptoms as anxiety, depression, memory problems and fatigue. Experts believe that these symptoms are likely due to long-term effects on the immune system. Viruses trick the body into producing a persistent inflammatory response resistant to treatment.
Myalgic encephalomyelitis, also known as chronic fatigue syndrome, is one such illness. Researchers believe this condition results from continuous activation of the immune system long after the initial infection has resolved.
In contrast to other viral infections, the COVID-19 survivors in the study reported persistent symptoms lasting more than six months, with no significant improvement over time. The abundance of psychiatric symptoms was also notable and likely attributable to both infection and pandemic-related experience.
These findings are leading researchers to hypothesize several mechanisms following acute COVID-19 infection that may lead to long-haul COVID-19. With the known historical context of chronic symptoms following other viruses, doctors and researchers may have a glimpse into the future of COVID-19 with the potential to create therapies to alleviate patients’ persistent symptoms.
When does COVID-19 really end?
COVID-19 is now known to be a disease that affects all organ systems, including the brain, lungs, heart, kidneys and intestines.
These findings may point to a direct immune related cause of long COVID-19, though no real answers yet exist to define the true cause and duration of the disease.
In February, the National Institutes of Health announced a new initiative to study long COVID-19, now collectively defined as Post-Acute Sequelae of SARS-CoV-2. The NIH created a fund of US$1.15 billion to study this new disease. The aims of the study include the cause of long-term symptoms, the number of people affected by the disease and vulnerabilities leading to long COVID-19.
In my view, public health officials should continue to be open and transparent when discussing the short- and long-term effects of COVID-19. Society as a whole needs the best information possible to understand its effects and resolve the problem.
COVID-19 remains and will continue to be one of the largest socioeconomic problems across the world as we begin to recognize the true long-term impacts of the disease. Both the scientific and research communities should continue to be diligent in the fight long after the acute infections are gone. It appears that the chronic effects of the disease will be with us for some time to come.