Students, Retirees, and School Nurses Pitch In to Fight COVID-19

Students, Retirees, and School Nurses Pitch In to Fight COVID-19

Nursing students, nursing schools, school nurses grounded after school closures, and retired nurses are all joining the fight against the rising pandemic.

Here are just a few examples to be found across the United States:

Jackson, Mississippi

Seniors at Belhaven’s School of Nursing are performing community outreach and educating the public on how to protect themselves and others from the virus. Students are teaching infection-control techniques, discussed sanitation practices with the college’s operations team, and have posted instructions in campus dorms on maintaining safe hygiene. Senior Rebecca Rylander tells Jackson’s WJTV, “There is a desperate need for healthcare workers amidst this pandemic, and I want to help fill that need.”

Long Island, New York

At nursing and medical programs in Long Island, students barred from immediate contact with patients are playing an active role behind the scenes and on the front lines. While medical students at the Renaissance School of Medicine in Stonybrook are conducting online research and serving patients via telehealth sessions, the Barbara H. Hagan School of Nursing and Health Sciences tells Newsday that they have “alumni, graduate students and faculty working in emergency rooms and testing sites, and undergraduates are working or volunteering as nursing assistants.”

Darien, Connecticut

School nurses have volunteered at Darien High School’s COVID-19 testing station. Lisa Grant, a school district nurse at Hindley School, said “We had been asking our director what we can do to help so when Darien signed up for a site, we volunteered.” Yvonne Dempsey, of Ox Ridge School was also ready to help out. Dempsey told the Darien Times, “As nurses, we put ourselves out there any way we can. I figured that’s something I can do in my free time with the schools closed.” She adds, “Testing is the key — testing and isolation as much as possible is the only way to stop the spread.”

Framingham, Massachusetts, Caldwell, New Jersey, and elsewhere

In response to calls from the American Association of Colleges of Nursing, nursing faculty at colleges, universities, and community colleges are rushing to donate supplies of everything from masks to isolation gowns, to hand sanitizer. “This is a time when we all need to come together as a community and work cooperatively to fight this pandemic for the health and safety of everyone,” MassBay Community College President David Podell told the Framingham Source. Jennifer Rhodes, DNP, a faculty member at Caldwell University’s School of Nursing and Public Health, remarked, “As a former emergency room nurse, I cannot imagine what they are experiencing on the front lines right now.”

Chapman, Nebraska

Retired nurses are also answering individual states’ call for help. Nebraska TV spoke to 61-year-old Mary Steiner, a former emergency response nurse, has volunteered for the Central Nebraska Reserve Core. As she waits to put to use her training in natural disaster and emergency preparedness, Mary remarks, “If it’s something that becomes as serious as what’s going on in New York City right now… They’re wanting all hands on deck and so regardless of what my workplace setting has been in the past I know they’re going to be able to use me.”

Cuomo Loosens Reins on NPs, PAs, and More

Cuomo Loosens Reins on NPs, PAs, and More

As New York state climbs the steep face of its COVID-19 curve, Gov. Andrew Cuomo (D) issued an executive order vastly widening the scope of practice for some healthcare providers and absolving physicians of certain risks and responsibilities.

Among the order’s provisions:

  • Eliminating physician supervision of physician assistants (PAs), nurse practitioners (NPs), certified registered nurse anesthetists, and others
  • Enabling foreign medical graduates with at least a year of graduate medical education to care for patients
  • Allowing emergency medical services personnel to operate under the orders of NPs, PAs, and paramedics
  • Allowing medical students to practice without a clinical affiliation agreement, and lifting 80-hour weekly work limits for residents
  • Granting providers immunity from civil liability for injury or death
  • Suspending usual record-keeping requirements
  • Allowing several types of healthcare professionals — including NPs, PAs, nurses, respiratory therapists, and radiology techs — with licenses in other states to practice in New York. However, physicians were not specifically included in the order, as the Department of Health and Human Services has not yet issued the necessary regulation
  • Suspending or revoking hospitals’ operating certificates if they don’t halt elective surgeries

The order, which remains in place through at least April 22, was met mostly with applause, though with some hesitation around work-hour limits.

C. Michael Gibson, MD, of Harvard, called it “stunning in both the breadth and depth of recommendations” on Twitter.

Shariq Shamim, MD, described it as a “great move,” with the exception that trainee work hour limits shouldn’t be scrapped: “They are already working equivalent to 2 [full-time employees] without Chinese-style PPE. More hours = more risk of exposure,” he tweeted.

Art Gianelli, president of Mount Sinai Morningside hospital in New York City, told MedPage Today that his team is “grateful to the governor for throwing the regulations out the window right now. He’s encouraging us and enabling us to do what we have to do to get through this. It’s the right thing to do.”

John Puskas, MD, chair of cardiovascular surgery at Mount Sinai Morningside, agreed that the steps are the right ones given that New York City “hasn’t flattened the curve adequately to avoid a big wave crashing. We’re really going to feel it in the next 2 or 3 weeks.”

“If simultaneously with that, we lost a meaningful number of healthcare providers to home quarantine, then we’d have a shortage not just of ventilators, but of people to run them and care for patients,” Puskas said.

by Kristina Fiore, Director of Enterprise & Investigative Reporting, MedPage Today

VA to Retired Medical Personnel: Help Us Fight COVID-19

VA to Retired Medical Personnel: Help Us Fight COVID-19

The Office of Personnel Management (OPM) approved a request from the Department of Veterans Affairs (VA) on March 19 to waive a section of federal law that governs retired VA workers.

The waiver makes it easier for the department to rehire retired VA health care workers and will help VA health care facilities bolster their medical staffs during the COVID-19 pandemic.

VA is implementing the authority and could begin hiring actions as soon as this week.

As a result, VA is inviting interested retired physicians, nurses, pharmacists, laboratory technicians, respiratory therapists and other medical professionals to register online.

VA is especially looking for health care providers with interest and expertise in:

  • Tele/virtual care
  • Travel Nurse Corps
  • Direct patient care/support (at a VA medical center and/or outpatient clinic)

As a re-employed annuitant, you receive your Civil Service Retirement System (CSRS) or Federal Employee Retirement System (FERS) annuities, as well as a paycheck as a federal employee. The waiver is in effect until March 31, 2021, according to OPM.

Choose VA

Nurses Scrounge for Masks to Stay Safe

Nurses Scrounge for Masks to Stay Safe

As the caseload of patients with the new coronavirus grows, masks and other personal protective equipment are in short supply — and nurses in Washington state are resorting to workarounds to try to stay safe. 

Wendy Shaw, a charge nurse for an emergency room in Seattle, said her hospital and others have locked up critical equipment like masks and respirators to ensure they don’t run out. 

Shaw is the de facto gatekeeper, and is now required to run through a list of questions when anyone comes to get a mask: “What are you using it for? What patient? What’s the procedure?” 

“I have become a ‘jailer’ in a sense of these masks,” she said. 

“We now have to learn how to work with less, and how to be good stewards of the resources that we have,” Shaw said. 

For Shaw, there’s a very personal stress driving her to be careful. She has Type 1 diabetes, and so does her young son, which puts her at high risk for complications if she were to be infected. 

“I am cleaning like I have never cleaned before. I am hyperaware of what I touch, who has brushed up against me,” said Shaw. “We think about this all the time. Every day I wake up without a fever or a cough is a win for me.” 

At some hospitals, nurses and doctors said they are being told that, contrary to standard protocol of disposal after a single use, they should try to clean and reuse their N95 masks, a respirator that protects the face from airborne particles and contaminated liquid. 

Ad Hoc “Mask Workshops”  and Mask Crowdsourcing

Meanwhile, office staff at the corporate headquarters of Providence St. Joseph Health in Renton, Washington, have opened an ad hoc workshop where they are assembling masks and face shields on their own, to bolster resources. 

“At any given time, we are days away from running out of personal protective equipment,” said Melissa Tizon, with Providence St. Joseph Health. 

Tizon said the health system has already delivered 500 face shields to Providence-affiliated hospitals in Seattle and Everett, Washington, and plans to start sewing masks in the coming days. 

Some nurses are even crowdsourcing masks. 

Bobbie Habdas, an ICU nurse at Swedish Medical Center, took to Facebook asking for help from her community. 

“I never thought that we’d necessarily be doing this,” said Habdas. 

Her post gained lots of attention, and she collected more than a hundred masks to share with co-workers. 

“Honestly, it shocked me and it really touched me — it’s extremely appreciated,” she said. 

The outpouring was a bright spot, but Habdas wonders why nurses have to scrounge for supplies, in addition to their regular duties. 

“There is a huge feeling of panic, not only externally, but also internally within the hospital,” said Habdas. 

She said spending time looking for supplies during her shift doesn’t help with the stress of responding to the coronavirus pandemic. Patients have died from the disease in Washington, with at least 74 COVID-19 deaths recorded across the state as of Thursday afternoon. 

Sally Watkins, executive director of the Washington State Nurses Association, said nurses are being forced to make do with less. 

“They are not being protected at the level that they should be,” said Watkins. She hopes the region will get more supplies from the federal stockpile soon. 

Communication Breakdowns 

After 39 years as an intensive care nurse, Mary Mills has dealt with other infectious disease crises, but her hospital’s response to the coronavirus outbreak feels different. She remembers helping to intubate HIV patients in the early days of the AIDS crisis, when there was still a lot of fear and unknowns about that illness. 

“Everybody was on the same page,” Mills said. “There was clear communication.” 

Mills works at one of the five hospitals run by Swedish Medical Center in the Seattle area. “I hate to say I don’t feel particularly supported now,” she said. 

Like many health care workers, Mills feels frustrated because the guidance on when to use personal protective equipment, or PPE, keeps shifting, sometimes daily. 

“What they decide I need, in terms of my safety, is being changed based on availability of product, rather than the science,” Mills said. 

“This is super contagious. We can spread it to our kids, our parents and grandparents,” she added. 

This story is part of a partnership that includes NPR and Kaiser Health News. 

Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente. 

COVID-19: Report from California

COVID-19: Report from California

Coping With COVID-19

On Tuesday, Dr. Jeanne Noble devoted time between patient visits to hanging clear 2-gallon plastic bags at each of her colleagues’ workstations. Noble is a professor of emergency medicine and director of the UC-San Francisco medical center response to the novel coronavirus that has permeated California and reached into every U.S. state.

The bags were there to hold personal protective equipment — the masks, face shields, gowns and other items that health care providers rely on every day to protect themselves from the viruses shed by patients, largely through coughs and sneezes. In normal times, safety protocols would require these items be disposed of after one use. But just weeks into the COVID-19 pandemic, supplies of protective gear at UCSF are already so low that doctors and nurses are wiping down and reusing almost everything except gloves.

“It is not a foolproof strategy at all; we all realize the risk we are taking,” Noble said. But as supplies dwindle, she increasingly finds herself asking the folks in charge of infection control at the hospital if they can make changes to protocols. “As days go by, one regulation after the other goes out,” she said.

Noble is among the Bay Area physicians applauding the decision this week by seven Bay Area counties and multiple others across California to order residents to shelter in place for the foreseeable future, directives that are upending life for millions of people and shuttering schools and businesses across the state. Without swift and dramatic changes to curb transmission of the virus, hospital officials say, it is just a matter of time before their health systems are overwhelmed.

Interviews with California physicians on the front lines of COVID-19 offer a sobering portrait of a health care system preparing for the worst of a pandemic that could be months from peaking. In the Bay Area, the battle is being waged hospital by hospital, with wide variations in resources.

Waging the Battle, Hospital By Hospital

The tent where Noble tended to patients this week was set up to deal with a recent rise in people showing up with respiratory illness. Even without the coronavirus threat, UCSF’s emergency room is a busy one, and doctors frequently see patients in hallways and other spaces. But the current outbreak makes that close contact unsafe. So instead, everyone who comes to the hospital is being triaged. Most people with fever, cough or shortness of breath are diverted to the tent, which is heated and has negative air pressure to prevent the spread of infection. For now, the pace is manageable, but Noble fears what’s ahead.

Farther south, in Palo Alto, Stanford Medical Center was testing patients with respiratory problems in its parking garage. The private university hospital has more protective gear than the public one in San Francisco; a global scavenger hunt several weeks ago bolstered supplies, though Stanford, too, has adapted protocols to be more sparing with some items.

“We don’t have an unlimited supply,” said Dr. Andra Blomkalns, professor and chair of the Stanford School of Medicine’s Department of Emergency Medicine. “But at least we’re not looking at our last box.”

The entire country is short on protective gear, a result of both the surging demand for such equipment as the virus spreads and the implosion of supply chains from China, where much of the equipment is manufactured.

Noble believes some equipment will need to be made locally. “If the [federal] government doesn’t step in and force manufacturing of these products here now, we are going to run out,” she said.

Empty supply closets affect everyone who needs care, including heart attack victims and people in need of emergency surgery, said Dr. Vivian Reyes, president of the California chapter of the American College of Emergency Physicians and a practicing emergency physician in the Bay Area.

“I know it’s really hard for us Americans because we’re never told no,” she said of the shortfall of supplies. “But we’re not in normal times right now.”

And protective equipment isn’t the only thing in short supply.

Looming Shortages

Until a few days ago, UCSF had to rely on the San Francisco Department of Public Health for coronavirus testing, and a shortage of test kits meant clinicians could test only the most critically ill. The situation improved March 9, when the university started running tests created in its own lab. First, there were 40 tests a day. By Tuesday, there were 60 to 80. But a new shortage looms: The hospital has just 500 testing swabs left.

Stanford pathologist Benjamin Pinsky built an in-house test that has been approved for use by the federal Food and Drug Administration. Since March 3, Stanford has used it to test more than 500 patients, 12% of whom had tested positive as of Tuesday. The university has been running tests for other hospitals as well, including UCSF. It’s a dramatic improvement from a few weeks ago, when Stanford relied on its county lab.

Blomkalns saw a sick patient in mid-February, before the hospital had its own test kits, who had symptoms of COVID-19 but didn’t qualify for testing under the narrow federal guidelines in place at the time. He went home, only to return to the hospital after his condition deteriorated. This time, he was tested and it came back positive.

In Santa Clara County, home to Stanford, 175 people have tested positive for COVID-19 and six have died. Late last week, the medical center’s emergency department saw the highest number of patients in one day in its history. Blomkalns doubts it’s because there are more cases in her area. “If you don’t test, you don’t have any cases,” she said.

Blomkalns worries about staffing shortages as health care workers are inevitably exposed to the virus. As of Tuesday, one doctor in the Stanford ER had tested positive. At UCSF, six health care providers had.

Not all Bay Area hospitals are seeing a flood of patients. In fact, some have fewer patients than usual, as they have canceled elective surgeries in anticipation of a COVID-19 surge.

The doctors treating COVID-19 patients say nearly all who test positive have a cough. They complain of fatigue, body aches, headaches, runny noses and sore throats. While most people are well enough to recover at home, those who get critically ill tend to do so in their second week of symptoms, and can deteriorate very quickly, several doctors noted. “We are recommending that patients get intubated a little earlier than they might otherwise,” said Reyes.

COVID-19 in CA: The Symptoms They’re Seeing

In general, officials are asking people who have mild cases of COVID-19 to treat their symptoms at home, as they would a cold or flu, and refrain from seeking care at hospitals. People experiencing shortness of breath, however, should definitely go to the emergency room, said Blomkalns.

For children, the criteria may be a bit different. Shortness of breath should trigger a visit, as should altered mental state, excessive irritability, or an inability to eat or drink, said Dr. Nicolaus Glomb, a pediatric emergency care physician at UCSF Benioff Children’s Hospital.

Gov. Gavin Newsom said Tuesday that rough projections suggest the state could need anywhere from 4,000 to 20,000 additional beds to treat patients with serious cases of COVID-19.

The testing problems worry Noble, as do the equipment shortages, but not nearly as much as the potential for a lot of sick people. “I’m mostly worried about a tsunami of very ill patients that we’re not equipped to take care of,” said Noble.

Blomkalns isn’t sure whether or when Stanford might exceed capacity, saying the caseload trajectory may hinge on how aggressively state and national authorities move to cut off routes of community transmission. “It all depends on what happens in the coming weeks and days,” she said. “We know what we need to do, and we’re doing the job.”

KHN Senior Correspondents JoNel Aleccia and Jenny Gold contributed to this report.

This KHN story first published on California Healthline, a service of the California Health Care Foundation.

Reposted courtesy of Kaiser Health News, a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

COVID-19: Surge in Healthcare Worker Self-Quarantines Raises Concerns

COVID-19: Surge in Healthcare Worker Self-Quarantines Raises Concerns

As the U.S. battles to limit the spread of the highly contagious new coronavirus, the number of health care workers ordered to self- quarantine because of potential exposure to an infected patient is rising at an exponential pace. In Vacaville, California, alone, one case — the first documented instance of community transmission in the U.S. — left more than 200 hospital workers under quarantine and unable to work for weeks.

Across California, dozens more health care workers have been ordered home because of possible contagion in response to more than 80 confirmed cases as of Sunday afternoon. In Kirkland, Washington, more than a quarter of the city’s fire department was quarantined after exposure to a handful of infected patients at the Life Care Center nursing home.

With the number of confirmed COVID-19 cases mushrooming by the day, a quarantine response of this magnitude would quickly leave the health care system short-staffed and overwhelmed. The situation has prompted debate in the health care community about just what standards medical facilities should use before ordering workers quarantined — and what safety protocols need to become commonplace in clinics and emergency rooms.

Dr. Jennifer Nuzzo, a senior scholar at the Johns Hopkins Center for Health Security, is among those arguing hospitals need to change course.

“It’s just not sustainable to think that every time a health care worker is exposed they have to be quarantined for 14 days. We’d run out of health care workers,” Nuzzo said. Anyone showing signs of infection should stay home, she added, but providers who may have been exposed but are not symptomatic should not necessarily be excluded from work.

The correct response, she and others said, comes down to a careful balance of the evolving science with the need to maintain a functioning health care system.

While hospitals are supposed to be prepared for just such a situation, Nuzzo said, their plans often fall short. “Absent any imminent public health crisis, it may not be one of their priorities,” she said. From 2003 to 2019, federal funding for the Hospital Preparedness Program in the U.S. was cut almost in half.

In Northern California, potential exposure to the new coronavirus was exacerbated because hospitals were caught unaware by the community spread of the virus and hampered by federal protocols that initially limited diagnostic testing to patients with a history of travel to a country where the virus was known to be circulating or contact with a person with a known infection.

“At the very beginning [of an outbreak] this will happen because you don’t know patients are infected and you only realize later that people were exposed,” said Grzegorz Rempala, a mathematician at the College of Public Health at Ohio State University who models the spread of infectious diseases.

Now that the disease has started to spread through the community, any patient with respiratory symptoms potentially could be infected, though health officials note the likelihood remains low. As providers start routinely wearing protective gear and employing strict safety protocols, accidental exposure should decline.

The Vacaville case offers stark insight into the fallout from the narrow testing protocols initially established by the Centers for Disease Control and Prevention. When a woman was admitted to NorthBay VacaValley Hospital with respiratory symptoms on Feb. 15, dozens of hospital workers walked in and out of her room performing daily tasks. Days later, as her condition worsened, she was sent to UC Davis Medical Center, where dozens more employees were potentially exposed.

Because the woman did not meet the testing criteria in place at the time, it took days for UC Davis to get approval to have her assessed for the coronavirus. After the test came back positive, about 100 NorthBay workers were sent into self-quarantine for 14 days. At UC Davis, an additional 36 nurses and 88 other employees were quarantined, according to the unions representing those workers. (A spokesman for UC Davis said the figures were not accurate but declined to give an estimate.)

“We’re not used to being concerned, before we even do the triage assessment, whether the patient is infectious and could infect hospital workers,” said Dr. Kristi Koenig, the EMS medical director of San Diego County. She said that thinking started to evolve during the 2014 Ebola outbreak. Hospitals should routinely mask patients who come in with respiratory symptoms, she said, given any such patient could have an infectious disease such as tuberculosis.

Yet providers don’t often think in those terms. “In many ways we’re spoiled because we’ve gone from a society 50 or 100 years ago where the major killers were infectious disease,” said Dr. Michael Wilkes, a professor at UC Davis School of Medicine. “Now we’ve become complacent because the major killers are heart disease and diabetes.”

Faced with this new infection risk, many hospitals are scrambling to retrain workers in safety precautions, such as how to correctly don and doff personal protective equipment.

Sutter Health, which has 24 hospitals in Northern California, started ramping up its emergency management system five weeks ago in preparation for COVID-19. Before coming to the emergency room, Sutter patients are asked to call a hotline to be assessed by a nurse or an automated system designed to screen for symptoms of the virus. Those with likely symptoms are guided to a telemedicine appointment unless they need to be admitted to a hospital.

Anyone arriving at a Sutter emergency room with signs of a respiratory infection is given a mask and sequestered. “A runny nose and a cough doesn’t tell you much. It could be a cold, it could be a flu, and in this weather it could be allergies,” said Dr. Bill Isenberg, Sutter’s chief quality and safety officer. A doctor or nurse in protective equipment — including N95 mask, gown and goggles — is deployed to assess the patient’s symptoms. If COVID-19 is suspected, the patient is moved into a private room.

Sutter has treated several coronavirus patients who arrived from Travis Air Force Base, which housed evacuees from the Diamond Princess cruise ship quarantined off the coast of Japan after an outbreak was detected on board. The Sutter patients were placed in negative pressure rooms so that contaminated air did not circulate to the rest of the hospital, and staff used an anteroom to take off gowns and masks.

“We do everything humanly possible to minimize the number of people who have to enter [the room],” Isenberg said. Still, he said, some workers have been quarantined; Sutter would not disclose the total.

Not all hospitals are adapting so quickly. National Nurses United, a union representing more than 150,000 nurses, recently held a news conference to call on hospitals to better protect their workers. Of the 6,500 nurses who participated in a survey the union circulated, fewer than half said they had gotten instruction in how to recognize and respond to possible cases of COVID-19. Just 30% said their employer has sufficient protective equipment on hand to protect staff if there were a surge in infected patients.

As the virus continues to spread, hospitals should be stockpiling such equipment, figuring out how to add beds and planning for staffing shortages, said Dr. Richard Waldhorn, a professor of medicine at Georgetown University and contributing scholar at Johns Hopkins who recently co-authored recommendations for hospitals on how to prepare for a COVID-19 pandemic.

Hospitals should already be training providers to take on expanded duties, Waldhorn said. If a hospital becomes overwhelmed, the Medical Reserve Corps can be mobilized, as can networks of providers who have volunteered to aid in emergency situations. Once workers have been infected and recover, it might make sense to have them treat other coronavirus patients since they will have immunity.

Eventually, as a disease becomes widespread, quarantine simply stops being a priority, said Nina Fefferman, a mathematician and epidemiologist at the University of Tennessee-Knoxville.

“There’s a point where we stop trying to quarantine anyone and we just say, OK, we’re going to have more deaths from the fire department not being able to fight fire than from everyone getting the disease.”

This Kaiser Health News story first published on California Healthline, a service of the California Health Care Foundation. Kaiser Health News is a nonprofit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation, which is not affiliated with Kaiser Permanente.

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