Healthcare workers deal with contagious diseases all the time. What’s the big deal?
Contagious disease exposure is not new to nurses. On any given day without any preparation at all, nurses may be exposed to tuberculosis, measles, varicella, influenza, HIV, Hepatitis, and whole host of others. So why is this different?
Measles, varicella, influenza, some strains of hepatitis, and others…..We have no fear of. We’ve either been vaccinated or in a couple of cases have obtained immunity from childhood infection. We have had those titers checked and we are protected. Hep C and HIV; We can contract those, but only if we make a personal mistake, in which case, it would suck, but we can take medications. There is a treatment or cure for those that has a high success rate for living a long productive life.
Influenza? Ordinary surgical masks are highly effective in halting the droplet transmission. We’re also vaccinated yearly. Even if our flu shot doesn’t prevent 100% of infections, it drastically reduces our chances of needing hospitalized from severe infection and our flu shot also ensures that we are nearly guaranteed not to die. Couple that with antiviral treatment which has been proven effective against influenza and we feel really confident. In fact, I’ve exposed myself to influenza every year in the emergency department (in ungodly amounts) for sixteen years straight, including 2009/2010 H1N1 and I have never been sick enough to suspect or be tested for influenza.
Now tuberculosis scares us a little. It’s airborne – relatively easily contracted and most of us are not vaccinated for that (because that vaccine is not on the US schedule). Tuberculosis can cause severe lung disease, and it is known to be lethal… however, there’s two things that quiet our fears: 1) it has a treatment. A rough one, many months of medications with god awful side effects, but a treatment/cure nonetheless. 2) n95 masks coupled with negative airflow rooms are extremely effective in protecting us. Because this is one of the only diseases that require healthcare workers to dawn an n95 respirator, we always have access to proper protection. The disease is well studied we can spot it by its tell-tale symptoms from a mile away. We know our protocols; We mask the patient and ourselves immediately, put the patient in a negative airflow room that causes the patient’s air not to mix with the general circulation and the patient and staff all practice proper isolation for the duration of their stay. I see maybe a dozen or so of these patients per year- they are all stable , not one of them in nearly two decades of work has required ER intubation, 90% or better were admitted and discharged from a non-critical care area of the hospital. We are tested yearly for exposure. It’s a slow progressing disease that when treated, people rarely die from in the US.
None of the things that we find personally comforting about the usual pathogens we’re exposed to in our daily work are applicable to Covid-19 caused by SARS-Cov-2. First, just like the general public, healthcare workers have no immunity. 100% of us are susceptible to infection. Next, UNLIKE the general public, healthcare workers have nearly a 100% chance of exposure. Not just once, but over and over and over for every single shift- and not just “fly by” exposure you’d get in a grocery store or bank. We’re talking in your face, make you gag your sputum with a swab, tube in your throat, flinging around in your lung goop exposure. The worst of the worst exposure. Nobody knows for sure which protective gear works best since some reports call it droplet transmission, some indicate airborne infectiveness, especially during procedures that produce what we call aerosolized droplets. They think it can probably get in through your eyeballs too. The only thing agreed upon is that it just hasn’t been studied long enough to definitively know all of the ways it can get us.
Ok cool, so it’s highly contagious, we maybe know all of the ways it can spread, so what now? No problem (say the front line) We will just suit up and assume the worst! Not so fast. See, the problem is, because scarce TB infections and a stray measles case were really the only germs we anticipated needing n95 masks for, all hospitals have a very limited supply of this protective equipment. Goggles and face shields and space suits are not required for anything else that we prepare for beyond a hazmat disaster, so there’s basically zero supplies of those things stockpiled-certainly not enough to treat a half million individual cases over the course of a matter of weeks so those are all on back order with the whole world scrambling and competing.
We can argue all day long about who should’ve been better prepared for what but the reality is that humans are horrible preparers. I lived in a place prone to earthquakes for a good portion of my life, almost nobody has that 3 weeks supply of food and water that the experts KNOW (it’s not a guess) you’ll need when the “big one” hits. We prepare for what we can see; the airborne diseases we know about. That didn’t help us prepare for this.
So, we have no gear to protect us from a disease that we have no immunity to, that we know is deadly for a statistically significant portion of the infected. We have no meaningful policies to guide us in the care of a brand new disease that we know very little about, and when, not if, WHEN we contract it……. there’s no cure and no proven effective treatment. THAT is the reality of every single frontline healthcare worker, right now. The cherry on top is that healthcare workers are more likely to suffer severe disease because of the high viral load in those we treat with the most significant disease.
Hospitals packed full of patients with a disease we will get, can’t treat, and could die from is really scary. That’s not a scenario any of us were anticipating when we went into nursing. We’ve always been willing to risk our safety to a certain degree. None of us had time to process certain infection with a high likelihood of hospitalization or death and weigh that against our career choice. I think most would agree that accepting this risk is typically a very personal decision that takes introspection to explore properly- we did not have that opportunity. So what you have been seeing in the social media posts of front liners is that process of the mind playing out in real time. All of the emotions; fear, sadness, resolve, pride, disgust, anger, and more. Give the front liner in your life the time and support to come to terms with their new reality. It would also go a long way to understand, that when they beg you to follow the guidance meant to keep you safe, they are quite literally begging for their own lives in that plea.
**this blog is run by nurses, so we speak in terms of nurses, but this entry pertains solidly to Doctors, RTs, Techs, CNAs, EVS, and all others who work the healthcare frontline. **