2020 The year of the Nurse and Midwife, celebrated officially on 12th May, was blighted by the knowledge that too many nurses have died after contracting the virus whilst providing care for COVID patients, and they continue to do so. The ICN is calling for all governments to accurately record how many health workers have become infected and died from COVID19. As of 3rd June, from a limited number of countries sharing these statistics, over 230,000 health care workers have contracted the disease and more than 600 have died, although the real numbers are likely to be much higher. It’s definitely not how we intended celebrating nursing in 2020, nor is it how any of us intended 2020 to unfold, by counting the death toll around the world.
We are half-way through 2020 and nervous tension coupled with emotional exhaustion are high rating stress factors as we adapt to the new norm, the constraints and the restrictions imposed to contain the spread of the virus. How are you coping with it all? Caring to ask because it really has been a challenging time for everyone and we are all coping differently with this reality. I am in awe of those who have managed to utilise the lock down time with vigour and great purpose, venting on social media platforms or creating TikTok clips to entertain us all. I have found it too hard to write about and feel I need nerves of steel to brace for the daily news up-date and Covid19 statistics; I’m my own worst enemy, caught between wanting to know what’s going on and wishing I didn’t!
A call to share COVID 19 nursing experiences have, to date, been hard to write about, especially whilst the daily up date of bad news from around the world has been as exponentially horrific as the numbers of COVID19 cases and deaths. Where do I start with how this has impacted on nursing in my current location, when the situation is still evolving so dramatically and, with it, the latest focus? It has felt very much like we have been ‘flying the plane whilst still trying to build it’ although that’s not a good analogy with fleets of planes globally grounded currently. Even now, I wonder where we will all be by the time this is shared.
Will it all be ancient history, with the focus on the economic fall- out and recovery being uppermost, or will we be still dealing with a second wave of virus statistics? It already feels as though the lock down and virus was ‘so last month’ and now we have moved onto the red hot topic of racial inequality and the Black Lives Matter movement protests; galvanised into action by the horrific murder of George Floyd in Minnesota on 25th May. What a catalyst for a revolution that has been and how tinder dry the situation, with everyone absolutely ready to burst out of lock down to participate in a worthy cause; social distancing nigh on impossible, with face masks worn half-heartedly and often ineffectively. The virus has not disappeared, and the fear of a second wave is very real. Oh, for a crystal ball and feeling safe and secure in predictability, but then again that is my white privilege to know safe and secure.
At least that is my experience when I am not contract nursing in remote rural WA. It is a completely different story working here, where I witness, on a daily basis, the negative impact of inequity experienced by the indigenous community. It is not a safe and secure environment and the issues associated with the negative social determinants of health, especially poverty, drug and alcohol abuse, are huge. Closing the gap remains the most pressing goal and challenge.
I was so worried back in March, when the threat of an outbreak of COVID19 in this socially disadvantaged community was very real. The potential spread of the virus could have been rampant, as we have a very transient indigenous community, miners flying in and out back to Perth, seamen coming ashore off the Iron ore carriers and the hospital is in no way capable of coping with an influx of high acuity patients. Fortunately the measures put in place to limit the spread have proved to be very effective to date. Flights have been reduced to a skeletal service, the seamen from the carriers have not been allowed ashore and there has been a serious lockdown observed. The indigenous communities, that are quite some distance from the township, were also locked tight. The elders effectively educated every community about how serious the virus is. No one could enter without quarantining first. It literally closed the whole region, within a hard border state.
The fear of the virus also added to community anxiety and reluctance to attend hospital for any reason. No one moved anywhere and, as a direct consequence and paradoxically, health improved for everyone. With no access to drugs or alcohol, no vehicle accidents, there were very few admissions. We all worried for those locked into abusive relationships and feared for the children being abused, the consequences of which are coming home to roost now, as we have had several young girls admitted with pelvic inflammatory disease and positive for sexually transmitted diseases. There is so much more that could be shared about the pressing issues of child abuse here, they are not safe or secure, irrespective of the virus.
The hospital was well-staffed; all leave having been cancelled in anticipation of being overwhelmed with patients that did not come. It was horribly quiet and felt like the calm before the storm. We all sharpened our PPE donning and doffing routine, we refreshed management of respiratory conditions and critical care. New tasks emerged such as counting PPE and more paperwork, which felt very retrograde, as lists had to be scanned and emailed to the powers that be, We removed hand sanitizer from the communal areas, which felt counter intuitive, but they were being stolen! Anyone with a fever was treated as a potential COVID patient, eliciting fear in the staff and even more in the patient, until clearance was given. We researched best practice for managing mothers and babies; “To cohort or not to cohort” that was the question. At a time when a new baby brings families together, we planned to keep them apart and it instinctively felt as though it would do more harm than good. Thankfully, we haven’t needed to implement these measures.
It was a particularly stressful time for expectant mothers. I looked after a young 18 year old primip 36/40 with a fever of unknown origin, absolutely terrified of having the virus, not least because it could be serious for her own health but because family didn’t want her back in the house; she didn’t know where she could go, as no one wanted any risk of exposure to the virus. It has been the same for many nurses too, abused in public and treated like a pariah. Even one of our nurses was asked to leave the family home as she was a perceived threat to the health and safety of everyone, potentially being a vector for the virus.
Extra planning and strategies were devised for ‘in the event of an outbreak’ but thankfully none have had to be implemented. All unnecessary stock that is usually to hand in SCBU, had to be removed from the neonatal unit, for fear of contamination. It was all very awkward and just good fortune that we didn’t have any COVID exposed premature babies during lock down and flights to Perth still continued with the RFDS, even though commercial flights have been cut
I can write today, with good reason to share a glimmer of hope, in that New Zealand appears to have eliminated the virus, being twenty two days without a new case, and are celebrating by life returning to almost normal, well, ‘the new normal’. There is optimism for a Trans-Tasman bubble for commerce and tourism to commence, but a very real need for caution, after the protests held in both countries could see a flare of cases. The borders are still locked and WA is still closed to the rest of Australia, with hard borders existing between all states that require fourteen day quarantine before entering… I remain locked out of NZ and into WA but mostly I remain hopeful that other countries will also manage to eliminate the virus, that eventually we will be able to travel again but, most importantly, I hope that appreciation of nurses and what we do will be reflected in ensuring our health and safety as front line workers, not just in 2020, but every year going forward. A round of applause is a nice gesture but it is not as effective as personal protective equipment in saving nurses’ lives. . .