Moral Courage in a Pandemic: a 14th Century Physician and Health Care Workers Today

What does it mean to be human? What values should we live by? How should we respond to those in need during a time of crisis? What would I do?

A physician during the Black Death.

Guy de Chauliac

As a hospice social worker who loves the humanities, I find that historical figures often come to mind when there’s a parallel with things that are happening with patients and their families. Amidst the COVID-19 pandemic, I’ve been thinking a lot about a 14th century French physician named Guy de Chauliac.

Although little known today, in his time he was one of Europe’s most respected medical practitioners. In fact, his text Chirurgia Magna was a standard part of medical education for 200 years.

I came across de Chauliac’s story years ago while researching the ‘Black Death,’ the plague that decimated Europe in the 1340s, killing up to a third of its population.

Those who have read Giovanni Boccaccio’s contemporary account of this plague in his work Decameron are often left with a cynical impression that, as Boccaccio puts […]

2020-03-27T12:15:38-04:00March 27th, 2020|Ethics, infection control, Nursing, nursing perspective, Public health|0 Comments
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Nurses and COVID-19: Into the Battle with All That We Have and All That We Lack

March 23: There is an important lesson to be learned from Italy, where COVID-19 has rapidly spread, placing a sophisticated health care system on the verge of collapse. Registered nurses (RNs) are suffering from exhaustion, contracting the disease, and leaving the workforce. As we bear witness to this unfolding tragedy, it is incumbent upon all U.S. nurses to take aggressive actions to protect our colleagues, our patients, and ourselves. Nurses who are ill or develop COVID-19 symptoms (fever, cough, shortness of breath) need to stay home. We can’t afford for nurses to infect other nurses. In fact, to ‘surge’ up to meet the anticipated demand for health care services due to the pandemic, still more nurses are needed. As a profession, now is the time to:

  • implement crisis staffing contingency plans,
  • expand the workforce as soon as possible,
  • and ensure the health and safety of all nurses through stringent observation of infection prevention and control measures and access to personal protective equipment (PPE). 

Crisis staffing.

Nurses should immediately make plans for surge capacity to address likely staff shortages. Facilities should consider polling nurses about their willingness to come to work; develop strategies to address the challenges that exist as barriers to coming to work (child care, pet care, transportation); and open conversations regarding the roles nurses are willing to play during the pandemic (see Table 1).

Table 1. Nurse Staffing Actions during a Pandemic (click table to expand)

2020-03-23T10:02:32-04:00March 23rd, 2020|infection control, infectious diseases, Nursing, Public health|2 Comments
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COVID-19: What a New Study Says and Doesn’t Say About the Possibility of Airborne Transmission

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 20. 

As we have become a little more comfortable with the concept of social distancing as a way to mitigate the spread of this new coronavirus, a new worry seemed to dominate conversations this week: the idea that the virus can linger in the air. The takeaway for many people, at least in the conversations I’ve been having, is that you can become infected by simply walking down the street. There is no evidence that this is true (unless, of course, someone sneezes in your face!).

Results of recent experiment deepen our understanding.

A March 17 research letter published in the New England Journal of Medicine reported on experiments in which SARS-CoV-2, the virus that causes COVID-19, was artificially aerosolized. (For comparisons, SARS-CoV-1, which causes SARS, was also aerosolized.) A nebulizer was used to aerosolize the virus, and the aerosol was fed into a rotating drum. The drum apparatus helps to keep the suspended aerosols from settling out of the air, so that their dynamics can be more closely studied.

Under these controlled conditions, the researchers were able to demonstrate that artificially aerosolized virus remained viable and infectious for three hours, and that therefore it’s “plausible” that, if something causes the virus to aerosolize outside of the lab, this could be another mode of transmission […]

2020-03-20T14:14:49-04:00March 20th, 2020|infection control, infectious diseases, Nursing, Public health|4 Comments
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Making Sense of Interim CDC Guidance on N95 vs. Surgical Masks for COVID-19

Surprising new CDC guidance.

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published: March 13, 2020. New posts will appear on this blog about aspects of the pandemic as the situation and our knowledge about the virus continue to evolve.

For nurses, the biggest news this week wasn’t the declaration of the COVID-19 epidemic as an official pandemic. It was the CDC’s release on March 10 of new interim infection prevention and control recommendations for COVID-19.

Many of us were taken aback to read the new document, which recommends the use of regular surgical face masks instead of N95s and the routine placement of patients suspected or confirmed of having COVID-19 infection in private rooms with the door closed instead of housing them in a negative pressure isolation room (which are always in short supply).

Unfortunately, without first acknowledging the concerns such a change from longstanding infection control practice might occasion among nurses and others, the CDC presented it as necessary due to an N95 shortage, stating, “When the supply chain is restored, facilities . . . should return to use of respirators for patients with known or suspected COVID-19.”

While it’s clear the CDC could have crafted this message more carefully, are caregivers being thrown […]

2020-03-16T10:25:22-04:00March 13th, 2020|infection control, Public health|2 Comments
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If I Want to Wear a Face Mask to Prevent COVID-19, Why Shouldn’t I?

By Betsy Todd, MPH, RN, nurse epidemiologist and AJN clinical editor. Published. March 6; updated March 12.

Times are uncertain. We don’t know how the spread of the new coronavirus will play out, or what parts of the country will be affected next. Many people continue to insist that wearing a mask in public places is “added insurance” against infection. But the reasons for NOT wearing a face mask far outweigh the purported benefit of keeping your nose and mouth covered when you’re out and about.

First, some background.

Health care workers use two main kinds of mouth and nose protection: either a regular surgical face mask, or an N95 respirator.

The purpose of a surgical mask is to prevent the wearer’s respiratory secretions from contaminating other people or surfaces. This is an example of “source control” in preventing infections. It is the reason the surgical team wears masks during operations and other invasive procedures.

N95 respirators look very much like face masks. They are designed to protect the wearer from inhaling hazardous particles (infectious agents, dust, etc.). Health care workers wear these when caring for people with COVID-19 or other serious respiratory infections.

But at least a face mask provides a physical barrier. Why shouldn’t I […]

2020-03-11T12:10:37-04:00March 6th, 2020|infection control, Nursing, Public health|0 Comments
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