1918 Redux: Supportive Nursing Care for the Coronavirus Pandemic Is Courageous Care

Litter carriers at Red Cross Emergency Ambulance Station in Washington, D.C., during influenza pandemic of 1918.

The lessons of the past.

As we struggle to make sense of unfolding data, announcements, and public health directives about the current coronavirus pandemic, appreciating the lessons from past pandemics can help us understand the effectiveness and challenges related to quarantines and social isolation, as well as the need for reliable and timely communications.

In times of public health uncertainty, nurses and nursing care have played a critical role in saving lives and relieving suffering. We now know a great deal about the role of nursing during the 1918 influenza pandemic. Some lessons need heeding now.

Historian Nancy Bristow’s American Pandemic (New York: Oxford University Press, 2012) presents the historical facts clearly. For example, public health officials’ 1918 prohibitions on public gatherings, the sharing of such (then) new personal items as toothbrushes, and school attendance and religious services met acceptance as well as resistance. […]

2021-01-21T11:05:06-05:00March 18th, 2020|infectious diseases, Nursing, nursing history, Public health|1 Comment
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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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COVID-19 for Nurses: Skip the Rumors and Stick to the Basics

(Published: February 28. Editor’s note: much information in this post is now dated and the post should be read only as a response to a particular moment in time. COVID-19 is now officially a pandemic and has rapidly spread worldwide. While rumors and misinformation were, sadly, already very much in play when this was written, and the overall tone of this post was neutral and descriptive according to our knowledge at that current moment, the post only remains live for archiving purposes. Our most recent posts on the crisis can be found here.)

In the U.S. at the time of this writing, the major risk presented by the current novel coronavirus (COVID-19) is not from the disease itself but from misinformation. Rumors, misinterpretations, and conspiracy theories are being transmitted at a rate far greater than that of the coronavirus itself. While the situation is evolving rapidly and things can change quickly, our understanding of the illness has also grown in a remarkably  short period of time.

So, is this a pandemic?

In an NPR interview this week, WHO director-general Tedros Adhanom Ghebreyesus said the term is used to suggest that the spread of a new infection is out of control and doing significant damage worldwide. We are not quite there yet. COVID-19 transmission in China appears to have plateaued, and, while the virus has been detected in numerous other countries this week, several countries have also been successful in controlling the spread of COVID-19 within […]

2020-03-19T14:34:33-04:00February 28th, 2020|infectious diseases, Public health|13 Comments
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Serious Mental Health Issues: No Room for System Errors

I knew that my patients were once without mental illness, just like my little sister Doris had been before her diagnosis 10 years before, and I always tried to picture them like that, each their own best version of themselves.

A sister’s preventable death.

In this month’s Reflections column, “No Room for Error: Reflections on My Sister,” family nurse practitioner Kelly Vaez shares the story of the unexpected death of her sister, who had been diagnosed with schizophrenia ten years earlier. It’s particularly heart-wrenching to be able to see clearly, in retrospect, the ways in which our rushed, fragmented, and mental-health-unfriendly health care system contributed to what was probably an easily preventable death.

A dentist prescribed an unusually long course of antibiotics after a routine tooth extraction. The primary care team seemed unaware of the antibiotic therapy. No one made the connection between Doris’ diarrhea and this antibiotic, a frequent cause of C.diff infection.

And finally, loperamide—a drug that should never, ever be given for diarrhea that might be caused by C. diff—was prescribed with what seems to have been minimal assessment for the cause of the diarrhea. Was this last because the patient was a young adult with schizophrenia, and […]

2020-02-10T10:13:29-05:00February 10th, 2020|mental illness, Nursing|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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