Category: pandemic

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pandemic

In Canada, doctors do nursing

“And starting this weekend, at least one Toronto-area hospital will begin training physician volunteers so they can help critical care nurses in the ICU, as a way to immediately add more staff to keep up with a flood of severely ill COVID-19 patients.”

I had to laugh about this one. The medical residents, aka “baby doctors,” barely know how to do anything. I’ve had to teach doctors how to place an IV line, how to reduce a prolapsed rectum, how to talk to patients about death. And there’s no way they’ve ever considered giving IV antibiotics or other medications. Talk about chaos in the ICU.

I couldn’t find the original news article. See video report on Global News

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pandemic

More Covid News Stories

As much as I want to ignore hysterical news coverage, I still cannot tune out covid stories. Even though I try not to open the news app on my phone, I find myself jolting into full consciousness after scrolling for who-knows-how-long and wincing as I realize that I’m reading yet another covid story. By that point, I’m halfway to bookmarking it to share with y’all later or reading it aloud to my sister. Because you know the old adage– misery loves company. With that depressing introduction, here’s three stories that caught my interest so far this week…

one: covid transplant

Organ transplant patient dies when they receive (unknown) covid lungs. You have to keep doing transplants during a pandemic because people are still dying waiting for them… and when an organ becomes available, you have a VERY limited amount of time to utilize it. But there is really such a short window of time in which the whole process occurs, sometimes 1 day. A person can test negative for covid but actually be positive in that time. So sad that someone got new lungs, only to get covid also.

two: doc photog

Dr. Scott Kobner is the chief emergency room resident at the Los Angeles County-USC Medical Center and an amateur photographer. He photo-documented covid as it occurred at his hospital in stunning black and white.

three: bird flu

Even the headline on this piece made my blood run cold and my heart shutter a little as I remember all the pregnant women in the ICU in 2009, the year we fought H1N1: “Russia tells WHO it has detected first case of avian flu strain in humans.” My first thought: pandemic on top of pandemic??? NOOOO!!!!!! But it turns out the headline is a little misleading because although 2 people have indeed been diagnosed with H1N8, a new bird flu to transmit to humans, it was from direct bird contact and has not passed from human to human. But, you know, we might want to insert the word “yet” in the previous sentence so it reads “it has not YET passed from human to human.” Don’t all the viruses seem to go that way eventually?

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pandemic

A Collection of Covid Links

I have been lax in writing lately. Maybe my posts about mental health have given you a small clue about why? Not so subtle hint… In the background, I’m still reading some news and research, but most of the links I find interesting just end up in a notes file loosely titled “pandemic.” Today, I decided that I could at least go back and share the stories I’ve found interesting enough to save over the last month. Some might be a little out of date, but I know you’ll excuse me.

Double Masking

Most recently, the CDC annouced some shocking news (to me!) about masking. According to this NPR article, “Double Masking Offers More Protection,” with the most common combo being a cloth mask over a disposable (paper) surgical mask. This apparently helps the masks fit tightly and seal any holes that might exist to keep out any stray aerosols. When both people in an “exposure” during research wore their mask according to newly recommended CDC standards, transmissions of covid was reduced by 95%. This is AS EFFECTIVE AS THE VACCINE.

New CDC mask fitting guidelines issued as of Wednesday, February 10, 2021.

So, wear a mask, or even better TWO MASKS!

A Covid Cure?

Monday, January 25, a group of scientists from UCSF announced promising research into the cancer drug Aplidin, currently only approved in Australian to treat multiple myeloma, but currently on limited trial in Spain for covid19. The anti-viral drug is 30 times more potent that the current standard treatment remdesivir. Aplidin, generic name plitidepsin, was discovered in a sea squirt called Aplidium albicans off the coast of Ibiza, Spain but is not commercially available in most of the world.

Read more about the research at “The UCSF-led team racing to find a COVID cure may have found a promising candidate“

Will Covid End Homelessness?

This is the question Emma Gray Ellis asks for Wired Magazine in the article “The Lasting Impact of Covid-19 on Homelessness in the US.” She explores programs like California’s Project Roomkey, which utilized unused hotel rooms to house homeless people to curb the spread of covid among the homeless population by simply getting them off the street. And then the how the plan has transitioned to Project Homekey, which is attempting to turn these places into permanent housing for the homeless. Will attempts across the country to prevent widespread covid in the homeless population actually result in long-lasting change and housing? I really hope so, and some signs point to yes.

January in Santa Clara County ICUs

Its only February and yet January seems years away. It was a horrible post-holiday surge, and in the Bay Area, Santa Clara County was one of the hardest hit–as it was at the very beginning of the pandemic as well. This article about what it’s like inside the ICUs during the surge is fascinating reading, if you’re into that kind of thing.

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pandemic

The nurses are restless

Happy New Year. I’m writing to you from the ICU where the nurses have all gotten their first vaccine, have the date for their second, and buoyed by the fresh spirit of 2021, have decided to make travel plans.

I’m the fly on the wall, hearing that 2 weeks after her second dose of vaccine, one nurse is going to India. Another nurse already has plans for Mexico City.

They are also chattering about throwing a party once the second vaccine happens. As they stand next to each other with masks down around their chins, eating potluck food in the hallway near the nurses station.

I’m starting to realize that even my colleagues are no longer with me in the fight against covid. I know people are tired of masks and lonely and burned out, but I also know that the vaccines are NOT 100% effective, nor does everyone have access to or want the vaccine.

Also there are more specific issues at hand— such as the obvious fact that most people won’t take the time to learn how the vaccine works, so they won’t understand in what ways they’re protected and what ways they’re not protected…

For instance, did you realize that you will still “get” the covid virus but the vaccine will have pre-prepared your body’s immune system to fight it so you don’t get ill (or get less seriously ill)? So as long as virus still exists in your community, all of the reasons to wear a mask and social distance still apply after vaccination.

Also, vaccines in general take a few weeks to reach peak effectiveness. In this case, you need to think of all the steps the body has to take to build an immune response:

  1. Get first & second vaccines
  2. receive vaccine mRNA into cells
  3. Start making protein spikes in cells, per the instructions in the mRNA
  4. Release protein spikes from cells
  5. Immune system recognizes these protein spikes as foreign invaders
  6. Immune system begins making b-lymphocytes and t-lymphocytes
  7. These lymphocytes and other immune cells such as macrophages “fight” the vaccine, eradicating it—and it’s important to note that this is really the phase where you’ll feel “side effects” from your body fighting the vaccine.
  8. After this is finished, your custom made t and b lymphocytes are put into storage to be used agsin later if you get the virus

Most vaccines take about two weeks for this process, but these vaccines work a little differently. The literature for the Pfizer-BioNtech vaccine says that peak effectiveness is reached 7days (1week) after the second shot.

But as I’ve discussed above, you will still need to wear a mask to protect yourself AND others as well as continue practicing social distancing.

I’m only saying these things because I’ve already been asked a lot of questions here at work by many of the nurses, and they seem to not fully understand the situation. I’ll also add some links to site that explain the vaccines. I’m sure this will be an ongoing topic, though, as the vaccines continue to receive FDA approval and wider distribution…

Understanding How Covid 19 Vaccines Work (CDC)

Frequently Asked Questions about COVID-19 Vaccination (CDC)

Facts about COVID-19 Vaccines (CDC)

Covid 19 vaccines: get the facts (Mayo Clinic)

Please, be safe for yourself and for the rest of us!

Wear a mask. Social Distance. Don’t travel unnecessarily.

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pandemic

The Struggle for N95s

Think about the N95 mask. Our lifeline in the fight against covid. At once something so simple and so complicated. Would you ever imagine that the inventor of this absolutely invaluable mask is a man of only 68, who just retired two years ago? That the N95 was only invented in 1995. Invented. In 1995. Holy moly.

I guess I’m showing my age, but that doesn’t seem long enough ago for a mask that protects so many people from so many things… before covid, it was (and still is) used for those who care for patients with tuberculosis, novel flu strains such as H1N1 back in 2009, hemorrhagic viruses such as Ebola, and construction workers use it to filter airborne particles many of which can cause permanent lung damage as well.

A world without N95s seems like a very dangerous place.

So, the shortage that occurred during our covid surges throughout America and the world are a major failure. The lack of ability for even healthcare providers to have adequate personal protective equipment (ppe) is a sign of how broken our healthcare system and our government really is.

The continued dedication of healthcare professionals however–those who go to work anyways, even if they have to reuse masks for way too long or wear homemade masks and gowns–is a testament to the goodness of people, to the bravery that can be found even in the face of mortality.

I have been going to work knowing that if I get covid, I could die. But I go anyways. And I always would.

That is why I so appreciate the story if Dr. Peter Tsai, the inventor of the N95. He has come out of retirement to help companies change manufacturing plants in order to meet the needs of our healthcare system. And he does this for nothing. He feels it is his calling… read more about him in this feature in the Washington Post.

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pandemic

T minus 2 days

That’s when I’ll be vaccinated. I am very very excited to experience what will likely be the first in a long line of revolutionary new treatments pioneered with mRNA. I’m not quite as excited to likely be experiencing vaccine side effects over Christmas but oh well… I have a few days off so I might as well take some extra antihistamines and NSAIDs and sleep it off. I hope all of you are lucky enough to be getting vaccinated this holiday season as well!!!

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pandemic

Week in Review: Covid Tests & ICU Capacity

Both of my covid tests came back negative. I feel more confident that there were two negative results, but I was still sick for a little more than a week all told–so I’m baffled. I don’t think it was the flu, but it’s possible. Could have been a cold, I guess–just one of those old-fashioned pre-covid coronaviruses? Luckily, I’m starting to feel better because the ICU is busy and I keep getting calls to come in extra. We planned ahead for the winter & holidays by hiring dozens of traveling nurses and new staff, but we’re still short staffed, unfortunately.

Speaking of staffing, there was an article in the LA Times explaining ICU capacity and why it is so important to use as a metric for “shutting down” California. The Bay Area is currently at 17.8% capacity (slightly about the 15% cutoff for mandatory stay-at-home orders), but according to the article, 36 million Californians are living in areas where the ICU capacity has dropped below 15%.

The bottom line when ICU capacity is so severely limited–and I’m going to give it to you straight as a nurse in one of the best ICUs in the Bay Area– is that the only beds left are often beds at small, less busy hospitals. Yes, a bed may be an ICU bed–but the are not all created equal. You see, there are different types of hospitals. General hospitals provide basic emergency services but may need to transfer patients for higher levels of care. Trauma hospitals is where people are taken when involved in an accident with immediate life-threatening injuries and a full surgical team is always available. A tertiary care center is where patients are sent for specialty care at the highest levels. Doctors, nurses, and other staff at these hospitals that perform more complicated surgeries and regularly care for sicker patients and will be more skilled. They simply have more experience, and may also be involved in research studies–thus giving them access to drugs or treatments earlier than other hospitals.

So in a rural area, you may go to the local general hospital, be diagnosed with covid and admitted. But if you decompensate in a small rural ICU, you may find that the ICUs at tertiary care centers where you need to go for specialty care are no longer accepting patients because they are full–or, and this is more likely–they do not have enough staff.

At my hospital, we are lucky because the charge nurses guard the staffing with their lives. They never let the nurses be forced to take more patients than is safe, even if that means that a nurse is only caring for one patient. But no all hospitals are so lucky. In California, ICU nurses can take care of up to 2 patients at a time. In other states, 3 patients is the norm. I cannot even manage taking care of my sick covid patients AND two other sick patients as well.

Stay home if possible. Otherwise, be safe out there & please wear a mask.

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pandemic

Waiting for my Covid Result, Again

I’ve been tested at 2 separate sites operated by 2 separate agencies since Saturday. It is currently 01:28 on Tuesday morning. I have no test results.

I was the first testee of the day at 07:00 on Saturday at an appointment that I was able to make the previous day. There were about a dozen staff and 2 people including me waiting to get tested when the Parkmerced Curative testing booth opened. At first, no one knew the code to get into the iPad used to check people in. Then when I got to the booth, the scanner was not properly hooked up via Bluetooth to scan the barcodes on the lab tubes. That took another few minutes to fix. Then, I followed the directions I’d seen on the video they had sent me to watch— apparently too quickly for the attendant to interrupt me to have me break the swab differently so it didn’t explode and drop on the pavement. A second swab needed to be done.

Let’s just say I didn’t feel 100% confident about my test leaving the site. But they told me 48 hours, so I prepared to wait until Monday morning to find out how it went.

By Monday at noon, I had already been refreshing the test status page every few minutes for hours. I had started looking for a different covid test by about 11:00am because my patience was waning. An email to Curative customer support received an auto-response but no actual response. It said my results might not be ready for 72 hours.

By continuing to check for cancellations, I found a test 15 minutes from home around 1pm with the county agency that had previously gotten me results in 24 hours. I scheduled the appointment and went in.

Later in the day, I did finally go back to check Curative’s website to see if there had been any updates to my test status. And there had been!!!!

2days from test collection to reception at the lab?!?!?!

Apparently my specimen had just been received at the lab for processing 2 days— actually more than 48 hours—after collection. W. T. F.

Now I’m assuming it’s a dead heat— I’ll probably get both results back at the same time late tomorrow or Wednesday. In the meantime, I quarantine.

I’m not quite sure why 9 months into this pandemic we still can’t get reliable and quick covid tests–especially for healthcare workers who have been exposed–but this appears to just be how it goes in America, land of the trump.

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pandemic

A nasal spray for covid

Hidden away in the news this past week was an announcement about a nasal spray that had been developed from already-existing ingredients that can help aid in reducing your chances of getting sick from covid! Holy shit!

Researchers say regular application of the spray could significantly reduce disease transmission, and believe it could be particularly useful in areas where crowding is less avoidable, such as on flights or in classrooms.

–SkyNews

The article has a few other details, but mainly just drops the little factoid that this simple spray could help prevent transmission for up to 48 hours. This seems like a terrific thing, especially considering that the vaccines will likely not really be available until springtime.

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pandemic

I’m covid negative, so now what?

On Thursday evening, while watching tv and learning to draw, practice session #4 this week, I decided I needed to get tested for covid before my parents arrived to visit for thanksgiving next week.

Just to be clear: I’ve been working with covid patients since early March including during the chaos when the entire country was running out of masks. But we have been lucky in the Bay Area, our surges have been smaller and more manageable. We’ve even had periods recently where no covid patients needed ICU-level care.

There was a time when my work mates and I were 100% sure that we’d already had covid—because how could we not?!?! Protocols were in flux, the federal government who was guiding our policies couldn’t decide what type of isolation precautions and PPE we needed. Not that the PPE (personal protective equipment) was even readily available then.

We probably had 20 pairs of goggles in our whole hospital… and reusable face shields? Oh hell no. Luckily our administration ramped up quickly, and many of our doctors with friends in tech hit donations of things like 3D printed face shields. We did have some crazy gowns mixed in there as our normal supply (made in China I’m sure) got depleted, but we got through the initial surge.

And while we were doing that, we also made our overflow hospital, overflow ICU, and organized anything else we needed. And then we did a trial run to make sure everything was do-able just to make sure.

As time went on, I actually became confident in all my colleagues’ abilities to deal with the covid patients. The isolation gear and protocols became second nature. I’m not worried that someone is going to expose us all.

So how does it feel to be tested for the first time this it a far in to the pandemic and be negative? I’m proud of my work crew. We’ve been keeping each other safe for 9 months now.

We just need to keep it up.