Tag: covid

Categories
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

Categories
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?

Categories
Quick Notes

2 observations from the week from hell, maybe 3 ok???

  1. Covid. Still everywhere & people are dying. It is going to take MONTHS, maybe the entire YEAR of 2021 to roll out the vaccines. Keep wearing your masks, stay home & stay distant.
  2. There are some heart attacks that should kill you, in my opinion. Maybe I’m just traumatized by my job, but when your heart is so damaged that you need A NEW ONE, it seems like life just wasn’t meant to be.
  3. People always talk about nurses not being able to pee for their whole shift. But when you extend that metaphor, having a job where you can’t sneak away to take a poop is also horrible. Gas pains hurt really bad!
Categories
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.

Categories
intensivecare

Drug ODs & PTSD: Consequences of Covid

We are having a record-breaking year for deaths from drug overdoses. There are many factors playing into it–synthetic fentanyl and its rapid spread from East to West coast; the silent pandemic of loneliness and despair that underlies covid and brings with it more drug use and abuse; a financial crisis leading to more homelessness which sort of closes the circle on the previous two factors. It’s hard to separate one thing from another as the bad news this year just kept piling on, and ultimately everything seems related in some way to the worldwide pandemic and the fallout from it.

So here we are. A record year for drug overdoses. An article from New York Magazine points out not just how we’re going to break records for drug ODs but that here in San Francisco, overdose deaths actually outnumber covid deaths. Maybe we should just add OD deaths on to the covid death totals… But then again, that is a slippery slope. We could say the same for heart attacks and strokes, and diabetes and decreased exercise tolerance. Maybe “pandemic syndrome” should be a new diagnosis. Let’s spitball a formal diagnosis criteria–it would probably involve 1) financial, housing, food, and/or racial insecurity AND 2) a concurrent development of a chronic illness, plus one of the following two categories 1) depression and/or anxiety; 2) alcohol and/or drug use disorder. I’m sure we don’t need this diagnosis–what we have covers it since this probably falls into the territory of a psychological diagnosis.

My fictitious diagnosis would be covered easily by “adjustment disorder” from the DSM V, but we’d all run into trouble when our adjustment problems go beyond 6 months. But you know what? Perhaps we’ll see a lot of PTSD or cPTSD coming out of this pandemic. I can only speak from what I see or read, and I know that many healthcare providers are being severely traumatized over and over by this pandemic.

They are taking care of patients who are isolated and lonely and sometimes, dying alone. There are times when the only visitors are Zoom calls with family, and the nurse usually is the one holding the iPad, absorbing day after day of each family’s sadness and overwhelm.

There are the days when even though they are sick, the patients still lash out at the nurses and other medical staff violently, sometimes causing permanent disability. Even though my hospital has done all of the things discussed in this article, we still have violence from patients and visitors: Cash-rich hospitals have done little to prevent violence against nurses and other medical staff — from The Milwaukee Journal Sentinel (the last of a five-part series called “In the Shadows” about violence against healthcare workers)

And none of this takes into account the high risk healthcare workers are at to actually get covid. This story of an ICU nurse in her 60’s who gets covid and ends up in the hospital for 8 months fighting for her life and then relearning how to walk is inspiring. But not many souls would fare so well with such a challange.

Could you imagine going to work, thinking that could be you? That was my previous 9 months. I did get my first vaccination, but I won’t consider myself safe until about two weeks after my second dose. Then–approximately February 1–I will consider my fully vaccinated, which wiull give me about 90% protection from covid.

But until then, everyday I go to work, I am still at risk. There is more covid than ever. And at my hospital, I personally see the high number of drug overdoses. Its like they come in waves… when the fentanyl hits the street, we get between 3-8 cardiac arrests “found down.” A complex cycle of homelessness, mental illness, drug abuse, and trauma all coming to an end in the ICU.

Categories
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.