Health08 เมษายน, 2563

Déjà vu all over again

Katie Morales, PhD, RN, CNE 

The COVID-19 Pandemic reminds me of so many things I faced as a new graduate in 1985.  There was a novel viral pandemic then, too.  I want to share my reflections on the similarities and differences in these two experiences and end with a message of hope and encouragement to all faculty and students.  

As a new graduate, I faced a novel viral pandemic known as human immunodeficiency virus (HIV). Adding to the confusion, the virus didn’t even have a widely accepted name at first. In America, we called it the human T-lymphotropic virus 3 (HTLV-III) until HIV was adopted worldwide in 1986. Similarly, we have called the current pandemic virus Wuhan, Corona, and COVID-19. We know our enemy and it has a name. It’s always scary to face a new threat. ;It helps to identify it and give it a name.

Just as my mother worried for my personal safety as a newly graduated nurse in a very stressful environment, now I worry for my graduates as they work in this stressful pandemic environment. I have decided to join them and work alongside them in the intensive care hospital where I live.  

Then just like now, we were experiencing a nursing shortage and I worked as a graduate nurse just as many are asking graduates to do today. I was pushed into a ridiculously heavy workload and was the 20-year-old graduate nurse in charge at night. No one had ever taught me I had the right to refuse an assignment much less how to do so. Nurses were sued for abandonment as they refused to take care of infected patients. Today, we need to teach our students about their rights and responsibilities when accepting assignments. 

During the HIV pandemic, you couldn’t tell who was infected just by looking at them. Asymptomatic carriers could and did infect others. We didn’t have widely available diagnostic testing and diagnosis was often made on history and presentation of symptoms. People were surprised the virus was in our county, as if the virus magically stopped at our border. While we did not know if HIV was spread through casual contact then (it’s not), we do know COVID-19 has been contracted through community contact. We have to increase our diagnostic testing to identify the asymptomatic carriers. Then, if you experienced weight loss and looked “too thin” others worried you could be infected. Now, a simple cough or sneeze has the same effect. There was some blaming of the victim if high risk behavior contributed to the person contracting HIV.  Then high-risk behavior included unprotected sex or intravenous (IV) drug use, but now it’s travel and socialization.  We have to remember this is a disease, not a punishment and extend compassion to those infected or affected.  

We didn’t have Health Insurance Portability and Accountability Act (HIPAA) or universal precautions.  Personal protective equipment (PPE) and alcohol-based hand sanitizers were not readily available. In fact, I remember being taught as a student not to wear gloves as it offended the patient and made them feel dirty. We didn’t discuss blood-borne pathogens and were not offered the Hepatitis B vaccine. We didn’t have sharps containers or engineered devices to promote needless or safe devices nor were we offered post-exposure prophylaxis as it didn’t exist. There is also no telling how this current pandemic will shape the future of healthcare practice for the better, but I believe it will.  

We didn’t have an effective treatment for HIV until 1997 when highly active antiretroviral therapy (HAART) became widely adopted. Without treatment, the mortality rate was for all practical purposes 100% compared to the mortality rate for COVID-19, which varies greatly, but the overall case fatality rate in hard-hit Italy as of mid-March was 7.2%. Dr. Anthony Fauci was leading the pandemic response then as well. He is receiving much more favorable press now than he did then. We balance the tension of the paradox of evidence-based treatments and innovative therapies to save lives in this novel pandemic. 

I will never forget seeing people die horrible deaths from full blown acquired immunodeficiency syndrome (AIDS). As a graduate nurse in charge, I helplessly witnessed a patient hemorrhage as he literally coughed up lung tissue. Nurses now are also relaying heartbreaking stories which will long remain with them. No one asked me about the personal toll the HIV pandemic was taking on me. However, now we are more aware of the mental strain healthcare workers are facing. Now we encourage counseling for post traumatic events. We didn’t have social media to share messages of hope or encouragement or the brilliantly simple innovative ideas (such as using extension tubing to place pumps outside of the room, using heliox bags to extubate, or a rigid container for removing the N-95). Now we have social media campaigns to express support and gratitude to nurses and other healthcare workers, to donate PPE, or to make masks. There are also social media campaigns to demand better working conditions.  

Overall, we have made it through pandemics before with far fewer resources and support. 2020 was ironically declared the year of the nurse. A friend sent a quote attributed to Florence Nightingale in 1870 saying it would take 150 years to see the kind of nursing she envisioned. Today in 2020, 150 years later, and nurses are applying time honored and innovative methods in this novel pandemic. I would expect nothing less from the most trusted profession. Nurses can trust in themselves as we advocate for ourselves and our profession. We can trust in our vastly greater knowledge and resources. We can do this!

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