On the COVID-19 front lines

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Nurse Samantha DeSanto had to make a gut-wrenching choice after COVID-19 spread to the United States. She could continue her job, as her husband, Gabe, a police officer, did the same at the Webster Police Department, or she could stay home and be with her 5-year-old twin boys. 

She chose the latter. 

“We had to make a choice as a family who was going to be the person to go out there,” DeSanto says.

This decision weighs heavily on DeSanto, who agonizes about the well-being of her coworkers and her sister, who also is a nurse.

“What I worry most about is the conditions they’re going to have to work in during this,” DeSanto says. “I feel guilty, truly guilty in the sense that I’m not there helping them. … We are such a family, such a team….To know that they’re going to be there doing this by themselves and I’m not there with them, it kills me, but then when I think about …protecting my kids’ lives, I don’t care. It’s a double-edged sword for me.”

DeSanto’s anxiety is shared by nurses and other front-line health care workers here and across the nation. These workers have been preparing for a surge in COVID-19 cases, worrying about becoming carriers of the disease and the possible impact on their families. Their concern is heightened by the fact that some people may not be taking calls for social distancing—increasing the physical space between people—seriously enough.

“One of the concerns that we all have in the medical community right now is what is the surge going to look like,” says Jim Hood, a paramedic and president of Victor Farmington Volunteer Ambulance.

Late last week, the number of confirmed coronavirus cases topped 100,000 in the United States, outpacing China and Italy. In Monroe County, as of April 1, there were 359 people who tested positive for COVID-19. Sixty-two people were hospitalized. Of the 59 new cases, 26 were under the age of 50. The county reported its first case on March 12.

Taking notice

On New Year’s Eve, a pneumonia of unknown cause found in Wuhan, China was reported to the World Health Organization’s office in that country. A month later it was declared a public health emergency of international concern. In Rochester, health care workers watched the story unfold.

Carolyn McElhinney, an adult nurse practitioner, recalls watching a CNN news report on closures in Wuhan.

“I watched a video, all the restaurants were closed and the streets were empty in Shanghai, which is a very busy area, and that’s when I started to become concerned about it from a global perspective, because of economics and people not being able to work,” McElhinney says. “They were delivering food and leaving it at people’s doors and on the receipts they would write the temperature of the person bringing the food and who prepared the food.”

She adds: “They don’t do that in places for the flu. … That’s when I sort of knew that things were a little different with this.”

Jon Kuppinger, a cardiac nurse and a paramedic with Monroe Ambulance, recalls being in a patient’s room when he first learned about COVID-19. He was flooded with memories of the bird and swine flu outbreaks of the past.

“I remembered how it was handled and I was very concerned because I knew a lot of it was on the bedside providers,” Kuppinger says. “Because they can make as many rules as they want, but the reality is that when it all comes down it’s really up to the person who’s standing there with the patient.”

When Italy began to scramble to deal with the virus, McElhinney was troubled. Italy shared clear data on the disease, from confirmed cases to death rates, painting a dismal picture. Many hospitalized patients required intensive care.

“I’ve worked in the health care system in Rochester for 13 years, and I don’t think that this is just a problem here in Rochester, but our hospitals have been overfull for quite some time,” McElhinney says. “This entire flu season we’ve been operating at over 100 percent capacity … and then people overflow into the emergency department. I knew that once the virus came here, our hospital systems could not manage this virus, so there was definitely quite a bit of fear with that.”

DeSanto, who had been following the virus’ path since December, recalls asking others on her unit about plans for preparation.

“Everybody was kind of laughing and joking with me and was like, ‘Sam, it’s just the flu, it’s just the flu. It’s no big deal,’” she recalls.

It became a big deal when the coronavirus arrived in New York. DeSanto stocked up on groceries for her family. On March 13, nearly two weeks after the first case was confirmed in New York City, DeSanto’s husband was returning home from training 400 police recruits in Albany. He called his wife to say it would be safer if he slept in their camper outside their home. 

Kuppinger echoes that sentiment: “I’m more concerned about becoming a carrier and contributing to the spread. If I get sick, I get sick. I kind of have already am resigned to the fact that it’s very likely that I’m going to get it just being in the environments I’m in.”

Sources of concern

Much of the anxiety these health care workers feel is due to the possible shortage of personal protective equipment. While researchers are still gathering facts about the virus, its spread is thought to occur mostly person-to-person via respiratory droplets among close contacts, according to the Centers for Disease Control and Prevention.

The agency has outlined strategies for the use of PPE like face and respiratory masks, gowns and gloves, and equipment such as ventilators, keeping hospital capacity and other factors in mind. 

Watching reports from Italy where doctors had to make tough calls  on the use of ventilators—deciding who would get one—unnerved many here.

“That’s something that in this country that we’ve never really had to worry about,” McElhinney says. “I think that’s the time when we all got really worried in the health care system.”

Nurses last weekend protested against the shortage of equipment such as masks and gloves. In the Bronx, 30 nurses and their relatives stood in front of Jacobi Hospital’s Emergency Room asking the government to provide appropriate PPE. A nurse at Mount Sinai Hospital in Manhattan, who used a trash bag over her gown as added protection, succumbed to the virus. Protests have taken place from coast to coast.

National Nurses United, a union and professional association of registered nurses, has filed more than 125 complaints with Occupational Safety and Health Administration offices in 16 states against hospitals for unsafe work environments.

DeSanto believes the nurses who are protesting have valid concerns.

“I signed up to be a nurse to save people’s lives, not risk my life to save someone else’s lives,” she says. “That’s called the military.”

Kuppinger, who served in the military, says he has a “suck-it-up” mentality.

“I don’t think people’s concerns are not valid, I just think there’s a job to be done,” he says. “Everybody wants to go home healthy and not be put at risk. … There is something a little bit heroic about adapting and overcoming and still facing things even though the conditions are not ideal.”

Still, he gets to wear an N95 respirator mask when he’s working at Monroe Ambulance. All staff are required to wear one on calls at Victor Farmington Ambulance as well, Hood says.

McElhinney says she hasn’t seen shortages here, but admits there is a potential for them. Monroe County and health system officials last Friday said the region is adequately prepared for a couple of weeks. 

No hospital administrator is deliberately putting health care workers at risk, McElhinney believes. But reports from Europe that show hospital staff in hazmat gear bring questions.

“We have thin plastic gowns, goggles and a surgical mask,” says McElhinney, who is in the process of becoming a flight nurse. “I think a lot of us are wondering why—why are they wearing that?”

She is intent on serving and hasn’t seen health care workers shy away from the call to action. McElhinney, who has young children, is relieved that children under the 10 rarely get severely ill from COVID-19. Like others in her situation, McElhinney is certain she will get the virus.

“It’s not if I get it but when,” she says. 

Preparing for the surge

The high transmission rate and the rapidly rising number of cases in New York City have prompted Monroe County and health care systems officials to address surge capacity. Last week, Monroe County Executive Adam Bello said the region is in the second phase of a possible four-phase surge-capacity plan. The third phase would see an increase in bed capacity, more than doubling the county’s available bed count to nearly 4,000.

Similar to actions taken in Europe, and as outlined by the CDC and state officials, local hospitals have canceled elective and outpatient procedures, cut visitations with a few exceptions, and taken other measures to increase capacity.

“In my judgment, based on the numbers from Italy and the growth of this virus, we haven’t peaked yet,” McElhinney says. “We’ll probably peak maybe in 30 days.”

Hospitals today are calm and eerily quiet, nurses say, as doctors interact with patients virtually. McElhinney sees a third of the patients that she would normally see on a shift, while Hood has noticed the call volume for ambulances has gone down.

“That’s given us a little respite, a little rest to make sure we’ve got ourselves together,” Hood says.

Kuppinger has noticed a sense of vigilance on his unit, especially when it comes to the “wash, glove, wash” policy.

“All of our hands are falling apart because of the excessive alcohol,” he says with a laugh.

Taking the temperature of patients has a new urgency. Kuppinger, who brings an extra set of scrubs to work in case he has to stay on site, says conserving supplies is key.

“The biggest thing people worry about is not having enough equipment, not having enough protective equipment, when you should mask, when you shouldn’t mask, who mask,” says Bonnie Cameron, a nurse educator. “(Hospitals) need to conserve resources that they have so that the people that are in ED or up on the units taking care of these patients don’t have to worry about having the equipment and that they don’t run out.”

Running out of equipment is one of Hood’s concerns as well.

“It’s a little bit scary for us—what’s enough?” he says. “It’s still not clear to us how big this is going to be at this point.”

On Tuesday, in response to rising COVID-19 cases, UR Medicine and Rochester Regional Health began “universal masking”—mandating that all medical providers, staff and visitors at the facilities wear surgical masks at all times in public, clinical areas.

Cameron has shifted training to focus on COVID-19 and the use of PPE.

“A lot of our education offerings that offer contact hours have totally shut down,” she says.

New nurses who are being onboarded have had to adjust quickly.

“To me one of the shining things about nurses is their ability to adapt to change, so when things happen last minute—you have your plan of what you’re going to have for the day and then something happens to a patient that you have, they have chest pain or something like that and it totally changes the course of what you’re going to do for that day or that hour and you just have to figure it out and adapt,” Cameron says. “So I think nurses are hardwired for that in some respects.”

The state is building a reserve of health care workers. Gov. Andrew Cuomo recently put out a call for 1.2 million additional health care workers to come to New York. Since then, more than 40,000 medical professionals have volunteered. Though the volunteer effort goes through the state Department of Health, Michael Mendoza, Monroe County’s commissioner of public health, last week noted that he personally has received an overwhelming response. 

“We know that we need nurses right now,” McElhinney says.

As of November, Rochester Regional Health had 3,890 nurses across the system, officials say. Strong and Highland hospitals, not including affiliates, have a total of 4,760 nurses.

Keeping a distance

Limiting the need for more health care workers hinges on the community’s ability to slow the number of cases coming into hospitals. Essential to that goal is social distancing and other measures like Cuomo’s order to close nonessential businesses and Bello’s state of emergency in Monroe County.

“You may think you’re a superhero, but you’re not,” Cuomo said at one of his daily coronavirus briefings, underscoring the importance of flattening the curve through social distancing.

Health care workers agree. They fear for aging parents and relatives who aren’t able to understand the need for social distancing and for younger people who blow it off, since they are less at risk.

“(Social distancing) is extremely important,” McElhinney says. “People really don’t like to be told what to do in this country, we have so much freedom here.”

People who scoff at social distancing, or doubt its ability to flattening the infection curve, don’t realize they place others at risk by not practicing it, health care workers say. 

“A lot of people my age are definitely not taking it seriously,” says Kuppinger’s 17-year-old daughter, Kira. “I definitely see people hanging out with friends and going out and socializing when they should be hunkering down. Most people are just not understanding why they need to isolate, they’re more thinking, ‘If I get it, I’m not going to die, so I’ll be fine. It’s OK if I get it.’”

The parking lot at Wegmans in Pittsford earlier this week.

Social distancing is very real for Cameron as she thinks of the wellness of her 84-year-old mother and her immunosuppressed siblings. 

“This is a brand-new illness, we have no clue how it’s going to affect us (long-term),” DeSanto says. “We have no clue what’s going to happen with it in children.”

She points to chicken pox, scarlet fever and mumps survivors. 

“Back in the day they had scarlet fever,” DeSanto says. “Fifty years down the road those people that had scarlet fever, now (the) majority of them come in, they either have heart damage or they need a valve in their heart replaced.” 

A recent study published in the Lancet found that a combined approach of physical distancing interventions, with quarantine, school closure, and workplace distancing, is most effective at reducing the number of COVID-19 cases. The study was conducted in a simulated setting in Singapore, comparing the hybrid approach with other intervention approaches.

Modeling studies in China showed that high levels of social distancing was instrumental in reducing the transmission of COVID-19. The report found that earlier intervention of social distancing could significantly limit the epidemic in mainland China. The number of infections could be reduced up to 98.9 percent, and the number of deaths could be reduced by up to 99.3 percent as of Feb. 23. 

“There is no vaccine right now for this virus,” Hood says. “So, the only defense that we have as a community is social distancing.”

A patient infected with COVID-19 is estimated to pass it on to an average of two to three people in the early stages of an outbreak. Since symptoms take up to 14 days to appear, the infected person, through close contact in groups, could pass the virus on to two or three more people

Skeptics wonder if social distancing is the answer, and spring breakers in March continued to flock to Florida and other cities. Others find the views on social distancing have begun to fall on party lines.

Source: Signer Laboratory

Regardless, based on the outbreak in China, Italy and elsewhere, COVID-19 could wreak havoc.

“The thought of a large number of our medics getting sick is something that keeps me a little awake at night,” Hood says.

In spite of their apprehension over the surge, health care workers voice optimism about the community’s ability to come together. They are certain that history will show that the region was united in its response to the outbreak and urge Rochesterians to stay out of the hospitals and follow CDC and state recommendations.

“We and everybody else that I know that’s in health care are doing everything possible to prepare for this illness coming to our communities,” Hood says. “We’re very fortunate … to have very talented, dedicated providers who really care deeply for other people.”

The best way to help?

“Do nothing,” Kuppinger says. “It’s not something people want to hear, because they want to do something. The best way to help at least right now, in the phase we’re in right now, is to stay out of the emergency room if you can, don’t burden the health care system by spreading it more or (by) being out and social.”

Smriti Jacob is Rochester Beacon managing editor. All Rochester Beacon coronavirus articles are collected here.

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