COVID-19 Freak-outs And Questions Answered!
As I have taken on a new role in healthcare to aid in the current pandemic's needs, I spend my 12-hour workdays on the phone talking COVID. Is it my favorite thing in the world? -maybe not, but I have realized that there is a dire need for accurate information dissemination for people to actually understand what the heck is happening. In this post, I will share and explain current best practices as outlined by the CDC, what you can do to stay safe, and what to expect if you find yourself exposed to this virus.
When I took an opportunity to help patients in a new way, I honestly had no idea what I had gotten myself into. Much like many people, I found myself incredibly overwhelmed by the unknown components of COVID in the early days and weeks of the pandemic. I will keep it real like always, and the truth can be scary, so if this content overwhelms you, take breaks, spend time doing things you enjoy, and be creative to connect with those you love. A general life update since the start of the pandemic coming at y'all.
March 2020: The outbreak is identified, and we start playing catchup. As healthcare employees, we are terrified that we will lose our lives because we have taken the career path we have, but we stay healthy for our patients and truthfully for ourselves. As healthcare providers, we are not immune to any physical or mental complications of the pandemic. New York is pulling refrigerated semi-trucks to hospitals to keep up with the death rates of COVID.
April 2020: My home unit on the inpatient floor closes due to low census meaning, my patient population was not large enough to warrant our entire floor remain open. Our patients were consolidated to other floors, and I was then floating every shift I worked. For those not in healthcare, I work on a different unit every time I show up to work based on hospital needs. I would quickly learn the policies and procedures of this unit from specifics to the patient population or how the unit ran as a whole. The unknown of this was crippling, but I could be floated every 4 hours. During my 12 hour shift, I could have to learn 3 different units, populations, and sets of patients on any given day. Not only is this stressful, but the patients are frightened. They were sitting in their rooms for hours watching the news broadcasting this scary virus that is plaguing the healthcare industry. Patients are no longer allowed visitors, and they are terrified. We are pounded with COVID anywhere we look, and it was exhausting. I would often find myself mentally strained and emotional because of the stress coming at me from COVID. I found myself full of nerves and even anger just to show up to work, not including the unexpected that can occur during even a good shift.
May and June 2020: I was done hearing about COVID at this point that work had created anxiety and I was burnt out, fatigued at best. I took a voluntary furlough so that I could quarantine and safely see my family. In my first year as a real "adult," in healthcare, during a pandemic, I now am navigating the unemployment system.
July 2020: I take an 8-week assignment for COVID needs in nurse triage talking about the virus for 12 hours a day. From drowning in anxiety from COVID, I dive into talking about it all day long.
With my new position, I have to be up to date on recommendations, research, and truth. Knowing what I do, I will share some general info that can be accessed through CDC resources (nothing I will be referencing is business confidential or specific to my employer). I want to use this platform as a way to give accurate medical information from credible sources.
The most common freak out I have started with "I was exposed to someone that now has COVID and I need a test right now!!!!!!!!"
Exposure does NOT mean testing needs to be done
Fact: if you are exposed right at this moment and will develop COVID, the earliest symptoms are seen is 48 hours and into 14 days.
IF symptoms are present, this tells us as providers that it is a good time to have a test done. The reasoning behind this is so that a true positive can be detected.
Fact: Asymptomatic testing is not an alternative to a 14-day quarantine. If you are exposed and do not have symptoms that does NOT mean get tested and move on, it means quarantine for 14 days, if you get symptoms in those 14 days, get tested and go from there.
PCR testing basics: this is the type of test used by the majority of agencies or healthcare institutions to detect the virus that causes COVID-19. PCR stands for a polymerase chain reaction. This just tells us the type of testing that is taking place. The most reliable forms of these tests are nasopharyngeal testing, meaning the specimen will be collected by entering the nasal cavity to swab the back of the throat. The is the optimal area to be tested since we KNOW transmission of this virus is primarily and most widely contagious via respiratory droplets. The idea behind testing (although not completely understood) is that the more of the virus in the body=more symptoms you have, which is why we now have symptoms=test. There was a lot of fear in the early stages that there are these "asymptomatic carriers" who are shedding the virus and don't know it. With any test, you want to error on the side of a false positive rather than a false negative. For example, we would instead wrongly tell you that you have the virus and quarantine versus incorrectly tell you that you don't and you potentially infect hundreds of others in the meantime. This is the idea behind ANY biomedical testing in clinical practice.
A common question I get is should I get a blood test or a swab? The swab testing is going to tell us if you have the virus right at this moment. Blood testing is going to tell us if you had the virus in the past 3 months to an extent that your body has created antibodies. Not everyone that gets the virus will create antibodies and the immunology and extent to which these antibodies protect you is still unknown.
I had listened to a podcast recently that made me look at COVID in a different light. They were speaking about what they had learned from the outbreak in New York. They spoke about COVID as a vascular process, not respiratory. Many of us think COVID and our mind goes to being on a ventilator, or at least for me, that's how the nightmare goes. Hearing that this virus was not respiratory specific was hard to wrap my mind around. Once they explained this a little more, it made total sense to me. We know that the main form of transmission is from respiratory droplets. Yes, transmission from any bodily secretion is also possible, but much easier to contain/prevent. The idea of COVID being systematically vascular truly means that lung damage is not the only thing we have to worry about. COVID infection could be limb compromise or amputation, kidney and liver failure, or permanent damage. The list of long-term cardiac effects is not totally understood but can be severe, and the list goes on and on.
Any organ that has vascular structures, i.e., ALLL OF THEM, can be compromised or damaged permanently. I like to focus on what we do know to take the fear aspects out of the anxiety that can come with COIVD, but the truth is, prevention is going to be essential. They are finding that COVID is not just another flu in that the long term effects are life-threatening. Northwestern Hospital has completed the very first post-COVID bilateral lung transplant....on a patient in their 20's! Media told us that older, immunocompromised, or patients with comorbidities are the only people at risk for COVID and the extremes it can hold. This misconception could not be further from the truth. The virus does not care. If you are the host, it has decided to infect it can look anywhere from "I don't really feel great, but I'm fine" to planning an organ transplant, or worse, a funeral.
Now that can be some compelling information depending on how you decide to look at it. I do not want to scare you because we do know how to prevent it! The risk of infection is incredibly low if you and others are masked AND adhering to social distancing. Having a mask does not mean you can come within 6 feet of someone, and staying 6 feet away does not mean you don't need a mask. The combination of these practices provides the most significant safety for you and others. If you have concerns about your workplace conditions, bring those concerns forward to your supervisor, and if you don't feel comfortable, do so anonymously. If you do not think your coworker minds you standing close to them while you sip your coffee, just remember that like underlying conditions, COVID cannot be seen, and we are all stewards of good health right now even if it seems harmless.
So let's talk droplets. I remember my dad asking me early on in the pandemic if I thought this virus was airborne. In nursing school, we learn about all types of precautions in the healthcare setting, including what bacteria/viruses have what specific kind of isolation precautions and the required personal protective equipment (PPE) were required to keep providers and other patients safe. Do I think this virus is airborne? Yes and No. Early on in the pandemic, I remember the initial freak out over 1. N95 masks, and 2. Negative pressure rooms. These two components are hallmarks of airborne precautions as no other precaution requires such equipment, and this is what we were seeing all over the news that was in shortage for many healthcare institutions. We also learned about the cruise ship quarantining early on because the virus was spreading from room to room with infected individuals having virtually no contact with other infected individuals. What I have learned about HVAC on a cruise ship, hotels, or your own home, is filtered air, but it does not filter all microorganisms. Negative pressure rooms are specific in they do not let particulate matter flow outside the room. Still, they also have to have particular HEPA filtration to keep other patients and providers safe. When I say yes and no to the airborne nature of this virus, not every activity with a COVID + patient is considered high-risk aerosolizing. High-risk aerosolizing procedures could be a nebulizer treatment, breathing treatments, non-invasive ventilation like CPAP or BiPAP (just like some people use at home), and several other respiratory specific therapies. In these cases of high particulate matter, this is when the virus is thought to be widely disseminated. Before that high-risk procedure, there is likely still particulate matter shed via the respiratory system, but not at the same extreme.
Now, what we also know is that we are still learning. This could change tomorrow or in a week even. I want you to take time for yourself during all this craziness! Things are constantly changing, but turn off the news or get away from technology and connect with things that make you happy. Lean on those that love you, even if you have to find creative ways to stay in contact. For example, make a picnic and sit 6 feet away from your friend at the park and still enjoy their company. Whatever you do during this time, make sure you are taking care of your health even if we cannot see what is harmful. Mental health is vital, and increased stress is known to lower the immune system, so stress less and put that extra energy into yourself. Fuel your body with nutritious food you love. If you don't feel comfortable in the grocery store, have it delivered or pick it up and make healthy at home instead of eating out. As always wear your mask and stay safe.
I sat down with my beautiful friend and talked about my story and more about my own battles during COVID and in my first year as a nurse. Make sure you check out my 2 part episode on Fit Friends Happy Hour too!
Resources:
Refer to your local public health department for questions about access to testing near you if you feel that you need it.
~To reach out for free 24/7 counseling or support, contact the Disaster Distress Helpline at 1-800-985-5990 or text “TalkWithUs’ to 66746
As always, please consult your primary care provider for any medical concerns as this is in no way meant to be diagnostic. My views on current medical interpretations and CDC resources are not representative of my employer.