At the end of last year and into January, coronavirus disease 2019 (COVID-19) began to sweep across the globe at an astonishing rate, creating a global health and economic crisis in its wake and changing every aspect of society. On our cover this issue is an image with which we have become all too familiar: a nurse in protective gear awaiting patients with COVID-19. She was one of the lucky ones who had the gear.
As I write this in late March, the number of confirmed cases worldwide is more than 737,000 with over 143,000 U.S. cases (since January 21), with few signs that the acceleration is easing; I shudder to think what the numbers will be by the time you read this. We are dealing with an unprecedented disruption of life on all levels. Many cities have shut down; international travel is suspended; borders are closed; gatherings of all sizes, from major sporting events to weddings and funerals, are prohibited as government leaders implore people to stay home to stop the spread of the virus. Others who cannot work from home—especially those in the hospitality, travel, and manufacturing industries—have been furloughed. Unemployment claims have soared, and states say they will soon run out of funds.
Although Congress has passed a massive relief package that includes direct cash payments to some Americans, and loans to small businesses and major industries in an attempt to support families and prevent bankruptcy, the economy teeters on the brink of a recession that may be worse than the recession of 2008.
Hospitals, especially those in large cities, are grappling with a surge in patients and a shortage of beds, supplies, and staff. On-hand supplies of masks, gowns, and other protective equipment for health care workers have been depleted and workers have been told to “make do.”
The secretary of the Department of Health and Human Services declared a public health emergency on January 31, but the White House, slow to recognize the speed and severity of the pandemic, didn't declare a national emergency until March 1 and initially left it up to the states to secure supplies. Then the federal government began deploying assets after states implored it to step in to stop bidding wars and price gouging, and ensure equitable distribution. In late March, the White House deployed national guard troops to set up “MASH” facilities in hard-hit areas. The Navy's two hospital ships—the Comfort and the Mercy—were ordered to proceed to the coasts as supplemental hospitals.
There are no ‘standard protocols’ to guide decision-making, but decisions need to be made mindful of their long-term effects. Clinical practicums have been suspended—should clinical hours be suspended for students who don't have enough clinical hours to graduate? Should nursing students be called to work, and should that count as clinical hours? There will be ethical struggles and moral distress as crisis care guidelines come into play. How are decisions being made to parcel out equipment/beds/care when there's not enough to go around, leaving some patients to die alone? We will need to support those caregivers who develop posttraumatic stress disorder from spending days in fear for their own lives or exposing their families to disease because they didn't have proper protection. And yet they still, courageously, show up to work. I wonder if many will leave hospital nursing.
Eileen Kennedy, president of the International Council of Nurses, noted, “In this Year of the Nurse and the Midwife the eyes of the world are on our profession in a way that we could not have anticipated. Nurses are in the spotlight, and all around the planet this tragic pandemic is revealing the irreplaceable work of nursing for all to see.”
The reality of an insufficient health care workforce and underfunded health care system is all too evident. Nurses, physicians, and many other health care workers—and ultimately all of us—are suffering the consequences of archaic and misplaced funding priorities that ignored science and dismissed warnings from experts. Perhaps things will change after this, and we will be ready the next time. I hope so.—Maureen Shawn Kennedy, MA, RN, FAAN