Letter from an Iowa City nurse: The situation is worse than you think. Stay home.

Jordan Sellergren/Little Village

Editor’s note: The author of this letter has been verified as a nurse at University of Iowa Hospitals and Clinics, but has chosen to remain anonymous to protect their job.

After months of quietly feeling the realities of the pandemic both in my home and work life, this morning I came across a Facebook post that pushed me over the edge. It was questioning why the media is still covering the pandemic, but not focusing on the recovery rate. While I understand that many may just want some positive news and others just don’t want to live their lives in fear, I do not think that the media has done enough to portray the gravity of the situation.

While the recovery rate may very well be great for COVID-19, it’s how people are recovering that continues to make COVID-19 a “media topic.” You might be able to recover at home (probably with a pulse oximeter, blood pressure cuff and oxygen, with instructions of when to call or go to an ER), or maybe you need more oxygen or more respiratory support — things that you can get only in a hospital. And, boy, are we seeing an increase in option two.

The problem with this is multifactorial: one, hospitals are seeing such a huge increase in cases (while also trying to prepare for influenza and RSV season which already corresponds to higher hospitalizations); two, people will still need the hospital for non-COVID related injuries, illnesses, etc. Simply put, hospitals are being overwhelmed. This is why we are still talking about COVID-19.

I am an intensive care unit nurse. I do not work in the primary COVID-19 ICU at my hospital, but I do frequently work with critically ill COVID-19-positive patients. Ours was the first unit that a hospitalized COVID-19 patient was cared for in Johnson County by a small group of specially trained doctors, nurses and respiratory therapists.

Fast-forward eight months, where now the University of Iowa Hospital is enacting the first wave of a COVID-19 census surge plan and COVID-19 patients are cared for on no fewer than seven units in the hospital. We have experienced policies that changed daily, changes in required personal protective equipment (PPE) worn for all patient care, growing pains related to where more COVID-19 patients would go when admitted, how to open to visitors, how to screen staff safely and quickly, and how to handle any potential surge increase in patients, among more than I feel I can articulate. Our world as healthcare workers has been turned upside down so many times that it is hard to know which way is up.

All of this is to say that I am tired. We are tired. It has been extremely exhausting to work in healthcare during this pandemic. Despite this, nothing is more emotionally draining for me than to hear how tired everyone else is, how non-healthcare workers loathe wearing a mask so much for their one-hour grocery trip or how they miss dining in restaurants. Each time someone claims that the virus was made up for the election year or somehow links it to a political candidate or party, I want to pull my hair out, scream, throw a temper tantrum and generally act like a child because it is just not accurate and, quite frankly, is insulting. This is not going to go away, no matter how much we don’t like it (if that was all it would take, I am sure that collectively, global healthcare workers would have trampled COVID-19 out of existence many times over by now).

A staffer (not the author) in UIHC’s MICU, or Medical Intensive Care Unit, where many COVID-19 patients are cared for. — via University of Iowa Health Care on Facebook

Unfortunately, this means that the brief moments that one does not wear a mask to the store, does not wash their hands or does not quarantine after known exposure puts everyone at risk for much longer than any of us want. I know that we are tired of not seeing our friends in person or seeing our extended family. I know how frustrating it is to feel like someone is trying to tell you not to go spend time with your family over the upcoming holidays. I know we are tired, but I am begging you to consider doubling down on your efforts.

The reality is that the situation in our local hospitals is tenuous at best. Healthcare workers are seeing what happens when a community experiences “pandemic fatigue,” letting down their guard and beginning to believe that COVID-19 is not so bad, or, worse, is fake. We have to take a moment to acknowledge that this is the situation we were preparing for in March and April, and for as much as a success as it was then, we are failing horribly now. We know better. We know how to prevent the spread of this virus — just like any other, keep your distance, wash your hands, stay home if you are sick — but due to the length of this particular pandemic, we have grown lax in these basic protections as a society.

In the ICU, where alarms constantly blare between monitors, IV pumps and other devices, and especially when they do not require action or are not “real,” we can experience what is known as “alarm fatigue,” where we get to a mentality that we do not hear the alarm. Alarm fatigue can lead to very real dangers to the patient and their safety. Right now, the public is experiencing alarm fatigue with regard to hearing anything related to COVID-19, the pandemic or precautions. “Yeah, I know, I’m going to do X, Y, and Z about it… later. Right now I’ve got to do A, B, and C.” We know about the alarm, we know why it is going off, but it isn’t always a top priority to fix an alarm that doesn’t matter (aside from causing our co-workers to listen to it constantly). The public knows the pandemic has gotten bad again, they know what they need to do… but right now, they’re formulating their plans for their holiday get-togethers, their Friendsgivings, their holiday shopping.

We need to put the priority back on addressing the alarm. If we cannot fix it, we need to change what we are doing. We need to try something else.

Many opinion articles are sharing the same sentiments I am writing here. We were successful in holding off the surge in hospitalizations earlier this year, which gave us time. We now know more successful treatments for this illness. We know that if a patient ends up on a ventilator, it is not necessarily the death sentence that it used to be. Production of ventilators and PPE has increased. However, we are only reaching the tip of the iceberg when it comes to all of the immediate complications of COVID-19 — we’ve learned patients can end up with viral cardiac injuries and blood clotting problems, to name a couple — and have not even begun to develop an understanding of the long-term problems, of this disease.

At the rate that positive cases are increasing statewide, local hospitals will simply not be able to keep up. Even if we can somehow increase our bed capacities, where will we find the staff for those patients? The very people the public depends on to monitor them when sick are falling ill with the same condition, out for weeks on end. Most hospitals are also trying to figure out their finances due to the significant blow they took by canceling elective surgeries and procedures. Many, therefore, do not want to cancel these procedures again, but are struggling to find places for patients who need beds after their procedures.

Opening up more ICU beds on units outside of the brick-and-mortar ICUs helps a little, but these units are not made for ICU care, where patients are tucked away behind doors we cannot see through, are located perhaps far from the nurse’s station, and do not have doctors, physician assistants or nurse practitioners monitoring them less than 30 feet away like they do in the ICUs. It is not the ideal situation, but it is the most available option, and as more and more COVID-positive patients enter the doors of our facility, creating a bed crisis, particularly among the intensive care units, it is one that is necessary.

North Dakota recently made headlines as they released guidelines for COVID-19 healthcare workers who test positive to return to work very soon after their diagnosis. If that enrages you, but you think Iowa is doing just fine, I’d like to point out that many employers are allowing essential employees to return to work after less time than the initial 14 days post-symptoms we were told about back in March.

This is an alarm that needs immediate action. We need to make sure that we have enough beds for all of our patients, but we cannot ensure that on any given night. We need to make sure that we have staff to monitor and care for the patients in those beds, but we take many signoffs daily. Each day, the staffing office requests help from nurses. We are burnt out and tired. We are tired of coming to work after hearing the latest conspiracy theory, we are tired of giving so much at work only to have to give our very best for the patients who yesterday thought we were exaggerating, and still do not believe the pandemic is that bad. We are tired of not getting our vacation time granted because decisions made to protect the finances are taking staff away from the bedside for up to a week at a time. But we are more depleted by feeling that no matter what we do or say, it does not seem to be enough to keep the pandemic at bay.

It is difficult to feel that what we say, the concerns we raise, and the actions we suggest get swept under the rug of the alleged 99.9 percent recovery rate. Yes, high recovery rates are great, but that number will drop if we do not begin to take control of this situation. It is rapidly careening toward a point of no return, an apocalyptic picture of following algorithms to determine who has the best chances of survival and, therefore, who will get the hospital bed and subsequent treatment. If this seems like déjà vu, it should — this was the picture experts painted if this surge happened in March or April. If this doesn’t incite fear, it should. I am beyond able to argue kindly and reasonably with those who “will not live in fear.” This is a fear-invoking situation, and those who freely admit that fear are not weak, but reasonable. There is much to be afraid of, but there is also much work to do.

2019 novel coronavirus — CDC

For those who ask where this hysteria is about yearly influenza outbreaks, I have two main rebuttals. First, each year, the influenza outbreak pushes the healthcare system to its limits, and similar stories are shared on the news about long ER wait times, long waits to be admitted to a hospital bed, and long waits to get tested. This component is exacerbated by the number of COVID-19 patients that we have and will continue to have in the hospital at the same time. Second, we know about the flu. We know how to treat the flu pretty efficiently, yet still it can be too much for someone to overcome, and we know that each year, people will die from the flu. Generally, these are people who are elderly and/or are in compromising health to begin with, but with COVID-19, we are seeing young, otherwise healthy people becoming critically ill and even dying. We do not know what the best treatment is for COVID-19. We do not yet have an effective (or even partially effective) vaccine against COVID-19 like we do for influenza.

If you do go out, wear a mask. Wash your hands frequently and correctly. If you have a known exposure to COVID-19, please quadruple your efforts to stay home. If you feel ill, do not go anywhere except to a medical appointment for your illness or to the ER. Above all else, please stay home.

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