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PEF members are on the frontline

PEF members are on the frontline

From the desk of PEF President Wayne Spence:

PEF members are on the frontline in the fight against the spread of the coronavirus.

The following article in the Times Union about PEF nurses working in the New Rochelle coronavirus hotspot was just posted online.

ALBANY — The calls for help from nurses began escalating on March 5, two days before Gov. Andrew M. Cuomo would declare a state of emergency as a cluster of people contaminated with COVID-19 emerged in New Rochelle.

The downstate city near the Connecticut border would quickly become the state’s hardest-hit area.

Public health nurses assigned to hospitals and other medical facilities were informed they were urgently needed in Westchester County. Drop everything, they were told, and pack your bag.

They were dispatched to a state Health Department command post in New Rochelle, where their principal mission was visiting households to take nasal and throat swabs from those afflicted with symptoms and others suspected of having contact with an infected person.

This is an account of one nurse’s experience over the past two weeks on that front line. Her name is being withheld, in part, because of concern that she and her family would be ostracized by some who might consider her at risk of having been infected, despite the extraordinary precautions the nurses in the center of that hot zone have taken.

Before she traveled to Westchester County, her personal physician had expressed shock at her decision to volunteer for the duty, she said, but she recited the words of Irish philosopher Edmund Burke: “Evil flourishes when good men do nothing,” she told him. “I had to respond.”

At the command post, the nurses initially underwent a grueling crash course on the proper use of the protective gear and filling out an eight-page questionnaire detailing any health issues, including asthma, that might make them unsuitable for the work or donning the Hepa N95 respirator masks that would prevent them from inhaling any contaminated airborne droplets.

On the first day, the process took more than six hours; by the second day it had been tightened to 45 minutes.

The people driving the nurses included Health Department investigators, emergency medical technicians and state transportation workers.

In the initial stages, the testing became difficult. Some residents would not answer the knock of nurses covered in protective gear — visits that, in some instances, came after midnight. In at least one instance a woman whose husband was very sick became suspicious and demanded to see identification, which would require the nurse to reach inside her gown and pull it out. She would not let the woman hold it, she said, fearful the ID badge would become contaminated. Another family opened their door but could speak only Spanish, making communication difficult.

Some of the nurses would not get back to their hotel — within walking distance of the command post — until nearly 4 a.m.

Despite the fluid situation, the processes were quickly tightened up: Residents would be called before the nurse came so that they would be certain to open the door.

Inside each home, the situation would be a mix of seriousness and emotion. Children watched uncertainly as nurses dressed in spacesuit-like outfits dabbed swabs into the noses and throats of their parents, some of them extremely ill. The symptoms — coughing, sore throats, high fever and, especially, difficulty breathing — appeared more serious than the regular flu.

Early rumors flowing through social media sites described shortages of protective gear or drivers not being protected. But the nurse said that information was inaccurate and they were fully stocked and prepared. She said the nurses and drivers also were provided with extra gowns, gloves and face-masks, in case their original outfit had an equipment failure.

“At all times after that we had the correct equipment to protect us,” she  said. “The eye masks they gave us had another pull-down mask. We had double mask protection. We also got red (disposal) bags for biohazardous waste, anti-bacterial wipes for vehicles; we got alcohol-based handwash.”

One of the testing calls was to the residence of a man who had visited a sick person in a hospital and wore only a surgical mask because they didn’t know at that time the person was suffering from COVID-19.

“It was actually the wrong mask for the coronavirus,” the nurse said, “so he had close, extended contact with the patient in that hospital.”

When the swabs are taken from patients inside the residence, they are placed in a sealed envelope that’s then placed inside another box that’s placed inside a cooler-like container. Those samples are then driven by troopers and other state workers to the Wadsworth Laboratory in Albany, where more than 22,000 had been processed as of Thursday.

People who test positive are informed of the results over the telephone. Initially, the nurse’s biohazard suits, which they remove at each residence and place in a red biohazard bag, were being left on people’s front lawns or placed in trash receptacles outside the home. Now, many are being instructed to leave the red bags inside the residence, since there would be no additional risk if anyone in the home tests positive for the virus.

The teams also were concerned that families would face stigma from their neighbors if the bags were visible “like a scarlet letter,” one driver said.

One of the most frightening situations unfolding involve people who are asymptomatic — in some cases showing no signs of illness, or only

symptoms mirroring a mild cold — and going on with regular activity: visiting friends, shopping and, sometimes, even going to work at their jobs in health care.

“I’ve seen everything, but this coronavirus screening became one of the most stressful things I’ve ever done as a nurse because everybody was still just going about daily lives,” she said. “We came across very few exposed people who were not self-quarantining. But when they were exposed they did not know. … They were part of the spread of the virus, and they never knew it.”

The nurse, who has worked in various health care facilities including New York City hospitals, said the governor should be commended for the swift action he took earlier this month.

“My thought is there’s this coronavirus where everyone is being asked by the governor, rightfully so, to stay home … and here I am on the front line seeing all of these individuals, prior to any of these safeguards being put into place because nobody knew,” she said. “The governor didn’t know, the (Centers for Disease Control and Prevention) didn’t know, and the president didn’t know how particularly virulent this particular virus would be. There’s nobody to blame. They did what they could as soon as they understood how quickly this could spread.”

Many of the state’s public health nurses, who are in some instances paid less than half of what is being paid to retired nurses who are being called into duty as private contractors, are working shifts that can begin at 7 a.m. and end around midnight.

But the toll of the virus on families is palpable even from inside the protective suits. “It’s really bad,” the nurse said.

“There was one young woman that we went to see, she was having such difficulty breathing that a family member brought her to the emergency room and the emergency room had to send her home,” the nurse said. “We were able to screen that young woman … and we could hear it, it was audible. They sent her home with antibiotics and we screened her entire family, which was five people.”

In one neighborhood, a response team was threatened by a crowd yelling at them to leave, apparently out of fear the people in the protective suits were spreading the contamination. State troopers have since saturated Westchester County and are escorting  the two- and three-person teams when needed, the nurse said.

She reiterated that in her decades of work as a nurse, she has never seen anything like it.

“Every one of them said they’re afraid,” she said, “and I would state to everyone I went to visit, ‘We will get through this together.'”

The nurse is scheduled to return to New Rochelle next week.