Wash Your Hands And Stay Home-Like Someone else’s life Depends On It
Photo by De an Sun on Unsplash
These days we wake up to updates about COVID-19, the respiratory virus that overnight has become a worldwide public health emergency. As work, school and gatherings are canceled or moved online, the situation feels more real. Suddenly, that person coughing next to you on the side walk is perceived as a threat. The toddler who wants to help lift groceries onto the check out belt while their nose runs and who might later spike a fever seems like a liability.
No one is immune to fear, and there is a lot of uncertainty. Science tells us that this virus is highly contagious and more deadly than the flu. We also know for sure that some are more vulnerable than others, both to illness and to the far reaching implications of closures and disruption of services.
In a time when everyone is asking “What can I do to keep myself and immediate loved ones safe?”my response might seem like a paradox: Wash your hands and stay home-like someone else’s mother, grandfather, aunt fighting breast cancer, or child’s life depends on it. Or, as a fellow nurse colleague often bluntly states, “It’s not just about you.”
Public Health requires consideration of how we meet the needs of an overall population-and by doing this, we also meet the needs of individuals. The idea is that if the system is strong enough to be a safety net for those most at risk, then no one will fall through.
Consider the statement“a chain is only as strong as it’s weakest link.” This is how we should be thinking when fear permeates and a mindset of scarcity takes over. By looking out for others, we actually ensure that we will all be better protected.
By now we are becoming familiar with the concept, stay ahead of the curve. Hand hygiene, limiting close contact, and staying home is how we interrupt the spread of this virus, and any cold, flu, or respiratory infection that lives in small droplets, the particles of your body secretions (that’s anything that comes from your eyes, nose, or mouth). We need to slow the spread so that our health system has time to treat sick people, and to restock, reorganize, sanitize equipment, and get ready to receive the next round.
When everyone shows up for care at once, health care workers must sort sick, sicker, and sickest. This is triage, a process that requires experience, the right data to help us decide, and the ability to prioritize. In addition to determining acuity, it is just as important to rapidly determine needs, and where individuals need to go to receive those services efficiently, so that everyone can receive adequate and appropriate care. Some care is supportive, some is diagnostic. Some care is life saving.
As an emergency nurse, I’ve done triage in a variety of settings-large university emergency departments, small community hospitals, internationally after a disaster, remote, low resource settings and in places where triage is a new skill being taught at the same time it is implemented. Currently I am doing this in the midst of COVID-19, and the experience validates what we have known for a long time: Resource allocation is paramount.
When we stay ahead of the curve, people get sorted and care delivered as needed. This does not mean that some people get more care, and some will get less! It means it will be different.
The system can support different levels of need, but-here is the sticking point-it can’t always support our individual wants or preferences. And in the midst of a pandemic, it cannot support poor choices. We have to take responsibility for our actions-not just how they impact us and our families, but people that we don’t even know. Especially people that we don’t know.
This is a difficult concept for American culture to embrace. We are the land of the free, lovers of rugged individualism. Sometimes we interpret that as entiltlement to have what we want, how we want it. What a health emergency teaches is that even the most isolationist among us rely on social safety mechanisms like health care, and a broader degree of wellness than illness in the general population. We see these safety mechanisms threatened. When the most vulnerable are threatened, eventually we all are threatened.
Yes, we need more test kits. Yes, the government’s response is late and there are horrendus gaps in our health care system. There is much improvement to be done. But it’s also on us to respond appropriately, especially now. We have to consider our role in minimizing strain to the system so that the sickest can receive care, and to ensure those services will still exist if we are unfortunate enough to become the sickest.
We have to change our behavior. Wash hands, and stay home. Wait. Not at your friend’s house, then another friend’s house. Not by going to visit your parents. Not by traveling. Stay put. Not just for you-for others. And, to prevent the spread of disease, to protect a system that is responding to a surge. This matters as much, if not more. Here’s why.
Some people have no choice-they need the medical system regularly. Consider a 21 year old yoga teacher with diabetes waiting for her insurance to fill a new prescription for insulin. Her blood sugar gets too high, and maybe she picks up a cold while handling debit cards from students at the studio all day long. Now she is breathing rapidly-maybe because of her cold virus, maybe because her blood sugar is so high that she has become acidotic. This fast breathing might be the body’s compensatory response to try to release extra carbon dioxide. She is having a medical emergency. She goes to the Emergency Room. Because of COVID-19 precautions, because she has cough and is breathing rapidly, she needs to go into the respiratory isolation area. That’s one bed occupied, at least one nurse in an isolation suit with a positive air pressure hood, mask, battery pack, a gown, booties, about 54 pairs of gloves changed over those first hours of treatment, etc., etc.
Soon, that isolation area will be filled with other patients. An older man comes in with a pacemaker feeling dizzy, short of breath, and weak for several days. His skin is pale from lack of circulation and his body tissue is starved for oxygen. His heart doesn’t pump blood efficiently-these symptoms could be from his underlying disease, but until we get his COVID-19 results back, he can’t be treated anywhere else but in the isolation area.
Next bed: an 18 month old child who has had congestion and a fever all week. Her nasal passages are blocked so she can’t nose breathe when drinking from a cup, so she has stopped drinking fluids. Now she is dehydrated and her parents carry her to hospital triage. They are tearful and terrified. This child has to be isolated-only one parent can stay with her, and that parent is now unable to go back out of the isolation area. The nurses and doctors are wearing scary looking space suits and trying to work while reassuring this child through a dome like hood and plastic windshield-like mask. Due to her isolation status, we can’t bring in specialty staff who usually soothe children and respond to their developmental needs. The child is afraid, cries harder, which makes her cough more, and her oxygen level drops.
We health care workers are stressed, sad about these restrictions, but most of all we fear a day when there are too many “sickest,” when many people need ventilators and there are just not enough. The system works now because not everyone needs the same resources at once. We are relying on the general public to step up and keep it this way. We need to flatten the curve.
For most of us, getting sick is an inconvenience. Some push through a work day at a cubicle, surrounded by tissues. Perhaps they have no approved sick leave. Some might take Tylenol to suppress body aches and get on that plane because the vacation was booked months in advance-logic suggests we can rest once we get there and still enjoy. Besides, everything is closed at home, good time to get out of town, right?
I recently heard about a group of college students sent home for spring semester who hosted a COVID-19 party. Someone went to 5 different pharmacies until they bought enough masks and gloves for everyone to “dress up” and gather at a friend’s house. I triaged one of these students the following week. She had a sore throat and wanted testing for the coronavirus. We evaluated her and sent her home. I couldn’t help asking, “Why would you go to a party named for COVID if you are so afraid of getting sick?” She said, “I just figured I should get the test to prove I don’t have it”. She could not understand why we couldn’t “set her mind at ease” by giving her a test.
Years of working as a nurse has made me familiar with the best and worst of human behavior. It’s important to remember that we are all imperfect, at times irrational, and that setting aside our own needs is harder than it sounds.
Maybe we feel well, and are going stir crazy. We meet friends out for a drink. We mitigate the risks, decide for ourselves that the benefits of socialization out weight the risks. Economic implications are also a concern. We don’t want businesses to close.
However, for those who have an underlying medical condition like asthma, that cold virus that you unknowingly left behind on the bar top might linger, causing them to need nebulizer treatments over and over again next week, until they finally have to call an ambulance. An older person who pumps gas after you might pick up that same cold, flu, or coronavirus. Older adults have have diminished lung capacity. Maybe they are on prednisone for Chron’s disease which makes their immune system less strong. Maybe they have had part of their lung removed due to cancer. When they get sick, it might rapidly go from shortness of breath, aches and fever to a secondary pneumonia. They might find themselves needing respiratory therapy in an intensive care setting. Hopefully there is space for them.
You see, it’s not just people with COVID who need health care. But a pandemic creates fear and suddenly that same person who left cold virus behind at the bar gets congestion, aches, and a cough the following week. While the person whose asthma got exacerbated when they picked up that same cold is arriving to an Emergency Department by ambulance, the person who now has cold symptoms is at home wondering if they have the virus that is all over the news.
They want to know. They may feel they need to know. Maybe their employer is pushing them to have documented results so that they can return to work. Maybe their friend’s daughter just returned from her college spring break and they were all sitting around a kitchen table together last week. The need feels urgent. Please understand this: If the traige lines and isolation area becomes full of people who are otherwise well but who suddenly are concerned that their illness might be “the virus”, it slows or obstructs care from those who are sickest, and weakens the system’s overal ability to respond.
This is where the CDC, your doctor, and every emergency health care worker implores you. Health care is a basic right, but public health and the the success of any health care system is all of our responsibility. Your rights do not supersede other people’s needs.
There is a process for determining what, where, and how. It’s called triage, and it means sometimes you will need to wait. Sometimes at home. Call your doctor, or local public health clinic, ask what to do, and where to go. Wait to be directed to get testing when it’s needed for treatment or documentation purposes. Wait if you are not showing signs of emergency to seek care until the surge in need subsides. Wait to do the things that you like and want to do. Wait, to slow the curve. Wait so that you do not take resources away from others who can’t get by without them. Wait so that if your situation changes and you are the one who needs life saving care, that care will exist for you.
Fair is not everyone getting the same thing. Fair is everyone getting what they need. Each link in our collective chain is undeniably stronger when we learn to think beyond ourselves. We are all stronger when we pause and think of each other.
