COVID-19: A Different Perspective, What Becomes of the Laboring, Sick, Shut-in, and Bereaved?

COVID-19 is here to stay for a while, and with each new day, it seems new local, state, and national records for the highest number of cases and deaths are reported.  At this point, it's almost like background noise for some.

Unfortunately, for me, COVID-19 is not background noise. I have the unique perspective of having worked in public health with a focus on communicable and infectious diseases before becoming a nurse.  Now that I am a nurse, I work in infection prevention.  I started my new job in infection prevention, the same week that COVID-19 got real where I am. Talk about trial by fire.  I am still just treading water.

All this to say, not only do I see the COVID-19 numbers daily as part of my job, I understand the numbers.  I understand what many laypeople may not. I cannot ignore COVID-19 and its effects on this country, and its impact on healthcare. I am saddened by the number of cases we're now seeing, after seeing a decline.  I am doubly saddened by the number of  I see.  

COVID-19 is a tricky virus that seems like it is always one step ahead of the curve.  However, we do have some tools to use to try to get ahead of it: social distancing, wearing a mask and practicing good hand hygiene.  When it was cooler outside, people were somewhat more inclined to practice socially distancing, but that was by default, not necessarily because people wanted to do it. Now that it's warmed up, it seems like people think social distancing is a thing of the past.  Masks, well apparently, they are a topic of great debate, which is utterly baffling to me.  Masks help to stop COVID from spreading.

Yes, I know early on, we were told cloth masks did little to prevent COVID.  However, the science has changed, and we know more now.  That is not a conspiracy, that is just how science works. Science rarely happens all neatly and wrapped in a bow.  

I am not going to spend this post talking about the benefits of wearing a mask or shaming people into wearing masks.  Shaming as a way to get someone to do something, doesn't work.  Instead, I'm going to tell you what I see daily.

Due to social distancing requirements, I had to move out of the office I shared with a coworker.  I'm now in a corner cubicle with lots of sunlight.  I can see the ER entrance from my office, and at least once a day, see a helicopter land on the helipad.  Pretty cool, huh. 

You know what's not cool, seeing families wait in the blazing sun for word on their loved ones in the ER.  Daily, it pains me to see families waiting outside of the ER. I have even seen families bring coolers because they know it is going to be a long day.  Waiting outside of the hospital is how people have to wait for their loved ones these days.  Sure, people can sit in their cars, however, it can still get hot in the car even with the air conditioning going and who wants to burn up gas in this fragile economy.  Most families will see their loved ones come out of the ER that day, their problem fixed or not deemed emergent enough for hospitalization.  What about the patient who does need hospitalization, when their loved one dropped them off, may be the last time they see the patient alive or at least in the previous state they dropped them off to the ER.

COVID-19 put a stop to most visitation at hospitals.  Some hospitals have limited visitation: end-of-life, labor and delivery, pediatric, and exceptions on a case-by-case basis.  Many hospitals are not allowing ANY visitation. As a substitute to visitation, a lot of hospitals are using FaceTime to connect patients with family members, including when death is near.  Saying goodbye via FaceTime is the new normal, but it doesn't have to be.

In case you weren't aware, people who have COVID-19 should have the door to their hospital room closed, pretty much at all times.  The only people they see are the healthcare providers who come to their room to treat them. Can you imagine being in the hospital and not even being able to see what's going on in the hallway and the world around you? 

Having someone being able to visit you and advocate for you is an important part of healing.  Yes, sometimes you can have too many visitors that interfere with healing. Still, nothing can replace having a second set of ears to hear what the healthcare provider has to say, to notice a change that they can notify a healthcare provider about, to help provide some assistance getting settled in bed or going to the bathroom.  This says nothing of the emotional importance of having someone visiting you and providing human interaction outside of a healthcare provider.

Unfortunately, COVID-19 has taken all of the above away from most patients.

Next, let's talk about our patients in skilled nursing facilities, group homes, or any type of communal health setting. Patients in group settings also cannot have visitors.  For a brief period, in some areas, visitor restrictions were lifted, but they're back in place due to increasing numbers.  Visitation is integral for patients in these communal settings; visits give these patients something to live for and look forward to. I mean that quite literally, patients can withdraw into themselves when they do not get visits and end up failing to thrive.  Some residents, unfortunately, do not get visitors, but they do benefit from the many volunteers that come to the facilities. Alas, even volunteers cannot visit due to COVID-19.

Bringing a baby into this world is a beautiful and magical experience.  However, it is one that can be stressful and does not always go as planned.  Many expectant parents, especially mom, find comfort in having more than their partner there at birth. Perhaps the laboring mom's mother, a best friend, or even a doula.  Doulas have been shown to have a positive effect on birth outcome.  With COVID-19, a mom can only have one person with her for labor and delivery. Some may say, what's the big deal, but for many moms, it is a big deal and they were really wanting, and in some cases needing an additional support person.  COVID-19 has taken the choice of multiple people present at birth away.

Even outpatient visits are different.  Can you be sure grandma or grandpa is going to remember all that the doctor says?  Better hope so, because the most you can do for most visits is drop them off.  Loved ones can try to call in when their family is seen, but again, there’s no substitute for in-person support.  

What of the bereaved?  I have friends who have been unable to be at the funerals of their immediate family members because countries have banned the US from entering their country, so even if they can get to the US for the funeral, they cannot get back to their respective countries.  Even within the US, friends and myself included, have to make decisions about traveling to funerals because attending the funeral could possibly mean have to quarantine in the state you're traveling to or having to quarantine when you get back from the state you traveled to for the funeral. Questions you have to ask yourself in the day of COVID-19: Is the area you're going to overwrought with COVID-19 and no real plan to for reduction? Being with family during bereavement is a natural and expected part of the grieving process, but COVID-19 has made it anything but natural.  Many outbreaks have started with funerals, and a family starts off burying one person, and then several family members get sick and may even die. Then the cycle starts all over again.

Reducing COVID-19 numbers is not just about stores opening, churches opening, schools opening, large gatherings like festivals being allowed, economics, etc.  There are people in hospitals, skilled nursing facilities, group homes, and more, who are hurting physically and emotionally because they cannot get the support they need and deserve because COVID-19 is running rampant.

Whether you believe COVID-19 is real or not, and if you're reading this, I hope you do think COVID-19 is real, at this point in dealing with it, I cannot imagine that there is an adult in the US who has not been touched by COVID-19 in some way.  Have you not been able to see Nana and Grandpa like you normally would?  A new grandbaby who's been born you can't see at the hospital? A friend in the hospital? A family member in the hospital? Lost a loved one?

If you haven't had to deal with any of the above, count yourself lucky.  Social distancing, proper hand hygiene, and wearing masks works. If we want any sense of normalcy, we have to do at a minimum, those three things.

Remember the sick, shut-in, laboring, and bereaved, who could use some normalcy in the form of visits from loved ones and cannot get it.  They don't have a choice, but you do.