Nurses are playing a crucial role in this pandemic — as always

‘Nursing’s contributions to improving the public’s health during times of crisis dates back to the days of Nightingale, modern nursing’s founder. In 1918 during the disastrous influenza pandemic, nurses were steadfast in modeling the teachings of Nightingale, a staunch supporter of good handwashing, proper sanitation and sound preventive measures. Members of the Visiting Nurses Associations made home visits to patients providing critical nursing care as one of the only treatment measures available during that time. Nurses were vigilant in promoting the benefits of being exposed to fresh air, practicing good hand hygiene and maintaining social isolation while conducting home visits to patients.’

Read here (Scientific American, May 4, 2020)

Nurses are trying to save us from the virus, and from ourselves

‘We’re in this together, but some of us are more in this than others. People keep saying that nurses are on the front lines, but they are actually behind enemy lines, surrounded on all sides. They are trying to save us, and save us from ourselves. Nurses are protesting protesters, standing in their scrubs and masks to glare at “freedom-loving” citizens who spew insults as they rally for the economy to reopen. Nurses are taking to social media to convey the extremity of their situations: They talk about war zones, about titrating a dozen IV drips while troubleshooting fluky ventilators, all without reliable stockpiles of supplies.’

Read here (The Washington Post, April 28, 2020)

Potential to develop a more effective cloth mask with finer weave, more layers and a better fit

This study, which compares the efficacy of cloth masks to medical masks in hospital healthcare workers (HCWs), says the following: ‘Cloth masks are used in resource-poor settings because of the reduced cost of a reusable option. Various types of cloth masks (made of cotton, gauze and other fibres) have been tested in vitro in the past and show lower filtration capacity compared with disposable masks.

‘The protection afforded by gauze masks increases with the fineness of the cloth and the number of layers, indicating potential to develop a more effective cloth mask, for example, with finer weave, more layers and a better fit.

‘Pandemics and emerging infections are more likely to arise in low-income or middle-income settings than in wealthy countries. In the interests of global public health, adequate attention should be paid to cloth mask use in such settings. The data from this study provide some reassurance about medical masks, and are the first data to show potential clinical efficacy of medical masks.’

Read here (NCBI, April 22, 2015)

Six points from Dr Amar Singh's article: ‘To understand our epidemic stop looking at daily Covid-19 numbers’

(1) Only 20% of the 11,500 daily test capacity we have are used to look for community spread. “The remainder are used to re-test confirmed cases with a view to determine discharge ability, treatment response and possibly repeated tests for suspected cases that are negative the first time (polymerase chain reaction (PCR) tests depends on quality of the sample and have only 60-70 per cent positivity for nasal swabs or sputum).”

(2) The number tested positive (daily or cumulative) is dependent on the number of tests we conduct. Some modelling studies estimate the actual number in any country to be 10 times that.

(3) If we used death rate and assumed 1 death per 100, we would have 6,200 cases (as at April 6) but this figure is distorted by other factors. E.g. we could have missed out counting Covid-19 among other pneumonia cases. Pneumonia accounts for 11.8% of deaths in Malaysia or 390 per week.

(4) There are two lag times that affect the figures: (a) First, “it takes about 7-14 days before an infected person presents clinically. It takes another 7-14 days before illness severity and dying (ventilation and ICU care).” (b) Second, there is a backlog of testing. “Some say it takes 5-7 days to get results. Even health care staff that have potentially been exposed may have to wait for 4-5 days to get their status known.”

(5) We have community spread: “From MoH Influenza-Like Illness (ILI) & Severe Acute Respiratory Infection (SARI) surveillance that is conducted at selected sites, about 1.2 per cent of these patients have been Covid-19 positive in the past week. This indicates community spread, as these persons have no contact with known cases. We do not know how many patients with pneumonia and severe respiratory illnesses (influenza-like illness) we have missed in the past 4-6 weeks.”

Point 5 justifies a lockdown because, given community spread, gatherings of people could become “transmission amplification events”.

(6) We need to do more to protect our front-line workers. “Many staff have had to rely on homemade (not all reliable) or donated PPE. We are still struggling with the distribution of national PPE supplies. Even as far back as March 20, MoH reported that 15 HCPs had been infected by Covid-19 as part of their work.”

Read here (Malay Mail, April 7, 2020)

Healthcare front liners demand action

“If this virus is not stringently contained now, the repercussions to the health of the American population, as well as the impact on the country’s economic, educational and welfare systems, will be incalculable,” notes Megan E. Brunson, RN, president of the American Association of Critical‐Care Nurses.

Critical care front liners in the US plead for (1) greater public cooperation (2) suspension of non-essential activities -- stop mass travel and close hotels and hospitality venues (3) suspension of non-essential health care (4) at least three weeks stay-in-place.

“Our guidance to the public, US Federal Government and state and local governments comes after substantial input from the U.S. Centers for Disease Control and Prevention (CDC) and careful examination of best practices from other health officials from around the world.”

Read here

Nurses. Nurses. Nurses

“Among the nine countries with the highest number of Covid-19 cases, the country that has the highest nurse rate also has the lowest death rate from the disease. Germany has 13.2 nurses per 1,000 (echoing a trend for high nurse numbers throughout Northern Europe) far above the other heavily Covid-19 affected countries.

“This may be just another armchair epidemiologist observation of course. But higher numbers of nurses may reflect one of two beneficial factors (or both): first, that nurses, the backbone of hospital (and especially ICU) care, are essential to patient management and, ultimately, survival.

“The second is that the sort of hospital or country that knows the value of nurses also is a hospital or country that understands how to deliver effective health care and has likely made countless other unmeasured adjustments to improve quality.”

Read here (CNN, March 25, 2020)