When one of her patients was being discharged last week from Millard Fillmore Suburban Hospital, Sarah Dempsey, a registered nurse, stepped into the hallway to get a mask. The patient didn’t have Covid-19, but was still required to wear a mask while leaving the hospital.
Dempsey couldn’t find a mask outside the room. That’s unusual. When the pandemic began, every room on the floor had a caddy outside the door stacked with gowns, gloves and masks. That garb was donned, and then thrown away, each time a nurse entered or exited a Covid room. If a patient needed a mask, a nurse would grab one there, too.
Last week there was only one Covid room – and thus one caddy – in the 32-bed unit. As Dempsey walked down the hallway to retrieve a mask for her patient, she thought about what it was like a few months ago. “This place was full,” she said to a colleague.
Covid wings and intensive care units across the region were loaded with coronavirus cases over the winter. But now, with virus numbers plummeting, the job is starting to feel a little more like it did in 2019, when Dempsey started her career. “I feel like I’m getting back to the normal nursing that I know,” she said.
But for many health care workers like Dempsey, the return to “normal” will be complicated – and for some, perhaps even more challenging than the last 15 months spent on the front lines of Covid.
What is “normal nursing”?
Having conversations with your patients, seeing their families visit, and “not feeling like I am just surviving,” said Dempsey, who was the subject of a story in this “Pandemic Lessons” series last December. Back then, she described the caseload and exhaustion weighing on nurses. “During this pandemic,” she said then, “it is extremely disheartening that my patients will not get my best because it is physically impossible.”
At Covid’s most intense points, Dempsey would leave a shift and head home to her husband and two young children feeling drained and unaccomplished. “Every Covid shift is just surviving,” she said. “You’re walking out of there feeling drained, yet you also feel like, ‘Did I do anything at all?’”
Today, when she sees a patient’s spouse or children walk in to visit, she smiles. During the worst parts of Covid, when nobody could come in, these visits happened over FaceTime, with nurses holding the phone or tablet. “We were that lifeline for a lot of people,” Dempsey said. “It feels like a lot of this has come full circle, where people are reunited again.
“I honestly cannot believe that we made it through this time.”
Then she quickly added, “Of course, it’s not over.”
Are we close to Covid being over?
“We are doing very well,” said Dr. Thomas Russo, chief of infectious diseases at the University at Buffalo’s Jacobs School of Medicine and Biomedical Sciences.
But he’s not using the word “over.”
New cases in New York dropped 61% over the last two weeks, while hospitalizations dropped by 23% and deaths by 31%. Given the plunge in new cases, those latter two numbers will likely drop further in coming weeks too. New York’s percent positivity rate for Covid tests, which was at 0.54% at the end of last week, has declined daily for the last two months. At one point last week it was the lowest in the country. Western New York’s percent positivity rate, which has generally been among the state’s highest, has dipped below 1%. Hospitalization numbers are about one-fifth of what they were at the height of winter.
“Things look great for the summer,” Russo said, adding we “will still have cases” in the warmer months and “the virus is not going to leave us. It will still be there.” He expects “a bump in cases” when cooler weather hits around Halloween and more gatherings happen indoors.
That sounds reassuring for the majority of people. But what about nurses and other front-line health workers?
Mental health is a stark concern.
In that December “Pandemic Lessons” story focused on Dempsey, a Johns Hopkins psychiatrist cited concerns for health care workers: post traumatic stress disorder, anxiety, depression and possibly suicide. The “psychological consequences” are “going to be growing with time,” said Dr. Karen Swartz, director of clinical and educational programs at the Johns Hopkins School of Medicine Mood Disorders Center.
In remarks to the Association of Health Care Journalists last fall, Swartz added, “It is probably going to be six to 12 months after we have a vaccine and a sense of control of the virus itself that I think we’re going to see peaks in the need for supportive care – when people have the time to actually look back at what they have survived to go forward.”
We’re entering that phase now. How is it playing out?
“We are already beginning to experience the longer-term mental health consequences that this pandemic will have on our health care workers,” said Dr. Ann E. Cornell, a clinical psychologist and director of the University of Rochester Medicine Employee Assistance Program, who responded jointly to our questions in an email with her colleague Janine Rowe, a mental health counselor.
“The conditions they have faced in the past year have been compared to that which many experience in combat zones,” Cornell and Rowe continued. “Given this, we have already begun to see an increase in conditions such as depression, PTSD and anxiety.”
If you know a health care worker who spent the last year treating Covid patients, what can you do to be supportive of them?
Remember that stress doesn’t melt away simply because the stressor is gone.
Imagine Covid as the attacker, and trauma as the scar. While you’re engaging your full body and mind in pushing back the attacker – as nurses and other health care workers did during the multiple waves of Covid – you may barely notice the scars that are forming. But when the attacks slow, you have time to focus on other things. You see the scars. You remember how you got them. You relive the experience, wonder what more you could have done, and worry whether it’ll happen again.
“It’s important for all of us to remember that our front-line workers will continue to experience stress, anxiety and burnout long after we return to ‘normal,’” Cornell and Rowe said. “A simple act such as asking someone how they are doing and truly listening to those that wish to talk can go a long way. Stepping in to provide emotional support, encouraging self-care activities or reminding friends and loved ones that professional help is available can help normalize their needs.”