Will you work during a Pandemic?

Mulan · Nov 3, 2007

"taken care of" with no PPE or meds available? What are they referring to when they say that? Probably a ride to and from and meals on duty, but not much more. Yes, I think I would go in anyway, but I'd be pretty realistic about not expecting any thanks or recognition. I haven't heard of any of the nurses that stayed during Katrina getting anything special, and I often wonder if they were paid for that last week or so. Anyone know?

I think if I went in, I'd expect to end up dead.

bagladyrn, RN · Nov 4, 2007

1. I would expect the highest level of PPEs to be provided, in sufficient quantity.
2. I would expect Tamiflu to be given to all HCW for free, if working. And scripts for family members to be filled at a discount in the hospital pharmacy.
3. The hazzard pay would be a BIG bonus, though I'm not quite sure if I'd demand it.
4. Yes, I'd expect to be given acceptable accomodations while working. But also want to be assured that I can see my family when I want/ need to.
5. ABSOLUTELY! In fact, that would be a huge factor in my deciding to stay and work. Executives can answer phones....and be messangers as well as anyone. To see them on site w/ us would be a huge plus.

I'm not sure if many really have a full appreciation of what the situation will be like in a full pandemic of this nature.

PPE's may not be available not only because they are being used, but because they are not being produced - the factory workers will be quarantined like everyone else, as will those who would transport the goods to your hospital. No doubt travel between areas of high to low infection will be closely regulated.

Tamiflu may not be available at ANY price, for the same reason.

Hazard pay - not a chance - the economy is going to have taken the big dive shortly after this happens, barter will likely become the most common form of transaction and where would you spend that money anyway? Most centers of commerce will be restricted from operating to avoid congregations of citizens passing on the virus.

Acceptable accommodations may become any horizontal place to sleep between shifts of patient care and the safest thing for your family may be for you NOT to see them.

I could see martial law being declared and enforced because too many of our citizens believe the restrictions shouldn't apply to them and that "just this time won't hurt", and "I'm a VIP". Ever been stopped at a checkpoint with National Guard aiming weapons at your vehicle? I have, and it's a weird feeling even when you know they are the "good guys".

This isn't aimed at you personally, merely using this post to encourage people to consider what this type of pandemic would truly mean.

elizabells, BSN, RN · Nov 4, 2007

I probably would, because

a) I don't have a family of my own yet, and

b) I have a nearly pathological lack of a sense of self-preservation.

Just tellin it like it is.

indigo girl · Nov 4, 2007

This still does not address the issue of PPE for these community volunteers. The hospitals will have to protect their supplies - they'll be short enough without sharing it with non-hospital providers (recall that in the given scenario, hospitals are running out of PPE). Most people do not keep a personal stash of PPE - where would they get it?

I believe that Ayerman is referring to this type of home-made mask, tested

in this study. It is better than no protection at all, apparently, but still there

are problems with it:

http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm

Here is another link addressing the use of our plain surgical masks if N95

is not available. I offer this only because it seems obvious that we will

run out of N95 masks rather quickly:

http://www.flutrackers.com/forum/showpost.php?p=107064&postcount=34

It is true that most people do not keep PPE at home. But, yes they can buy

it. I have seen gloves and masks in drug stores, some Sam's Clubs, Home

Depot etc. My local drug store has N95 masks. Of course, in a time of great

need none of these are likely to remain on the shelves which brings us back

to the home made masks for our volunteers. It is better than nothing.

That is all that I can think of that community volunteers might have access to.

But, I am saying also that if our volunteers are senior citizens, and I think

that they might well have to be, then these folks are not as likely to be at

risk (at least for dying) from H5N1 if that is the virus that we will be dealing

with. The bigger question might well be, will they volunteer to help? I think

so, if the statistics are made very public, that the younger people represent

the majority of cases. Our senior citizens are very civic minded people, and

a valuable resource. We will need them to help us.

These are my own personal conclusions and does not represent any type of

study. Perhaps we should ask AARP or some other group to poll their members.

RN4NICU, LPN, LVN · Nov 4, 2007

I believe that Ayerman is referring to this type of home-made mask, tested
in this study. It is better than no protection at all, apparently, but still there
are problems with it:
http://www.cdc.gov/ncidod/EID/vol12no06/05-1468.htm
Here is another link addressing the use of our plain surgical masks if N95
is not available. I offer this only because it seems obvious that we will
run out of N95 masks rather quickly:
http://www.flutrackers.com/forum/showpost.php?p=107064&postcount=34
It is true that most people do not keep PPE at home. But, yes they can buy
it. I have seen gloves and masks in drug stores, some Sam's Clubs, Home
Depot etc. My local drug store has N95 masks. Of course, in a time of great
need none of these are likely to remain on the shelves which brings us back
to the home made masks for our volunteers. It is better than nothing.
That is all that I can think of that community volunteers might have access to.
But, I am saying also that if our volunteers are senior citizens, and I think
that they might well have to be, then these folks are not as likely to be at
risk (at least for dying) from H5N1 if that is the virus that we will be dealing
with. The bigger question might well be, will they volunteer to help? I think
so, if the statistics are made very public, that the younger people represent
the majority of cases. Our senior citizens are very civic minded people, and
a valuable resource. We will need them to help us.
These are my own personal conclusions and does not represent any type of
study. Perhaps we should ask AARP or some other group to poll their members.

The question I was responding to asked if we AS NURSES would volunteer in the community. This is a much different question. As you point out, seniors are at a lower risk of death from H5N1 than many nurses would be. It is a different situation for nurses in the age group at the highest risk of death from H5N1. I, for one, would not be willing to make do with makeshift and reused PPE if my life were on the line.

indigo girl · Nov 4, 2007

The question I was responding to asked if we AS NURSES would volunteer in the community. This is a much different question. As you point out, seniors are at a lower risk of death from H5N1 than many nurses would be. It is a different situation for nurses in the age group at the highest risk of death from H5N1. I, for one, would not be willing to make do with makeshift and reused PPE if my life were on the line.

Sorry for the misunderstanding. Thanks for clarifying that.

I completely understand your refusal to work with makeshift and reused PPE.

That information is offered only for those that may need it in extreme emergency

with no other resources.

Goju · Nov 6, 2007

We have a team of Moms at the American Public Health Association Annual Meeting & Exposition in Washington, D.C. November 3-7, 2007. and this is the report SusanC posted from today from flu Wikie - http://www.newfluwiki2.com/showDiary.do?diaryId=1791

Today was very different from yesterday. For one thing, there were lots of people passing through the whole day on their way to and from the poster sessions!
I think the new flier really worked (but I'm not sure whether that is easily transferable to other contexts) because it places us accurately in people's minds right away. The other thing is, I suspect that it helps to keep detractors away, cos it's pretty hard to come over and harass a bunch of moms doing things out of the goodness of their hearts, right?
A few examples, I spoke to a flu epidemiologist who of course know a lot, she's read John Barry and all the rest of it as well, but when I showed her the 'if H5N1 becomes weaker' poster, she bent down and looked at it and checked the figures very closely and agreed that I was right! I think it was very powerful revelation even for someone for whom this is THEIR line of expertise.
Someone else worked in another area of PH that involved community engagement, and he really appreciated my telling him about 'hive mind' and how to facilitate the aggregation of non-traditional knowledge.
There were various people from cdc, PH people from different states, a number of MPH students, a policy person (from a state health department, I think) who is in the middle of writing up grant proposals for community engagement, so we spent some time talking about the stuff that I put on the posters. She already knew about the keystone project but not the Redefining readiness, and I gave her more details of references that she can use to support community engagement. She wrote all that down.
I also had various conversations with this person and others about how to get HCW to come to work, and I stressed the importance of recognizing people's reality, that nurses are also moms with kids, and will have conflicting interests in a pandemic. I gave out the link to allnurses.com to at least 3 of 4 people, and I said it is so important to listen to nurses talk about this in their own words. Which is exactly what the redefining readiness study found too.
My theme today gradually consolidated around the issue of empowerment, that we don't tell people what they need to do, but give ideas to help them think.
I'm ready to move tomorrow towards more overtly talking about the points on the new flier today. I have a sense that this is one opportunity to overcome the biggest problem for the majority here, (witness the hhs blog) that of TELLING THE PUBLIC.
The biggest limitation really is our stamina and ability to keep up with the number of people. For practical purposes, the number of people who visited our booth and talked to us was severely limited by both space and our ability to talk to them. So if there were 2 of us, we would each be talking to one person, and then once someone leaves, almost immediately we get someone else. It was just an unending stream of people.
It's just too intense and tiring. None of us have been eating 'proper' meals. I think BB managed to get a burger or something, but RM and I have been living on cereal bars, nuts, and fortune cookies (yes, they were freebies from one of the booths!) but at least today I made sure I drank (almost) 2 bottles of water, whereas yesterday I didn't even finish one! Someone from FW offered to bring us some ENsure tomorrow, and I said yes to that, just cos it is so much easier to get liquid nutrient down than to eat real food. We joked about getting an IV so we don't have to worry about it! LOL
This probably gives you a sense of how intense it was!

mhawkins38 · Nov 7, 2007

One thing it doesn't seem like anyone is taking into account is that during a pandemic, hospitals would not be the only care areas. School gyms, churches, any area with space will be converted to care areas. As for getting paid during this time and continuing to work during an episode, where is that going to take place? Most areas will be shut down. School would not be in session. Non-essential businesses would not be open. I understand the fear, I really do, but the only way to get through any crisis is with everyone working together. I live in a small town with all-volunteer Fire/EMS. If half of those people succumbed to a pandemic, there would not be enough personnel left to transport or care for anyone or respond to anything.

Infrastructures of cities would be affected by lack of key personnel running the systems. Electric companies do not run on their own, nor do the wastewater treatment facilities, phone companies, gas companies, petroleum companies, trucking companies to move the goods and products we count on. Think about the sanitation engineers. The streets of New Orleans could end up looking like yourtown, USA. No one to keep the waste in check.

Isolate yourself from other people. Good thought but how do you do that? In reality you come into contact with thousands of people everyday even though you are not physically in their proximity. If I interact with 30 people today, I will be exposed to whatever those people may be carrying. Now consider that those 30 people interacted with 30 people and those people interacted with another 30. Just in this short scenario, I have been exposed to whatever 2700 people have come into contact with. That's just me. Now consider that if you have a husband and say 2 children...triple that number.

That's just exposure to people. Now how are you going to limit exposure to the birds? Ducks, chickens, sparrows, wrens. A CDC doctor gave a lecture and I learned that the virus is not passed to pigeons. Their feces is too high in nitrates. Interesting.

I guess where I am coming from is that I will do what I can, without thought of pay. A pandemic will level the economic playing field. It doesn't care how much you make or how much you work. As far as spending time with my family and caring for them...I don't know. My head tells me that in such a situation, if they were sick I would want them to be closest to where care was being given. Established centers would recieve treatments and supplies before private residences.

I know in my heart I would report for duty to my family, friends, neighbors, colleagues and anyone else who needed me. Not to work.

deleern · Nov 7, 2007

ayrman, So well said, as i said in an earlier post. I would work, as would my husband. he is not a nurse or a medical person but a mechanic, handyman, he can feed an army. we live in a very rural area. but for how mobile we are today it will strike at every point.... look at the 1918, flu people contractied it in Sitka alaska.

1997 Flood and Fire devestated East Grand Forks MN and Grand Forks. evacuation of hospitals and nursing home had people living in Curches, the College and the schools (Thief River Falls) people opened up there homes for strangers.... Every one volenteered to help in any way they could.... the week before we didn't have power for 3 days due to Ice storms... we had wood heat and a generator. we had 15 people in our little house. during times like that you don't work. During the flood all of the town was evacuated people lost there homes and there jobs. it took years for the recovery... Imagine if it is world wide. we will be bartering to survive.

Happy2Beme · Nov 7, 2007

I might be wrong, but I was under the impression that a pandemic would be a very LONG thing, like MONTHS.

I might die, but I don't have a choice not to work for months , unless I want to see my whole famkily in the street.

Then what?

I'm truly happy for those of you who would have a choice financially not to work for an extended period of time.

I don't feel I have that luxury, I'd have to take my chances.

daverika · Nov 8, 2007

I am one of a handful of actual staff members that sit on our hospital's disaster committee, in a system that is actively preparing for a variety of disasters (volcano, earthquake terrorism, pandemic, etc). When we covered bird flu last year the statement was made that "10-20% of staff won't show up", either due to illness or unwillingness to be exposed. I spoke up and said I thought the number would be closer to 50 or 60%, that those who actually stayed would not want to go home and expose their families, and would need on-site housing and food. My comments were met with silence, then discussion resumed with the assumption that 90% of staff would show up to work. After reading these posts I'm pretty sure that our hospital is in for a major shock if bird flu mutates into a contagious killer strain. As for going in to work, I probably would, with my own PPE that I would not hesitate to use and re-use. Once PPE became unavailable I would go home and stay away from my family for a week, til I knew I was flu-free. And I heartily agree with those who envision apocolyptical chaos. Panic will rule an the majority will be looking out for themselves. Not a petty picture but reality is what it is. As for the government taking care of me, I know there are tons of body bags stockpiled somewhere.

No thanks, I can take care of myself a lot better than that!

EmmaG, RN · Nov 8, 2007

I am one of a handful of actual staff members that sit on our hospital's disaster committee, in a system that is actively preparing for a variety of disasters (volcano, earthquake terrorism, pandemic, etc). When we covered bird flu last year the statement was made that "10-20% of staff won't show up", either due to illness or unwillingness to be exposed. I spoke up and said I thought the number would be closer to 50 or 60%, that those who actually stayed would not want to go home and expose their families, and would need on-site housing and food. My comments were met with silence, then discussion resumed with the assumption that 90% of staff would show up to work. After reading these posts I'm pretty sure that our hospital is in for a major shock if bird flu mutates into a contagious killer strain.

I'm by no means an expert in disaster preparedness, but common sense tells me you hope for the best but prepare for the worst.

Oops. 'Common sense'. What was I thinking...

My bad.

Will you work during a Pandemic?

Nurses, would you go to work during a Pandemic?