COVID Corner - WMP Board Commentary: Part 1

The Wound Management & Prevention Editorial Board is providing their experiences and insights during the pandemic.

“Life is what happens while you’re making other plans. — John Lennon”

Our Pacific Princess 2020 World Cruise was scheduled to return April 26. We had sailed the lovely Caribbean Sea, dropping our cares, then continued through the amazing engineering feat that is the Panama Canal and onto Hawaii. Our stash of hydrocolloid dressings from local drug stores allowed us to helped fellow passengers quickly heal blisters, cuts, and minor wounds and helped relieve their pain, so their vacations might continue with glorious diving and snorkeling in Maui and French Polynesia and rugged adventures in New Zealand and Australia.

Russ and I were settling into the delightful shipboard routine of port excursions, exercise, Zumba, ballroom dance lessons, writing, Sudoku, and trivia when the coronavirus (COVID-19) fears began sealing ports early in March, deleting our planned visits to Bali, Singapore, and Phuket, Thailand, from March 2 to 7. By March 11, when we reached Colombo, Sri Lanka, our ship was allowed only to refuel and take on provisions; no one was allowed on or off the ship.

Frightened residents stoned a virus-free cruise ship in Mauritius, another port on our schedule, illustrating how fear can elicit primitive thinking. I quickly learned not to respond to panicked friends who asked that I critique a small “controlled” case series, published in a formerly trustworthy journal, of hydroxyquinone. Who was I to dash their hopes? But I felt proud of peer-reviewed wound care journals like ours that publish sound science with clearly stated limitations.

The ship was a floating isolation unit with enough fuel to travel 5000 miles, so we set off toward South Africa, but were denied access, as successive ports closed and 2 other Princess ships with COVID-19 cases onboard made the news. Princess headquarters ordered our captain to immediately return to Fremantle, the port for Perth, on the west coast of Australia.

We are grateful to the Princess company; we were each provided an N95 mask and 100 mL of hand sanitizer, and the company arranged and paid for our March 21 flights home, which involved 24 hours in the air and 13 hours in airports (Perth to Melbourne to San Francisco to New York). During the first 2 flights, Qantas gave us delicious hot meals, free wine/beer, and delightful movies—a pleasant contrast with other recent flights!

Alaska Air cancelled our flight from San Francisco to our home airport of Newark, NJ, but kindly paid for our ride from New York’s JFK Airport to our home so we didn't need to run the 2-hour viral gauntlet on mass transit from JFK to our home. There is opportunity in everything!

More than 50 passengers with medical conditions that made air travel dangerous stayed on board the Pacific Princess. They will arrive to the US West Coast in late April. 

Spring flowers welcomed us home on March 22. As we read 4 months of mail, we were struck by how the world had changed compared to December 2019. We’re finding opportunities to enjoy each other and write while self-isolating for 2 weeks (until at least April 4) to avoid sharing any anything we may have acquired en route to home. Friends and neighbors dropped off fruits and vegetables bought during their own shopping trips, until our online grocery order is to be delivered (potentially delayed due to excess demand). We are amazed and delighted by the kindnesses we are being shown and by the senior helpline set up by our community. Like our wound care community, we all help each other.

This pandemic has reminded me to focus on life’s higher priorities, because none of us lives forever. The universe briefly lends us molecules, and we do what we can with them, appreciating nature and each other as best we can. There is still much to learn. Will it teach us to recognize life’s treasures? Will it “cull the herd,” making way for a more prepared, vigorous, creative generation with better values and priorities? Will it spare some of us from senile dementia or other diseases of advancing age? What opportunities has it given us to flourish in this moment and share what we have learned? — Russ and Laura Bolton

Dealing with the unknown. A stream-of-conscious report.

One Thursday, weeks ago now, when I went to the nursing home in Tucson, it seemed like business as usual. The difference was, for the past few weeks, we all had to come and go through the front entrance and be screened by the activity staff before working. We answered a short questionnaire, had our temperatures taken, and used see-through purses similar to those used in sporting events before we entered or left work. When we left, we all had to exit through the front entrance and allow inspection of the contents of our purses or bags before leaving. Somehow, some way, the personal protective equipment (PPE) had been coming up short. Extra PPE supplies are now under lock and key. We presently have enough right now but any extra is now locked up.

Starting several weeks ago, we limited visitors to 2 per patient, the visit was limited to 30 minutes, and the visitors had to be escorted to and from the room. Now, no visitors are allowed unless someone is actively dying. The definition of actively dying is loosely defined and is difficult to fit a checklist. 

Our clinicians are accustomed to washing hands for 20 seconds and putting on gloves before taking care of each patient. After caring for the patient, we remove our gloves and wash our hands again for 20 seconds. So, as the nation is just now dealing with a lot of these issues, we in healthcare and postacute care have done this for years.

I am very proud of the staff. They were not calling out but coming in as usual and doing the wonderful job they do every day. I did see and hear the fear they had in taking care of patients, wondering who and when any of the patients would come down with COVID-19, and the deep fear they had in bringing it home to their families.

Some staff insisted on wearing a mask, even for the patients who were not in isolation. Some, but few, of the patients asked the staff to wear a mask when they were taken care of. Absolute fear and panic surrounded the need for a patient to go to the hospital for a fever, a cough, and respiratory problems.  

Building staff quickly reviewed in their heads if they had seen, taken care of, or walked past the room the patient was in. The devastating fear was that after the patient would get tested for COVID-19, it would take 3 to 5 days or longer to get the test results back. It is difficult to deal with the unknown—the unknown of wondering for several days if the patient has it, and, if they do, what about all the patients and family you have been exposed to while you are waiting for the test to come back?  Can you go home to your family? Can you still go to work? So many questions. 

It is amazing how kind and caring the aids are to the patients and how they are there for them.

We are a one-story building. Families are visiting their family members through the window. There is talk about the virus, the latest news, and personal concerns—many questions we have no answers to.

One nurse aid told me now that the patients are not allowed to leave their room for anything (activities, physical therapy, eating meals in the dining room, and so on). On the plus side, clinicians now have more time with the patients, making it much easier to cut and file fingernails and toenails and provide the extra care they have always wanted to give.

Another thing I thought was very helpful was the administrator and director of nursing meeting with the staff before the staff shift ended to update them on any new things needing to be implemented and to address any questions the staff had. It was explained to the staff that if they had any questions, the administrator’s door was always open, and the facility would be transparent if and when we had COVID-19 cases. We are not here to hide anything, and we are keeping abreast of guidelines.

In some ways, this situation reminds me of giving wound care in Haiti after the earthquake, doing the most with what we have at the time with the information we have. We are all in this together and none of us know how this is going to end. But leaving work at the end of each day, I think, “There is always good in every situation.” Here in Tucson, at this nursing home, we are very lucky to have such caring aids who love the patients as if they were family. — Karen Lou Kennedy-Evans

Using “idle” time wisely.

I am working from home as all meetings (and even some webinars) have been canceled. But the break is good and is giving me some time to catch up on various things. I wrote something for Today’s Wound Clinic. — Nancy Collins 

With the lab closed down, I am working from home and using the opportunity to catch up on protocol writing and curriculum development. —  Judy Fulton

Responding to possible exposure.

Our students have been sent home. I am self-quarantining until April 2. A friend had been taking care of an elderly gentleman who was just diagnosed with COVID-19. Since I had taken this friend to dinner recently, I am taking this precaution, even though he had not actually been in contact with the gentleman because he had been in a nursing home (which just confirmed its eighth patient with the virus¾thank God no staff have been infected). With Easter fast approaching, I am “going” to daily Mass that is live-streamed from a different church every day. Another chance to travel the world...Blessings. — Nancy Ann Faller 

Only the weather is hot in Miami.

When I submitted this, things were relatively quiet in Miami. People had yet to fully embrace social distancing. Now it’s an entirely different story. With regard to my personal situation, I have worked from my home office for the last 16 years or so and am very used to it. I have not changed my daily discipline. 

A major difference of course is that we choose not to visit friends although, to our knowledge, no one to our knowledge appears to have the bug yet. We cannot visit family since they are all in The Netherlands. There are virtually no flights and the country is on lockdown. A pity, since we planned a major party there in June.

Shopping is also as limited as possible. Annoying but understandable. Although the weather is gorgeous at the moment, the pools are closed. — Michel H.E. Hermans, MD

The opinions and statements contained herein are specific to the authors and not necessarily those of Wound Management & Prevention, the Wound Care Learning Network, or HMP Global.