COVID in the Field

Story by McKenna Tanner

Each time she needs to go into the room of one of her patients with COVID-19 symptoms, pediatric emergency room nurse Elyse Stieber has to make a stop in a vacuum-sealed isolation room. The negative pressure in the room keeps any contaminated air from entering the rest of the hospital while she pulls out a bag labeled with her name and looks for the right mask. Each N-95 mask in the bag corresponds to a different patient she is responsible for, and she switches them in between patients.

“It kind of goes against everything that you learn in nursing school about not reusing supplies,” Stieber said in an interview conducted over the phone. “Those masks are supposed to be one- time use, and now, because of the shortage nationwide, it’s one mask per patient.”

For Stieber, who works 12-hour night shifts at Dell Children’s Medical Center in Austin, the status quo has changed significantly. Recently, she’s been spending many of her shifts as the “COVID nurse,” wearing the most involved personal protective equipment or PPE. Any child who comes in to the emergency room with novel coronavirus symptoms—fever and cough, congestion, or shortness of breath—who also lives somewhere with confirmed cases is labeled a “patient under investigation” and becomes the responsibility of the COVID nurse.

“My job was to become their primary nurse because we would have to go and put on the face shield, a mask, a gown, double glove, shoe covers, the whole outerwear airborne precaution for our policies,” Stieber said. “Typically in the ER, we’re in charge of four patients, but because of all these different precautions, we have been limiting the amount of people that go in and out of rooms that are possible COVID.”

To prevent cross-contamination, “dirty” nurses are responsible for potential COVID patients in their own separate hallway while “clean” nurses care for other patients. A side effect of the stay home orders is an increase in the number of kids coming in with orthopedic injuries after falling while playing outside, which they’re doing more frequently while schools remain closed.

“It’s kind of interesting because it’s been like a respiratory season plus a summer,” said Stieber, who graduated from Stratford in 2014. “Typically, in the summer, we see a lot of orthopedic injuries, but now we’re seeing kind of a lot of both.”

Despite the extra precautions hospitals are attempting to take, Stieber says nurses like herself are not as protected from exposure as guidelines dictate they should be. In addition to reusing N-95 masks, the specific masks required to prevent inhalation of virus-bearing particles, nurses are also wearing the same face shield multiple times, another piece of equipment crucial to protecting healthcare workers from coming in contact with virus—and another component of their PPE that’s intended to be single-use only. At Stieber’s place of work, when she’s not treating her patients in the COVID rooms, she has to wear a separate mask that’s expected to last for her entire shift. And according to Stieber, far more is necessary.

“Nurses here in the U.S. are extremely less protected than those in other countries as we are currently not funded for full protective Hazmat suits,” Stieber said. “We are putting ourselves on the frontlines without the proper protection we need.”

While Stieber has to act as though many of her patients have the novel coronavirus, only a small number of them will be tested to see if they actually do. In order to give a patient a coronavirus test, they must go through “basic screening exams:” chest X-rays, liver function screenings, white blood cell counts, electrolyte levels, and respiratory panels. A decision to test a patient means filling out a form from the CDC listing the checks they’ve done to rule out other diseases and disorders.

“The hope is that something comes back positive,” Stieber said. “The people that we’ve tested [for COVID-19], we had to go through all those steps to make sure that we had a reason to test them because there’s a shortage of tests. We have to make sure that the doctors have a way to

verify that there’s a prominent enough reason to go ahead and use our resources for testing them for COVID.”

Dell Children’s patients whose symptoms aren’t serious enough to require hospitalization are sent to outpatient testing sites in the community instead. Getting a test at one of these sites still requires a doctor’s order detailing what screenings the hospital conducted, and the emergency room’s case managers have to book a time slot for their patients at the busy sites. The hospital doesn’t receive the results of these outpatient tests, though, which is a source of concern for Stieber.

“We’re sending these kids out into the community, but then we don’t really know if they’ve tested positive or not,” Stieber said. “We could have potentially been exposed and not done all the precautions just because of the symptoms that they had when they came to us because we’re also trying to conserve on our PPE. We’re not a hundred percent sure who we have been taking care of that could potentially have tested positive.”

This lack of clarity means healthcare workers are having to take additional steps to limit their own potential to spread the disease to others. A system at the hospital helps Stieber track which patients she has treated, and at the start of each shift, she must check her temperature and fill out a questionnaire affirming that she doesn’t have any COVID-19 symptoms, including sore throat. Workers in other hospitals are having to take more extreme measures, according to Stieber.

“I have a friend who works up in New York City, and she’s not allowed to go to her apartment,” Stieber said. “All the medical staff are having to stay in a hotel, and they’re having to work longer hours and have more patients than they’re supposed to. They definitely have it a lot more rough, so I feel very blessed for my current position.”

Her current position still has plenty of rough spots, though. Stieber and her fellow nurses aren’t earning hazard pay despite the high potential for them to be exposed to the virus, a situation that she hopes will change soon. She’s also had to be cautious when she goes to and from work.

There’ve been reports of healthcare workers in scrubs being targeted by other people in the community, prompting her place of work to recommend staff members bring a change of clothes to work rather than be in public in their scrubs. A nurse getting gas for her car had a visit from police officers because people claimed she posed a threat.

“We’re recommended not to go anywhere in our scrubs, so that’s scary,” Stieber said. “I know a lot of it has to do with the fact that we are being very stingy on who we test, and some people who come in specifically to get tested don’t end up getting tested, and then they’re angry about it. So we just have to take extra precautions in that sense too.”

For those hoping to offer belaboured healthcare workers some support, Stieber says that in addition to washing hands well and often, simply sticking to the normal shopping list rather than hoarding groceries can be a big help to medical professionals.

“Because of the weird hours we work, it’s hard to get to the grocery store at times when people are lining out the door and stocking up on all their supplies,” she said. “It’s been hard for us to just get basic things that we need. I get wanting to have enough supplies, but when you go to the grocery store, just buy what you would normally buy.”

Stieber said that even though members of younger generations may not be at the highest risk for complications from the virus, the potential to pass on the disease means social distancing is important.

“I would say, think of your neighbor,” Stieber said. “The reason we’re taking these precautions is because of the fact that it is hurting a lot of people. I think that you have to look at that

perspective, that you may not particularly be the affected population, but you could potentially expose someone that is.”

When not serving as the COVID nurse, Elyse Stieber wears the less involved PPE required for protection from diseases that spread through contact with droplets. In addition to potential COVID cases, Stieber says Dell Children’s Medical Center, where she works, is experiencing an increase in orthopedic injuries.
Pediatric emergency room nurse Elyse Stieber wears highly involved PPE when working with her patients who may have COVID-19. Greater protection is required from the airborne virus, but Stieber is forced to reuse her mask and face shield due to the supplies shortage.

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