WHAT YOU NEED TO KNOW

Even as they’re being hailed as heroes, medical workers caring for COVID-19 patients often are not getting the support they need to carry on. This means they, too, are falling victim to the disease, in some cases when they become patients themselves, and increasingly as their mental health suffers from incredible stress: They are overworked, underprotected, and often frustrated by the lack of personal protective equipment (PPE) like masks and other resources. All that, and they must balance the emotional burdens of losing patients, barring families from visiting their dying loved ones, and the anxiety and guilt of risking their own family’s health. A study published in JAMA in March revealed troubling trends among 1,257 Chinese healthcare workers caring for COVID-19 patients, including depression (50.4%), anxiety (44.6%), and reported distress (71.5%). The mental toll of COVID-19 also presents a higher incidence of clinical burnout, which can lead to medical errors that risk patient safety; however, the long-term impact on their mental health won’t be known until years after we’re past the current crisis.

 

COVID-19 may be nondiscriminatory, affecting anyone regardless of race, ethnicity, gender, or beliefs, but it seems to be hitting black communities around the United States harder than anyone else. This disparity may stem from other health disparities that make blacks more susceptible to diseases, including higher likelihood of living in poverty and underlying health conditions such as diabetes—which in turn makes them particularly vulnerable to complications from coronavirus. An estimated 72% of COVID-19 deaths in Chicago have been among blacks, who comprise only 30% of the population. This is a distressing echo of the way HIV/AIDS has been affecting black Americans, who accounted for 42% of new HIV cases in the country in 2018, though they make up just 13% of the U.S. population. HIV also increases the risk of developing chronic conditions, so many blacks are currently facing a double whammy of HIV and COVID-19. A prevalent lack of medical insurance as well as distrust of health professionals among black patients means they often can’t or won’t get tested for either condition, potentially accelerating the spread of the viruses throughout their communities. Black activists and healthcare leaders and advocates may be able to reduce the impact of coronavirus among black Americans as they did with AIDS; however, to replicate that success and save more lives, they will need data on the racial and ethnic breakdown of COVID-19 victims, and disparities limiting access to testing and treat- ment will have to be addressed.

The COVID-19 pandemic has brought many changes to how we do things, including restrictions on patients in the hospital. But even though these precautions are neces- sary, even lifesaving, it can be hard on loved ones to be away from hospitalized family members and challenging to look out for their best interest. So how can you communicate with them and their health providers to advocate for them when you can’t be at their side? Experts share some suggestions for maintaining the connections you need to stay involved in their care, including supplying the patient with a smartphone capable of video chat, making sure their family’s contact information is visible and doctors know to call a designated spokesperson, and educating yourself about the pa- tient’s condition so you know what questions to ask. Patients should also make note of questions to remember to ask their family members. Being in isolation doesn’t have to mean leaving your family members alone and on their own—learn about the hospital’s guidelines to see what is and isn’t permitted and what measures they’re taking to keep you informed and part of the patient’s care team.

The elderly residents of long-term care facilities are among the most vulnerable population for COVID-19. For their own safety, nursing homes around the United States are closed to visitors. But what about the certified nursing assistants (CNAs) who care for them? Given the demands of their jobs—close, personal contact while feeding residents, dressing and cleaning them, helping them move around—it is im- possible for nursing home workers to practice social distancing. And yet, these essen- tial workers are also struggling with a lack of personal protective equipment, forced to ration and reuse what were intended to be single-use face masks. Consequently,  many of them worry about getting coronavirus themselves—and passing it on to their family members. Despite the low wages for certified nursing assistants (CNAs) around the country, giving up their job isn’t an option, for reasons both practical and compassionate. “Who else is going to take care of them?” asks Cynthia Yee, one of several CNAs in Northern California whom The New York Times interviewed about their experiences with COVID-19 in a recent video, “Low Pay, High Risk: Nursing Home Workers Confront Coronavirus Dilemma.”

With all of the infection prevention (IP) products available, and more new technologies appearing all the time, how can you know which are worth buying? The Healthcare Infection Control Practices Advisory Committee (HICPAC), Centers for Disease Control and Prevention (CDC), may have a tool that can help. Their Products and Practices Workgroup recently developed a one-page framework form that allows healthcare officials to evaluate a broad range of IP products and devices, such as ul- traviolet light cleaning enhancers and silver aginate dressings, as well as hold their manufacturers accountable for claims they make about them. While this tool is cur- rently aimed at providing a standardized method for HICPAC and the CDC to examine evidence and date in reviewing and recommending IP products, it may inform infection preventionists and hospital administrators about what to look for in their own assessments, and one day the tool could be more useful to them in product research.

Among the many unknowns related to COVID-19, one of the most confounding is how people are spreading it when they don’t seem to be sick. While data is still sparse, there are three main groups of these so-called “silent spreaders.” Those who are asymptomatic are infected but never show any symptoms, making them impossible to diagnose without testing. The median age of asymptomatic cases is just 14 years old, and as of now we don’t know if they can transmit COVID-19 to others. Presymptomatic people have been infected but aren’t showing signs of the infection yet; however, they can pass the virus on to others one to three days before they display symptoms. Finally, some people are considered mildly symptomatic: they get sick, but at most will experience a slight cough or fever. Meanwhile, if they feel well enough to continue their activities in public, they could be spreading COVID-19, and some of those they infect won’t be as lucky. There are still many questions surrounding coronavirus—how it’s spread and how it affects different people—and the only way to resolve them is with more testing and follow-ups.

 

Although we don’t know why, we do know that young children are not getting sick from COVID-19, or at least generally are experiencing only mild symptoms (although those infected are likely spreading the virus to others regardless); the number of se- vere cases and, even more rarely, deaths is a small fraction of those affecting adult populations. This, and the reduced number of well-child visits, is leaving some pe- diatricians with fewer patients to tend to, while older COVID-19 patients are testing the limits of hospitals and healthcare providers. Consequently, some pediatricians are changing tack and helping to care for adult patients for the first time in years— under the supervision of physicians more experienced at treating adults—or taking on young adult patients who might otherwise have sought care at an adult hospital. Meanwhile, parents who keep their children at home instead of getting their regularly scheduled checkups and vaccinations might be setting them up for other illnesses lat- er on, or they risk adding to the burden on adult hospitals with ER visits if they don’t get the care they need. This also does nothing to alleviate the mounting stress on kids facing extraordinary circumstances and adds stress to pediatricians with practices that will fail without business.​