An analysis and acknowledgement for healthcare providers during the pandemic.
Written by: Kavya, Haritha, Akshaya
It has been approximately nine months since the beginning of the COVID-19 pandemic. Although millions of people have been advised to stay at home, healthcare workers have been on the front-lines of the pandemic. Physicians are doing their best to treat numerous cases on a daily basis. However, there are several other healthcare professionals whose timely action and collaboration with the physician are essential to saving lives. Here, we discuss the roles and responsibilities of the other health professionals on the front-lines of the pandemic.
Pharmacists
Who are pharmacists?
Pharmacists are health professionals responsible for monitoring the safe and effective use of medication. There are many types of pharmacists including retail pharmacists - those that dispense medication at pharmacies, and clinical/hospital pharmacists - those that work as a part of a healthcare team in a hospital setting. Pharmacists are known as the ‘drug experts’ on healthcare teams and are responsible for optimizing patient outcomes by providing the best possible medication therapy for patients, while ensuring drug safety (1). They are further involved in designing cost effective drug therapies and counsel patients about the safe use of medication (1). Pharmacists additionally provide information to physicians about the latest drug therapies and collaborate with them to ensure rapid patient recovery.
Pharmacists, the ‘drug experts,’ provide medication therapies to patients, monitor their medication and teach them how to take their medication. They work closely with physicians on drug therapy management. Pharmacists also educate the public about disease prevention. (4)
How have pharmacists been involved in the COVID-19 pandemic?
Pharmacists are playing a crucial role in patient care during the pandemic. They have been especially important in providing reviewed and updated information on drug therapies to physicians, especially when physicians are experiencing increased patient volume (2). A few months ago, a clinical trial testing the effectiveness of lopinavir/ritonavir was conducted but the results proved to be insignificant (2). During clinical studies like these, pharmacists play a unique role in providing accurate data to physicians about the potential side effects of administering such a drug as well as how to formulate the drug, for example, if patients cannot swallow (2). Pharmacists have also played a crucial role in counseling patients about drug usage, especially when its use is widespread in the community (2).
Additionally, clinical pharmacists play a role in minimizing the spread of the disease within the hospital. They limit the use of personal protective equipment (PPE) by preventing unnecessary entry of other healthcare providers such as nurses into patient rooms (2). Pharmacists do this by converting intravenous (IV) lines to orally administered antibiotics/medications whenever possible thereby lessening the frequency of nurses responding to pump alerts (2). Pharmacists have also developed treatment protocols that limit nebulizer use and promote metered-dose inhalers whenever possible so that staff come into contact with patients less frequently (2).
Community pharmacists have been educating the general public about effective strategies to prevent further outbreaks by engaging in practices such as wearing a mask while outside and frequent hand-washing (2). Some states like Ohio have permitted pharmacists to prescribe emergency refills of medication when alternative treatments are unavailable (5). Several pharmacies have also set up COVID-19 testing sites (2). Overall, pharmacists are playing a key role during the pandemic as medication experts and are involved in making system-level as well as patient-level treatment decisions (2). They serve as a resource not only to physicians and nurses but also to patients and the general public (2).
During COVID-19, pharmacists have been on the front lines of patient care by working closely with physicians to optimize patient care, as well as educating the community about social distancing and the importance of wearing masks. They have also been administering flu shots and providing emergency medicine. (5)
Nurses
What Role Does a Nurse Play?
Nurses not only work to fulfill their patient’s needs and keep people educated on health issues, but also improve public health, overall. Although the role of nurses varies depending on their specific specialization and place of work, we can come to understand that their ultimate goal involves taking care of patients and their wellbeing, everyday. A nurse’s role is very key in the improvement and steady recovery of any patient, as they oversee the patient's general needs and are present during the entirety of a patient’s health-care journey.
Specializations include labor and delivery, medical surgical care, and even trauma, which typically require certain educational requirements to be met. Nursing professions can be categorized into 3 different sectors; Registered Nurses (RNs), Advanced Practice Registered Nurses (APRNs), and Licensed Practical Nurses (LPNs). Aside from providing general care of a patient, APRNs have specialist roles including prescribing medication, aiding in gynecological and low-risk obstetrical care, as well as taking care of a broad set of both physical and mental problems (3). Whereas APRNs work to introduce and improve technology being developed in the medical field and tend to often diagnose patients, LPNs usually provide overall care of their patients throughout their health care journey. This compares to RNs, who are known as the “backbone” of healthcare professionals, aiding in health promotion and education, executing physical examinations, and coordinating a patient’s care with other professionals with the patient’s health in their best interest (3). Additionally, specialties can also involve having research responsibilities as well as performing physical exams (4). The specialty of a nurse depends on what area they are focusing in, and where they work (hospitals, ambulatory care, schools, etc.) (4).
Overall, as we have seen, nurses have the important duty of monitoring the behavior of their patients and to use the knowledge and expertise they have gained to take care of the health and wellbeing of their patients. From this, we can imagine just how much of an impact COVID-19 has had on nurses.
As a direct result of being surrounded by patients who have contracted COVID-19 and spending much of their time in high-risk (of transmission) environments, many healthcare workers have also gotten the virus. This image was taken in Washington, where 88 empty nurses’ shoes were placed to represent the nurses (and other healthcare workers) who have been lost to COVID-19 in early May. (6)
Impact of COVID-19 on Nurses
The COVD-19 pandemic has not only made it harder for the general public to fulfill their everyday needs, but has increased complications of health care professionals including nurses, in taking care of their patients. Nurses not only have to work overtime and are constantly being met with COVID-19 patients and new and difficult situations, but have to deal with wearing extra protection which causes more issues throughout their days at work. According to an interview conducted by HealthLeaders, Megan Brunson, a Critical Care Nurse, discusses her experience with the pandemic and talks about the overall impact on health care professionals. From always having to wear PPE which makes it really hot and dealing with fogging up of their glasses, to constantly being surrounded by COVID-19 patients and washing their hands repeatedly “till they’re raw,” nurses have to deal with sudden changes in high-risk environments (6).
It is no doubt that the nervousness around the spread of the virus can be found within the healthcare professions, as they are always in close proximity to those with COVID-19.
The sacrifices of many health care workers, especially nurses, have shown the necessary precautions we need to take in order to reduce the spread of COVID-19 to prevent worsening of the situations many people are experiencing. They are willingly working in vulnerable locations where they could catch the virus. The pandemic does not only have an impact on the health care systems, but on the workforce, as observed by a systematic review of the experiences of nurses in hospitals during the pandemic. The findings suggested that the role of nurses needs to be much more highly valued and appreciated, especially during a pandemic. Additionally, not only does the access to more supplies of PPE need to be made more efficient, but we need to take into account the physical, as well as psychological impacts of the stress and increased work during the pandemic (7).
The constant demand of nurses during a pandemic can lead to nurse burnout due to overtime, as well as increased stress and anxiety. (7)
Brunson responds to a question about her most difficult experience being a nurse by stating that COVID-19 doesn’t compare to anything else, and that “[nurses] want to feel protected and supported” (6). With the lack of supplies, they are unable to help their patients as much as they would like, and be the kind of nurses they want to be. The government needs to monitor the support of nurses more closely, with the help of healthcare organizations, in order to provide help from added stress and anxiety of the workers (7).
The need to reform the response to a global pandemic and give proper support to healthcare workers, as well as care for patients is such a pertinent issue today. A review on the information available and evidence that shows a timely response to such a pandemic revealed that there was a lack of this evidence (in how primary care should go about such issues and adapt palliative care provision) (8). There was not much literature published on the necessary role of the general practices and work from nursing services during pandemics, which shows how much more support we need to provide to healthcare workers, especially during these times. Overall, it has been clearly identified that in general practice, increased demand and proper services need to improve during response to a pandemic, and more research evidence from pandemics is necessary to do so. Although nurses have been providing the general public with better knowledge of the issue and the virus itself, as well as working to support patients, not enough preparation and proper guidelines have been set in order for them to give a better, more effective response to the pandemic. Increased research is necessary in more communities, so that we can learn about how to best respond.
EMT
What roles does an EMT play?
EMT stands for Emergency Medical Technician. EMTs are often the first responders to any emergency medical call. EMTs are the first contact health professionals who analyze the nature of the injury and accompany the patient while in transit to a hospital, depending on the severity of the injury. The information about the patient’s vitals that the EMTs convey to the hospital staff is vital in determining the treatment required. Their main responsibilities are to ensure that the patient is stable during the transit. EMTs are trained to perform CPR (cardiopulmonary resuscitation), performing first aid activities, administering oxygen and glucose (9). The qualifications to become an EMT include a high school diploma, CPR certification, successful completion of a 150 hour course, and passing the National Registry Emergency Medical Technicians (NREMT) exam (9).
An EMT usually works under the supervision of a paramedic or a physician. A paramedic is a licensed health professional who has more advanced training in treating acute injuries and providing advanced life support. Paramedics can perform various emergency procedures including delivering babies, providing ventilation, and administering IV (9). Similar to an EMT, paramedics must complete a training program and pass a national certification. Along with that, paramedics must also gain a state license to practice. Paramedics needs to complete 1,200 to 1,800 hours of training (9).
EMTs in New York graduate early in order to help with the increasing cases of COVID-19. (8)
Impact of COVID-19 on EMTs
EMTs and paramedics are the first responders who will aid patients suffering from serious COVID-19 symptoms and need to be transferred to the hospital for immediate treatment. As of early May, 10,500 EMS (Emergency Medical Service) personnel tested positive for COVID-19 in the US (10). These numbers have been steadily increasing. It is estimated that medical professionals make up 20% of the COVID-19 cases (11).
EMTs in Boston have seen the number of cases rise from a few per week to hundreds of cases per day. At the beginning of the outbreak, they began to implement viral and droplet protection protocols. These protocols were mandated after the Ebola virus outbreak in 2014 (12). For their protection and to minimize the spread of COVID-19, they respond to each call as if it is COVID-19 related until it is proven otherwise. Although EMTs are usually emotionally strong, COVID-19 has affected their mental and physical health. The increase in the number of calls they receive requires them to respond quickly, as situations are time-sensitive. Usually, the worst cases of COVID-19 present themselves with severe breathing difficulties. LaToya Lewis-Guy, an EMT in Boston, recalls that the hardest situation about COVID-19 cases is that no family member is allowed to ride along to the hospital with the patient (12). The family is neither allowed into the hospitals. Lewis-Guy claims that it is emotionally burdening to watch families say their potentially last goodbyes to their loved one (12).
On a daily basis, EMS workers endure physical and emotional stress in order to provide service for the public. Their resilience in combating COVID-19 should inspire us to follow the protocols in place to minimize the spread of COVID-19 in order to ensure that their efforts do not go in vain. The writers at E-CURE would like to thank each and every one of the medical professionals for their unwavering efforts during this pandemic.
Pharmacists, nurses and EMTs among others have been front-line health professionals during the pandemic, and have greatly enhanced the effectiveness of physicians in treating patients. These health care providers, though often not acknowledged enough, are the limbs of physicians. The pandemic has affected them as much as it has affected physicians. So the next time you visit the hospital, show gratitude and make them matter!
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