THE PIONEER
Written: 3/18 -3/19

There's an eerie silence around the State Capitol here in Sacramento, CA. The roads empty, the halls of our building silent, and except for the occasional construction noise, activity here is vacant.

While we all reel from cancelled events, closed bars, and restaurants to practice our social distancing, it's important to remember there is still much that can be done. Especially in nursing advocacy... you can start with this:


Now, let's catch you up on the happenings this week... we're dedicating this Pioneer issue to Coronavirus given all that has happened in the past week. And there's been a lot...

We're AT work even when we aren't AT work. #remotework

- Your ANA\California Team
--- Is this newsletter helpful? ---
Simply click the button to email us - explanation optional.
*No? Email us why.
CORONAVIRUS UPDATE

ANA's CNO Dr. Debbie Dawson Hatmaker, PhD RN FAAN, met with President Trump yesterday to discuss #Coronavirus prevention strategies. Key points highlighted included safety, staffing, and capacity.

ANA's VP of Nursing Programs, Cheryl Peterson, MSN RN, was interviewed by MSNBC to discuss how the rise in COVID-19 patients could swamp hospitals and why nurses need more communication on hospitals' plans to move forward. Watch the interview.

Trump invoked the Defense Production Act to increase supplies of vital equipment. The act allows the President to ramp up manufacturing for personal protective equipment, ventilators, military hospital ships, and more.

UCSF Health officials said they would have to stop testing patients in about five days because they will run out of nasopharyngeal swabs. The main manufacturer of the swabs, Copan, is an Italian company whose manufacturing plant is in Northern Italy, a region that has itself been hard hit by the coronavirus outbreak. On Wednesday, UCSF Health said it had secured another two-day supply of swabs. Read the article.

Despite D.O.D. promises of 5 million facemasks - with 1 million facemasks said to be available immediately via military reserves - and 2,000 respirators, there is no known timeline of when the PPE equipment and other services will arrive on the doorsteps of facilities in California. This is the latest as of today, March 19th. Read the article.

Tell your member of Congress to do everything possible to increase PPE prioritization and distribution to nurses! Send a message to your officials with one click!

The CDC has recommended strategies for optimizing the supply of PPE. Eye Protection. Isolation Gowns. Facemasks. N95 Respirators. While we anxiously await more supplies, understanding how to best utilize them is absolutely critical.

Expect the best, prepare for the worst: CDC modeler reveals worst-case scenarios for Coronavirus spread in the U.S. Projections show between 160 million and 214 million people could be infected over a period of more than a year — and kill anywhere from 200,000 to 1.7 million people.

Coronavirus cases "hockey-sticked" in the U.S. in just thirteen days. To no fault of the NHL... cases show an exponential curve, from 76 cases on March 1st to 2,179 cases on March 13th. The Washington Post put together these four MUST SEE simulations to show you the effects of social distancing and how to #flattenthecurve.

On a positive note, China only reported one new domestic case of COVID-19 recently.* However, 20 other new cases in the country were said to be imported. *Update: March 19th - China has reported no new locally transmitted Coronavirus cases for the first time since the pandemic began. Read the latest.

Dr. Sharon Goldfarb, DNP, RN, FNP-BC, with the support of ANA\California and our coalition partners, issued a letter to the CA Board of Registered Nursing requesting a temporary emergency regulation change. The proposed change would increase the allowed simulation substitution percentage for clinical hours to 50% from the current 25%. Additionally, we are requesting that the 50% allotment of clinical simulation be applied to nursing programs instead of individual nursing courses. Share our LinkedIn Post.

Due to California Gov. Gavin Newsom's state of emergency declaration on March 4th, 2020, nursing education has been impacted greatly. Many nursing schools’ clinical partners have refused to allow nursing students to receive their clinical training. Some clinical sites are choosing to decrease nursing student instruction in order to decrease exposure risk to patients, visitors, and staff. Other sites are restricting the clinical activities of nursing students. Finally, many clinical sites have canceled clinical instruction altogether.

California hospitals have already begun submitting applications to the Office of Emergency Services (OES) for additional personnel in response to COVID-19. ANA\California has been working closely with the California Hospital Association to monitor their needs for nurses and other healthcare professionals. Which leads us to...

Want to join the fight against the Coronavirus? Trusted Health has devoted a page to nurses who are looking for opportunities to help. View their posted jobs.

Keep reading for more Coronavirus updates and news. See below.
TIPS

We've heard burning questions from nurses working the front lines of the Coronavirus pandemic about concerns returning home to families...

So, we connected with ANA\California member - Thao Tran MSN APRN-CNP FNP-BC RN-BC PHN CHIPS, a Nurse Specialist for the Department of Health and Human Services and infectious diseases expert - who's been fortunate enough to receive training in 1 of only 10 bio-containment units in the nation. We asked her some questions, which have been lightly edited for clarity:

1. Would you recommend self-isolation for nurses working in the ICU and ED? I would not recommend self-isolation for nurses because what we do know is those infected with COVID-19 will recover. What I do recommend is if the nurse did work on a patient with COVID-19, the nurse should practice social distancing as a precautionary measure. The least we want is healthcare providers bring home COVID-91 to their families.

Just like with Ebola, SERS, MERS, and patients who are resistant to TB, you would have nurses with good knowledge about infection control to provide care to patients in an environment that is safe. Safety to the nurse workers, patients and their families are a must!

2. What measures would you recommend these nurses' families take? Based on what is already known about the virus, transmission is droplet. I recommend these families to exercise droplet precaution. If caring for a loved one who has COVID-19, make sure you limit exposure and have that person only stay in one room. If possible, place the infected family member in a room that has a bathroom. If no bathroom is available, provide a commode. The goal is not to have the family member share, walk, or do things with healthy members in the family until the sick family member recovers. Remember, social distancing does not mean isolation. Strict isolation guidance is not good. If people are well, having some contact with family is important for their mental health. 

3. I live with an elderly person, what should I do to minimize exposure beyond hygiene? Practice good hand hygiene (soap and water are preferred and if soap and water is not available, use alcohol that is at least 60% or higher), wear gowns, gloves, and face shield prior to handling any human body wastes or body fluids. You want to keep your distance as much as possible to minimize respiratory droplets from spreading to clothes, hair, etc. Change clothes if needed. You don’t want to walk around with respiratory droplets on your clothes and infect others. As we found out yesterday on March 18th, we have seen the first death among the pediatric population. There is more about COVID-19 that we still do not know. 

Clean and disinfect surfaces. Make sure you allow the disinfectant to have contact time with the surface. Each disinfectant has a manufacturer’s recommended disinfectant contact time. For example, if the disinfectant product says disinfectant contact time is 2 minutes, then you should allow the surface to be visibly wet for at least 2 minutes to ensure the disinfectant is given enough time to kill the microorganism. Disinfect regularly using household cleaning wipe or spray.

4. Final thoughts? The nursing workforce is not prepared for a large-scale pandemic. I would say practice good infection control, review donning and doffing PPEs, washing hands between patients. These are practices every nurse should do. 

Most importantly, do not panic. There many aspects of COVID-19 that WHO and CDC do not know. Everyone is turning to the local health department which turns to the state health department. The state health department turns to CDC and federal agencies for guidance on how to respond to this pandemic. Coronaviruses have always been around, but COVID-19 is different. It’s a novel virus. Scientists and medical researchers are working together to understand the COVID-19 outbreak. Because of the amount of misinformation on social media and various sources, it is important for nurses and the public to remain calm and allow local, state, and federal government agencies work together to better understand and mitigate the spread of COVID-19 in our communities. This is not a time to challenge government directive but cooperate with authorities in their response to COVID-19.

A big thank you to Ms. Thao Tran for providing these answers!

If you have questions you'd like to ask, we'll do our best to get answers. Email us directly.

Cabin fever yet? Working remotely, while fun for the first week or so, can put strain on families and lifestyles. ANA\California has compiled new (FREE) resources being offered during the Coronavirus pandemic. Check them out:

CORONAVIRUS UPDATE - CONTINUED...
Written: 3/19

ANA\California's Executive Director, Dr. Marketa Houskova, released a comprehensive summary via Youtube today, March 19th. Learn about the State of California’s response to COVID-19 pandemic including healthcare, homelessness, education, food security, statistics on CA hospitals, SPA loans, testing capacity, and more. WATCH THE VIDEO!

A Phase 1 clinical trial evaluating an investigational vaccine designed to protect against Coronavirus (COVID-19) has begun at Kaiser Permanente Washington Health Research Institute (KPWHRI) in Seattle. The study is evaluating different doses for safety and its ability to induce an immune response in participants. Forty-five individuals have been selected and the first participant received the investigational vaccine on Wednesday.

New GI symptoms may be added to COVID-19 symptoms per American College of GastroEnterology. Recent evidence suggests the potential for coronavirus transmission through droplets and perhaps fecal shedding, posing potential risks during endoscopy and colonoscopy to other patients, and endoscopy personnel. Learn what the College knows and their recommendations.

Becker's spoke with a dozen infection control and clinical leaders overseeing response efforts at hospitals and health systems nationwide. Here's how 12 institutions are responding to the pandemic, organized into seven main categories: leadership, screening, triage, communication, education and training, supply chain, and telehealth.

Microsoft released their Healthcare Bot, a service to empower healthcare organizations to build and deploy an AI-powered, compliant, conversational healthcare experience at scale. The service combines built-in medical intelligence with natural language capabilities, extensibility tools and compliance constructs, allowing healthcare organizations such as Providers, Payers, Pharma, HMOs, Telehealth to give people access to trusted and relevant healthcare services and information. Read more about the Healthcare Bot.

NSO's risk management team has identified four specific risks/tips nurses should keep in mind to protect themselves during COVID-19. They also created this in-depth document to answer more questions regarding telehealth security, confidentiality, informed consent, and more. Members of ANA\California are offered special discounts and services through NSO.

Amazon confirms first known case of Coronavirus in a Queens, New York warhouse. Amazon is already struggling to meet demand, and some employees feel they’re being unfairly endangered by working in warehouses filled with other workers. It’s unclear how deliveries could continue if the workers who sort, pack, and ship Americans’ goods start getting sick in droves. Read the article.
CORONAVIRUS RESOURCES
Written: 3/19

We do our best to keep you updated through the Pioneer and social media, but as you can see there is only so much we can include in a single email. Check out these amazing resources updated daily:

Hello. We're ANA\California.

We enhance the health and well-being of Californians and advance the profession of nursing by advocating for legislation, regulation, and policies. We focus on improving quality care, quality experiences, quality nurses, and the quality of our profession. We're the ANA\California Team and we're here for you. How can we help?

As the legislative cycle heats up, advocating for important issues can come down to the minute. ANA\California is using Phone 2 Action, a mobile texting and advocacy platform, to help you contact your legislators with curated messages in seconds... seriously... seconds, it's that quick. Click this link to opt-in and receive text messages from ANA\California when your fellow nurses need you most!

Looking for a new job? Check out our Career Center.
ANA\California is available for speaking arrangements. Email us.
Questions or feedback? Just reply to this email.

-- Your ANA\California Team