co-venting....

 interesting week in the hospital.  Alaska got it's first + test for Covid-19 right before i headed to work it was announced.  from what i have read that person is in home quarantine.

 i did end up in the middle of it all.  i suppose i will be for the duration, unless i get sick i guess.  viruses are known to hit all. it cares not whether you are a good person or a bad person. it doesn't care if you are rich or poor.  it doesn't care if you are good looking, average or ugly. 

 my first night was in the ICU.  my patients were just regular patients.  we did have a video streaming about how to don and doff protective gear.  of course, the thing is stuff changes rapidly. information comes out, clarifies, alters.

 for those who are like the "flu" is worse than this...the big difference is the stuff we usually deal with we have a handle on.  we pretty much know how it works.  this one is just a dance with the unknown.  i suspect we will eventually get a handle on what covid is and how best for us all to deal with it and thankfully for us, there are others who have been dealing with this now for a bit so we can learn from what they had to learn without any information.  my heart goes out to those who were put in that situation...having no clue what was killing people.

 this is from my first night.  MW is always fun.  we were shooting a picture to send to our friend LM. we hadn't heard from her for a bit so just checking in and being goofy. 

 the thing is that everything we normally would do we have to question and clarify, discuss and look up the latest information...if it exists. the covid test uses the same swab that we use for multiple respiratory pathogens, like influenza and rsv so we can test for those, if those are negative we can then send that sample out for a test for covid.  my last two nights were in the ER.  a co-worker was doing the test on our patient for this and i heard him say to the patient both nostrils...

 now i generally just go up one nostril as did other co-workers...so now it's like, have i been doing it wrong this whole time, is he doing it wrong, are both ways correct or is there a different technique that they want for covid?  this is how everything was going the past two nights.  how do you transport those who have had the test but await results. is it the same as we would with any droplet/aerosol/contact? is there anything different.  so it's just that everything that we normally based on past protocols we have to work out if it's the same or different now. how best to clean a room after a patient with rule out covid.

 recommendations change rapidly with all of this. in the ICU all of the potential patients would be placed in negative flow rooms for aerosol isolation.  this means the air is sucked out of the room to the outdoors basically. we use it for TB.  hospitals have limited rooms of this sort.  we can, apparently, alter areas/rooms to become extra negative pressure rooms so there is a lot of new plastics put up to prepare for possible onslaught.  tests are still slow to be run. my understanding was that it takes possibly over 24 hours...of course, right now it will take longer because those running the tests at the state lab have the weekend off...

 my shoes are being relocated a lot this weekend.  outside, upstairs/downstairs. i really should just put them away.

 anyway, it does seem odd that in a state of Emergency the only place running these tests are off for the weekend.  so clearly testing needs to be made quicker and places other than the state lab in Fairbanks should be given the ability to test.  this is how it is at my hospital anyway. a delay in running this test could delay the flow.  with limited negative pressure rooms we need rule outs quickly so we can spare putting patients that turn out to be negative into those negative pressure rooms and we can save those for real cases that may come up.  ICU has limited numbers of these beds so we need to be able to have those for the more ill who may show up. backlogs of tests only creates a back up of patients. 

 also working on getting more of a drive through/walk up testing station.  i was thinking i would love to do OT as a "dirty nurse" meaning those who are dressed in head to toe gear shoving swabs in folks noses over and over for the test.  that sounds fairly safe.

 these are all from the ceremonial start.

 i'm sure that will be a possibility at some point. i heard it will be staffed with resource nurses...is this true? who knows and it may change as all information is subject to.

 the odd thing was even though these patients are treated as aerosol in the main hospital, in the ER they are treated as droplet/contact so regular masks, gowns...unless you are doing something that causes aerosolation of the droplets...like doing a nasal swab, giving a breathing treatment, intubating...the patients are supposed to keep masks on in the ER when they are in these non negative pressure rooms...

 so felt strange to go from the ICU where the plan was for a more full coverage to the ER where it felt less restrictive.  it is the nature of the beast though.  it is ultimately a droplet from what all i have read, but still strange and this alone created many questions and discussions as to what we were to do to best protect ourselves and others.

 our flow is basically disrupted, in the ER that flow is already in a state of perpetual disruption.

 a note had gone out saying staff was not to wear masks around the unit...though a few weeks ago we were all told to wear masks around everywhere. masks are in a bit of short supply, which could get worse, especially for the n95 masks. ours are currently no longer just out in the open and are instead behind locked doors. 

 i still have a little cough so i am wearing a mask.  oddly, we are all told to wash our hands often and avoid touching our faces...not an easy thing to do for anyone...the thing is everytime you take a mask off/on, you are touching your face. irony...

 my first night i saw a tech out of the corner of my eye grab all the things from an isolation cart,  on the outside of a room that was empty now of patient, and toss those items in the garbage!  when i jumped up and asked about this i was told that this is the protocol.. i explained that masks and gowns are in short supply and so tossing boxes of them seemed a wrong idea under the emergent situation.  how many gowns and masks of all sorts have been tossed by this tech and the many others who have been told this as this person was. that morning and the next night i did make a point to tell management for 3 different units that this needed to be addressed immediately. i am not sure if anything came of it despite them being shocked by it but then saying they were sure this wasn't happening.

 i just said that this needed to be messaged out to all techs...i haven't heard that this has happened. i did talk about it with techs i came in contact with.

 tests are starting to be opened up more as far as criteria despite the slow test times so more are coming in.  many are just anxious have concerns, some more legit than others but anxiety does seem very high. many, in social media land,  are blaming the media.  the media always over hypes things and floods the airways.  they have done this ever since "news" coverage went 24 hours/day. the difference in my mind is the administration.

 the iitoo is a chaos king.  this nation has lived with a perpetual state of chaos from this administration..the only place to go from chaos is panic really.  he keeps getting up and talking, his feeble attempt to appear calm but he just rambles  off and blames others, takes no responsibility, presents lies and misinformation that his surrogates are fairly pathetic at correcting.

 the trust in the government is at an all time low due to this lying iitoo.  he can't calm the waters because he is only capable of chaos. 

 runs of supplies are fairly common. TP a popular item as are hand sanitizers. i have several bars of soap and a refill bottle, which are supplies i keep extra of, not for virus but for earthquakes. as for bottled water. always good to have some of that on hand...again for the natural disasters not the virus.  there is no evidence that anyone's water supply has been tainted.  we all have taps, just drink that.  buy a water filter system or pitcher...seems much more rational.

 folks should be  stocking up on attends, not tp...haha, since they are all shitting their pants over this.  the + covid result in Ak did cause another run on the supplies. i'd just been to the grocery that day for basic stuff and things did seem to be fairly well stocked, with some items having signs that said limits such and such per person. if you are in quarantine people can still drop off supplies. by that night i had seen posts that seemed to point to another run on items. what they do with all their hoarded items if this gets out of hand will  be the test of humanity i guess

 schools are closed for a bit here. i'm starting to suspect that our WARIS lecture will also be cancelled. people avoiding close encounters is the latest advice.  i'm kind of introverted so that isn't a huge issue for me.  of course, as a nurse, i will be in close proximity.  that is how it works.  ICU made it clear that the only ones who would be getting out of covid duty were those who were pregnant.  i do think it's odd that employees over a certain age or who are known to be immunocompromised are not given any chance to voice their own concerns.  i'm not over 60 but anyone who is over 60 is seen as being in the high risk category...but they are not exempt.

 one nurse asked me why they weren't testing us...it does seem like it would be wise to know if any of us are carriers.  at the very least, i said, agreeing with him, they would be wise to test someone like me who is coughing and was recently ill.  i just told him i suspect they don't want to know.  they need us.  haha.

 the truth is without wide spread testing we will have a tough time getting answers to have far spread this is and percentages. how many have it, how many who have it are carriers who are asymptomatic, or have mild cases...we just don't have the information and it seems we don't have the tests.  this administration opted to not utilize tests already made but instead make our own. this administration also blocked a task force in 2018 that dealt with world pandemics as far as national security and dealing with one.  it had Obama's signature and that is enough to take an axe through it all. 

 the Iditarod is also impacted by this.  concerns in the villages as they are remote so if a virus gets loose out there they are more ill equiped to deal with this, concern of elders being vulnerable. so the banquet in Nome is cancelled or greatly limited as far as #'s of attendees.  i think cancelled/postponed though.

 also there is at least one check point where the village decided not to allow the teams to stop in town.  they did help set up an area for the check point outside of town.

 was reading one dog ended up having bloat.  the musher felt something was off then noted the dogs gut was distended.  thankfully, the team was in a check point. the dog was basically medivac'd to Anchorage for surgery.  the musher was very grateful to the volunteer vet who was stationed at that checkpoint. 

 a glimmer of hope politically...one patient told me he was generally a big fan of trump but with this corona stuff he was disappointed in how he was reacting.  the patient was over 60.  many patients brought up covid and voiced general concerns, questions. 

 Petit has had a tough go of it. mild frost bite and some vomiting dogs.  a dog bite, dogs chasing a buffalo, deep snow.  with all that he's still in the top 20. he nearly gave it up and scratched but still hanging in there, checkpoint to checkpoint.

 Seattle has had quite a few covid cases and response can be a bit hospital to hospital.  they did do testing on staff but so far none have tested positive and that was with positive patients there. this seems to me to be the most dangerous time here...getting started and working out the bugs to our plan of action.  that is when the most exposures could happen.  we don't know who has this and exposures happen as we deem a patient is a possible covid patient and decide to test. 

 i can attest there is a lot of anxiety out there regarding this.  part of my job seems to be calming those anxieties..for some that isn't really easy. 

 Zoya's husband is running her dog team. he's done these races, even winning two yukon quests, but he really just has no desire at this point to do more of this..but an hour before the race started there he was on the line up deciding to run.  he doesn't seem thrilled about it but is doing it.  he is now more writer than musher.  at least it will give him something new to write about i suppose.

 the one positive test came off a cargo plane, international so no real contacts here so that is a good sign. 

 omg one letter to the editor tries to connect covid outbreaks with bans on plastic bags.  of all the foolishness.  i really have little tolerance of the conspiracy theories at this point.  they can dish it out but they can't take it. 

 a couple that furs together....?

 i've hit the dog park the last 2 days.  still quite a few dogs and owners out there.  you have space in the open.  hopefully this gets people out in nature as opposed to together in closed spaces.

 so quite a few rule out cases, which i seemed to be on most of those cases or involved.  we shall see. you eventually just go into the mode of caregiver. you do the best you can with all of your patients and hope for the best.

 i think Waerner out of Norway is last i saw in the lead. i have admittedly not been on the insider page so perhaps tomorrow i will make a run at that, watch some videos and catch up on the Iditarod news. they are getting fairly close to the end of it..well many are. 

 South Korea has been doing wide spread testing and it does seem to be helping keeping things in check.

 i am hoping that our experience here will just turn out to be a test that shows how unprepared our nation is for this and the next outbreak.  they are out there and they will happen. each has it's own unique way of taking on it's victims so you can't fully prepare for each outbreak situation but it does help to have basic plans in place. 

 i am starting to get tired again. i ended up taking another of those early evening naps and waking up after 9:30 i think.  so hopefully i will drift off into a deep and long sleep

 the days have been beautiful.

 perhaps tomorrow i can look at the rest of the restart photo's.  also need to do the WARIS taxes....always that to do list.

 the only thing on the dogs to do list is walking and where to move mom's shoes

thankful for: A.  a great crew of co-workers from all the different pieces of the puzzle that keeps a hospital running.  B.  laughter C.  free pizza that we were told not to share by the CDC news update as we were sharing it..oops.