The following dispatch was sent by a nurse who asked to remain anonymous in order to protect their job. The state I live in would be classified as having a high rural population, and I work for a hospital that is struggling financially and part of large nationwide health system. We have had no communication from the top of our organization. This leads me to believe that they have no idea how to handle this situation, and my local administration has no idea how to handle this either. The first I heard any communication from anyone about precautions for coronavirus were small, colored signs asking patients and visitors to “Stop! If you have cough, fever … or have traveled outside the US or had contact with someone that has.” I am trying to quote the sign, but it’s from memory. These were posted right around the time we had the first confirmed case of coronavirus in the U.S. Up until this sign was placed, the only person I had heard mention coronavirus was one of the guys in Supply Chain who was irked that Personal Protective Equipment (PPE) was on back order due to what was going on in China.

The next communication we had was in the form of e-mail. It might surprise most people, but e-mail is a terrible way to communicate to patient caregivers. While plenty of nurses sit in front of a computer, they are rarely logged onto e-mail — they are charting medical documentation on their patients. Nurses, like all the other staff in the hospital that has actual physical contact with patients regularly, do not routinely check their e-mails. They simply are too busy with patient care activities to remember to log in and get the latest newsletter the hospital sends out. Any updates or changes to protocols or policy will reach these staff members long after they have been announced because the information will trickle down to them in an incredibly inefficient game of telephone. The first e-mail was sent out on March 5. It instructed staff that if they happened across a patient they suspected needed to be tested for coronavirus, that we should place a regular mask on the patient, stay six feet away, and contact a Charge RN who would have the appropriate training to handle the situation. Every healthcare worker should know, and sadly there are probably many that don’t, that PPE gear isn’t used this way. The masks they want us to place on the patient are loose fitting. The air patients breathe out will just go out the sides of the mask. If a patient is already infected, these masks will do next to nothing to prevent an airborne virus. The next update to our coronavirus policy came on March 9. It stated that we will most likely end up treating one of these patients in the future. This update was to remind us that we had to keep patient privacy in mind and that we need to not discuss patients on social media or outside the hospital. This e-mail showed a clear misunderstanding of what the coronavirus even is. If you treat one patient, you will be treating more. It was becoming alarming that leadership in my hospital — leadership that includes physicians — were not understanding the potential severity of an outbreak. Next update was March 11. These other e-mails were from lower-level people in administration. Secretaries sending out a quick note from their bosses. This e-mail was the first that we got from our Top Physician Administrator. We are thanked for our hard work and are assured that we are fully prepared to handle patients with Covid-19. We are told that they are following the CDC recommendations and that the risk according to the CDC is low. A few brief statements about how we need to practice good hygiene, isolation precautions, and that they are working with the local health department. The bulk of this e-mail is regarding privacy. I quote: In cases where patients have tested positive for coronavirus, the name of the facility treating the patient is not publicly disclosed. We respect and honor that decision. As we receive these patients, their information and diagnosis will remain confidential; we will not be making any public statement about COVID-19 to protect patient privacy. This is NOT about patient privacy. This is about keeping the doors open for routine business and not hoping that this silly, inconvenient virus doesn’t impact their bottom line too much. I keep reading about how bad things are in Italy, how hardly anyone in the U.S. is getting tested, and I’m really starting to worry that we are going to be overwhelmed. We aren’t slowing down elective procedures, we aren’t trying to empty our ICUs to be prepared, we aren’t designating an area where suspected patients will be placed to limit exposure, we aren’t limiting the number of visitors allowed. We did put up a larger version of the original sign, so that should keep the virus out…

Next update was March 11. A few brief statements about how we need to practice good hygiene, isolation precautions, and that they are working with the local health department.