Putting a Pandemic in Perspective

A USA Today headline reads, “Flu could kill 90,000 Americans this year.” Obviously, sophisticated computer models have been used to make projections of morbidity and mortality related to the two flu viruses expected to circulate this season. Some say it is a scare tactic or maybe just fuel to sell newspapers or support 24-hour news on television. This constant flow of information, projections and scary news can take a toll on everyone. As healthcare providers prepare to launch their vaccination programs this month, they must decide what information is necessary and appropriate in order to ensure compliance. Some providers are choosing a mandatory approach to drive compliance. Others are providing the information they think will empower employees and volunteers to make the vaccination decision based on their personal perspective.

So, how do we get perspective, give perspective and keep our perspective in a pandemic environment? Many think that we must use fear in order to stimulate individuals to take preventive action or make behavioral changes because they would otherwise not take action. I think there is a risk with this strategy. Since prevention of overwhelming infection is dependent upon a holistic response by the individual, we advise getting plenty of rest and stress reduction. Yet, daily headlines tend to create fear and emotional stress. My 14-year-old grandson admitted to me that he was worried he would die during his recent illness (probably H1N1). He was aware that he was in a high-risk population and a fear of dying surfaced in the hours he spent convalescing in front of the television.

At the invitation of the Canadian Ministry of Health in 2003, a handful of American infection preventionists (IPs) went to Toronto to assist tired Canadian colleagues with the management of the SARS crisis. I spent one month helping my assigned hospital to work through the end of the crisis and revise their infection program to establish “the new normal,” as they called it. I arrived in the seventh month of the epidemic bringing with me my perspective as an outsider to merge with the perspectives of those who had spent six months “in the trenches” and had recently buried a middle-aged staff nurse who died of SARS.

I felt as though my perspective was valued but I became fully aware of the perspective of those I came to assist as we debated the issues. The most emotional was the elimination of N95 masks. The indication for this resolution was the supporting data that three or four incubation periods had elapsed with no new cases. However, the perspective of the IC team was that they had made this change earlier in the epidemic and a second wave of infections occurred. Contributing to the perspective of angry nurses in a heated debate about whether to take off their N95 masks was the fact that the masks had been a trigger for the “hazard pay” offered to them earlier in the crisis and used to pay for all the additional personal expenses incurred with the crisis. Obviously, everyone’s perspective was shaped by previous experience and the realities of family life – mine too.

I also recall a time in the 1980s when I was really being challenged by staff members (many of them good friends) concerning the hospital’s ambitious promotion of flu vaccination. As sole practitioner in a 300-bed municipal hospital, I had conducted many in-services on this topic and even had a photo taken of me getting a flu shot – the first dose administered that year by the employee health nurse (hoping that would spur others to follow). When the flu started to hit our community, I remember thinking, “What if I get a bad case of flu even though I have been vaccinated – will my credibility be destroyed? How will I live that down and get compliance next year? Would I be accused of not practicing what I preach so passionately?”

As the H1N1 pandemic unfolds, IPs will put on another “hat” as they address prevention and control of this infection. Our responsibilities will extend into the community and the routine prevention of HAIs will need our attention, too. I think our perspective will determine our success. There are definitely many obstacles in our path – the economy, the current uncertainty about healthcare insurance reform, the unhealthy state of many Americans, and our previous commitment to quality care and zero tolerance of HAIs. We will need to accept these and release any negative feelings about them – at least for now. Then we better “get personal.” Spend some time assessing what is important to you and how your work and career fit into your life mission. Include your family in that holistic assessment. Role model good hand hygiene and cough etiquette. Evaluate your own health. Identify unhealthy behaviors and change them. Sleep more. Stay home if you are sick.

I have also found great comfort in the theory of Eckhart Tolle in his book, “The Power of Now.” My advice to family, friends and neighbors is this: Stay in the “now,” and do what you can now to stay well. And my mantra remains – “Intend to be... infection free.”

Nancy Haberstich is a registered nurse and founder/owner of nanobugs, inc.