Pandemic nursing ain’t over…Here’s the nursing work that remains to be done.

Raise your hand if you, or someone you know, has acquired COVID in the past few weeks…

I’m willing to bet it’s almost everyone reading this right now. Yet, mingling about in the community, I’m also willing to bet that basic COVID precautions — mask-wearing, social distancing, avoidance of large crowds — has seen no appreciable change. 

This begs the question: with so much COVID out in the community at present, why the laissez faire response?

The reasons, of course, are multifactorial. One of the largest being that the daily confirmed death toll began a sharp decline this past winter. Daily death rates dropping from 2,609 in early February 2022 to 420 by early July helped create a false sense of security in the public as to the number of current cases being seen. But, there’s a flaw in this thinking: dramatic decreases in death rates are more reflective of effective treatments and less virulence, not current transmission levels. 

With so many recommendation changes seen in response to what we’ve learned about COVID in the past year — and the resulting hygiene theater that is so darn hard for people to let go of — it’s understandable that people prefer to pass the buck when it comes to controlling infection. What remains true when infection levels rise is adherence to adequate ventilation and wearing good masks. 

Businesses that want to project an image of “concerned community player” do have a harder time letting go of the performative cleaning routines. But by investing their dollars into ventilation improvements, they are making a much more solid contribution towards infection control than scrupulous counter wipe downs. We, as nurses, must also carry this message — masks and ventilation make all the difference — and be prepared to model responsible behavior for our communities (that are indeed watching). 

The other half of responsible COVID nursing is pushing the idea that quarantines following positive test results must still happen. When your worst symptom is a runny nose, and you are surrounded by a social circle that anecdotally reports the same mild symptoms, it can be tempting to forget that COVID remains a serious risk to the immunocompromised and chronically ill.

For myself, I have friends who have jumped on planes within 24 hours of a positive COVID test, presumably weighing their inconvenience at delaying travel as more harmful than exposing an entire plane full of people to their mild symptoms. For others, they are just unsure when to end an isolation period when their nonexistent symptoms clash with rapid tests that remain positive long after the 5-day isolation recommendation. As a nurse, I know I have a duty to speak up; even if, as a friend, I find it excruciatingly uncomfortable. But, I have done it, and will continue to do so. 

(Even as we move from sub-variant to sub-variant, the recommendation hasn't changed — following a positive test, one must isolate for 5 days, and then may join the community for the next 5 days while masked, as long as symptoms are resolving and they are fever-free.)

Here is what’s working: continued boosters, increasing herd immunity from natural exposure, the release of vaccines for younger children, as well as the aforementioned improvements made to ventilation and masking vigilance. All of these measures are moving us from pandemic to endemic status. Good news, yes, but, in other words, we will be living with COVID for some time. 

More than anything, nurses need to continue the baton race of public health messaging. In our communities, we are trusted voices of health information — in our social spheres, that voice can carry far outside of our proximal communities, particularly if we have large audiences and many followers. There is a tendency for people to assume that all of our attempts to control COVID have failed; after all, more than 1 million people have died from it. It is our job to remind them that this number could have been far worse. 

Reminding people of the good that has come out of COVID is one helpful strategy. The incredible race to create a vaccine, the amazing effectiveness of antivirals, developments and access to monoclonal treatments — these have all been areas of real scientific progress. Misinformation will always present like a whack-a-mole game to those invested in pushing positive — and factual — public health messaging, but we must come armed with our hammers nonetheless.

The trust breakdown between the medical community and the public needs to be repaired. In particular, communities already vulnerable to health inequity via systemic racism continue to suffer the consequences of decreased access to reliable care. If our goal as nurses is to heal and educate our community, we must act as a fail-safe for the cracks in our (barely existent) public health system. No matter what area of nursing we draw a paycheck from — aesthetics to bedside ICU — we can all play a positive role in mending the infinitesimal cracks that perpetuate our broken systems. COVID, for all its demons, has provided a platform to advance these causes, and nurses are the way through. 

Yes, fewer people are succumbing to COVID, and that’s always a good metric. But, many, many people have lost beloved family and friends and will continue to do so. Many, many people are dealing with long COVID, and face murky prognoses. Part of our unspoken yet inherent job requirement is our ability to soften the edges of what COVID will mean to people in their daily, forever lives. This has always been the magic of nursing — medicine via relationship. 

Eventually variants will no longer have the ability to evade detection in populations who have dealt with numerous outbreaks and developed layered and nuanced immunity. In this way, we will move from pandemic to endemic status, at least by definition. But as nurses, we know that true health is much more than the absence of disease. Social connections, being productive, living a fulfilling and enjoyable life — these are also measures of health. 

We will forever be pandemic nurses — our holistic approach, our ability to reach our patients through therapeutic rapport, our advocacy for the vulnerable AND ourselves — we have leveled up into a new dimension, and for that, we should be proud.