COVID-19: diary of a nurse in self-isolation
A nurse lecturer’s moving personal account of self-isolation and its effects on her and her family, as the coronavirus outbreak spread in the UK
I’m a nurse and lecturer, with a clinical background in infectious diseases.*
Earlier this month, final-year nursing students were asking me if they should work during the coronavirus epidemic - yet to be classed as a pandemic. They wanted to know if it would be safe; where they might be placed; what they might be expected to do; and whether they would have the skills to do it. Clearly they were frightened.
Having an honest conversation about core nursing values
I didn’t have the answers and had similar questions myself. We had an honest conversation. We talked about the Nursing and Midwifery Council (NMC) code and about core nursing values – how frameworks for nursing values can guide you as you rise to an unprecedented challenge.
We reviewed the 6Cs of nursing – compassion, care, competence, courage, commitment and communication – a values framework that underpins nursing practice.
I wanted to document my thoughts and decision-making during the epidemic, relating them to the 6Cs wherever I could. A few days later my family and I self-isolated. The diary entries that follow were made during this time.
16 March: ‘We’re now in self-isolation’
My son woke with a high fever so, as per government guidelines, my family is now in self-isolation for 14 days.
I know it’s my public health duty to reduce the transmission rates of the virus and I’m committed to undertaking the strict measures needed to ensure we don’t transmit whatever it is that is making my son unwell to anyone else.
Implications for our families and our health service
But the prospect of 14 days indoors with a young child is daunting.
I feel anxious. I’m going to have more time than ever to think about the unimaginable toll this virus will take on my family, friends and colleagues, on my local community, the nation, humanity. I’m really scared by what is unfolding.
I have a clinical background in infectious diseases. I sometimes run seminars on viral epidemics and have been following developments in the SARS-CoV-2 epidemic carefully.
‘I’m concerned about the lack of understanding that what happened in China can happen here; that what is happening in Italy will happen here’
I’m no expert, but I am well informed. I have been deeply concerned about the government’s inaction or lack of understanding that what happened in China can happen here; that what is happening in Italy will happen here, indeed is happening already.
The government’s strategy is starting to change. But this slow response will have unimaginable implications for our health service. We have lost valuable time both to reduce the number of infections and ensure services are as prepared as they can be.
I begged my parents – who are in their seventies – to start social distancing two weeks ago. My dad is awaiting chemotherapy after surgery, so I know they understand and are taking it seriously. I worry about their mental health with them stuck at home and I know how important seeing their grandchildren is to them. But I have been fearful of visiting in case I or another family member infects them.
My husband also cares for his mother, who is frail. She has memory loss and multiple comorbidities. With us in isolation, she must rely solely on a 30-minute once-daily visit from a carer.
17 March: ‘I was prepared to go and nurse wherever I was needed’
I feel lousy. I had a fever overnight, my throat is sore and my neck aches. My legs feel like I have just run a marathon. My son is still unwell and is wiped out. We both are.
Three weeks ago, well before we started self-isolation and when government policy was still to test suspected cases and track and isolate contacts, I knew exactly what I was going to do when the time came. When front-line healthcare services needed all hands on deck, I was committed; I would ‘step up’.
I haven’t worked full-time in a hospital since 2018 but I was prepared to go and nurse wherever I was needed.
‘I feel lousy... my legs feel like I have just run a marathon. My son is still unwell and is wiped out. We both are’
I have been qualified 15 years and have worked in general medicine as well as specialist areas. I feel confident in my fundamental nursing skills and my competence. I knew it wouldn’t be perfect, but I also knew I would have the courage to recognise my limitations and communicate them to my team.
I would do my best to get up to speed quickly, be flexible and give the highest standard of compassionate, empathic and respectful nursing care I could.
But conversations with nursing and healthcare professional friends and colleagues have me deeply concerned. London has the highest number of confirmed cases to date and human proximity in big cities creates a fertile environment for viral transmission.
Serious concerns over the quality and lack of personal protection equipment
There are serious problems with personal protection equipment (PPE). Some areas have no supplies and where there are supplies there isn’t the range of sizes needed. Questions are being raised about quality.
My nursing and healthcare professional friends and student nurses are frightened. The reassurances that every measure will be taken to keep them safe can’t be given.
This is an awful dilemma for staff. We want to help but, for the first time in my career, the epidemic and lack of governmental and NHS preparedness is forcing me to wonder about the possible personal cost.
What if I am not immune and get exposed – assuming, in line with current thinking, that immunity can be conferred? What if I am part of a team caring for a patient who develops symptoms and no PPE is available?
To what lengths am I willing to go as a nurse with a young family and people who love and depend upon me? The Code expects me to take account of my own safety and preserve public safety which, during an epidemic, are one and the same.
The Health and Safety Executive and the RCN tell me what I already know: employers have a duty of care to protect their staff. Yes, but what about when PPE is not available?
Should nursing staff be asked to put themselves at risk to care for others?
This raises a fundamental ethical question: should staff be asked to put themselves at risk to care for others? The Health and Safety at Work Act answers that question unequivocally, and yet the commitment to care is still there, as is the courage to speak out when safety is compromised. But the guilt I feel when I think about not ‘stepping up’ is overwhelming.
‘My husband and I talk about me signing up for shifts once our isolation is over. He is worried about the risk to me and our family’
I feel angry. Doctors in Wuhan in China strongly advised back in January that PPE be used. I wonder what efforts were made then by our government to ensure PPE availability. Only on 16 March was a call put out to manufacturers with capability to switch focus to rapid ventilator production. What timely attempts were made to secure PPE supply lines?
My husband and I talk about me signing up for shifts once our isolation is over. He is worried about the risk to me and our family. He respects my commitment and wants to support me to use my skills to help, but he needs reassurance to be able to do that. It is reassurance I can’t currently offer.
I am despairing about the lack of testing. I wonder when the government started to realise it needed to prioritise testing capability. I think about what I could be doing right now for patients and the wasted capacity of the healthcare workers that are needlessly self-isolating.
Then I wonder about the limitations of the tests available, and what the implications of false negatives might be in staff returning to work. I hope that a reliable antibody test is just around the corner. I want to know that when I nurse, I won’t be an infection risk to my patients.
18 March: ‘The misinformation has reduced’
No fevers overnight, but I can’t sleep and my body aches. My son, conversely, seems to feel better. But the limitations of self-isolation and the tendency of every WhatsApp video-call with family and friends to stray into coronavirus is starting to have an impact on him.
Despite trying to limit the level of coronavirus anxiety our children are exposed to, it is starting to affect my four year old. He is clingy one minute and uncharacteristically angry and frustrated the next.
Last week, I started using my nursing competency and communication skills in ways I haven’t before by offering local parents and community groups handwashing sessions and advice on keeping themselves, their families and their volunteers safe during the epidemic.
‘Friends and family who aren’t in healthcare told me they knew how to handwash effectively, but then realised they never spent more than five seconds doing it’
I teach on, and have written about, infection prevention and control. And, like all nurses, I know that handwashing is vital to break the chain of infection.
Friends and family who aren’t in healthcare told me they knew how to handwash effectively, but then realised they never spent more than five seconds doing it.
Messages about handwashing were starting to appear in the media, so in my spare time I set up the community sessions.
It felt like a small, additional commitment to improving public health. It was a new way to provide care, not in the way I would normally define it as a nurse, but a caring and compassion-rooted commitment to helping people with one of the few protective tools they have against coronavirus.
In a small way it felt like the start of the flexibility that will be required of nurses to make a difference during this epidemic. People who came to the sessions were frightened about the threat the virus posed and were motivated to pass on what they learned to friends and families. I really felt that every effective handwash undertaken as a result of their new skills might prevent a COVID-19 case.
People are looking for reassurance
I was, probably naively, surprised by the level of misinformation about the virus. The ‘infodemic’ led to remarks that COVID-19 was the ‘same as flu’, that ‘drinking ginger and lemon prevents infection’ and that ‘gargling with salt or vinegar when you have symptoms will cure you’.
I found myself working my communication skills hard, trying to address health beliefs sensitively while emphasising the risks to public health of unreliable sources, and encouraging people to use the NHS and World Health Organization coronavirus web pages.
‘It takes courage to keep challenging misinformation and to engage with communication platforms in ways that uphold the values of our profession’
I keep in touch with some of the people who attended the handwashing sessions via WhatsApp. The misinformation has reduced but now, as supplies of reliable alcohol gel are no longer available, ‘make your own hand sanitiser’ posts abound.
It takes courage to keep challenging misinformation and to engage with communication platforms in ways that uphold the values of our profession. But people are scared and are looking for reassurance.
19 March: ‘Colleagues want to talk about difficult situations at work’
I started coughing last night. My son is coughing this morning and sounds hoarse. When I heard him it filled me with dread, but he is running around excitedly playing Spiderman, so I feel reassured.
Family members have questions about infection control and risks of infection, and friends and colleagues want to talk about difficult situations that lack of epidemic preparedness and resilience has created at work.
I want to help but I also want to turn my phone off and focus on my family, my son especially.
‘I started coughing last night. My son is coughing this morning and sounds hoarse. When I heard him it filled me with dread’
As a nurse, I occupy a position of trust in my community, conferred by a belief on the part of the public that my clinical competence, compassion and commitment to those who need help are central to my professional registration. More than ever, nurses hold a position of great responsibility.
Once my self-isolation comes to an end, my courage and commitment will help me make the right decision about what my role will be in this unprecedented health emergency. These values will also ensure the quality of the compassionate, competent care I provide.
I hope the government will be guided to do the same and commit to all the measures necessary to reduce the impact of this epidemic on communities and on all the healthcare professionals who are ‘stepping up’.
*The author wishes to remain anonymous