COVID-19 and the Respiratory Therapist
Here we take a look at the RTs fighting COVID-19 and the impact the pandemic has had on them. RTs have been on the front lines, caring for patients, preparing new RTs to join the fight and helping their friends and neighbors deal with the devastating impact this pandemic has had on all.
The outbreak was first identified in Wuhan, China, in December 2019. The World Health Organization (WHO) declared the outbreak a Public Health Emergency of International Concern on January 30, 2020, and a pandemic on March 11, 2020.
Little did anyone at the time understand at its onset the effect it would have globally. What followed was a series of shortages in the health care arena including: personal protective equipment (PPE), shortages and threats of shortages of hospital beds, ICU beds, ventilators, and respiratory therapists.
In the United States and throughout the world, stay at home and shelter in place orders led to a shutdown of the economy and life as usual. Universities, businesses (other than those deemed essential), and a vast array of stores and service providers were forced to either close or conduct business in a virtual world.
Wearing masks and social distancing became the norm. Shortages of other goods occurred either due to hoarding, increased demand, or disruptions to the supply chain. These included shortages of meat, toilet paper, hand sanitizer, and surgical masks.
Seamstresses were called to duty to sew cotton masks in lieu of the shortage of surgical masks to try and meet the demand for health care workers as well as other front-line and essential workers, and finally to anyone venturing out into public places.
What follows is how a virus first identified in Wuhan China, became a pandemic, a worldwide threat to the health and economic wellbeing of those around the world and how respiratory therapists responded as on the frontlines caring for those affected—becoming the “unsung heroes” of the pandemic crisis.
WHO reported 7818 total confirmed cases worldwide, with the majority of these in China, and 82 cases reported in 18 countries outside China. WHO gave a risk assessment of very high for China, and high at the global level.
Click on this link to read more about the worst epidemics and pandemics in history in this March 20, 2020 article in LiveScience.
Also, noteworthy is the role of the inhalation therapist (respiratory therapist) in the care and management of those patients falling victim to polio during the 1940s and 1950s, as polio led to respiratory failure as well, although by an entirely different route.
Click on this link to read about the transition from iron lungs to positive pressure ventilation and the creation of intensive care units.
Click on this link for more information from the CDC.
How do SARS and MERS compare with COVID-19? Click on this link for more information.
With N95 masks and medical grade masks in short supply and reserved for frontline workers, the general public resorted to the use of simple cloth masks. Social media was flooded with patterns and tips for creating homemade masks and the use of alternative supplies, especially when elastic and cording for ear loops was suddenly in short supply.
Many complaints have been voiced about wearing a mask in a store for a short shopping trip. It's almost comical to watch shoppers rip off their masks the moment they exit a store. One can only hope they truly appreciate what respiratory therapists and other frontline workers endure for a 12 hour shift in their full PPE "armor".
During the plague, the beaks of the masks were filled with aromatic herbs.
Grocery stores and other businesses implemented "one way" aisles to reduce contact between shoppers and placed floor markers to encourage social distances in areas where lines were expected, such as check out areas and customer service .
Due to the restrictions of crowd size imposed within communities and/or states, the general public was left with limited activities for entertainment outside the home.
Since respiratory therapist programs are housed in these academic institutions, the training of respiratory therapist students was impacted as well. How to train respiratory therapist students when campuses converted to on-line learning? And what about clinical and laboratory courses? The spring semester proved to be unique for millions of college students nationwide as institutions struggled with the continued delivery of education in the on-line environment.
The University of Washington became the first large university in the U.S. to close related to the pandemic. The school canceled in-person classes for its nearly 50,000 students. Students converted to remote learning, taking classes and exams on-line. Soon after, schools across the country followed suit.
Harvard joins a growing number of colleges and universities that announced a major shift to remote learning canceling all in-person classes and, in some cases, asking students not to remain on campus. The trend of closing campus buildings, academic buildings, and dorms, sending students home, converting to on-line learning continues nationwide.
Click on this link for a March 2020 article regarding school shutdowns.
Click on this link to access an early March 2020 article listing colleges and universities that closed campuses and in-person classes due to the pandemic.
While initially thought to be a short-term closure over an extended Spring break with a return to campus, becomes apparent that the spread of the pandemic is worsening. College and universities decide over the coming weeks to remain in the remote learning phase for the remainder of the semester offering instruction and final exams on-line.
Many colleges and universities utilize software programs such as Zoom, Google Meets, and Microsoft Teams to engage students in on-line learning.
Respiratory therapist programs housed in colleges and universities nationwide are also subjected to the closures and the move to remote learning. Programs undergo pivotal changes as they work to continue instruction in the on-line environment. Many programs are forced to move not only didactic instruction, but also laboratory and clinical courses to the on-line learning arena. This requires a creative focus in providing content and instruction in ways that don’t hinder learning or negatively impact the learning process.
In early March 2020, guidance provided by the United States Department of Education (USDE) allows accrediting agencies some flexibility in addressing these circumstances. Accordingly, if face-to-face instruction and learning activities are disrupted by campus closures, distance education may be utilized to continue instruction and learning activities. CoARC allows for the need of additional time to complete programmatic accreditation requirements (for example, self-study reports, progress reports, etc.). CoARC suspends all scheduled site visits through May 15th, 2020. If needed, CoARC allows the program to consider make up options should students miss clinical time or utilize alternate sites if clinical facilities are unable to accept students due to COVID19.
Because of the need for respiratory therapists as essential health care workers, the NBRC secured nearly 70 PSI assessment centers for candidates to take the Therapist Multiple-Choice (TMC) and Clinical Simulation (CSE) Examinations in mid-April.
On April 29, 2020, the NBRC announced the availability of live remote online proctoring for the Therapist Multiple-Choice Examination (TMC) and Clinical Simulation (CSE) credentialing examinations.
Updates to the NBRC's testing procedures during the pandemic are available on the NBRC's website (www.nbrc.org).
Respiratory therapists whose licenses had been inactive for less than five years were allowed to temporarily restore their licenses with fees and CEU requirements waived in order to return to work during the pandemic.
Click on this link to read more on the call to action.
Click on this link for a related March 24, 2020 article that discusses the initial response from healthcare workers.
A respiratory therapist from Presbyterian Brooklyn Methodist Hospital in New York City is shown in this photo along with an early inhalation therapist. Deja vu?
Increased patient volume in the hospital, ICU, and those requiring mechanical ventilation, led to other health care related shortages, including PPE, ventilators and requisite supplies, and respiratory therapists to care for the mechanically-ventilated patient.
To read an April 30, 2020 article from the New England Journal of Medicine about shortages of critical equipment, click on this link.
Click on this link for an April 23, 2020 article that discusses the shortages during the pandemic, including suction catheters.
Creative individuals began supplying frontline workers with home-made shields and masks.
Click on this link for a May 29, 2020 article that features an individual who created 10,000 face shields.
Click on this link to access the April 25, 2020 article.
Click on this link to access the June 22, 2020 article.
Click on this link for a LiveScience article that discusses ventilator-sharing of up to 4 patients per ventilator.
Not long after these discussions, it became apparent that this practice shouldn’t be endorsed because it couldn’t be done safely with current equipment and technology. A joint statement was issued by the Society of Critical Care Medicine (SCCM), American Association for Respiratory Care (AARC), American Society of Anesthesiologists (ASA), Anesthesia Patient Safety Foundation (APSF), American Association of Critical‐Care Nurses (AACN), and American College of Chest Physicians (CHEST) discouraging this practice.
Click on this link to access the March 26, 2020 Joint Statement.
These included concepts such as:
1. Patients with severe CoV-19 should be managed with invasive ventilation following ARDSnet Guidelines. 2. Patients who require mechanical ventilation are severely ill. 3. The intensity of treatment parallels treatment for any ARDS patient. 4. Prone position should be considered with refractory hypoxemia. 5. A heat and moisture exchanging filter (HMEF) or heated humidifier can be used in these subjects.
Click on this link to read an April 12, 2020 article about Percussionaire's increased ventilator production during the pandemic.
Click on this link to read about an Ohio factory that is manufacturing ventilator components during the pandemic.
In addition, industries not previously manufacturing mechanical ventilators responded by producing ventilators for the first time ever to try and meet the anticipated need. This included mechanical ventilator production by auto companies and universities.
To learn more about the RaidVent prototype, click on this link.
Click on this link to access the article.
Respiratory therapists were featured in a number of articles and newscasts during the pandemic. Click here to see a listing of interviews with AARC staff and AARC members.
That’s why one respiratory therapist made a special name tag to spread some comfort and joy. Robertino Rodriguez works at Scripps Mercy Hospital in San Diego, California. He puts on his personal protective equipment, known as PPE, like any other health care professional – except on the outside of his isolation gown is a special laminated badge.
"I felt bad for my patients in ER when I would come in the room with my face covered in PPE. A reassuring smile makes a big difference to a scared patient," Rodriguez wrote in an Instagram post. His giant badge lists his first name and job title in big, bold letters. And underneath, is a smiling picture of the respiratory therapist. "So my patients can see a reassuring and comforting smile," he continued.
Rodriguez posted a picture of the get-up to his Instagram page, amassing more than 10,000 likes in just two days. More than 1,000 users also commented, writing thank yous, well wishes and many, many heart emojis.
Since the outbreak began, there has been more than 1,400 COVID-19 cases in San Diego County. Roughly 18% of those who test positive for the novel coronavirus require hospitalization, according to data released by the county in early April.
Click on this link to access the April 6, 2020 article.
The AARC House and Delegates and Board of Directors met virtually for their Summer meetings.
For the first time in the history of the AARC, the in-person AARC Congress was cancelled due to the pandemic. A virtual learning event, offering over 100 sessions over 4 dates in November and December 2020 will replace the traditional in-person Congress.
Respiratory therapist programs are impacted not only by academic institutional policies, but by clinical affiliate policies related to student clinical rotations as well. The response is variable across the nation, and with infectivity rates, as well as state mandates. Programs are faced with students being unable to attend clinical sites, are restrictions on which patients/patient areas they may be allowed access to for learning purposes. Some clinical sites, for safety concerns and shortages of PPE, decide to disallow students in Emergency Departments, and COVID positive areas. Academic policies continue to evolve as the pandemic continues to progress and spread. Ultimately most instruction in most institutions moves to on-line learning, including not only didactic instruction, but lab and clinical courses being offered in an on-line format as well.
Some switched to remote learning for the entire semester while others offered hybrid course options and revised their course formats as COVID-19 cases occurred.
Many of the traditional college activities, such as orientation programs, sporting events, concerts, fraternity and sorority activities have been cancelled for the Fall semester.
The Bourdon Bell at the National Cathedral in Washington, DC rang 200 times on the afternoon of September 20, 2020. Each ring represented 1,000 lives lost from COVID-19.
Should the vaccines receive approval, there will still be delays while distribution plans are developed and implemented and adequate quantities of the vaccines can be made available for American citizens.
Meanwhile, for many, news of these vaccines seems like a light at the end of a long dark tunnel.
The Congress presentations were recorded in advance with presenters available by Zoom to answer attendees questions. Open Forum presentations, a virtual Exhibit Hall, industry sponsored symposia, and other special activities were offered during the Congress.
The American Respiratory Care Foundation (ARCF) donated two commemorative blocks in our Wall of Donors for each of the respiratory therapists lost to COVID-19, one block for the family and one block for the employer of these RTs. Click on the DONORS icon on the museum's navigation bar then click on BLOCK DONORS to view the memorials.