Class, Convicts, and Controversy of COVID

Many people were of the rushed conclusion that at the stroke of midnight at December 2020's end, COVID-19 would simply vanish into yester year. Not even twenty-five years into the 21st Century, the year 2020 is worthy of its own exclusive section in the history books. Currently, the day after Thanksgiving 2020 the death toll in the US was sitting at 264,925. There have been 12,886, 204 cases as of the day after Thanksgiving 2020. The day after Black Friday sat at 13,092,661.The US has reached a new record high for Corona hospitalizations. It would be fair to conclude that we are nowhere close to being out of the woods. Dr. Lena Wen, Emergency Medical Room CNN medical analyst recommends quarantining for seven days then get tested.

Next to death itself, the largest burden felt has been on the nurses and other medical professionals. In a recent edition of the Atlantic Magazine, one Rhode Island Hospital based nurse stated that every time she reported to work, there was an increase in patients. Emergency rooms are starting to fill again with COVID-19 patients as there are more patients in the hospitals than at any other point since the pandemic began. Much of this can be attributed to several significant factors.

Health professionals are missing out on moments of children's upbringing such as birthdays, kindergarten promotions to 1st grade, learning to ride a bike and so forth. At the 380 bed hospital, Asante Rogue Regional Medical Center, in Medford, Oregon, alarms are constantly going off as patients' oxygen levels drop or their blood pressure changes. Those alarms haunts the anonymous nurse, even in his sleep. He hears them in his dreams and they jolt him awake. “That kind of stress of having to be at work all the time, it doesn’t go away,” he said. For some professionals, it has even put a strain on their marriages. Not only are medical professionals fighting against a deadly virus both at work and for their own well being, but have limited ways to refresh, and recharge.

The first case of suicide due to stress of a medical professional was in Italy on the 26th of March 2020. Daniela Trezzi, was a 34 year old Italian nurse, working in an Intensive Care Unit in San Gerardo Hospital located in the badly-affected Lombardy region near Milan. She'd been quarantined and was distressed by the conditions at the hospital. After being confirmed positive for COVID-19 on 10th March, she took her own life.

The COVID-19 pandemic has greatly affected the psychological health of nurses and other medical professionals. Numerous nurses have been facing mental complications associated with quarantine such as psychological distress, fear, and anxiety. The severity of COVID-19 pandemic is triggering further mental health issues among nurses. The continuous stress that nurses are facing, could also trigger post-traumatic stress symptoms, poor service delivery in hospitals, suicidal thoughts/attempts, and actual suicide. Assessing and preserving the mental health of nurses and the health care workers in general is necessary for optimal disease control.

The Pandemic has taken such a tumultuous toll that in Nebraska there is a severe shortage of nurses. This was projected to happen just a few years ago. COVID-19 only hastened the inevitable. In the midst of this grim reality, California has broken its hospitalization and ICU records. The State of Nebraska recently allocated $40 million dollars of CARES Act funding to assist with filling the staffs in area hospitals. The Nebraska Department of Health and Human Services (DHHS) recently launched a new website to recruit nurses to fill the current staffing shortage. It is predicted that by 2025 he shortage of nurses in Nebraska will be up 34%.

COVID-19 is now the leading cause of death in the US. President-Elect Joe Biden has now urged a 100 day mask rule during his first 100 days in office. One week after Thanksgiving, the total cases in the US reached to 14,372,568. The total deaths are 279,008 The American Nurses Association conducted a survey in March–April 2020 of 32,000 nurses and found that 87% feared going to work. As frontline health care professionals, nurses are our true heroes who risk their very own health to care for patients. The COVID-19 Pandemic caught the world completely off guard. In the midst of the confusion

and lack of knowledge of this deadly global pandemic, we've still expected them to perform with the utmost professionalism and care. Despite this period of fear, uncertainty, doubt, stress, and most of all the physical and mental exhaustion and depletion, nurses are pressing forward but at what expense ?

What is needed is a host of supportive psychological interventions and systems to promote positive emotional release. Even before COVID-19, medical professionals were experiencing physical and mental exhaustion and PTSD. In Philadelphia, Pennsylvania the Einstein Medical Center staff has been given free access to 24/7 hotlines and virtual support sessions with psychiatrists. In the private sector the virtual therapy app Talkspace is offering free counseling to health care workers.

Mrs. Stephanie Hampton-Oliver, UAB Nursing graduate has seen the dismal toll taken on the underserved and often marginalized. "The COVID pandemic has highlighted disparities that have existed through generations and put more strain on a health system that values productivity over quality of care", she says. Currently working as a nurse in the North Carolina Department of Corrections, she's also seen the limits to which medical staffs are pushed even before the Corona Virus. America's prisons were the most hit during this epidemic. "It’s unfortunate that I’m accustomed to a chronically understaffed unit or mostly transient staff, and high patient census." As a native of Birmingham, Alabama, Mrs. Oliver thoroughly knows the plight of the state's "Black Belt" Region.

The Black Belt is a region of of Alabama known for its rich, black topsoil. The term took on an additional meaning in the 19th century, when the region was developed for cotton plantation agriculture, in which the workers were enslaved African Americans. After the American Civil War, many freedmen stayed in the area as sharecroppers and tenant farmers, continuing to comprise a majority of the population in many of these counties. Historically, Alabama's rural Black Belt includes some of the poorest counties in the United States. Along with high rates of poverty, the area is typified by declining populations, a primarily agricultural landscape with low-density settlement, high unemployment, poor access to education and medical care, substandard housing and high rates of crime. "Much of my career has been in more rural and underserved communities", she reflects of her career history.

When the Pandemic initially hit a little more than a year ago, medical professionals were demanded to work long and exhausting hours. Historically, the medical profession has always been short staffed, mainly due to the challenge path to becoming a medical professional within any particular medical discipline. The demands of a global pandemic only deepened the issue. With medical professionals in hot demand, most assume that doctors and nurses have the best job security in the world as sickness is a part of life. Mrs. Oliver disagrees. "The public sees any medical profession as being safe – meaning we still have stability even when others are being laid off. Not true. When the pandemic hit, my hours were cut by 50% and I was changed to an hourly employee in one meeting" she revealed. She went on to explain that, " Almost half of the support staff were laid off. It’s feast or famine, the haves and have nots, or whatever you’d like to call it. I left out of concern for my own safety and health." A survey conducted by the New York Times revealed that nearly a fifth of primary care clinicians surveyed in September say someone in their practice plans to retire early or has already retired because of Covid-19, and 15 percent say someone has left or plans to leave the practice.

Just as with Mrs. Oliver, many were forced to take a pay cut. A recent survey by the California Medical Association (CMA) found that 87 percent of doctors saw a reduction of their revenues by a third. A quarter of the respondents said their revenue is down by 50 percent. There was an increase in expenditures by some 14 percent because of having to acquire personal protective equipment (PPE), new disinfection protocols, and telehealth technology to deal with the deadly virus. These unfortunate factors forced some doctors into an early retirement.

Working in a prison brings yet another set of problems due to its close quarter environment. By mid-March of 2020, at least 390,076 people in prison had tested positive for the virus, an increase of less than 1 percent from the week before. According to The Marshall Project. In March of 2020, there were 8,898 reported cases of COVID-19 in North Carolina's state prisons, one of which Mrs. Oliver is employed. That was 2,889 per 10,000 inmates. There were 52 deaths among North Carolina inmates as of March 2020. That was 15 per 10,000 inmates. What makes the situation more grim is the effect that the pandemic has had on prison staff. Since the start of the pandemic, 106,376 prison staff members have tested positive—with new cases at an all-time high the week of December 22, 2021. As of March 2021, there have been a reported 194 deaths among prison staff workers nationwide. The State of North Carolina DOC saw 12 deaths among staff members since the beginning of the pandemic in 2020. The State of Alabama DOC has reported 3 deaths thus far in 2021.

"I’ve seen those prisoners receive better and more consistent care than much of the general public. I wish people knew that we are tired and our masks are hot too. We give all we have everyday to the extent that our families may only get a few words or minutes when we come home", Mrs. Oliver speaks of the emotional drain taken on her and her family, including her husband who's an officer in the US Army also stationed in North Carolina. What Mrs. Oliver may be speaking to is the vulnerabilities of prisons. The situation facing North Carolina prisons perhaps was not as dire as some others. However, the emotional toll may have been just as bad.

The Covid-19 pandemic reduced the number of correctional staff, and in many states, prisons are unable to provide adequate security, which leads to more violence and abuse within correctional facilities. Alabama, has the highest rate of prison homicide in the country. The Cook County Jail in Chicago, one of the nation’s largest jails, reported a rate of coronavirus infection that was higher than almost anywhere else in the country, with more than 1,018 people testing positive so far. Miami-Dade County Jail has the second-largest cluster of cases nationwide, with 2,443 cases. Working in these volatile conditions have had a very dark impact on the mental health of inmates and medical staff alike.

From June to September of 2020, Mental Health America (MHA) hosted a survey to listen to the experiences of 1,119 healthcare workers during COVID-19 with the objective of creating better resources to help support their mental health as they continue to provide care under dismal conditions and unfavorable circumstances. What the found was depressing in and of itself. The responses collected revealed that medical staffs were stressed out and stretched too thin. About 93% of health care workers were experiencing stress, 86% reported experiencing anxiety, 77% reported frustration, 76% reported exhaustion and burnout, and 75% said they were overwhelmed.

In the prisons, visitations were halted as well as court proceedings which prevented some inmates from making bail or bond who under normal circumstances would have been granted such. Although inmates were denied visitation, medical personnel left for home everyday at the end of their shifts. Just as with medical personnel in traditional medical facilities and hospitals, doctors and nurses were very concerned about endangering the lives of their families. About 76% of healthcare workers with children reported that they were worried about exposing their child to COVID-19. Nearly half were worried about exposing their spouse or partner and 47% were worried that they would expose their older adult family member(s) according to MHA.

"I wish people knew that we are tired and our masks are hot too. We give all we have everyday to the extent that our families may only get a few words or minutes when we come home", Mrs. Stephanie Hampton-Oliver expressed. Working in a high COVID risk environment such as a prison or understaffed hospital eventually leads to a host of emotional and mental health issues According to the MHA study, emotional exhaustion was the most common answer for changes in how healthcare workers were feeling over the previous three months (82%), followed by trouble with sleep (70%), physical exhaustion (68%) and work-related dread (63%). Over half selected changes in appetite (57%), physical symptoms like headache or stomachache (56%), questioning career path (55%), compassion fatigue (52%) and heightened awareness or attention to being exposed (52%). Nurses reported having a higher exposure to COVID-19 (41%) and they were more likely to feel too tired (67%) compared to other healthcare workers (63%).

This epidemic caught the world off guard. As we have never dealt with anything as such in modern and recent history, there was no contingency plan in place Nurses and doctors were expected to work without the proper PPE, which left them even more vulnerable to the deadly virus. Taken for granted, medical personnel were expected to take care of those infected, despite the overwhelming workloads. This left them feeling void of emotional support. Thirty-nine percent of healthcare workers said that they did not feel like they had adequate emotional support. Nurses were even less likely to have emotional support (45%, according to MAH.

Among those with children, during the peak of the Pandemic, half reported they are lacking quality time or are unable to support their children or be a present parent. For those with babies and toddlers, this proved even more disheartening as parents would not be able to participate in traditional milestone events such as a child's first words, first steps, birthday parties and learning to ride bikes. All of these experiences contributed to high levels of stress, anxiety, frustration, and exhaustion among nurses and other personnel. As a result many were left questioning their career path, had problems with sleep, had changes in appetite, fatigued, experienced increased tobacco and alcohol consumption, and a host of other negative feelings and behaviors.

For decades, global pandemics only existed in motion pictures such as: Outbreak, Contagion, Carriers, and Pandemic. Although many movies within this genre of films referred to as "Apocalyptic Films" teetered between reality and science fiction, the results were seemingly the same. Thought to be only contained within Hollywood films, what an actual global pandemic exposed was the vulnerability of the medical field. Doctors and nurses were being expected to work without Proper Protection Equipment (PPE). This was the beginning of what was yet to come regarding the severity of what was expected among nursing staffs.

"COVID brought about drastic nursing shortages nationwide. As the number of patients steadily increased at unforeseen rapid numbers, there simply wasn't enough nurses having to work and care for patients, resulting in nurses having to work and care for patients at unsafe nurse-patient ratios and endure mandatory overtime demands due to the staffing needs. COVID has left many nurses physically, emotionally, and mentally drained", says RN Jasmine Polk-Williams of Ascension Sacred Heart Hospital in Pensacola, Florida. Mrs. Polk-Williams' sentiments reflect those of the national nursing community.

At Elkhart General Hospital in Michiana, Indiana, one nurse stated to the South Bend Tribune of the dismal conditions in which the nurses and other medical staffers worked. We don’t have enough resources. We’re running out of everything right now. We don’t have enough therapists to care for every single one of these patients that are on a ventilator. We don’t have time for breaks, so by the end of your shift you’re starving, you’re dehydrated, your back hurts, your whole body just hurts,” she said. he nurse went on to explain how many workers contracted COVID themselves due to being exposed to patients with the Corona Virus and exposed at long periods. Already short staffed before the Pandemic, seasoned nurses, especially older ones, retired in 2020 because of the stress and risks. This only compounds an existing problem.

The cause of the current shortage is actually three-fold: an aging population, an aging workforce, and a limited supply of new nurses. An aging population, hence, the baby boomers (persons born between 1945-1950) are going into their golden years thus an aging workforce. As the population ages, so do the nursing staff. Georgetown University's Center On Education and the Workforce conducted a study a few years ago concerning the impending nursing shortage. The study projects that the economy would create 1.6 million job openings for nurses through 2020. Yet, there will not be enough nurses to fill those openings. We project the nursing workforce will be facing a shortfall of roughly 200,000 nursing professionals by 2020. The Pandemic only worsened these already troubling statistics.

“We can’t just produce nurses and support staff out of thin air, so it’s really difficult and challenging", explained Jackie Kinnear, a 47-year-old registered nurse in the Saint Joseph Health System. Kreg Gruber, CEO at Beacon Health System, is pleading for “the support of the communities” in his region. Commenting to the South Bend Tribune he stated, "Our fears are that if we don’t raise the awareness and the urgency in the communities, we’re already at our limits. We’ve very, very concerned about what happens next because when we’re stretched as far as we are, both with facilities and staff, and especially staff, it is going

to cause us to make decisions about the ability to deliver other care in our communities.” All of this comes while Indiana had the second highest COVID hospital rate per capita.

Despite millions of Americans having taken the vaccines, dozens of states are now loosening travel restrictions including masks no longer being mandatory, airlines now opening middle seats, and a host of other moves to "return to normal", and the nation and the world for that matter is far from being out of the woods on the pandemic.

Recovery efforts will successfully take years. Long term care and nursing home facilities alone will require a major overhaul to recover from the Pandemic. As of early May 2020, Covid-19 had claimed the lives of more than 28,000 nursing home residents and staff in the United States. Kirkland, Washington, more than 153,000 residents and employees of 7700 U.S. nursing homes have contracted Covid-19, accounting for 35% of the country’s deaths, according to a May 9, 2020 New York Times article entitled, " One-third of all U.S. coronavirus deaths are nursing home residents or workers. New York Times." For decades nursing homes have been the most vulnerable and neglected health facilities. The long-term care sector has been marginalized for decades. The unfortunate problem is that aging adults who can no longer care for themselves at home are left neglected and reliant on poorly funded and insufficiently monitored institutions. Therefore from the start of COVID, nursing homes were ill equipped to stop the spread of the Corona Virus. Most of these facilities lacked the resources necessary to contain the outbreak, including tests and PPE and their staff are routinely underpaid and poorly trained. With these discouraging statistics as well as a host of other issues regarding the medical system and health, can the US withstand another pandemic outbreak in the near future ?

"It is simple, I do not believe that the U.S. can handle another pandemic in the near future. This is evident by the state that the country is currently in. Though the vaccine has helped to decrease numbers, COVID is far from over. It will take a while for this country to fully recover", RN Polk-Williams expressed. As a Florida native currently working in the Florida, Alabama, and Mississippi Gulf Coast region, Polk-Williams who is also an alumni of UAB has seen first hand the devastating statistics regarding African-Americans and COVID on both sides of her state line. In Florida, whites account for approximately 53% of the population accounted for 40% of COVID cases whereas African-Americans represent 15% of Florida's population but accounted for 14% of COVID cases according to the Kaiser Family Foundation (KFF). The health disparities among blacks has always been known, through empirical data. The Pandemic exposed the depth of them.

While African-Americans represent only about 13% of the population in the states reporting racial/ethnic information, they account for about 34% of total COVID-19 deaths in those states. The coronavirus pandemic also birthed widespread mental health problems. African-Americans in Milwaukee and Chicago account for about a third of the population, but represented over 70% of the deaths. In Georgia just the same, African Americans make up a third of the population but represented 80% of hospitalizations. in Michigan, African Americans account for 14% of the population, but yet they represent 33% of the COVID cases, and 41% of deaths. Recent decades have revealed drastic health disparities in the African-American community. Despite many major urban cities being home to world ranked hospitals, why are African-Americans lagging so far behind medically and why did the Pandemic hit so hard even in communities with strong medical services ?

"History has proven that as a black community we can not trust the government and medical industry because as we know many 'experiments' and disparities occurred at our expense", explains Mrs. Polk-Williams. Details of such experiments and the history of a conspiratorial relationship between African-Americans and the medical industry can be read in detail in books such as "Medical Apartheid" and "The Immortal Life of Henrietta Lacks". Nurse Polk-Williams goes on to further reveal that, "Because although we don't want to be another experiment, sometimes our lack of knowledge and ignorance to certain health issues still contributes to our own morbidity and mortality rates." These sentiments of Nurse Polk-Williams are in fact echoed throughout the medical field.

"I don’t think blacks inherently take our health less seriously that any other race. I think we have to address the healthcare disparities that prevent people from prioritizing their health. We have to make healthcare easily accessible and affordable instead of waiting to seek care once it becomes an emergency. We have to restructure the system to fit the needs of our population", explains Dr. Khalilah Brown, current Laboratory Director for Jefferson County Department of Health. By and large, the United States is the most medically advanced country in the world. So why was the medical community caught in such a web of confusion? Many medical professionals such as Dr. Brown believe that the gridlock that the medical/health community found itself gripped in stems not so much from the medical community itself but top tier leadership, both from within, as well as on the state and national political level as well.

"I think there was a lot of misinformation and denial from some very prominent sources for a long time that ended making what should have been a public health and medical issue a political issue. Our country was already so divided politically that it became very difficult for the facts and the science to be heard and understood", states Dr. Brown who is also serving as Child Health Medical Director since 2016. There is a strong disconnect between the scientific and political communities with a seemingly reluctance on the part of the politicians to educate themselves on the intricacies of health and medicine. This trickles down to the general public being gravely ignorant about healthy lifestyles and choices. Dr. Brown, who is also a UAB graduate goes on to further explain that, "We have to value healthcare and make it a priority. We have to invest in it for everyone, not just those who can afford it. We have to become a healthcare system that prioritizes prevention and wellness as opposed to medication and emergencies.". In other words, as a nation, we must become proactive rather than reactive.

When asked if the US can withstand another pandemic in the near future, Dr. Brown seems optimistic rather than skeptical. "My hope is that we will take what we have learned from out successes and failures over the last year and begin making changes to create a medical infrastructure that will allow us to withstand the next pandemic whenever it should occur. This pandemic was difficult to control because the virus was novel and spread easily. We had to learn about the virus and how to fight it, how to protect people. That all took time and unfortunately we were losing thousands of people a day at times as we were trying to understand the science and medicine. Perhaps the government was bungling up the process? "

The COVID-19 Pandemic is far from over. Despite a rush to "return to normal", the threat is still very real. Although millions gave taken the vaccine, and some states having relaxed their mandatory mask orders and travel restrictions, this country is still very vulnerable. What has to take place is a massive overhaul of a medical infrastructure from pole. From creating a competent educational system that creates on the K-12 level, solid scholars that enter into the collegiate ranks. As a result, you have constructed an invaluable selection pool that compels and propels modern medicine to new heights. This meets the obvious shortages that will continue to impede medical growth and development for some time until drastic measure are undertaken. Second, medical professionals and scientists need to granted without restriction, the proper equipment, supplies, and responsible and necessary funding. Health workers should not be expected, let alone bullied and forced to work in highly contagious environments without the proper PPE due to hospitals not having sufficient amounts. Lastly, the average citizen, not the politicians should become proactive in the concerns of their health. These factors taken under serious consideration and actions, will not only reduce the likelihood of another pandemic, but be very well prepared to fight one should one arise.