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rinflammatory responses widespread coagulopathy blood vessel damage changes to blood cell morphology and survivors can be left with damage from infertility and erectile dysfunction to irreversible impairment of any vital organ extreme fatigue to neurological impairment equivalent to a decade of ageing there are international reports of people contracting covid more than three times so far with differing symptoms and post viral effects from nothing to profound debility or disability each time odds are a virulent genuinely mild variant will evolve eventually and become the dominant strain that this will become something we can vaccinate against annually and only worry about if we re older or immune compromised which is absolutely not me saying either of these groups is okay to be put at risk but omicron is not that variant and we are a long way from being able to live alongside this virus without precautions whatever business economists and politicians more influenced by them than constituents would like to believe one near universal caution is not to take prophylactic blood thinning medication as we don t even know enough yet to know if that will increase the risk of complications we need to give up on herd immunity 16 saturday oct 2021 posted by tara nipe in uncategorized leave a comment tags breaking research covid 19 health care nursing pandemic population health science vaccination a pre published iranian study https www medrxiv org content 10 1101 2021 10 04 21264540v1 confirms what experts have been saying from early in the pandemic striving for herd immunity is hopeless contracting covid 19 doesn t confer immunity but vaccines do at least for a while the colour coding in the map below indicates the average number of times residents in each province have been infected the darker green the more instances in three provinces kurdistan north khorasan qazvin the average rate over 5 surges across iran is 1 5 times for every person 1 55 1 57 and 1 63 respectively over 21 months this rate was higher in baluchistan and sistan the average infection rate was 120 by january of this year i e in the first year of the pandemic but despite this exposure the fourth and fifth surges were the deadliest and every person living in these provinces contracted covid 19 2 5 times on average the odds are still good that sars cov 2 will eventually mutate into a flu like illness that s predominantly benign for the majority of people but the question is how long that will take while we still can t say with certainty how long acquired immunity is effective with over a billion people world wide double vaccinated we do know that all the available vaccines substantial reduce every risk contracting the virus passing it on being symptomatic becoming significantly ill requiring hospitalisation needing icu level care intubation ecmo dying and developing long covid how do we avoid following iran get vaccinated continue to wear masks and social distance and support our exhausted frontline workers extracorporeal membranous oxygenation ecmo is like dialysis for lungs that are too damaged to exchange gases if you need it then you already have a tube down your throat so you can breathe drugs to sedate and paralyse you other drugs to keep your blood pressure stable a catheter into your bladder to drain urine intravenous fluids and nutrition either through a tube into your stomach or directly into your blood stream at a minimum adding ecmo is a big deal it can only be done in major hospital icus is needed 24 hours a day until you die or your lungs recover enough to exchange oxygen and carbon dioxide again and requires even more drugs to reduce complications like blood thinners to stop your blood clotting in the tubing or machine how many aged care deaths before the government acts 25 thursday feb 2021 posted by tara nipe in aged care australian politics clinical nursing 1 comment cw although the most graphic photo is censored the abc story linked below contains distressing descriptions of abuse and neglect the covid 19 pandemic has highlighted many of the problems and inequities in our community and none more so than the devastating death toll in nursing homes we saw more deaths in victoria which has the most publicly owned nursing homes 180 out of some 780 across the state than across the rest of the country combined but only a handful of cases and no deaths in the state run facilities it s true that the majority of these are in regional and rural settings where there were fewer cases of covid but two of the largest victorian owned nursing homes are in melbourne and their residents survived virtually unscathed the primary difference mandated staffing numbers and mix there s a lot of money flowing around the aged care sector particularly residential aged care but although it s obvious just on the face of it that older people who need supervision and or assistance with daily living activities which is why they live in nursing homes have complex medical needs sometimes complicated by dementia and other psychogeriatric conditions many providers have cast their role as primarily the provision of food and accommodation they ve been allowed to do this because in 1997 the howard government deregulated the sector allowing private for profit groups to enter the market that s also when residential aged care began to replace nursing home and the numbers of nurses in the sector began to plummet providers employed more assistants in nursing also called aged care workers patient care attendants and other variations but not at the same rate as they shed registered and enrolled nurses with both trends resulting in an overall reduction in staffing numbers and a precipitous decrease in capacity to deliver expert care the majority of ains care deeply about their work and their residents but they simply don t have the education and experience or accountability of enrolled and registered nurses the tasks of nursing care are mostly not that complicated the reason our education programs are so long is because the key differences between us are understanding what s going on why and how everything interconnects and our ability to assess evaluate and review these are invisible skills so even ains often don t appreciate how their care differs from that of an enrolled nurse while ens often see rns as spending time on paperwork instead of direct patient care without appreciating the importance and abundance of documentation in aged care in all cases the staff are overworked with far too many residents to provide optimal care for even before they face restrictions in equipment and supplies and every year their residents become more frail and medically complex the royal commission into aged care quality and safety ran for some two years hearing evidence from nursing home residents their families staff providers clinicians regulators academic experts and unions the interim report was titled neglect the final report and recommendations are due to be released tomorrow watching witnesses give evidence even reading the transcripts was at times harrowing with far too many stories like those reported on the abc news program 7 30 which this week published a report about a five star residential aged care facility on one of the country s largest providers regis nedland s resident brian hunter s back after being exposed to the sun on a 40 degree day photo provided to the abc and sourced from the linked story throughout the royal commission process there were clear accounts that regulation and minimum standards including english proficiency and training are needed for assistants in nursing patient care workers and consistent advice from experts that no other measures will be effective without the introduction of a mandatory skill mix of registered nurses enrolled nurses and assistants in nursing and staff to resident ratios despite all of this the federal government has already indicated it is opposed to a minimum staff training standard and wants to see better evidence that the regulator should be changed if they won t even require the people caring for some of our most vulnerable citizens to complete a certificate iii training program what hope is there that they ll act on the devastating shortfalls in care provision by increasing the numbers of nurses kudos to the six student nurses from edith cowan university who reported the neglect they saw we need more people at every level with that clarity and courage is a fifo workforce the answer for covid quarantine 23 tuesday feb 2021 posted by tara nipe in australian politics clinical nursing leave a comment tags clinical case study covid 19 nursing quarantine through a combination of good luck and good management australia has been far more fortunate than almost any other countries when it comes to the covid 19 pandemic at least so far at the time of writing we have had fewer than a thirty thousand cases less than a thousand deaths overwhelmingly in one state and predominantly in residential aged care and have 39 active cases with only ten of those being treated as inpatients in contrast the netherlands with some 8 million fewer people and canada with 140 of our population have had over a million cases and 15 000 deaths and some 846 000 cases and over 21 000 deaths respectively this is a spectacular achievement but it also means many australians have been insulated from the realities of the pandemic that other countries have faced particularly the pressure on hospitals health practitioners and resources but also the rapidity of covid 19 spread especially the newly emerged b 1 17 and 501 v2 or b 1 351 variants this means the key driver of precautions from social distancing to lock down is not understood as being avoiding overwhelming health care capacity and a commonly held expectation that we can easily prevent any cases from entering the community in other words any cases of transmission are the result of human and or system errors a week ago victoria came out of a five day stage four lock down triggered when a single case of the uk covid variant entered the community at a pace that demonstrated its increased contagability while this lock down achieved the aim of halting the spread at 25 cases calls for a regional site with fly in fly out staff have increased this would resolve the issue of community transmission from quarantine hotel workers in a country with little to no community presence of covid 19 for months a fly in fly out workforce housed in purpose build accommodation is used in a number of industries particularly but not solely mining so how hard could it be here twitter user mattiecamp described in a 28 post thread on 5 february many of the logistics involved in setting up a best practice quarantine specific facility from the physical space needed single storey living units separated by 2m buffers on all sides to minimal capacity to flex numbers up or allow for family units of differing sizes some of these issues would be less difficult with a number of small facilities rather than a single national centre but most of them persist regardless and the greatest of these is workforce set aside for now the requirement of a well equipped hospital with icu capacity because people with covid can deteriorate rapidly that would mostly be inactive and focus on security cleaning catering logistics and waste management staff it s this last restrictions on staff members free time that i d like to discuss in a little more detail the comparison of a fly in fly our workforce for quarantine with mining isn t as apt as it seems at first sight because current fifo workers get to go to the pub shop and interact with co workers and locals in their downtime those activities would be prohibited for quarantine staff whose only face to n95 masked face interactions would be during working hours that isolation would need to be maintained during the staff quarantine period between finishing their block of work and flying home another fortnight of solitude or if you recruited couples unrelieved intimate proximity quarantine leave would need to be paid take place in a physically separate space from quarantine residents and accommodation for staff on duty and require its own dedicated catering and cleaning workforce who also need accommodation and leave time to avoid any cross infection that doubles at least the number of staff needed in victoria hotel quarantine workers are screened every shift by an onsite doctor and covid tested by nurses these tests are prioritised so the results are most often available before the worker has finished their shift to replicate that speed so any transmission is detected and curbed before it spreads widely means an onsite or nearby pathology lab working around the clock the pathologists and supporting lab staff may not need to isolate but would still need to fly in and out because regional facilities don t have an abundance of people with that education and skill unutilised and they would also need a purpose built lab that allows them to treat the highly infectious samples without risking transmission i briefly mentioned earlier the need for a well staffed hospital able to provide icu level care that would be for anyone who develops severe covid but we would also need health care facilities for anyone who has an acute illness or a chronic condition requiring health care oversight even as we saw in the recent victorian case an acute asthma attack at present these needs are managed by two specialty hotels one for people who have tested negative but have health care requirements from assistance because of a physical disability to people requiring oxygen from preexisting cardiorespiratory disease and one for people who ve tested positive to sars cov 2 whether or not they have signs or symptoms anyone in the health hotel who returns a positive test is transferred with strict precautions to the hospital hotel for close monitoring i haven t been clinical during the pandemic but i worked in an infectious disease ward during the swine flu and bird flu pandemics as with covid 19 most of my patients were well with only a few or no symptoms but i ll never forget the speed with which one patient with h1n1 deteriorated i ve changed mai s identifying details to maintain her confidentiality a 27 year old business woman who had been visiting family mai had been afebrile when leaving china but admitted later that she had experienced some low level cold symptoms headache congestion and a sore throat for the last two or three days of her holiday but they were very mild and she dismissed them over the course of her flight to melbourne mai developed a runny nose and a cough and on screening at tullamarine had a low grade fever she was transferred from the airport and directly admitted to the ward bypassing the emergency department with a presumptive diagnosis of novel influenza a h1n1 which was confirmed when a nasopharyngeal swab was positive for th...
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