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The intense physical and mental effort required by health care workers amid COVID-19

Florida is among the U.S. states seeing cases of COVID-19 grow significantly. Its surgeon general now says residents will likely need to wear masks in public for up to a year. But for health care workers, protective equipment measures are much more extreme. William Brangham talks to Joseph Falise, a nurse with the University of Miami Health System, about the physical and mental strain involved.

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  • Judy Woodruff:

    While some states do appear to be hitting a plateau with COVID-19, others, like Florida, are seeing their cases grow.

    This week, the state's surgeon general said that residents may need to wear masks in public for up to a year, until a vaccine is rolled out.

    William Brangham spoke with Joseph Falise — he's a nurse at the University of Miami Health System — about what health care workers are facing.

    They started by focusing on the practical difficulties of treating patients while wearing so much protective gear.

  • William Brangham:

    For people who are not familiar with the process of just putting on all of that protective gear in order to be safe going into care for patients, could you walk us through what that is like physically?

  • Joseph Falise:

    I think that the main difference between now and prior to COVID is that it's palpable, the sense of urgency with which we need to protect ourselves. And, if we don't, what will be the outcome?

    We have heard of, you know, health care workers who have gotten sick. We have heard of health care workers that are dying, and some even in our own local community. And we know that we are not immune to this and that, if we're not careful and if we don't hold each other accountable, that we will get sick.

    So we have a very heightened sense of awareness and a very heightened sense of, you know, compliance with our current protocols.

  • William Brangham:

    I understand that, when someone is going through the process of putting on all of that gear, you assign someone else to watch them to sort of guide them through that process. Can you explain why you do that?

  • Joseph Falise:

    We kind of took a page out of the aviation industry.

    We know that when you work off of checklists, things get done much more consistently. So, we developed a checklist of how to put on the gear, so that no stuff gets missed. And, similarly, we made a checklist of how to take off the gear.

    It's well known that the most vulnerable, most risky part of putting — of this whole process is what we call doffing the equipment, taking the equipment off.

    We have been in rooms with patients who have COVID, and we know that the outer PPE is contaminated. So we want to protect ourselves from having any contact with that virus. So, we have developed a process where we have an observer who both watches us put on our gear. And then, also, we don't allow ourselves to take off the gear unless we have an observer watching us.

    And there's also that absolute awareness that, if we're not extremely careful, you will get sick.

  • William Brangham:

    I understand the job is physically exhausting, but to go through that, both trying to deliver wonderful care to people who are themselves very, very sick, at the same time being so worried about your own health, that has got to be a lot to bear day in and day out.

  • Joseph Falise:

    Yes, I think that's the hardest part. The hardest part is the mental exhaustion.

    We're fortunate right now that we're not understaffed, though the stressor becomes, how do I take care of these patients with all of this gear on, knowing that putting personal protective equipment on will restrict the way that I take care of patients?

    But, also, how do I work within this gear and protect myself from all the viruses that are out there? So, it is mentally exhausting, absolutely, no doubt about it.

    And we have nurses that are staying in these rooms for hours at a time.

  • William Brangham:

    Hours at a time?

  • Joseph Falise:

    Yes. Sometimes, they stay in there for hours at a time.

    But we have to be there to monitor those machines, address any alarms that may go off, change I.V. fluid bags. You know, most of these patients are 10 — and have been on six or seven or eight infusions. It takes a lot of monitoring to make sure that none of these tubes come out, that all of the infusions are running, and that the bags don't run out.

    The gear that we wear, you know, the bunny suit and the outer gown, it's very hot inside, extremely hot inside. And if the nurse stays in there for a couple of hours, yes, the evidence is, when they come out, they look like they are completely drenched in sweat.

    And it — not one single person is immune to it.

  • William Brangham:

    I don't think people appreciate just the physical taxation of what you're doing, on top of the mental taxation.

  • Joseph Falise:

    Yes.

    You know, when I go back into the isolation units, and I'm in patient rooms, it's a different — it's — and I have been an ICU nurse for a long time. If I was to imagine what a war zone would be like, that — I feel like that's what it would be like, because it doesn't matter what room you walk in.

    You feel the same sense of — I don't know. You just feel the same sense of, this is a really sick patient, and what can I do to help this patient get back to their family?

  • William Brangham:

    You're obviously seeing this pandemic in a way that very few Americans get to see.

    And out here, outside of this front-line work that you all are doing, there's this constant debate about, are these restrictions too much? Should people stay at home more? Should we reopen the economy?

    Do you have anything to say to people who don't get to see this pandemic the way you do, about that debate?

  • Joseph Falise:

    I think probably my most important message would be, nobody is immune to this.

    And the only way that has been proven to stop the spread of this is through distancing, is through staying home. These things have been proven to work. And we have known this for many, many, many years. But it's hard to do. And I understand that.

    I think my most important message would be, it could happen to you. As somebody who's seeing it day in and day out and dealing with families who really are heartbroken and who really are just — their lives are shattered because they're losing their family members, and their family members are having to die without them, and we do our best to try to ease some of that suffering by FaceTiming and by promising to be there as a surrogate.

    But the reality is, it could be you next. You have an option. That's my main point.

  • William Brangham:

    All right.

    Joseph Falise, clinical nurse manager at the University of Miami Health System, thank you very much. And good luck in all your work.

  • Joseph Falise:

    Thank you very much. Thank you for bringing this up.

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