A Q&A With Linda Spaulding on the Frontlines of COVID-19

Back in 1992, Linda Spaulding, RN, BC, CIC, CHEC, was working at a hospital in Hawaii when she began to wheel a transplant patient to his room. The surgeon told Spaulding: “Now take this patient back to your unit and make sure he doesn’t become infected or you’ll kill him.” That’s when Spaulding, a regular contributor to Infection Control Today^®and a member of ICT^®’s Editorial Advisory Board, decided to become an infection preventionist. She now works as an infection prevention consultant, but there are consultants and, then, there are consultants. Spaulding is hands-on all the way. That’s her “consulting” above at one of two hospitals in Texas that asked for help in fighting COVID-19. Recently, Spaulding managed to spare a few minutes to talk to ICTabout her work in the trenches. 

Infection Control Today^®: What’s going on out there?

Spaulding: Well, a lot of fear, a lot of worry, and a lot of exhaustion. Everybody across the country is busy with this COVID pandemic right now. The frustrations coming in when we can’t get test kits, or we can’t get PPE that we need. And we’ve always taught people that you when you go in an isolation room, you come out, you take your PPE off and you dispose of it. Now we’re telling people, you have to either wear it all day, or when you come out, you have to take it off and hang it up and save it for the next time because there may not be PPE in a week or two weeks. So, it’s bringing a lot of fear.

ICT^®: You have to advise people to do what you’ve been advising them not to do all these years, right?

Spaulding: Exactly. It’s very different for healthcare providers.

ICT^®: We got a picture of you [above] in full metal jacket so to speak, right there on the frontlines.

Spaulding: Yeah, that was that was my way to try to get people to understand to protect the healthcare workers so the healthcare workers are not ill so that they can take care of them if they come down with coronavirus. It was like please stay at home. Social distancing is the most important thing. I’m currently in Texas working. I’m a consultant. I get many calls off and on during the week. And I try to provide as much information as I can to attempt to keep people safe.

ICT^®: Who’s calling you? 

Spaulding: A lot of physicians. Been getting a lot of calls from them. A lot of nursing staff. And actually quite a few people in the public, because they hear on TV, everybody can get tested. And so they call the hospitals to say, “Hey, I want to come in and get tested.” When the reality of it is, they can’t get tested. The hospital I’m at: We have about 48 testing kits. And that’s it. We’re trying to save those to test the people that get admitted to the hospital that are so unstable they can’t go home and quarantine in place. So triaging over the phone as much as we can to keep people at home if they don’t need to be hospitalized. And of course, everybody wants to be tested.

ICT^®: What’s the biggest challenge for infection preventionists right now? 

Spaulding: For infection preventionists: Just keep your patience. We’re asking people to do stuff that they’ve never had to do before. We have never done it ourselves as infection preventionists. So, a lot of it is new to us. We have to be comfortable with the fact that we have to reuse PPE for multiple patients. But one of the things they have to remember is those multiple patients all have the same illness. So, it’s not like we’re going to transfer multi-drug resistant organism to the next patient. Because we try not to use the same PPE for those situations. We just don’t want to get to the point that we have nothing to use.

ICT^®: You’re telling infection preventionists and others on the frontlines that as much as you don’t like the idea of reusing PPE, if you do it for COVID-19 and only do it for COVID-19, it’s probably a better way to go?

Spaulding: Exactly. And we don’t know, you know, what’s going to happen when this is over. Maybe we have transmitted multi-drug resistant organisms to multiple people because of the practice. But we don’t have an option.

ICT^®: You’re a very fine writer. Are you going to write about this when you're done?

Spaulding: I’m thinking about it. I think there’s a lot of nurses out there that are in worse situations that I’ve been in since this started. But I think there’s a lot of questions that medical professionals need to have answers to when this is all over with. We learn from each other from different areas of the country. And maybe make better pandemic plans for each of the hospitals. Everybody should be writing about lessons learned.

ICT^®: What have you personally learned from this?

Spaulding: I have learned that there are a lot of healthcare workers that will step up and do whatever they can. I have also learned that there are a lot of healthcare workers, like the general public, they’re fearful. They’re afraid they’re going to get it. They’re afraid they’re going to take it home to their families. We have some healthcare workers that the families have broken up. Not broken up literally, but living in two different houses now, because one of them is a nurse. He or she wants to keep the family safe. We have physicians doing the same thing. Families are living in one place, the healthcare worker is living in another place so it decreases the fear of taking it home to their families. Because we know 25% to 50% of the people out there are asymptomatic carriers. What if we become one of those asymptomatic carriers? We’ll potentially give it to our co-workers and everybody we’re around and we’re never going to know we’re an asymptomatic carrier.

ICT^®: What advice can you give healthcare workers regarding maintaining their health and emotional wits about them in this crisis?

Spaulding: If there’s an ethics committee in the hospital, they can help make decisions that healthcare workers may have to make. If you have one ventilator left and you know the people that need the ventilator, how do you make the decision on which one you’re going to intubate? You know, maybe it’s two co-workers, maybe it’s two doctors that are loved in the hospital. And now you have to make that horrible decision. Use your ethics committees. Even if it’s telemedicine. Even if it’s a psychiatrist or somebody that can talk to you and make you feel better about the bad decisions you’ve had to make. Because some patients, we’re just going to have to let go, and that’s going to really cause sadness and internal frustration for healthcare workers. I won’t be surprised if some of them have PTSD after this.

ICT^®: Is there a certain demographic of people who are more at risk of getting COVID-19? worse? Everybody says that older people are much more vulnerable to it. 

Spaulding: I’m glad you brought that question up, because a lot of people are saying it’s the elderly. We’re seeing a lot of individuals under the age of 40 in Texas. I’d be very cautious for people to label any group more likely to get it. I think it depends on your underlying health. Yes, you have very healthy elderly that can get through and I saw a newscast the other night about a 100-year-old lady who recovered from it. She was relatively healthy other than coronavirus. If you get young people with diabetes, with arthritis, with asthma-those are the people that are going to have a problem. I have a nephew who has asthma. And I worry so much about him. He’s having a hard time getting his inhalers. We have to try not to just think it’s the elderly. It can be any age, depending on the place you are in the country. Like I said, Texas, it’s mostly the younger individuals under the age of 40 so far. In Florida, it’s the elderly population. Well, because there’s younger people in Texas and there’s older people in Florida. It’s going to depend on the demographics. New York will tell us a lot about ages once they’re able to publish what ages they’ve gone through because they’ve seen the most cases They’re going to teach us a lot when this is over.

ICT^®: Are you personally practicing social distancing from your family? 

Spaulding: I live in Florida, my family’s in Ohio, and I’m in Texas helping with COVID. I’m definitely distancing from my family. Initially, I couldn’t convince them to distance from each other. But in the last week, I think they’ve gotten the message that they do have to be very careful and stop going on vacations and that kind of stuff. We have a lot of people we have to watch. We have to test. We have to encourage them to self-quarantine. Just because we’re not able to test a lot, and we’re not getting results back very fast either. Our results are coming back seven to 10 days later. People hate to be self-quarantined. And that is the challenge to get people to understand to stay home. My hours? I get phone calls up until midnight every night and they start at 7 a.m. I get calls all day long. And even this past weekend, I turned my phone off one night, because I needed to get some sleep. And I turned it on and I had missed eight text messages and phone calls.

ICT^®: Do you see any silver lining, or is it just basically nose to the grindstone? 

Spaulding: Right now, it’s nose to the grindstone. Try to convince people; teach people to stay their distance and to stay safe. I mean, we are seeing some people acknowledging that and staying away. We’re seeing a lot of people in the communities making masks at home and bringing them into the hospital for us to us. Will that give us the same protection as a surgical mask? No. But if we have nothing, it’s better than nothing. There have been a lot of communities that have stepped up. There was a 10-year-old girl on TV last night they interviewed. She’s made over 100 masks for her local hospital. My sister is making masks to send them here to Texas. She sent some to Kansas City yesterday. So, the community is pitching in. Kind of reminds me of back in World War II when the women all went and started sewing things for the men that were off to war. Well, the communities are making masks for the healthcare workers. One thing that happened today, we had a healthcare worker that went to a local store looking for a pair of goggles. She was going to buy her own because we didn’t have enough. And she told them why she was buying them. That store donated an entire box of goggles, which we desperately needed. And a whole box of different types of masks. Now, that tells me there’s more PPE out there, it’s just people don’t realize we need it. So good things are happening.

ICT^®: Is there anything you want to add about until your fellow healthcare workers about how to get through this.

Spaulding: You know, hang in there, we're going to get to the end. I always say everything is only temporary. Okay, I keep reminding myself that every day.

This interview has been edited for clarity and length.