SON student Daniel Meltzer (FNP ’20), is on the front lines of the COVID-19 response as a nurse in the UNC Medical Center Emergency Department. Here, he offers a detailed picture of what his day looks like and the precautions his department is taking, as well as the importance of the current stay-at-home measures, the support he and his colleagues are receiving from the community, and his takeaways on how this pandemic highlights economic disparities.

UNC SON: How has your role, or the roles of nurses in general, changed during this time?

DM: As the orders came in to shelter in place, Orange County seems to be heeding the call. Our ED daily census has been cut in half, almost a third! An area separated from the main ED has been converted to a respiratory care area for all patients with complaints of fever, cough, shortness of breath, tested without result, contact with suspected or confirmed COVID-19 patients, or recent travel outside of the state. I’ve been working in this area, and the acuity of the patients has mostly varied based on their underlying chronic illnesses or unrelated-to-COVID-19 acute complaints (for example, stroke symptoms or chest pain in a patient who also has a cough) rather than the course of COVID-19. There are a lot of infrastructural changes and some new minimal contact protocols including MDs seeing patients “virtually” through a portable Epic device [editor’s note: Epic is an electronic health records platform] or calling the patient’s cellphone and doing the history through the glass door, or even use of a bluetooth stethoscope in order to avoid PPE use for some patients.

What are your daily job responsibilities, and how are they a part of the health care ecosystem that is fighting this pandemic?

The flow of the emergency department has changed, and we have a number of new protocols. First of all, our ED has a set-aside area for complaints of fever, cough, or shortness of breath. Any patient presenting with any of these symptoms, as well as patients who have had contact with known or suspected COVID-19 patients or whose COVID-19 tests are still pending or resulted positive are sent to this separated area of the emergency department. These patients are screened at the entrance into the drop-off area by a registered nurse before they enter the building, and if they are headed into the respiratory care area, they are triaged outside. Stable patients are triaged and seen virtually via an Epic-enabled portable device in their cars. Many of these are redirected to the RDC. Patients who arrive to the emergency department to be seen for signs and symptoms beyond cough, shortness of breath and fever, or whose severity of the aforementioned symptoms is high enough to warrant an emergent hospital visit are also triaged outside and then brought into the respiratory care emergency department. All patients without these symptoms or suspected exposures are taken to the main side of the emergency department, triaged, roomed and treated as normal.

What would you say to those of us who are not healthcare providers?

I would say that you all are doing a great job of maintaining social distance and keeping the spread of the disease to a minimum. It is so important to make sure our healthcare systems aren’t overwhelmed, and this social distancing and self-quarantining is literally a life-or-death issue for our most marginalized populations. It is terribly disempowering to cower in fear of a disease and keep loved ones, friends, and acquaintances outside of your life. It is terrible to have to miss work or work from a home that has been set up to be an oasis from your work. But it is sadly necessary right now, without reliable treatment or medical preventative measures. We also really really appreciate the outpouring of support for frontline providers! We have been flooded with food from restaurants who want to show their support. Aestheticians and tattoo artists have brought in their unused PPE. Someone wrote very sweet chalk messages on the sidewalk outside of the ambulance bay doors. It has been incredibly sweet to see these demonstrations of appreciation.

Is there a particular story you would like to share with others?

I think the pandemic has exposed some fundamental disparities and economic contradictions in our day-to-day lives. It makes absolutely no sense to have health insurance tied to employment in a context where people are laid off from work for a pandemic. It makes absolutely no sense for landlords to rely on money from people who are less well-off than them who are unable to pay because of reduced hours or layoffs due to a pandemic. The good news is that I’ve seen some neighborhood mutual aid organizations crop up in various neighborhoods across the city in which I live (Durham) and I’d encourage anyone to get involved in these to help and receive help from their neighbors. We can (and likely need to) be more socially cohesive, even if we are physically separated.