Pandemic Nursing: Forty Years of Advocacy

To honor and elevate the history and relevance of providing care with love to populations that have been stigmatized or marginalized, we invited a guest author, Kristopher J. Jackson, to share his voice on the COVID-19 and AIDS crisis. 

Kristopher J. Jackson, MSN, ACNPC-AG, CCRN
PhD Candidate, University of New Mexico College of Nursing, Albuquerque, NM
Acute Care Nurse Practitioner, UCSF Medical Center, San Francisco, CA

“Across the United States, wards of patients admitted to the hospital with an unusual pneumonia became more commonplace. Little was known about these patients’ condition, their projected illness course, or how to treat them.”

For those who have worked in the acute care setting during the last fifteen months, these statements certainly sound as though they were intended to describe the thousands of Americans hospitalized with severe COVID-19. However, the sequestration of patients afflicted with a poorly understood viral illness is not a novel practice. For those in clinical practice four decades ago, many may recall a different viral illness that created similar panic and confusion among healthcare professionals: the beginning of the AIDS epidemic. Undoubtedly, AIDS patients who presented with pneumocystis pneumonia in the 1980’s differed clinically from present-day COVID-19 patients today in a myriad of ways. Clinically speaking, the two diseases have almost nothing in common at all. Despite the overwhelming number of differences between AIDS and COVID-19 as clinical entities, there are some poignant similarities in the American public’s reaction to these two pandemics and they tend share a common theme: a fear of the unknown.

As both pandemics began to ravage communities in the United States, providers and public health officials found themselves having to answer challenging questions: How is the virus spread? How do nurses, providers, and hospital staff care for a patient with a potentially deadly disease? What protective equipment do providers need to take care of these patients? Who should take care of these patients? Meanwhile, the American public had many questions of its own: How do we protect ourselves? Where did this virus start? Who is to blame? Who should we ostracize? As both pandemics began to jeopardize the “American way of life,” fear and anxiety plagued a nation.

In the early 1980’s, more patients died from a disease initially referred to by scientists as “gay related immune deficiency” or “GRID” and – more colloquially – “gay cancer.” In 1982, one particularly reprehensible reporter and White House correspondent, Lester Kinsolving, once mockingly referred to the disease as the “gay plague” in a press conference with former President Ronald Regan’s acting press secretary, Larry Speakes. Despite the thousands of American deaths, Kinsolving’s remarks were met with jokes and laughter by members of the White House press corps. While reporters and government officials in Washington D.C. amused themselves with commentary about those suffering and dying from AIDS, these patients were being abandoned and spurned by their families and communities. Fearing what they did not understand, some physicians and nurses refused to see or care for patients living with the virus. Other members of the American public felt an HIV diagnosis was some sort of karmic punishment for the gay men and intravenous drug users that contracted the first cases of the disease. These are beliefs that, to this day, remain deeply embedded into the very fiber of some sects of American society.

Nearly forty years later, in December 2019, early reports emerged of a bizarre coronavirus-associated pneumonia in China. As the World Health Organization and international public health experts began to investigate this new virus in the weeks that followed, the American public prepared a response of its own. Videos of Asians or individuals of Asian descent consuming bats or “bat soup” plagued the internet. Much like the early years of the AIDS epidemic, the American “way of life” was in jeopardy and the American people needed to hold someone accountable. Former President Donald Trump would later come to refer to COVID-19 using a variety of derogatory, xenophobic, anti-Asian epithets including: “China virus,” “Wuhan virus,” “China plague,” and the “Kung-Flu.” As the leader of the free world ‘dialed-up’ his anti-Asian rhetoric to provide Americans a target for their rage, Asian-Americans faced more violence and more racism; hate crimes committed against Asian-Americans became more commonplace.

While decades apart, the early failures and relative inaction of the executive branch of the U.S. Federal Government during the beginning of both the HIV/AIDS and COVID-19 pandemics are well documented. The first cases of HIV surfaced in 1981 and the virus itself was isolated in 1983. Sadly, President Ronald Regan would not publicly utter the word “AIDS” until 1985. According to the Centers for Disease Control, more than 50,000 Americans would be diagnosed with HIV between 1981 and 1987 when President Regan formed the Watkin’s Commission to investigate the AIDS epidemic. More than 95% of Americans diagnosed with HIV as a result of President Regan’s flagrant disregard for the disease died during this same period.

In early 2020, as international public health experts warned of the severity and virulence of the novel coronavirus, the executive branch of the federal government failed to heed these warnings. However, perhaps more disturbing, is that former President Donald Trump offered the American people false assurance and abject lies. On April 7th, 2020, President Trump told the American people: "…so, you know, things are happening. It's a -- it's -- I haven't seen bad. I've not seen bad." The day before this announcement, the death toll of Americans who had succumbed to COVID-19 surpassed 10,000. By April 11th, more than 20,000 lives had been lost to COVID-19. The Federal Government also failed to issue a federal mask mandate or mandatory guidelines regarding social distancing, instead allowing individual states to choose how they would respond to this public health emergency. This leadership failure translated to a highly partisan response to a deadly virus, as well as unnecessary death and human suffering. To date, nearly 600,000 Americans have died as a result of COVID-19.

Despite the early failures of the U.S. Government to lead or act during either of these viral pandemics, everyday heroes worked to answer the desperate calls for help from patients, providers, and their communities. One of the first specialized AIDS wards in the country was opened at San Francisco General Hospital using an all-volunteer nursing staff. Shortly after the formation of Gay Men’s Health Crisis in New York City, the oldest AIDS organization in the United States, nurses offered volunteers trainings on basic caretaking skills. Over time, as HIV care transitioned to the outpatient setting and overburdened clinics, advanced practice nurses answered these calls for help and now play an integral role in the treatment and management of HIV in the United States today. Decades later, as COVID-19 wreaked havoc across New York City, more nurses answered pleas for volunteer assistance in the city’s overburdened hospitals than could be processed. During the last year, nurses across the United States stepped out of their outpatient clinics and lower acuity settings and into makeshift intensive care units to care for our country’s sickest and most vulnerable patients.

The AIDS and COVID-19 pandemics are merely two examples of public health emergencies where nurses have worked —proudly — on the front lines in their communities. While government leaders and policymakers may have been slow to respond to these crises, nurses were among the first to care and advocate for these vulnerable patients. Unfortunately, new threats to public health continue to emerge, almost daily, that further jeopardize the status of sexual and reproductive health care in America. Unlike AIDS or COVID-19, we as nurses know what these threats look like; we know how these threats will adversely affect the health and well-being of our patients. Taken together, these crises represent public health emergencies that require the same diligence and commitment to our patients that we have shown throughout history. The future of person-centered, quality sexual and reproductive health care in the United States rests on our shoulders.

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