Many lessons can be learned from the Great Pandemic of 1918-1919, which attacked in three waves and killed between 50 million and 100 million people worldwide.
The delay in instituting community social distancing strategies -- such as closures of schools, theaters and churches -- as well as the poor communication by leaders of the seriousness of the disease on the public’s health greatly contributed to the rapid spread of disease and death.
My research included a review of Boston-area newspapers and personal journals of public health nurses who described conditions as “pitiful.” Although temporary hospitals were set up with additional patient beds, many were unable to open due to a lack of nurses.
In this Great Pandemic, as in the current novel coronavirus, there was no vaccine to prevent nor medication to cure the virus. Treatment was only symptomatic so there was an urgent call for untrained volunteers to provide nursing care. But soon their lack of skills became evident as one newspaper reported “1 trained nurse is worth a score (20) of untrained volunteers.”
The Massachusetts commissioner of health sent a desperate pleas to Washington, D.C., for 500 doctors and 1,000 nurses. Washington responded, “Can send all the doctors you want, but not 1 nurse.”
Access to skilled nursing was the greatest predictor of survival in the 1918 pandemic.
According to Dr. Sanjay Gupta, 1 out of 5 persons with coronavirus will be critically ill. For these, he estimates that 200,000 ICU beds and 64,000 ventilators will be needed. Currently we have only 100,000 ICU beds and 64,000 ventilators, which are already in use for other conditions.
Even with more ICU beds and ventilators, we will need many more highly trained and skilled nurses to monitor complicated equipment and care for critical patients. This would mean that we would need 500,000 to 1 million more nurses to care for COVID-19 patients.
To prevent a strain on other hospital resources, many ill patients could be treated at home under the care of Public Health and Visiting Nurses. These nurses are skilled in assessing patient status and providing direct care to prevent hospitalization. Additionally, they are experts in teaching and controlling disease spread and identifying and monitoring contacts.
Sadly, we currently have a serious shortage of all nurses without this additional strain from COVID-19.
Although there have been shortages in the past, the current crisis, without intervention, is alarming.
The Bureau of Labor Statistics estimated that by 2024, there will be 1 million unfilled positions for skilled nurses. This does not include the surge of nurses which will be required for future pandemics or natural disasters.
Given that nurses are on the front lines working long hours, under high stress and with insufficient personal protective equipment, they are more likely to become ill themselves requiring relief and replacement.
World War II created a similar need and shortage of nurses. Within one year, the government created the U.S. Cadet Nurse Corps (USCNC) in less time than is now needed to develop a vaccine.
The USCNC was credited with preventing the total collapse of the health care system during and immediately after World War II. They were trained to care for patients with acute and infectious disease. For example, cadet nurses were deployed to polio wards to care for very contagious patients for whom there was no vaccine or cure.
We could address the shortage of one million nurses by recommissioning the USCNC. They would be trained in contagious, biological and disaster response and deployed to “hot spots” or wherever needed. For example, upon completion of training, senior cadets could have been deployed to the Kirkland Washington nursing home where 19 residents died and another 50 including staff who are ill with coronavirus. This is a highly unusual epidemic for a tertiary health facility which is not equipped or staffed for critically ill and highly infectious patients. The rapid deployment of additional skilled nurses would have decreased morbidity, mortality and community spread.
Congress just passed legislation to create a national Space Corps, so a U.S. Cadet Nurse Corps is not a pie-in–the-sky dream, with far less cost and a direct benefit to our citizens.
If there is anything positive to come from the coronavirus, it may be that we recognize the essential value of skilled nurses. This means expanding our nursing workforce and advancing their training in caring for patients with acute and infectious diseases in hospitals and homes.
This is a urgent national security concern. If we fail to act today, there will be serious consequences for the health of our nation tomorrow.
Barbara A. Poremba is professor emeritus at Salem State University and director of the Friends of the United States Cadet Nurses WWII. She can be reached at firstname.lastname@example.org.