Jane Thomason

Remarks at National Nurses United COVID-19 Presser

delivered 5 March 2020, Oakland, California

Audio AR-XE mp3 of Address


[AUTHENTICITY CERTIFIED: Text version below transcribed directly from audio]

Thank you to our nurses for sharing their on-the-ground experiences with COVID-19. Their stories are perfect examples of why all health care facilities must be prepared -- not only as a responsibility of the employer to provide a safe and healthy workplace, but to stop the spread of this global disease to protect public health.

My name is Jane Thomason and I'm an industrial hygienist for National Nurses United. My job is to identify and mitigate conditions in the workplace that harm nurses. Protecting nurses in turn protects patients and our communities.

The results of our national survey of more than 6,500 nurses is [sic] truly disturbing. They show that large percentages of the nation's hospitals are unprepared to safely handle COVID-19.

Here are just a few highlights:

-> Only 27 [29] percent of nurses responding report that there is a plan in place to isolate a patient with a possible COVID-19 infection.1

-> Twenty-three percent of nurses report that they don't even know if there is a plan in place.

-> Many nurses either don't have access to necessary Personal Protective Equipment -- the PPE that you heard about already -- don't have enough stock on hand, or haven't been fitted or trained on how to use -- how to properly use PPE.

-> Only 63 percent of the nurses responding to our survey had access to N95 respirators on their units.

-> Only 27 percent had access to PAPRs -- the Powered Air-Purifying Respirators -- the higher level of protection that we are recommending.

-> Only 44% of nurses report that their employer has provided them any information about COVID-19.

As Bonnie [Castillo] explained, nurses follow that precautionary principle -- because they are patient advocates, and also because they are are scientists. Nurses understand how diseases spread. Vigorous infection control means that you always take the safer route: you opt for the higher level of PPE; you adopt the higher standards.

Sadly, our federal government agencies have not followed this principle in their approach to containing this virus; and now we are reactive when we could have, months ago, been proactive.

In recent days, just this morning, we have heard discussion about the Centers for Disease Control [and Prevention], the CDC, weakening their guidance even further, including recommending surgical masks, instead of respirators, for nurses providing care to patients with COVID-19.

NNU [National Nurses United] is opposed to these changes.

We have ample scientific evidence that this is the wrong step to take. For example -- this is only a portion of the SARS Commission Report from 2006 that clearly and explicitly states that the use of surgical masks instead of respirators did not protect nurses from SARS,2 which is a similar coronavirus to SARS-CoV-2, which is the virus that causes COVID-19.

Many health care works in Canada and around the world were exposed, infected; some died; and many brought the virus home to their families because of this lack of protection.

Now is not the time to weaken guidance.

Now is the time to use every possible tool available to guarantee the highest level of protection, guided by the precautionary principle, to prevent the spread of infection, to protect health care workers, and to preserve our capacity to respond to a potential widespread outbreak.

National Nurses United has written to multiple agencies, including the presidential administration, all members of Congress, and the CDC asking them to step up protections.

Just yesterday we petitioned the Federal Occupational Safety and Health Administration, OSHA, to adopt an emergency temporary standard immediately on emerging infectious diseases, because currently no such enforceable standard exists nationally.

California, though CAL/OSHA, has the protective aerosol transmissible diseases standard, which must be thoroughly enforced and held as a model to ensure that our nurses, other healthcare workers, their patients, and communities are safe.

We are continuing to monitor agency action closely and look forward to working with local, state, and federal agencies to implement our recommendations, the nurses' recommendations, to combat COVID-19.

1 According to the survey summary, 29% of respondents -- not 27% as stated -- indicated "there is a plan in place to isolate a patient with possible novel coronavirus infection." Apparently, a single survey item was used to measure the absence or presence of an infection plan. However, neither the survey item nor the summary result from that item appears to distinguish between what respondents believe to be the case and what is actually the case with regard to the absence or presence of a quarantine plan. Convergent measures -- positing more than one survey item to measure the same idea -- or disaggregating the data by level of experience or level of authority, among other variables, might shed additional light on the matter. There may well be a problem, even a serious problem, regarding hospitals' coronavirus infection isolation plans -- and perhaps on a national scale -- but the survey summary, as provided, does not seem precise enough to get us there. Further, although the sample size is quite large, especially given the population from which it was taken, it would be useful to see the response rates both for the survey as a whole and for the individual highlighted survey items above,

2 NOTE: The foregoing and following does not constitute expert medical advice. It is based on a lay reading of source material from the 2006 SARS Commission Report. Interested readers are encouraged to read the Commission report for themselves toward an understanding of the targeted issues. The SARS Commission Report findings located here appear to offer inconclusive evidence on the empirical questions of whether and to what extent surgical masks -- in lieu of respirators (which offer greater protection for users against airborne contaminants due to leakage correctives) -- may or may not have protected nurses from SARS. See, for example Vol 2 pps. 11-12, pps.26-27 p.259 (and see note 221), p.293, On the related policy question, however, the report was clear: "The prioritization of respirator use during a pandemic remains unchanged: N95 (or higher) respirators should be worn during medical activities that have a high likelihood of generating infectious respiratory aerosols, for which respirators (not surgical masks) offer the most appropriate protection for health care personnel. Use of N-95 respirators is also prudent for health care personnel during other direct patient care activities (e.g., examination, bathing, feeding) and for support staff who may have direct contact with pandemic influenza patients" [emph. added; source: http://www.archives.gov.on.ca/en/e_records/sars/report/v2-pdf/Volume2.pdf (p.28)]

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