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We know the hell we’re in. It will get worse before it gets better | Melbourne ICU nurse

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My therapist says it’s OK that sometimes I feel dead inside.

I’m a critical care nurse. I worked in intensive care for all of 2020 and 2021.

I’ve seen people die without their family. I’ve cried at work. I’ve scrubbed salicylic acid into my face before going to work so that my N95-induced acne doesn’t scar.

I’ve held my pee because we didn’t have enough staff to watch my unstable Covid patient. I’ve supported incredible nurses brand new to ICU with extremely sick ventilated patients. The cognitive load used to bring me to tears.

Now I just feel weary.

I started noticing it when I couldn’t bring myself to really feel the emotions. I could say, “Oh, that’s sad,” when talking about something – but not feel it.

According to traditional descriptors of burnout, compassion fatigue is a pillar that most often affects caregivers.

When fearfully bringing this up in session, my beloved therapist told me that this is a defence mechanism to prevent being overwhelmed.

As much as I am an advocate for meditation, yoga and self-care practices at the best of times, there’s not a mindfulness practice that slaps a Band-Aid over the pandemic itself.

My non-medical friends get angry on my behalf at protesters and anti-vaxxers, because I don’t have the energy. I obtained my critical care registered nurse qualification in 2020 after nursing in ICU for a few years, and almost all of the colleagues I graduated with have attempted to leave intensive care since.

The vast majority have been redeployed back to ICU. Some ICUs have been birthed from the pandemic, and more have opened additional beds and floors as we strive to cope with the sheer number of patients.

Those beds need staff, so doctors are pulled from wards, nurses pulled from theatres, and the “experienced” staff are darting between their own patients and those of junior staff to support them in the incredibly complex care that an intensive care patient requires.

An ICU admission is a nuanced beast. People haven’t stopped having strokes, heart attacks, car accidents, transplants and any number of other treatments that we can perform.

We need to titrate life-saving medications, prioritise daily goals, manage a ventilator or dialysis, and that’s not even mentioning the higher-tech interventions like heart and lung machines.

Traditionally, these specialised treatments required specialised training – but in the absence of appropriately trained and energised staff, and with an abundance of patients, we make do.

Redeployed staff members learn on the fly and we do our level best to support them. Through all of this we strive to treat our patients with the humanity they deserve.

We move the breathing tube regularly so it doesn’t create sores on the lips. We roll our patients to prevent pressure areas and keep them comfortable. We brush their teeth, we wash their hair, we fill up a basin and shave their face so they are somewhat recognisable for a telehealth with their family (who are still sick and isolating at home).

At times, family members will drop off pictures of their loved one to put in their cubicle. I’ve found myself staring at those – trying to find similarities between the animated and joyous photograph of someone’s father and the sick individual in a hospital bed.

It sounds selfish to say but it’s hard on the body.

An N95 for 12 to 14 hours leaves you with dented cheeks and the raspiest voice imaginable. Interventions such as proning (turning a patient on to their belly to maximise the interaction between oxygen and blood) can be physically demanding.

Face shields can create tension headaches. Double-gloved hands struggle to open packaging and the dependence on everyone outside your glass-walled cubicle to bring you everything breeds a sense of powerlessness.

I’m 24 and, strangely, I have spider veins now.

Even though I am now splitting my time between intensive care and supporting those isolating at home with Covid via telehealth, I have seen the system groan under the weight of all it needs to support.

The guilt I felt in reducing my contact time in intensive care was damn-near insurmountable but I realised I was not able to provide good and thorough care if I was completely burnt out.

Preservation of energy became a priority for healthcare workers. It has been heartening to see the vaccine work, to hear those at home have mild or even no symptoms, and to find people get better quickly.

In both the hospital and the community there are always some who bring up ivermectin, or go retro with hydroxychloroquine, but overwhelmingly people are vaccinated and ride out their symptoms at home with minimal issue.

Sure, our system is still not there yet. Testing sites are closing before they even open due to lines more than a kilometre long. Pathology centres work 24 hours a day. Rapid antigen tests are sold out almost everywhere. GPs don’t take new patients and the wait for 000 can be a terrifyingly long time.

The work is not done and it won’t be for a while. There is a camaraderie, an even darker sense of humour, pervasive among medical people. We know the hell we’re in and we know it will get worse before it gets better.

Sometimes I enact a no-Covid talk policy. It helps, because sometimes I feel things deeply again.

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Solar storms may cause up to 5500 heart-related deaths in a given year

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In an approximate 11-year cycle, the sun blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field, which may disrupt our body clock and ultimately affect our heart



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17 June 2022

A solar storm

Jurik Peter/Shutterstock

Solar storms that disrupt Earth’s magnetic field may cause up to 5500 heart-related deaths in the US in a given year.

The sun goes through cycles of high and low activity that repeat approximately every 11 years. During periods of high activity, it blasts out charged particles and magnetised plasma that can distort Earth’s magnetic field.

These so-called solar storms can cause glitches in our power grids and bring down Earth-orbiting satellites. A handful of studies have also hinted that they increase the risk of …

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UK Covid infection rate rising, with more than a million cases in England | Coronavirus

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Coronavirus infections are rising in the UK, figures have revealed, with experts noting the increase is probably down to the more transmissible BA.4 and BA.5 Omicron variants.

The figures from the Office for National Statistics (ONS), based on swabs collected from randomly selected households, reveal that in the week ending 11 June an estimated one in 50 people in the community in England are thought to have had Covid – around 1.13 million people.

The figure is even higher, at one in 45, in both Wales and Northern Ireland, while it was highest in Scotland where, in the week ending 10 June, one in 30 people are thought to have been infected.

While the figures remain below the peak levels of infection seen earlier this year, when around one in 13 people in England had Covid, the findings are a rise on the previous week where one in 70 people in England were thought to be infected. Furthermore, the data reveals increases in all regions of England, except the north-east, and across all age groups.

Experts say that a key factor in the increase is probably the rise of the Covid variants of concern BA.4 and BA.5.

“Infections have increased across all four UK nations, driven by rising numbers of people infected with the BA.4 and BA.5 Omicron variants,” said Kara Steel, senior statistician for the Covid-19 Infection Survey.

While Steel said it remained too early to say if this was the start of another wave, others have warned it may already have begun, with increased mixing and travelling among other factors fuelling a rise in cases.

Among concerns scientists have raised are that BA.4, BA.5 and another variant on the rise, BA.2.12.1, replicate more efficiently in human lung cells than BA.2.

Prof Azra Ghani, an epidemiologist at Imperial College London, said the latest figures were not surprising, and might rise further.

“This increase in infection prevalence is likely due to the growth of the BA.4 and BA.5 Omicron subvariants, which as we have seen elsewhere in Europe, appear to be able to escape immunity generated from previous Omicron subvariants,” she said.

“It is therefore possible that we will continue to see some growth in infection prevalence in the coming weeks and consequently an increase in hospitalisations, although these subvariants do not currently appear to result in any significantly changed severity profile. This does however serve as a reminder that the Covid-19 pandemic is not over.”

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NHS to offer women in England drug that cuts recurrence of breast cancer | Breast cancer

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Thousands of women in England with breast cancer are to benefit from a new pill on the NHS which reduces the risk of the disease coming back.

The National Institute for Health and Care Excellence (Nice) has given the green light to abemaciclib, which cuts the chance of breast cancer returning after a patient has had surgery to remove a tumour.

Trials showed that patients who had the drug with hormone therapy had a more than 30% improved chance of their cancer not coming back after surgery, compared with hormone therapy alone.

“It’s fantastic thousands of women with this type of primary breast cancer will now have an additional treatment option available on the NHS to help further reduce the risk of the disease coming back,” said Delyth Morgan, the chief executive of charity Breast Cancer Now.

“The fear of breast cancer returning or spreading to other parts of their body and becoming incurable can cause considerable anxiety for so many women and their loved ones.

“New effective treatments such as abemaciclib, which can offer more women the chance to further reduce the risk of the disease recurring, are therefore extremely welcome and this is an important step change in the drug options available for this group of patients.”

The twice-a-day pill is suitable for women with hormone receptor-positive, HER2-negative, node-positive early breast cancer at high risk of recurrence who have had surgery. About 4,000 women will benefit initially, Nice said.

Helen Knight, the interim director of medicines evaluation at Nice, said the draft recommendation came less than a month after abemaciclib received its licence.

“The fact that we have been able to produce draft recommendations so quickly is testament to the success of our ambition to support patient access to clinically and cost effective treatments as early as possible,” said Knight. “Until now there have been no targeted treatments for people with this type of breast cancer.

“Abemaciclib with hormone therapy represents a significant improvement in how it is treated because being able to have a targeted treatment earlier after surgery will increase the chance of curing the disease and reduce the likelihood of developing incurable advanced disease.”

Abemaciclib works by targeting and inhibiting proteins in cancer cells which allow the cancer to divide and grow. It normally costs £2,950 for a packet of 56 150mg-tablets, but the manufacturer, Eli Lilly, has agreed an undisclosed discounted price for NHS England.

“Thanks in part to this latest deal struck by NHS England, NHS patients will be able to access another new targeted drug for a common and aggressive form of breast cancer,” said Prof Peter Johnson, the cancer director of NHS England.

“Abemaciclib, when used alongside a hormone therapy, offers a new, doubly targeted, treatment option, helping to increase the chances of beating the cancer for good, as well as meeting the NHS’s commitment to delivering improved cancer care under our long-term plan.”

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