Editor’s Note: The opinions expressed in this blog post are solely those of the author.

“Where do we begin? What marks the start of any new adventure? 
Is it the first step?...the deep breath?.... the single leap of faith? ….and what do we leave behind us—when the future calls?”

I watched Episode 1/ Season 9 on March 3rd when it had been sent to me by email. I have written my blog and rewritten my blog several times. The reason is that the novel coronavirus (COVID-19) has been an escalating public health crisis…and the intensity or level of what I wanted to say or the emotions that I project within my words has shifted over this time frame…it is now March 26th—so much has occurred and unfolded. Episode 1 dealt with a 1960s health crisis of smallpox. As a Modern Day midwife we are dealing with a 2020 global pandemic. Much has happened in a short time: Dec. 31, 2019, a Chinese Health official informed the WHO about a cluster of 41 patients with this mysterious pneumonia; Jan. 7, 2020, they identify this new type of coronavirus (called novel coronavirus or nCOV); Jan. 20 the first US case is reported in Washington State; Feb. 8, the first US citizen dies in Wuhan; Feb. 29, the first death on American soil; March 8, we see Italy placing all 60 million residents on lockdown; March 11, the global pandemic is declared; March 13t a US national emergency is declared.

I have been a clinician, administrator, and educator. The last few years I have taught within several courses in the graduate nursing program Evidence Based Practice and Epidemiology/ Biostatistics. I am accustomed to talking about diagnosis, containment, mitigation, flattening the curve, herd immunity; however, I realize for many these are new words and concepts to grasp. Another thing is information is coming at people at lightning speed. Also—some do not know who to turn for reliable information. I have put some reputable sources at the bottom—I put my stock in science and data—so the CDC and the WHO are reputable sources.

When we started to hear more about the virus many people asked me—what is a pandemic? So within a community there can be a disease or illness noted and when this occurs in greater numbers in that community, region, or even for that season - it would be considered an outbreak. If it is considered highly contagious—even a single case can be considered an outbreak. When infectious diseases spread rapidly to many people this is an epidemic. An example was in 2003 and we can remember the severe acute respiratory syndrome (SARS) epidemic. When we have a global disease outbreak then it is considered a pandemic. It is frightening to see the rapid spread and increasing mortality (death) rate with COVID-19. Varied things can impact this rate—the number of people that become infected, how virulent or severe the disease process is, the vulnerability of the population that are affected, and also the effectiveness of the preventative steps. With a new virus, like COVID-19, there really is no immunity – so then everyone should consider themselves at risk.

I live in Michigan—again things have progressed at lightning speed. On Feb. 28, Gov. Gretchen Whitmer announced the state would activate its emergency operations center to prepare for potential cases. It was on March 10 that Michigan confirmed its first 2 COVID-19 cases (this happened to be our election day). Gov. Whitmer had the State colleges and schools to suspend classes and urged “social distancing”. It is shocking that by March 12 we had a total of 12 cases. By March 13 all K-12 schools closed, and there were restrictions on gatherings of 250 or more people. Incredibly by March 14, we have 30 cases and more restrictions were instituted. By March 16, bars and restaurants closed and we have 50 reported or diagnosed cases and people could not gather in groups larger than 50. Our first death was on St. Patrick’s Day, and we have more than 100 cases. By March 18, the Army National Guard is called in to help our state with getting coronavirus supplies. March 21, the US-CANADA border begins to close to non-essential traffic. By March 22, the COVID-19 cases surpass 1,000 and the death toll is 9 people. March 23, we have a stay at home order for at least 3 weeks. As of today we are listed as the 4th highest state with 2,856 cases and 60 deaths.

With a pandemic we are now seeing the impacts that can occur to our economy and life can be quite disrupted. But I cannot emphasize enough that people need to take this seriously. Someone wrote on social media—our grandparents gave up so much for us—we are being asked to wash our hands and stay at home!! Midwives are continuing on…. they are facing many challenges and obstacles. Yes, we will do this by applying our education, knowledge, and skills; however, we are facing things we have never encountered before as we try to continue to protect women, families and the birth process.

The weekend of March 21 I attended the American College of Nurse-Midwives (ACNM) Board meeting—our weekend was spent discussing how to help our midwifery members with up to date information/ resources/ shifting care by many avenues such as telemedicine/ personal protective equipment etc. We have been busy with webinars and attending briefings from CDC, WHO and an ACNM Board member represented ACNM at a White House briefing.

For myself—I want to stay calm so that I can keep my mind/head clear…I have found it important to plan ahead and to prepare. It is important to really try to stay healthy with getting adequate rest and sleep, eating nutritiously, getting exercise, and managing one's stress. I try to consistently begin and end my day with time meditating, writing in a daily gratitude journal, and journaling so that I remember the progression of things historically. We also really need to take a page from the Nonnatus house midwives and nuns—to be compassionate and truly take care for our community. The most vulnerable can be our seniors in our community. Yes ‘social distancing’ can be very disruptive and difficult for so many. I saw an analogy the other day on the news with match sticks beside themselves—then lit—and the rapid spread of the fire….then space with distancing—and the flame extinguished. It really visually illustrated how we can slow the spread and have time to learn more about this virus, to give time for our scientists to come up with effective treatments and a vaccination, and to help spread the healthcare resources so that the use of them can be handled (flattening the curve). Here in Michigan—I have read we are now at our capacity—so we will need to ramp up and find more resources.

It is important to take this seriously— protect you, and thereby protect each other. If one person breaks this they will break the circle. We need to act as a unified community. We have to pay attention to the data and science. Lives are depending on it!

“The past is never lost to us. We carry it with us everywhere we go. It is in every cell of our body and our soul. It is where we have been. It is where we learn to love. It is where we made our mistakes…. and where we can consign them. The gift is knowing that the present will soon pass and the way we embrace it has the power to change everything.”

References and Resources

CDC information regarding Coronavirus

CDC situation summary

CDC and Pregnancy

CDC on Care in Inpatient Obstetric Healthcare Settings

Clinician Outreach and Communication Activity (COCA)/ CDC

World Health Organization (WHO)