My father was 10 years old when the Spanish flu pandemic, a novel H1N1 bird flu, ravaged the world more than 100 years ago, claiming between 20 million and 50 million lives.1 My grandparents were immigrants from Italy who lived with their 6 children in a tiny rented home in inner-city Philadelphia when the Spanish flu hit. My father, the eldest of the 6 children, often reminisced about his experience, staying home from school, the policed quarantine, food scarcity, and the death of his little sister, aged 3 months. Weeks before he died at the age of 104 years, my father described his mother's overwhelming grief and her efforts to keep her youngest alive during the second wave of the Spanish flu. Here we are 100 years later and theoretically, at least, smarter and more medically sophisticated, living through another global pandemic that is tracking eerily like the pandemic of a century ago.
At the mid-April writing of this editorial, the US death toll from COVID-19 was approaching 30 000 and climbing but signs were that a "flattening of the curve" was beginning in some parts of the country. It should be noted that in addition to deaths from COVID-19, seasonal influenza is taking its toll. For example, during the 2018-2019 flu season, the Centers for Disease Control and Prevention estimated that influenza "...was associated with more than 35.5 million illnesses, more than 16.5 million medical visits, 490,600 hospitalizations, and 34,200 deaths...."2
The lessons of this pandemic have been painful; a health care system ill prepared to manage volumes of patients, short supplies of protective equipment to keep direct caregivers safe, job loss and economic stress not experienced since the Great Depression, isolation from loved ones, a constant barrage of information and speculation sometimes referred to as an "infodemic," and a lingering uncertainty about how long the pandemic will last and whether it will resurge. We are also witness to the enormous generosity of people who are finding creative ways to stay connected and live life as normally as possible, to the herculean efforts by scientists to understand the pathogenesis of COVID-19 and develop a vaccine, and to the dedication of direct caregivers such as nurses, physicians, and first responders who risk their own health to care for those afflicted.
This issue of Holistic Nursing Practice explores perspectives and possible interventions that may enhance health and promote healing through these difficult times including (1) an overview of COVID-19, its origins, pathogenesis, effects on the immune system, and specific holistic interventions to enhance health and immunity; (2) an exploration of the nuances of moral distress experienced by direct care providers on the front lines of care; and (3) observations on the clash of COVID-19 with cultural practices by a staff nurse who spent a year in Italy and is now practicing in the United States.
The authors, readers, reviewers, and Editorial Board members of Holistic Nursing Practice span the world, and many reside in countries seriously affected by this pandemic such as China, Korea, Iran, Italy, Spain, Turkey, and the United States. Holistic Nursing Practice will revisit pandemic issues in the coming months to share strategies and best practices in caring not only for pandemic patients but also for enhancing the resilience of direct caregivers.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief
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