Nurse practitioners across the country are living in a new world. They’re finding new ways to help people from a safe distance, prioritizing in-person visits the best they can, and suiting up each day in case COVID-19 finds its way in the door.

And while many problems have gotten better, such as shortages of protective equipment, with time marching on, treating patients from a distance is only getting harder. And some things can’t be put on hold, so they’re having to see more patients in person.

Jane Carson, 54, has been at the Virgil clinic a total of eight years, with one year off in the middle doing palliative care in the community.

“It’s very different than it was before COVID-19,” she says in a phone interview.

“The clinic is on lockdown.”

While normally she would be seeing about 16 people a day in person, now she’s down to about three or four face-to-face visits per week.

The focus now is on trying to do as many telephone and virtual appointments as possible, though “seeing” patients over the phone or video has its challenges.

“There’s a little bit of increased risk in terms of assessments that we do by phone or video are not as fulsome as in-person physical exams,” she says.

Patients are also told of the higher risk.

“When we contact a patient about their concerns, we have to describe that potential risk to them that we’re taking by trying to manage their health concern in that way,” she says.

One of the risks is not having all of the information that they normally would, she says. And video can also make it harder to see if there is a physical problem.

“For example today, I had somebody with a fall, an injury, a wound, and try as I could to see her wound on her arm, the lighting is just not the same, and so we decided together that she should come in tomorrow to be seen,” Carson says.

It’s also getting to the point where people who have waited for weeks need to be seen in-person.

“What I’m finding is you know, in the first couple of weeks during COVID-19, a lot of the concerns, you know, ‘Oh we can put that off for a week or we can put that off for a couple of weeks,’ but now that time is going on, there’s less things that we can continue to put off.”

“So we’re seeing more patients in-person, and from a personal and professional satisfaction perspective, I am feeling better and much more alive when I’m able to see the patients in person.”

She says most patients are still reluctant to come in, even with the precautions the clinic has in place.

“So, it’s busy, but it’s a very different busy post COVID-19.”

She hasn’t dealt with anyone with COVID-19, which she says is a good indication that NOTL is doing well when it comes to the virus.

Carson thinks the public really has embraced the government’s messaging about physical distancing and only making essential trips.

“And that has helped a lot with the numbers that we’re seeing already,” she says.

“I don’t think Niagara Region Public Health has broken it down or at least they haven’t shared that information of the different regions within Niagara and what the case numbers are, but I haven’t had a positive result.”

Initially, health care providers were “a lot more selective” in who they could test, she says because there was concern about scarce resources of testing materials and lab capacity.

“And so we were following strict criteria from the medical officer of health with Niagara Region Public Health on who could be tested. The criteria was very tight, whereas now that has very much changed and public health would like us to test anybody with any type of symptom. You know, as little as a sniffle or a runny nose. So the testing has increased dramatically.”

The increased testing is because the symptoms of COVID-19 are so varied, ranging from mild ones that could appear similar to allergies “to the other end of the spectrum with severe symptoms,” she says.

“And we’re finding that in the elderly the presentation is often even more vague,” sometimes without fever, but with gastrointestinal symptoms like diarrhea. “And so now that we have the capacity for the increased testing, we want more testing.” Asymptomatic carriers are a concern as well.

Though there was initially a concern health care workers would be short on personal protective equipment, they’re now getting the supplies they need from suppliers, as well as help from the community, she says.

The Shaw Festival recently donated custom-made washable gowns to the clinic. Dillon’s Distillery in Beamsville also provided hand sanitizer.

“It’s amazing, it’s very heartwarming, overwhelmingly heartwarming, actually,” Carson says.

She says patients aren’t panicked about the pandemic situation. People are concerned, “But it seems that the public is well-informed and they seem to understand the risks. And a lot of times when we are speaking to our patients, they have a concern for us as the health care providers as well, which is also really quite heartwarming.”

With the measures they take at the clinic, she says she’s not worried either.

Like Erin Jarvis, featured in last week’s story, Carson has to put on and take off personal protective equipment every day. 

“When we think back to the SARS situation from 2003 a lot of health care professionals were being infected when they were removing their protective equipment, so it’s a very systematic way that we have to do that in order to prevent contaminating ourselves.” she says.

When she’s not working, she essentially doesn’t go anywhere and is ordering groceries online every two weeks.

“So I’m not taking unnecessary risks out in the community,” she said.

At home, in the rural area of St. Ann’s, near Smithville, she has a husband, two grown daughters, a dog named Charlie, and chickens.

Aside from being on NOTL’s front line, she’s also got a green thumb.

“We’ve got quite the large vegetable garden. We’ve got beautiful raised beds, we love to grow tomatoes — every kind of tomato – and cherry tomatoes. We like to make our own sauce. We like to do peppers and hot peppers and kale. And I’m also going to be using one area of my garden for a wild flowers for a cut-flower garden.”

Her husband is a nurse in Burlington.

When she’s not in the garden she also enjoys  exercising and spending time with her family.

“And raise the chickens. We’ve got some chicks coming soon,” she says.

Her best advice should be familiar to everyone already: stay home, only make essential trips, and wash your hands after touching anything.