The Impact of COVID-19 on Nurses

Mary C. Vrtis, Ph.D. MSN, RN, OCN, NEA-BC, FCN

December 20, 2025

As of November 2025, 1.23 million Americans died following a COVID-19 infection and 103,080 died AFTER the public health emergency was over.

More than 7.1 million global citizens lost their lives due to COVID-19 with 170,000 deaths since the PHE was declared over on May 11, 2023.

Nurses worldwide are already facing the challenges involved in caring for patients with emerging, highly pathogenic viral, bacterial, and fungal variants of infectious diseases. If we study the issues that arose during the COVID-19 pandemic we can learn how to prevent such massive loss of life the next time.

The life you save may be your own…

Table of Contents

Dedication

Methods

• Use of Primary Sources and Archived Statistical Data for Secondary Analysis
• References
• An Example of Information that Has Been Removed from Government Websites
• Secondary Sources and Fact Checking
• Conspiracy Theories and Myths

I am Dying to Take Care of You Part 1, Personal Stories of Nurses Who Died of COVID-19 Infections

• Introduction
• A Lack of Accurate Official Information
• Inadequate Respiratory Protection and Nurse Deaths, March-April 2020
• In Their Memory
• The First Fourteen U.S. Nurse Deaths, March 24 to April 1 of 2020
• The First Fourteen (continued), Nurses and Retirement, March 14 to April 1, 2020
• More Nurses Who Had Planned to Retire or Returned to Fight COVID-19, April 2, 2020, to February 2021
• Nurses in the News Who Died on the Frontline, August 2020 to February 2021
• COVID-19 Deaths of Pregnant Nurses
• Tributes to Nurses and Healthcare Providers
• New York State Nurses Association
• American Nurses Association We Honor our COVID-19 Fallen Nurses
• International, Interdisciplinary Healthcare Worker Deaths
• Medscape (2021, June 3). In Memoriam: Healthcare Workers Who Have Died of COVID-19
• The Guardian/ Kaiser Health News: Lost on the Frontline Tribute
• Conclusions of Guardian/ and Kaiser Health News Research Team
• A Study of U.S. Healthcare Provider COVID-19 Cases and Deaths
• Summary
• References

COVID-19 Pathophysiology and Disease Process

• A Global Effort to Learn About this New Pathogen
• A Range of Responses to COVID-19
• Modes of Transmission – SARS-CoV-2 (COVID-19) in 2020
• COVID-19 Pathophysiology
• SARS-CoV-2 and the ACE2 Receptors
• Viral Mutations
• Cytokine Storm Post-Acute COVID-19
• The Innate and Adaptive Immune Systems
• The Cytokine Storm Inflammatory Process
• Injury to the Vascular Endothelium
• Post-Acute Multisystem Inflammatory Syndrome
• Multisystem Inflammatory Syndrome in Children (Under Age 21)
• Multisystem Inflammatory Syndrome in Adults (MIS-A)
• Post-Acute or Long COVID
• A Mini Primer on the Viral Genetics of SARS-CoV-2
• Summary
• References

COVID-19: A Path of Death and Destruction

• China – December 2019 to February 2020
• Advanced Technologies, Genetic Sequencing and Global Sharing of Information
• Deadly Mutations: Probable Zoonotic Origin of SARS-CoV-2
• Why Did the Virus Spread so Fast?
• Humans Spread the Virus Throughout the World
• Modes of Transmission – SARS-CoV-2 (COVID-19) in 2020
• The Situation in China and the World Worsened January 2020
• China Published an Epidemiological Study February 2020
• Fatalities in China February 2020
• U.S. COVID-19 Study – Outcomes in March 2020
• COVID-19 Rages Uncontrolled
• References Cited

A Global Shortage of Personal Protective Equipment

• COVID-19: Guidance for Personal Protective Equipment
• U.S. Nurses on the Front Lines did NOT Have Adequate Protective Equipment
• Nurse Surveys
• National Nurses United Nurse Survey and Press Conference March 5, 2020
• The American Nurses Foundation Survey, May 2020
• The American Nurses Foundation August, 2020
• Reuse of N95s: The Science Did NOT Support Practices
• National Nurses United Surveys March and September 2021
• Inadequate Protective Equipment: Nurses at Risk
• The Consequences of Failure to Protect Healthcare Providers
• Disruption of Global Personal Protective Equipment Supply Lines
• Emergency Authorization for Use of Non-NIOSH Approved Respirators in the U.S.
• Changing Standards of Care for Staff Protection
• Consequences of Required Prolonged and Reuse of Disposable PPE
• Rapidly Rising Costs and Price Gouging
• Counterfeit Personal Protective Equipment Floods the Marketplace
• International Fraud
• A European Scam
• A U.S. Scam
• The Situation in Other Countries
• Moving Toward Solutions
• Acceleration of Personal Protective Equipment Production Worldwide
• Defense Production Contracts: General Motors and the Ford Motor Company
• A Return to Conventional Capacity Standards of Care
• A Sustainable Public Health Supply Chain
• Recommendations
• References Cited

The Kindness of Strangers

• Help Started to Arrive, the Impact of Ordinary People Who Came to Our Rescue
• Craftivists versus COVID-19 the DC/Maryland/Virginia “Million Mask Challenge”
• #GetUsPPE Distributes Millions of Units of Personal Protective Equipment to Healthcare Organizations and Schools
• Apple Produced and Donated Millions of Masks and Face Shields
• References Cited

The U.S. Response: Too Little Too Late

• Introduction
• The U.S. Had a Disproportionate Number of COVID-19 Infections and Deaths
• Deadly Delays: The U.S. Governmental Response
• A Closer Look
• Public Refusals to Follow Basic Infection Control Recommendations
• From Zero to 1 million Cumulative Cases in Four Months
• Nurses and Other Healthcare Professionals were NOT Protected!
• Pre-pandemic Readiness
• What DID happen?
• Political Divisions and an Inability to Fight Against a Common Enemy
• The U.S. Plan to Withdraw from the World Health Organization During the Pandemic in April of 2020
• Superspreader Events Compound the Problem
• References Cited

Dangerous Mutations: the Continuous Emergence of SARS-CoV-2 Variants

• Viral Reproduction
• SARS-CoV-2 Variants and the Impact on Nurses and the U.S. Healthcare System: Looking Back so we can Move Forward
• World-wide Collaboration
• Classification of Variants and Subvariants
• Basic Concepts
• Reproduction Number and Transmission
• Viral Lineages
• Case Fatality Rates versus Mortality Rates
• Estimates of Case Fatality Rates for Nine Countries While Variants of Concern were Dominant
• Outcomes for SARS-CoV-2 Variants of Concern in the U.S.
• Methods
• SARS-CoV-2 Variants of Concern 2020 to 2021
• Case Fatality Rates/ Mortality Rates for the Ancestral Variant
• Infections and Deaths of Health Care Personnel January to October 31, 2020
• Infections and Deaths of Health Care Personnel January to October 31, 2020
• New Mutations, New Variants
• The Iota Variant B.1.526 and other variants, circulating November/ December 2020 to June 2021
• The U.S. from October 31, 2020, to February 27, 2021
• Healthcare Worker Deaths October 31, 2020, to February 27, 2021
• The Alpha B.1.1.7 SARS-CoV-2 Variant, February 27 to July 3, 2021
• Nurse and Other Healthcare Worker Deaths during Alpha
• Mitigation Strategies February 2021 to January 2022
• The Delta B.1.617.2 Variant, June 5, 2021, to January 1, 2022
• Nurse and Other Healthcare Worker Deaths During Delta
• Omicron Variants, Multiple Variants of Concern, December 2021
• Omicron B.1.1.527 and BA.1, December 28, 2021, to April 2, 2022
• Omicron Reproduction Number and Transmission
• Omicron BA.5 June 4, 2022, to December 31, 2022
• Mitigation Strategies: Vaccinations and Omicron
• Omicron XBB.1.5, December 24, 2022, to August 5, 2023
• Omicron Mutations
• Vaccinations
• Emerging Variants Can Change Everything
• Front Line Staff Nurses are an Invaluable Resource
• COVID-19: The Public Health Emergency Has Ended; COVID-19 Will Be With Us for Many Years to Come
• Summary
• References

The Birth and Re-emergence of the “Vaccines Cause Autism” Conspiracy Theory

• Autism spectrum disorders
• Author’s note
• Andrew Wakefield – Measles, Mumps, and Rubella (MMR) and the Birth of the Contemporary Anti-Vax Movement, 1998
• The Journal Article
• The Press Conference
• The Lancet Published a Critical Review of the Wakefield Article in the Same Issue
• An Investigative Journalist Uncovered Egregious Ethical Issues
• An Immediate Backlash in Letters to The Lancet Editor
• Taylor Study: Vaccines Do NOT Cause Autism
• Wakefield was Cast as an Expert in the U.S.
• Wakefield Testifies at a Hearing at the U.S. House of Representatives in April 2000
  • Burton Promoted Wakefield During the Hearing
  • Wakefield’s Testimony Before the U.S. House of Representatives
  • Dr. Offit Explained Why the Theory that Vaccines Cause Autism was Flawed
  • Dr. Boyle Described Studies that were in Progress by CDC, NIH and the Agency for Toxic Substances and Disease Registry in 2000
  • Dr. Brent Taylor Described One of the First Large Studies (of Many) that Showed NO Evidence of that MMR Vaccines Caused Autism – and Critiqued Wakefield’s Claims
• Wakefield Left Royal Free Hospital Medical School
• Representative Dan Burton Again Portrayed Wakefield as a Hero, U.S. House of Representatives, June 2002
  • Representative Henry Waxman of California Challenged Burton’s Support of Wakefield and Unsubstantiated Vaccine Theories
• Wakefield and Financial Conflicts of Interest
• Wakefield’s 1997 Patent for a Separate “Measles Vaccine” is exposed in 2004
• Complaints to the General Medical Council February 2004
• Simon Murch and Nine Co-authors of The Lancet Publication Sent a Partial Retraction of the 1998 Study, March 6, 2004
• United Kingdom Parliament House of Commons Debate on MMR Vaccinations and Autism was Held in March of 2004
• The UK General Medical Council Conducts Fitness to Practice Hearings, 2007 to 2010
• The General Medical Council Fitness to Practice Hearing, January 2010
• Wakefield Lost His Medical License in 2010
• The Lancet Fully Retracted the 1998 Wakefield Article
• COVID-19 Reignited the Vaccines Cause Autism Conspiracy Theories
• Summary
• References

After Action Analysis Sample Report

• Sample of an After Action Report

Pandemic Preparation, U.S.

• Pre-COVID-19 Pandemic Preparations, United States
• Bad Decisions and Factors that Fueled the Pandemic
• Pandemic and All-Hazard Preparedness Laws and Reports
• Governmental Agencies, Institutes, Offices and Entities Involved in Infectious Disease and Pandemic Preparation and Response
• Centers for Disease Control and Prevention/ Health and Human Services
• The National Institutes of Health (NIH)
• ASPR/TRACIE
• U.S. Department of Defense
• State and Territorial Health Departments