This article was first published in the Orlando Sentinel

The coronavirus pandemic was conspicuously slow to arrive in America’s South and Midwest, but a tectonic shift in who the contagion touches and where it reaches has forced a grim reckoning: the coronavirus isn’t just a big-city crisis anymore. Now, it’s a Florida problem — it’s an everywhere and everyone problem.

But unlike bustling urban corridors with well-staffed and provisioned hospitals, the rural and bedroom communities in which the virus is spreading today are the least-equipped in the country to contain the emerging outbreak. 

Long before Florida became a hotspot for a virus that’s already infected more than 100,000 of our families and neighbors, many hospitals across the state were already struggling to recruit and retain nurses and doctors to meet ordinary demand for care.

Not only are these health systems chronically financially strained but they lack the physical resources and clinical expertise to treat a massive influx of critical-care patients. It’s a serious problem if a hospital lacks beds and ventilators, but it’s a whole order of magnitude worse when they also lack enough nurses to staff those beds.

Ironically, many of these same understaffed hospitals were forced to temporarily furlough the few clinicians they had when operating revenues bottomed out after regulators prohibited planned procedures. They’re back on the payroll and their wards now, but the fundamental, underlying imbalance between clinicians and patients remains: Florida needs more nurses if we’re going to make it to the other side of this.

Of course, this phenomenon isn’t unique to any one state, but Florida is especially vulnerable thanks to extraordinarily high rates of co-existing conditions like diabetes, cardiovascular disease, and lung disease that are prime predictors for hospitalization and mortality. 

And as the rates of infection and hospitalization accelerate across the state — and by every measure, they have — the matter of nurse staffing will become a life-and-death concern, because nurse workloads and patient mortality have an inverse relationship. According to the National Institutes of Health, an increase of just one patient in a nurse’s workload tracks with a 7 percent patient mortality increase. 

With the ravenous coronavirus, nurse workloads aren’t just increasing by one patient but by a factor. If overworked nurses means undertreated patients, the obvious solution is to train or hire more. But that seemingly obvious solution has stubbornly eluded policymakers and health-care providers for almost a century, because the United States suffers one of the world’s most persistent and acute nursing shortages.

Health-care analysts estimated that the U.S. would need 1.6 million nurses to satisfy rising demand for care, but would be forced to leave more than 200,000 of those positions empty with the country’s workforce deficit. Unfortunately, that forecast was predicated on stable demand, not the sort of health-care crisis that is subsuming our hospitals today. 

As an emergency stopgap, a bipartisan group of 31 U.S. senators have introduced legislation that would make it easier on hospitals to hire qualified international nurses. The bill, which would recapture previously unused visas for English-speaking nurses with perfect clinical and criminal records, won’t even displace a single American worker because the domestic labor deficit is so enormous, according to the Bureau of Labor Statistics.

The front line in America’s fight against the coronavirus is no longer in major metropolises or tony suburbs. The pandemic spared us a few months, but it’s here now and we need nurses to fight it.