Nurses around the world tell us how their lives have changed during the pandemic, and how they cope on the front lines

• The World Health Organization named 2020 the "Year Of The Nurse" long before the pandemic arrived.
• Business Insider spoke to nurses in countries around the world about how their lives have drastically changed, and how they are coping mentally and physically.
• Each nurse said they chose the profession because of the close relationship they have with the patient.
• That proximity means they are now the most exposed to the coronavirus.

Nurses are the on frontline of the global fight against the novel coronavirus. They make up 59% of the healthcare workforce, and provide the majority of patients' day-to-day care.

The latest data from the International Council of Nurses (ICN) suggest 90,000 nurses have been infected, and at least 260 have died, though that is probably a huge underestimate, according to Annette Kennedy, director of the ICN.

Even before the pandemic, nurses were already stretched, working back-to-back shifts with limited resources.

After the coronavirus hit, double shifts turned into triple, with vacation replaced by extra shifts or sick leave for those who've contracted the coronavirus — an increasingly common scenario, exacerbated by global shortages of coronavirus tests and personal protective equipment (PPE) for healthcare workers.

"They are the backbone of the healthcare system," Kennedy said. "I think the pandemic has shown how invaluable nurses are in the whole scheme of things. But they need support. They're the only people between the patient and the relatives, but the relatives can't visit any longer. So that's extremely stressful. Those nurses are going to be mentally and physically challenged."

Business Insider spoke to nurses in countries around the world about how their lives have changed, and how they're coping on the front lines.

Here, they explain their experiences in their own words. (All of the interviews have been edited for brevity and clarity.)

Cristiana Macor, a nursing manager in Udine, Italy: 'I basically live for COVID'

Cristiana Macor is the Nursing Manager of Anesthesia and Resuscitation at Udine Hospital in Udine, northern Italy, a region hit hard by COVID-19. To date, Italy has recorded 227,000 infections, 129,000 recoveries, and 32,169 deaths. Udine is in the province of Friuli-Venezia Giulia, which has recorded 3,203 infections and 320 deaths. Macor wrote to Business Insider in late April. Her words have been translated from Italian.

At the moment I basically live for COVID. That may sound strange, but it's true. It is the focus of my work, my department I work for 100% involved in the emergency.

I manage 170 people, including nurses, social workers, the analgesic therapy surgery, ambulance drivers, and a helicopter rescue service.

Having to manage all this when the COVID-19 outbreak began, the fear has never left me, but the adrenaline has saved me. My endorphin levels skyrocketed, and kept me working continuously for almost two months. I have been working 10 or 11 hours a day, including weekends.

As a manager, I had to rethink the structure of everyone's working day. I planned more breaks during the service shift for both psychological and physical recovery. We created a new refreshment area to limit gatherings among the staff, we put in bathrooms with showers.

It looks like a war scene, and it was just like one. We couldn't have imagined it. In a short time we created structures and services dedicated to positive or suspect COVID patients. We closed off all the intensive care wards to visitors.

The human dimension of care is always important, but in this pandemic, where isolation is necessary, it has become extraordinarily important. But it has been difficult, both because we don't fully understand each patient's clinical outlook, and because we need to wear PPE (personal protective equipment), which makes it hard to see each other.

Wearing a mask, double gloves, cap, gown, visor, overshoes is definitely challenging. The undressing phase is very delicate — you are terrified of not doing it in the right order, worried that you might have mistakenly touched some part of your body, or brought home the "contagion." That fear stays with you throughout the day. Talking to patients' family members on the phone is also complicated, telling them about their relative's condition, which can be uncertain or even critical, all from a distance.

My life has changed. I haven't seen my daughter, who lives with her fiancé in another region in Italy. I have not seen friends or relatives, for fear that I could infect them, even when I've had a test and I know it's negative. At home, I live alone with my husband, who works in healthcare, so we are both dealing with the same problems. I am a marathon runner, so the ban on jogging has been hard to deal with. I've been walking the 5 km (3.1 miles) to work for about a month to get in some movement.

The people of the city of Udine have been so supportive. In the first few days of the outbreak we received brioches, pizzas, focaccias and ice cream, from the bars and restaurants that were closed except for take-outs. I've received a lot of support from my family and neighbors. One has left dinner on my landing everyday so I have food ready when I get home!

I can't put into words how much I have learned from this experience. It has been difficult and it's really defied belief, to see how our professional community could come together and pull off what we did. I'm very proud.

Kelvin Ossai, an emergency room nurse in Eastbourne, England: 'If we don't look out for each other, who will?'

Kelvin Ossai is a Registered Nurse and a musician in Eastbourne, on the southern coast of the United Kingdom. He has worked as a nurse since 2014. The United Kingdom has the second highest COVID-19 death rate in the world, after the United States, with 34,796 as of May 15. Eastbourne is just south of London, the epicenter in the nation.

I had always wanted to be an astronaut, but I couldn't study it where I grew up in Nigeria, and my family wouldn't have been able to afford it. I was in and out of hospital a lot as a kid so I chose nursing.

I like a lot of things about being a nurse. But most importantly, I like that I can save lives. There is this joy it brings you. Every day I go out there to save at least a life or contribute to the saving of a life.

Every job is challenging, but, you see, nursing, it breaks and makes you. Standing for hours during a shift, holding your urge to urinate, holding back your tears when you lose a patient, having to work in a short-staffed shift, and so many other things I can't put into words.

I am on the frontline of the pandemic right now. COVID-19 is the focus.

I'll never forget when it all shifted. I panicked at first. I was on leave, and when I came back, a lot had changed. There was a Red Zone for COVID-19 cases, and a Green Zone for other cases with no respiratory symptoms. We now have a board where you get to see where you are allocated each day. If you're in the Red Zone, you gown up with all the PPE and everything, and work starts. If you are in the Green Zone, you can't enter the Red Zone. A lot changed, but we adapted. This is what we do as nurses.

A&E [the emergency room] is a very busy place and can be crazy. It's hard to count how many patients I see daily. More staff had come to join us to cushion the amount of patients coming in.

When I get home from work I have to carry out hygiene protocols. Then I have a meal, and rest.

I make music, which makes my off days quite fun. Before the pandemic I would usually hang out at gigs and shows where I end up singing. I am writing a book as well and am quite active on social media, especially Twitter, so my off days are never idle. I also join my wife in cooking, and cleaning up the house.

It's a difficult time, and I'm sure none of us saw this coming. We draw light and strength from the fact that we are saving the world. My colleagues and I FaceTime with each other, catch up in group chats, and check on the ones who've fallen ill and make sure they are doing fine.

If we don't look out for each other, who will?

Léo Warning, an intensive care nurse in Paris, France: 'You learn to leave your emotions and difficulties behind'

Léo Warning has been a nurse for six years. For just over a year he has been at Clinique Ambroise Paré in Paris, a private ICU, medicine, and surgery clinic specializing in cardiology. France has recorded nearly 180,000 infections and 28,200 deaths, with the highest proportion concentrated in Paris, the capital. Warning spoke to Business Insider over email in English.

I wanted to become a nurse because it's about working with people. Taking care, relieving pain, contributing to society, being useful. It's important to me. I like helping others, being there for people in their time of need. I like that it's a technical job with a human dimension.

Given that I work in the intensive care department, most of the time we're dealing with emergencies. It's challenging, and there's a lot of pressure, but that makes the job very interesting and formative.

Now, COVID-19 is everywhere. The entire clinic has been reorganized to care for patients with the virus.

There was one day the coronavirus became the primary concern. It happened suddenly on March 19. That day we received a lot of patients being transferred from overcrowded public hospitals. We set up respirators and ventilators in all the rooms and, the next day, nurses from other cities arrived to help.

The job remains the same, but since the pandemic started, we have to take extra care of ourselves too, to limit the transmission of the virus. We have special gear to wear before entering a patient's room — mask, gloves, gown, goggles. We dress up and undress every time we come in and come off. It takes time, it's hot and tiring.

With the special gear we have to wear, the relational aspect is different than before. It's not easy to build a connection with the patient, because they don't recognize you, hidden behind your mask and glasses.

One of the rare good things about this situation has been the generosity of people, the locals, the patients' families, the restaurants, bakeries, who all provide us with food every day. Uber and taxi companies are also giving us free trips to get to work, and a car rental company has offered up free cars for healthcare workers. We're very grateful.

Before the pandemic I would play basketball, and run regularly. I need exercise to clear my mind. And I would go out, living the Parisian life as much as possible.

Now, when I get home I watch sport on my TV, and I cook on my day off, which I've always done. I live with my girlfriend, so it's nice to have someone to talk with when I come home. I don't like to talk about my job, though. Being a nurse, you learn to leave your emotions and difficulties behind when you come home.

It's a hard time for everyone, but we just do what we have to do. It's our job. We face death more often. Patients may seem well and then suddenly their condition deteriorates, and we can't do anything about it. But we need to stay strong and keep going because people still need us.

Nitra Chanchaidechachai, a scrub nurse in Nakhon Pathom, Thailand, near Bangkok: 'I have faced HIV, SARS, and bird flu, but nothing like this'

Nitra Chanchaidechachai has worked as a scrub nurse in an operating room in Thailand for 33 years. Thailand, which was the first country to record a coronavirus cases outside China, has not been as hard-hit as other countries, with just over 3,000 infections and 56 deaths. But, even still, the pandemic has overhauled its healthcare system and society at large. Chanchaidechachai spoke to Business Insider through a translator.

I chose to become a nurse because, when I was young, my family was quite poor so I didn't have many choices, but if you went to nursing school the government waived your tuition fee. But I never regretted my decision. I am proud of my job because it means I can help people, and it provides a stable income.

The work itself is challenging. I need to be active and be constantly learning to improve my work.

I have faced other epidemics. Thirty years ago I faced the HIV epidemic in Thailand, which affected a lot of aspects of my work. In 2002, there was the SARS outbreak, and in 2004, there was H5N1 influenza ("bird flu"). But none of them caused such a large impact and burden on the healthcare system as this coronavirus has.

In Thailand, we have been monitoring the coronavirus since January but it became our primary concern in March. The situation was getting worse in April, with more than 100 new cases per day. Then the government announced a lockdown and the number of cases became stable and has been steadily declining. The thing that keeps me looking on the bright side is that the number of cases in Thailand is declining everyday.

The situation in Thailand is not as bad compared to other countries — coronavirus patients do not overwhelm the hospital. However, there is a lack of PPE and surgical masks, which we need to prevent coronavirus transmission.

I live with my husband. Life is almost the same but with more protective measures. When I get home from work, I need to keep my distance until I take a shower, and disinfect all my personal belongings. I still cook, but we keep our food separate. I try to avoid going outside, apart from going to work. My hobbies are gardening, listening to music and, of course, sleeping when I have free time.

It is a hard time not only for medical workers but for everyone. Many people have lost their jobs because of the outbreak.

I believe that we can pass this situation together. Please keep social distancing, wearing masks and avoid gatherings. My colleagues and I will do our best in our work to limit the spread.

Sandra Bautista Mora, director and a nurse of a care home in Fusagasugá, Colombia: 'Sometimes we just want to cry, or sleep'

Sandra Bautista Mora is the director of Fundación Reverde Ser, a care home just outside Bogotá, Colombia's capital city. Colombia sits between the two countries with the highest rates of coronavirus in Latin America: Brazil and Peru. Rates are lower in Colombia, but have climbed sharply in May, to 16,200 infections and nearly 600 deaths. Sandra spoke to Business Insider in Spanish.

All the work I do is to improve people's health, not only physically but emotionally and spiritually. In Colombia, the nursing profession is undervalued, not only financially, but it doesn't get much social or professional recognition, even in health institutions. We are low on the scale, but we are the ones who best know the patient, and deal with their ups and downs.

I work with people over the age of 70, and many have underlying conditions that increase their risk of contracting the virus.

Things changed on March 11, when we decided to stop visits from family members, home doctors, home therapists, and support personnel. We also stopped walks and activities outside the home. We speak to patients' relatives over the phone, and send them photos every week.

Now I'm working 24/7, day and night. As director and a nurse, I have to be aware of all the logistics of the home and the health of the 10 patients in our care. I live at the home. It is a job that does not stop. I like the gym, so that helps me to relax, and I need it for my job, which often requires physical strength when managing my patients.

Some of the patients do not understand the situation, so they question it, asking every day why no one is coming to visit them. I have to be encouraging and positive for them, although my energy is dwindling. I keep asking God for an extra dose of strength and patience, hoping that everything will pass soon.

I am lucky because my workplace is in the countryside, surrounded by nature, fresh air, and an excellent climate. In the city, that's not the case — healthcare workers are very exposed, with little support and restrictions on going outside.

The patients' activities include reading, music therapy, and sharing anecdotes, so I have 10 people full of wisdom who don't stop talking. We've all become close friends. My family lives here with me, they are my support and light. One nice thing that's happened is that, due to the pandemic, we share more [about how we are feeling].

Although I believe that God endowed us with a special strength, it is not easy to smile, and encourage and care for patients, when sometimes we just want to cry, or sleep. But seeing a patient recovering from any disease, that fills the heart more than any amount of money in the world. It's priceless.

Marina Angulo Urturi, ICU nurse in Vitoria-Gasteiz, Spain: 'Many of my colleagues are testing positive, and that terrifies you'

Marina Angulo Urturi works in a hospital in Vitoria-Gasteiz, the capital of the Basque Country region in Spain. It was an early epicenter of coronavirus cases. In early March, when there were just 100 confirmed cases in the entire United States, over 150 people were diagnosed with coronavirus in Vitoria-Gasteiz, most linked to one funeral. It was one of the first Western cities to "lock down." Angulo Urturi spoke to Business Insider in Spanish.

From a very young age I've been fortunate enough to have a very clear idea about what I wanted to be. I never considered anything else.

Nursing is a profession that goes beyond caring for a sick person: it is about serving people. Being a nurse is everything I had always imagined. I have the opportunity to use the tools I've learned, and also grown as a person through direct contact with patients. It is very gratifying to end the working day having helped others, seeing an improvement in their serious illness, a smile on the patient's face, and a sigh of relief from their family.

At the peak of the pandemic, we would see more than 150 patients per shift in the emergency department, which meant each nurse might be attending to more than 10 patients at a time — something that, in normal situations, would be considered exceptional.

I have never seen anything like it, a virus that spread like this.

Emotionally it has been very hard, not only because of our workload, but also because our patients are so alone. I have realized that one of the greatest aspects of human suffering is caused, not by disease, but loneliness. I know people who have died, and how they died — alone — is devastating.

The media overload is stressful, especially if you are a health professional. You go 24 hours a day without disconnecting. I try to watch the news twice a day to stay informed about what's happening, but without becoming overly saturated. So I make space for other types of activities, like watching TV shows and movies, playing sports, cooking.

I live with my parents and my sister, and at first I was worried about putting them at risk. When I get home, I leave my shoes on the landing, take off my clothes on the terrace and put them straight in the washing machine to disinfect it as much as possible. I clean my glasses and phone with sanitizer, and shower thoroughly with hotter water than usual.

These measures make me feel better about living with my family. I didn't want to live alone during the pandemic. I don't know how I'd cope with all this on my own.

The epidemiologists say we've passed the serious peak [in Vitoria], so we're not expecting as much as there may be in other provinces, but patients still come to the emergency room with symptoms of COVID-19. There is a quiet sense of "relief" among us, but none of us are letting go of that fear or letting our guard down. Many of my colleagues are testing positive, and that terrifies you because you know that at any moment it can touch you.

[To those reading this] I want to convey hope. We are doing everything humanly possible to overcome this situation, and I am sure that we will. We must.