MADISON, Wis. – A deceptive calm hovers over the COVID ward. The hallways are relatively quiet. Through windows, the patients look peaceful, their bodies perfectly still as they slumber.
An observer might find the scene at University Hospital in Madison, Wisconsin, almost reassuring. But this is a vision of just how serious the state’s COVID-19 surge has grown these last few weeks.
The patients are calm because they are terribly sick and must be deeply sedated. The sedation stops their arms from flailing in fear and confusion, and possibly disconnecting their ventilators.
But there’s another reason.
So deprived of oxygen are their bodies that they must be sedated to the point of paralysis. They cannot afford to consume even the modest amounts of oxygen needed to move an arm or a leg. They lie so still their faces show no emotion. Often doctors cannot tell if a patient feels anxious or afraid.
From time to time, the calm breaks. When a COVID patient drifts into crisis, red lights flash at their bedside. A loud bell sounds, the ventilator alarm. In an instant, five to six nurses rush into the room and begin emergency treatment.
In recent weeks, the number of such severely ill patients has grown, forcing the COVID ward to expand. A week ago, a general care neurosurgery unit became a 12-bed COVID-19 unit.
In spring, the hospital hit a peak of 21 patients hospitalized with COVID-19. “We’re at double that, and it may end up being close to triple,” said Jeff Pothof, UW Health Chief Quality Officer.
Nurses who are scheduled for three, 12-hour shifts a week have been volunteering to work a fourth.
After an exhausting day on the COVID ward, critical care doctor Hilary Faust checks her patients’ medical records from home before bed, and again when she wakes up in the middle of the night.
“It’s all-consuming,” Faust said. “Every loss is hard. It’s especially hard knowing that patients have been mostly alone during the last weeks and days of their lives.”
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Virus doesn’t slow for an election
In recent days, it may have seemed to many Americans that their world had shrunk to the single image of an electoral map. Yet since Election Day dawned, more than 6,000 Americans have died from the new coronavirus and more than half a million have tested positive for it.
There has been no letup when it comes to the gravest issue facing the nation. If anything, the intense focus on the election may have worsened the pandemic.
In the campaign’s final days, the number of large, maskless rallies increased, as did the false insistence from President Trump and his supporters that the virus had turned a corner.
“People have stopped being terribly concerned about the coronavirus,” said Rob Davidson, executive director of the non-profit advocacy group the Committee to Protect Medicare. “Any time you take your eye off the critical event that has been happening there is a concern”
In Michigan, where Davidson is an emergency room doctor, “We’re having record numbers of cases … What I’m being told anecdotally by doctors in southeastern Michigan is that hospitals have been looking at case numbers that mirror the point that comes about two weeks before a crisis.”
Moreover, so many states are peaking at the same time that it is very difficult to find one that is experiencing a lull and can afford to send doctors to another state that is surging. Such mutual aid between states helped different regions of the country get through hard times in the spring and summer.
“Now it’s happening in so many places that there’s nowhere to take anyone from,” Davidson said. “Everyone is having a crisis or is on the cusp of a crisis.”
Health experts said the pandemic challenges remain much the same after the election as they did before it.
“We need to continue to pay attention to the basics, including consistent messaging about masks and social distancing,” said John Auerbach, president and CEO of the non-partisan Trust for America’s Health and former associate director of the U.S. Centers for Disease Control and Prevention.
“That included testing and contact tracing and making sure that when people are symptomatic and in need of critical care they have access to that.”
Auerbach added that the Biden administration will face the complex task of guiding a massive vaccination campaign.
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“It takes a lot to vaccinate your entire population,” said Auerbach, who led a vaccination campaign against swine flu as the Massachusetts Commissioner of Public Health.
Excluding the cost of the vaccine itself, Auerbach estimated that planning and vaccinating the entire country will cost around $8 billion.
“You have to have a unified national, state and local registry of who has been vaccinated,” he said, explaining that it is likely people will need to receive two shots to reach immunity. “You also need the capacity to track people post-vaccination to make sure there aren’t unintended consequences and there are going to be some (such as adverse reactions to vaccine).”
One of the greatest challenges will be convincing some of the groups at highest risk from the new coronavirus, such as Blacks, Latinos and Native Americans, to get vaccinated. These groups also happen to be among the most likely to be skeptical about the vaccine.
Tara Kirk Sell, senior scholar at Johns Hopkins Center for Health Security, said the most important thing for the new administration to do is work towards regaining trust across the spectrum, particularly in terms of communication and engagement with a range of communities.
“Try to meet people where they are, listen to them and try to help them move toward doing things to protect themselves, and not doing things that are high risk.”
The barebones description of a life
At University Hospital, the medical staff had been adjusting to COVID-19 through the course of many months.
“I feel like we finally got used to COVID,” said Chloe Carrigan, a nursing assistant at the hospital for the last three years. “I feel like we’d started to get into a groove of how to treat the patients.
“Then we had this surge.”
Many of the same doctors and nurses have been working exclusively with the COVID patients. They get used to all of the precautions that need to be followed with personal protective equipment and can make sure colleagues do not forget key steps.
In the new section of the COVID ward, most of the patients cannot speak because of the machines and medications sedating them and helping them to breathe.
“Some of them can open their eyes and interact,” said Andrew O’Donnell, the 33-year-old nurse manager in the Intensive Care Unit. “Most of these patients are spending close to two weeks on the ICU.”
Some are in the hospital for a month, even two. Some die.
Although the nurses cannot speak to, and get to know, some of their patients, they talk to relatives and assemble the barebones description of a life. A single page goes outside each room to remind nurses that the patient inside is an ex-Marine, or bought lottery tickets, or has a dry sense of humor, or a fondness for golf.
A second page alerts medical staff to a patient’s care and outlook. A star is placed to suggest where the patient is heading. If the star is at the top of the page, they are improving. If the star is closer to the bottom, staffers fear the patient might not make it.
Often doctors talk to the patients even though many are not awake.
“I tell them where they are. We’re taking care of them and telling their families what is happening,” Faust said.
Nurses do the same.
“I’m going to clean out your mouth. You’re going to feel a poke,” nurse Melissa Olson will tell a patient. “I’m going to give you a little more medicine. You’ll feel a little sleepy.”
Sometimes a patient who has been in deep sedation is getting well enough to be brought out, a transition that can be frightening and disorienting.
At times, nurses find that the family member they have been updating for weeks, sometimes becomes the newest patient in the COVID unit. A husband and wife have occupied neighboring rooms.
The work often follows the medical staff home.
“I’ve never had a job like this,” Carrigan said. “I have roommates and some nights I go home, I won’t even talk to them. I just go to bed. I’m so exhausted.
Many of the nurses are close to one another and visit each other’s homes, where they talk about their experiences at work, or life with their family.
Faust, the critical care doctor, comes home to two young children, a 2-year-old and a 5-month-old.
“They need energy and attention and love,” she said. “You walk in the door and try to switch off the doctor and turn on the mom. You get the children bathed and fed.”
Then it’s story time.
To protect her family, Faust has a set of shoes and a jacket that she wears only at the hospital.
There are worries that keep the doctors and nurses up at night.
“I think there’s a lot of people who think this isn’t as severe as it is,” said Olson, the nurse. “They need to understand that it’s bad and it’s going to get worse. What I worry about is that there will be places for these patients to go to, that there will be hospital beds.”
Follow reporter Mark Johnson on Twitter: @majohnso
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