DEVASTATING TOLL
Dismay as New Mexico continues to count its dead
For the first several months, the illness caused by the novel coronavirus felt far away from the small city of Socorro, even for the town’s mayor. Then, Mayor Ravi Bhasker, who is also a local physician, started to see people he knew get COVID-19. Then his patients got it. And then they started dying.
Last week, as the state approached 1,000 deaths from the illness, he said it’s become a lot more personal.
“The hair on the back of your neck starts going up a lot faster when you start talking about COVID and the possibility of somebody having it,” Bhasker said.
The first of his patients to succumb to COVID-19 died in the fall — a grandmother in her 70s who tested positive along with her granddaughter and four other family members. The woman was fine at first but then took
a turn. She was hospitalized within a week and died a few weeks later.
“And then everything stayed quiet,” 72-year-old Bhasker said. “Then just in the last five weeks I’ve had 10, 11 positives.”
He said over the past two months, he has had three patients die. Comparatively it’s a low number but, unlike doctors at a large hospital, he has known these people and their families for decades.
“That’s the attraction of working in a small town, you can know people horizontally through their life,” Bhasker said, adding that he is used to death but not at this rate and the “way people are going.”
It took New Mexico seven months to cross the 1,000 COVID-19 deaths mark, a milestone the state hit on Friday. There are now 1,018 people dead from the disease in the state.
And a projection from the Institute for Health Metrics and Evaluation — an independent health research center at the University of Washington that accurately predicted when the state hit its first 500 and 1,000 deaths — forecasts the state will mark more than 2,200 deaths from COVID-19 by the end of the year at the rate things are going.
Tracking mortality
The coronavirus is emerging as one of New Mexico’s leading causes of death.
In just over seven months, the illness has already been listed as the underlying cause of death on death certificates more than the flu, pneumonia or Alzheimer’s were in all 12 months of 2018 — the most recent year with full data available.
Almost one in five patients who are hospitalized with COVID-19 die, according to statistics provided by the state’s Human Services Department. That’s three times higher than the mortality rate for the next highest diagnosis — cancer.
In the weeks after the state’s first death from COVID-19 was reported on March 25, the death toll from the virus rose quickly, reaching its first peak of 71 deaths the week of April 27. Another peak came three months later, when 53 people died the week of July 27.
The month of May saw the highest number of deaths with 258 statewide and September saw the lowest, with 61.
Now the state is in the midst of its third and so far biggest spike in new infections, with 136 recorded deaths in October, according to data provided by the state Department of Health. The country is also in the midst of a major outbreak with a record number of cases last week and a rising death count.
Jodi McGinnis Porter, a spokeswoman for the New Mexico Human Services Department, said death rates tend to follow the rate of new infections after a lag of about four to six weeks.
She said in recent months the rates of new infections have been higher in the southern regions of the state than in the northwest region.
For instance, in McKinley County 133 people died from the virus in the first three months; in San Juan County it was 132. In contrast over the past three months, 30 people died in McKinley County and fewer than 15 people have died from the virus in San Juan County, according to DOH data. Doña Ana County, meanwhile, had more than 40 people die from the virus in the past three months compared to four in the first three.
State data shows the percentage of New Mexico cases that ended with death declined since April — when it was 6.3%. In August and September it was 2.4% and 2.5%, respectively.
In McKinley County and among Native Americans, McGinnis Porter said, deaths declined after the Navajo Nation responded with public health orders.
Death rates have also been affected by clinicians gaining more experience treating and managing patients and having drugs like Remdesivir and Dexamethasone available to mitigate the virus, McGinnis Porter said.
Plus, she said, the populations that were infected in May — including older people living in nursing homes — were different than those who were infected in the later months.
“In May the COVID-19 positive cases were older and a greater percentage had underlying medical conditions that put them at risk of a poor outcome,” McGinnis Porter said.
Although the virus is the most deadly for those with underlying conditions, officials have warned New Mexicans against assuming they are not high risk. About one-third of the state’s adults have high blood pressure, for example, and about half have an underlying condition of some kind that could be a COVID-19 risk factor.
‘Alone and scared’
Staff at larger hospitals have been immersed in the pandemic since the beginning, at times being the only ones at the side of scared and dying patients, charging their cellphones and tablets so they can contact family members. Their work shows no signs of slowing.
There are more than 300 people hospitalized with the virus throughout the state — more than there has been at any other time over the past several months — and general beds and Intensive Care Unit beds are more than three quarters full, leading officials to raise the alarm that facilities could soon reach capacity.
Whereas the first wave of patients last spring and summer were disproportionately from the northwest corner of the state, lately hospitals are seeing a surge of patients from the Albuquerque metro area and southern New Mexico, said Dr. David Pitcher, the executive physician at the University of New Mexico Health System. For that reason, for the first time the city’s hospitals have been transferring patients to rural hospitals instead of vice versa.
Dr. Renee Varoz, a hospitalist at Presbyterian Healthcare Services, who has been treating COVID patients since the beginning of the pandemic, said dying from COVID is unlike anything else.
“Unfortunately, they are dying alone and scared,” she said.
Dying of the disease, she said, can include weeks of lingering illness punctuated by rapid and unexpected bad turns. Death is often the result of progressive respiratory failure, Varoz said.
She said when a patient’s oxygen saturation levels decline health care workers will try many different methods to deliver oxygen — including placing lightweight nasal cannula tubes in a patient’s nostrils or a nonrebreather mask over a patient’s nose and mouth to deliver a higher concentration of oxygen.
Ultimately some patients need a ventilator just to breathe. They can stay on that ventilator — the device mechanically pumping air into their lungs through a tube down their windpipes — for weeks.
Eventually, when nothing is improving, the patient’s family will say it’s OK to remove the ventilator. They say their goodbyes to a sedated relative over FaceTime with the assistance of hospital staff.
“We’ve all seen it. For months and months on end. People come into the hospital and that’s the last time they ever see their family members,” Varoz said.
As the state passes 1,000 deaths, Varoz said she’s been on a roller coaster of emotions over the past year and is fearful of what’s still to come.
“My gut instinct knew we would likely be seeing another surge. I just didn’t realize it would come this soon,” she said. “Part of me is really saddened, and a part of me is frustrated at the people who think this isn’t real, that they are young and will survive this or that a mask isn’t necessary. Because I have seen all the contrary.”
Staff overwhelmed
As the sole chaplain at San Juan Regional Medical Center in Farmington, Todd Smith has spent countless hours sitting with dying patients and consoling their families.
He said the patients are anxious, and struggling to breathe.
“You’re just having to be with them, there’s really not a whole lot you can say,” Smith said. “A lot of times it’s just acknowledging it … to say to somebody, ‘You’re really scared aren’t you,’ or ‘You must be angry.’ It gives them a chance to say ‘No I’m not really scared, I’m just disappointed. This isn’t how I pictured myself. I had things I wanted to do.’ And that gives them an opportunity … to talk about their feelings.”
But, just as often he has found himself being there for his colleagues.
One day, Smith said, he heard a veteran respiratory therapist say, “I don’t know what to do anymore. I don’t know how to do this.”
“I heard that from a lot of different people and I myself felt very much that way — it was a very alien kind of experience for most of us,” he said.
Smith said he counseled staff members, doctors and others in distress and, when he asked what more he could do, managers told him: “Keep showing up.”
He recalled one nurse standing in shock in a room where a patient had just died of COVID-19.
“She said ‘I feel like a horrible person because I have to keep telling families that they can’t come,’” Smith said. “You can tell by her body, nonverbal communication, it was like ‘I’m exhausted … I can’t wait to go somewhere and cry.’”
For Smith, too, the situation got to be too much, especially during a bleak stretch when he was on call 24/7 for 14 days a month.
“It’s hard to relax, it’s hard to sleep, can’t really go out to dinner with your wife or go to a movie — it’s always in the back of your mind and, eventually, takes a toll,” he said.
But even in the hardest times Smith said there are glimmers of hope.
He recalled one time when a woman who had been on a ventilator — at death’s door — for a long time recovered and was released. Smith said the hospital employees all lined up at the main entrance as she was wheeled out.
“There were nurses and people from the cafeteria, senior leaders, janitors, everybody lining up, cheering and clapping,” he said, remembering it fondly. “This was a success, we just didn’t have nearly enough of those as it turned out. I mean we’ve seen a lot of people go home but not so much after they’d been like that. Really, really sick and really, really close to the edge. So that’s pretty rewarding.”
COVID autopsies
It’s not always straightforward but the staff at the Office of the Medical Investigator say there are some clear signs someone might have died from the coronavirus.
Dr. Heather Jarrell, the Interim Chief Medical Examiner, said when a body is run through the CT Scanner the autopsy technician looks at the lungs. If they are marred by a “complete white out” then further testing and work is done to determine if the person died from COVID-19.
“Normal lungs should be pretty much black (on the CT Scan),” Jarrell said. “With COVID instead of that diffused black color it’s completely white. It’s fluid, the lungs on these COVID positive decedents are very heavy and they’re filled with fluid.”
Jarrell said since the pandemic began OMI has had a 15% increase in autopsies compared to last year. However, most people who die from COVID do not undergo an autopsy if they had already been diagnosed. Since March 16, OMI has identified 58 people who died from the illness before they were diagnosed.
Jarrell, who became interim chief on April 1, said she became familiar with the state’s “mass fatality plan” very quickly and has been watching what her colleagues have gone through in other cities throughout the country. Refrigerated trucks have been sent to hot spots — including McKinley County and parts of the Navajo Nation — so funeral homes can store the dead when their capacity fills up.
The autopsy technicians used to wear N95 masks, but after the pandemic began and the devices became scarce, they switched to Powered Air Purifying Respirators or PAPRs — “what you think of when you think of the movie ‘Outbreak.’”
Jarrell said seeing younger bodies, and those of seemingly healthy people, with lungs filled with fluid is terrifying.
“For me personally, I can say that it definitely makes you more cautious,” she said. “Particularly when we see a younger person who tests positive for COVID with what we believe is an intact immune system. It definitely causes you to pause and realize that just because you’re younger and healthy you may not escape a COVID-19 infection unscathed.”
‘But it didn’t have to be as bad as this’
When 35-year-old Vladimir Keeswood died of COVID-19 in mid-April, fewer than 40 New Mexicans had succumbed to the illness.
For his widow, Alison Keeswood, thinking about the deaths that followed is devastating.
“I can’t imagine 1,000 families going through what I’m going through,” Alison said in a phone interview last week. “People without their child, women without their husbands, men without their wives, and most of all children without their parents. It’s so upsetting to know that we let it get this bad. We knew that we were going to see fatalities, but it didn’t have to be as bad as this.”
In the past six months since the death of her husband — her high school sweetheart — 37-year-old Alison said she has good days and bad days.
Her family helped her celebrate the couple’s wedding anniversary in August with a small, masked, outdoor cookout. And she’s gotten into listening to K-pop — popular, upbeat music from South Korea — and is now learning how to speak Korean.
The bad days center around her feelings of frustration and anger when she sees people flouting the public health guidelines as they visit the pharmacy in the San Juan County grocery store where she works as a technician.
“I asked a woman to put a face mask on and she refused. … She just wasn’t having it, she was telling me that there’s no science behind any of it, there is no reason for her to wear the mask…,” Alison said, adding that her boss — who had and recovered from COVID himself — intervened on her side. “Just talking about it makes me upset, that adrenaline. There are days where I just want to say, ‘You know what, my husband died from this’ and leave it at that but I don’t like pulling that card. It’s just way too emotional for me to do that, I really don’t want to start opening up something I can’t stop.”