Resistance imperils vaccination push
Treatment does little to quell Lubbock’s COVID crisis
LUBBOCK — The blue sign went up outside the patient’s room early Wednesday afternoon, with a seemingly hopeful message that was anything but: “Covid Negative.”
Inside, a man in his 70s lay comatose, his chest rising and falling robotically amid a tangle of cords. He had been hospitalized so many days that he was no longer infectious with the virus that is ravaging this and other northwestern pockets of the state.
But hewould likely never recover fromthe physical toll. At least now a relative could come say goodbye.
“We just don’t want them to be alone when they die,” said Katie Hensley, an intensive care nurse who has treated the city’s sickest coronavirus patients for months. The hallway where she stood was dotted with blue signs.
Threeweeks after Gov. Greg Abbott visited Lubbock to celebrate new antibody treatments amid a surge of infections, the city remains in crisis. Its two main hospitals had nearly two dozen patients waiting for beds Friday, and the city has administered only about 200 doses of the new medications, with about 4,500 active cases countywide.
Hospitals are also filling in Dallas, Houston, San Antonio and other parts of the state that were slower to be hit by the fall surge. The state is hovering around 9,000 hospitalized COVID-19 patients and re
ported fewer than 700 available intensive care beds for the first time this week, less than half the supply in September.
While most hospital officials in Texas welcomed the new treatments and remain hopeful that they prevent some hospitalizations, the limitations are also becoming apparent. Without enough doses or a way to distribute them quickly, hospitals will continue to be strained unless infections slow or until vaccines become widely available, not likely until at least early summer.
In Lubbock, hundreds of nurses and other hospital employees are out sick or quarantining from the coronavirus, and administrators worry that the hundreds more who have come to help from across the state and country will be called back as outbreaks in their home communities worsen. More than 231,000 new cases were reported Friday nationwide, nearly 4,000 above the previous record set on Dec. 4.
“We always have more contingency plans, and we’re deep into the middle of some of those where we truly are turning away patients from out lying communities because we can’t take them ,” said Dr. Ron Cook, Lubbock’s health authority and the chief health officer at the Texas Tech University Health Science Center.
The treatments, made by the companies Eli Lilly and Regeneron, were granted emergency use authorizations last month to help prevent hospitalizations for the most vulnerable patients, including those over 65 and with chronic illnesses such as diabetes, obesity or kidney disease. They are the same treatments President Donald Trump and his lawyer Rudy Guiliani have received.
Texas got about 20,000 doses in the past five weeks, while it reported 330,000 new infections. Early clinical research suggests the drugs prevent about 1 in 20 people who receive them from being hospitalized.
Doctors at University Medical Center in Lubbock are encouraged by the early outcomes, but have often struggled to contact and persuade enough eligible patients to receive the treatments. The drugs need to be administered early on, before a person is hospitalized, and patients may not yet have developed symptoms. Some have never heard of
the treatments or spoken with the hospital’s doctors before.
“Challenging is a good word,” said Dr. Craig Barker, an outpatient physician and UMC’s corporate medical director. He is one of the doctors cold- calling people about the drugs, which the hospital administers intravenously inside a converted bus in the parking lot, to avoid contaminating non-COVID patients.
“We would rather work a little bit harder to get them three hours on the bus than to work with them for amonth in the hospital,
and try to keep them healthy as much as possible,” he said. “So it’s certainly a worthwhile process.”
Fiercely independent
Filiver to Flores waited outside the bus Wednesday for his 71year- old wife, Paulta, to finish her infusion. She tested positive for the coronavirus the day before and has diabetes, high blood pressure and asthma.
“She was kind of nervous when she come in,” he said, smoking a cigarette. “She said, ‘Is that deal going to help me out? Because I don’t want to get worse than I am right now.’” Their 39year- old daughter, who lives with them and three others, had also recently tested positive.
Across town in a medical tent outside Covenant Children’s Hospital, Susan Sayari watched as nurses treated her 71-year- old husband, David, with remdesivir, an antiviral drug that has shown some promise in treating more severe COVID-19 cases. He had already received the Eli Lilly drug earlier in the week but was feeling worse. They had both tested positive for the virus after flying to Idaho to visit her brother, who was dying of cancer.
“He’s very healthy,” said Sayari, who is also the nursing director at Covenant Health. “So this is new for him.”
Combating the virus has been especially tough in Lubbock, a college town in a fiercely independent swath of the state where pandemic science has been regularly questioned and the governor’s tepid mask mandate largely unenforced. In recentweeks, the mayor and others have resorted to pleading with residents to physically distance and wear face coverings.
“Our independence is also hurting us,” Cook said.
Abbott’s mask order includes several exceptions and calls for fines only on the second offense, which county officials have said is nearly impossible to track.
Intense cases
For much of November and early December, the city was among the top metro areas in the country for new cases per capita. Those have dropped slightly this past week, possibly because Texas Tech students are off for the holidays. Hospital officials said it’s too early to know if the trend will stick.
Even if it does, doctors and nurses will be dealing with the impacts of the surge for the next several weeks. The two hospitals have devoted five of their intensive care units to the most severe COVID-19 cases, and are still scrambling for space because patients are taking up beds for sometimes a month or longer. Nurses who normally would oversee five patients at a time have been reduced to two or three, given the intensity of each case.
“These patients, we’ve never seen them as unstable as they are,” Hensley said.
On Wednesday, she and four other fully suited nurses hoisted a 56-year- old man onto his stomach, careful not to dislodge the breathing tube that was keeping him alive. These types of maneuvers, intended to increase oxygen flow, were rarely used before the pandemic. Now they’re routine, one of the few tools physicians have left to try weaning patients off a ventilator. The odds of it working at later stages are not great.
“Most of the people who get this are OK, but the ones who are sick are really sick — they’re that,” Apryl Keaty, an intensive care nurse, said, pointing to the 56-year- old patient. It’s become especially tough for her and colleagues to see people outside of work still refusing to wear masks or avoid big groups, measures that are proven to reduce transmissions.
“When we go out and see nobody give a damn, it’s like, do you realize what we’re doing to save your loved ones?” she said.
“Most of the people who get this are OK, but the ones who are sick are really sick.”
Katie Hensley, intensive care nurse