PANDEMIC TIGHTENS GRIP ON S.A.

Deaths are on the rise as the strain increases on hospitals in the area

As they woke up on the Fourth of July, Kelly Alvarado’s family members hoped it would be a good day. They needed one.

The night before, they had prayed for the 42-year-old Alvarado, who had COVID-19 and was on a ventilator at Northeast Baptist Hospital. A few days earlier, her 76-year-old great-uncle, who also tested positive for the novel coronavirus, had succumbed to a heart attack in the same hospital.

Alvarado’s family was optimistic she would pull through, despite her asthma and chronic obstructive pulmonary disease. She was so young, so vibrant and full of life. The alternative was unthinkable.

At the hospital that day, Dr. Tamara Simpson, a critical care pulmonologist, checked on Alvarado. Simpson had been treating COVID patients for months and had developed a gut instinct about who had a chance of getting better and who didn’t. Patients would “declare” themselves, she had found, and Alvarado seemingly had.

The longtime teacher’s aide at Sunshine Cottage School for Deaf Children had received all possible treatments, except for extracorporeal membrane oxygenation, which would have added oxygen directly to her blood. Simpson couldn’t refer her to another hospital for that treatment because there wasn’t a bed available. That hospital already was full of COVID patients.

Alvarado died that afternoon. “It’s a nightmare that ended in a nightmare,” said her younger sister, Vanessa Castillo, 39.

Alvarado is among the latest victims of San Antonio’s coronavirus surge, which has rapidly filled area hospitals and claimed dozens of lives over the past month.

Since the beginning of June, Bexar County has recorded more than 16,000 cases and 101 deaths, 13 of which were identified

through a postmortem review by the Bexar County medical examiner’s office. Forty deaths have been reported in the past week, including that of a teenager.

In hospitals across the area, more than 1,200 people still are battling the disease, more than 400 of whom are critically ill. Coronavirus patients now account for a third of all hospital admissions. The availability of staffed hospital beds has dipped to 11 percent.

To keep up, San Antonio hospitals are bringing on hundreds of medical personnel from the military, the state health department and contract agencies to staff overburdened intensive care units.

They are making room for COVID patients across their facilities and are preparing beds in areas that don’t usually house patients. In some cases, multiple patients are occupying the same room. Health care workers have fallen ill from the same virus they have treated in so many others.

Now, hospitals are facing the possibility that gatherings over the July Fourth holiday could yield another jump in cases, further straining staff and capacity. And, should they become overwhelmed with COVID patients, health care workers are bracing for a spike in deaths.

“Everyone is pretty scared,” said Dr. Kamyar Haghayeghi, a hospitalist at University Hospital and assistant professor at UT Health San Antonio, who has been treating COVID patients for months. “Everyone from nursing staff to the doctors to the respiratory therapists to administration, we’re all fearful of what could happen.”

Before Alvarado died, her mother, Norma, got a phone call from Simpson, telling her that her daughter’s organs were failing. She had little time left.

Transmission of the virus had become so widespread in San Antonio that the family wasn’t allowed inside the hospital.

Instead, Simpson donned protective gear and arranged a multi-way video call on her cellphone from Alvarado’s room.

One by one, her family members told her they loved her, that they would miss her, that they knew she had fought hard but was tired. Simpson did what those closest to her patient couldn’t — held her hand, caressed her face and traced the sign of the cross on her forehead. She promised the family Alvarado wouldn’t die alone.

An hour later, she was gone. The nature of this crisis — its tragedy, repetition and relentlessness — is not unlike the stress of war, Simpson said.

That’s why, at the beginning of the pandemic, she had mentally fortified herself. Still, the call with the woman’s family had left her N95 mask soaked with tears. That night, she had trouble sleeping.

Alvarado and Simpson were only a few years apart in age. Both were single mothers and had children who attended schools in Alamo Heights.

“We expected it, and yet we didn’t expect it on such a great magnitude,” Simpson said of San Antonio’s surge. “We’re doing everything we can, but the population is very different from the first time around.”

Praying for patients

On the 10th floor of University Hospital, Zahra Garza was at work, keeping a close eye on nurses putting on and removing protective equipment.

As one nurse exited a patient’s room, Garza asked her if she needed a glass of water, noticing her flushed cheeks and the sweat beading on her face.

“Everything’s hot,” the nurse said, fanning herself.

As the executive director of patient care services for the floor, Garza oversees a 60-bed unit that usually is dedicated to surgical patients.

But now all her patients are from the pandemic. On June 28, the floor was converted into a ward for coronavirus patients who are acutely ill but don’t yet need intensive care. COVID care now is spread across three floors of the hospital.

By Thursday morning, 43 of the beds on her floor were taken. Along a hallway, phone numbers were posted on the wooden doors so nurses and doctors could easily call COVID patients, minimizing the time they needed to spend in their rooms.

John Palmer, 82, has no idea how he was exposed to the coronavirus. A few days before, his wife had driven him more than 130 miles from their home in Austwell, a tiny town in Refugio County. He was receiving supplemental oxygen in Garza’s unit.

“The real story is those nurses out there, taking care of us,” Palmer said by phone from his hospital bed. “This hospital has been very, very fortunate to get such quality help.”

He couldn’t say much more before his oxygen levels began to drop. Nurses urged him to remain quiet so he could catch his breath.

“He’s a very sweet guy, very sweet patient,” Garza said, looking at Palmer through the small window of his room. “Just breaks my heart.”

A few minutes later, a voice over an intercom announced there was a code blue — a patient in need of resuscitation. It was on the fifth floor, home to another coronavirus ward.

As the hospital has filled with COVID patients, Haghayeghi said

Bob Owen / Staff photographer Jerry Canedo, 57, watches his nurse as she checks on his vitals at University Hospital. Hospitals and health care workers across the city are dealing with the rapid surge of COVID-19 patients. At University Hospital, nurses are seeing younger and younger patients.

Marie D. De Jesús / Staff photographer Family members of Kelly Alvarado mourn her death from COVID-19 at a poolside gathering. From left are Eva Castillo, 7; Vanessa Castillo, 39; and Norma Alvarado. Kelly Alvarado died July 4 at Northeast Baptist Hospital.

Bob Owen / Staff photographer Irene Martin, left, confers with another nurse before entering a patient’s room at University Hospital. More resources have been devoted to treating COVID-19.

Kayla Colazo, from left, Vanessa Castillo, Norma Alvarado and Beatriz Vallez look at photos of Alvarado’s daughter, Kelly, who died of COVID-19 on July 4 at Northeast Baptist Hospital.

Bob Owen / Staff photographer John Palmer, an 82-year-old coronavirus patient at University Hospital, talks with his nurse, Garcia.

Bob Owen / Staff photographer Wearing an N95 mask under a blue surgical mask, Aylin Garcia gets help with removing and cleaning her face shield.