In COVID-19’s dark winter, reason for hope
STAMFORD – The “wildness and craziness” started in March, Dr. Michael Bernstein remembers.
COVID-19 came through Stamford Hospital’s Intensive Care Unit like a tidal wave.
“March into April and May are probably the craziest point any physician will ever have in their career,” said Bernstein, associate director for pulmonary and critical care at the hospital. “We usually have 12 ICU patients at a time, but we created about 60 more beds and filled most of them with critically ill patients in a way most of us have never
seen.”
ICU doctors, nurses and staff are used to handling multiple types of emergencies at once – heart attacks, strokes, injuries, respiratory and other systemic failures. This was different, Bernstein said.
“It was the volume of patients,” he said. “And everybody had the same thing.”
There was no way to suddenly have all the needed resources in place for a brand-new virus, he said. It took days, for example, to get back test results for COVID-19.
“We had ventilators, but they don’t all do the same job. We figured out we had to use the most complex ventilators to manage the most critically ill patients,” Bernstein said. “We had to figure out what medications and drugs we should use. We were making decisions week by week, based on our experience, national guidelines and from reading peer reviews.”
Stamford at times was hardest hit by the virus of any municipality in the state. Doctors, nurses and staff at Stamford Health absorbed the brunt of that hit. Now, in the midst of another COVID wave, they are relying on hard-won experience to combat the illness, and looking forward with more optimism and hope than was possible to muster in the first, overwhelming weeks of its grip.
Call a friend
Help came from critical-care colleagues in other hospitals far and wide, he said.
“We were texting and calling friends who we trained with to see what they were doing,” he said. “I have 25 friends I keep in touch with, and my colleagues each have a number of friends, so it’s a lot of resources.”
Because they see the sickest of the sick, ICU doctors are used to death — there were nine fatalities a day in April. But the virus is tough, too, on those who survive, Bernstein said.
“It can be a fairly slow disease. People may be sick at home for four or five days, then sick in the hospital for four or five days before they have to come to the ICU,” he said. “They become more short of breath and develop more difficulties as it goes on. That’s tough on patients. I did see a fear you don’t normally see.”
COVID-19 has another unnerving property, he said.
“There’s a lot of randomness,” Bernstein said. “Sometimes a 90-year-old person does fine and someone who is 40 has a devastating outcome.”
Managing OK
With much of the country gripped in another wave of the virus, Stamford Hospital is managing, said Kathleen Silard, president and CEO of Stamford Health.
“Other areas of the country have seen a big post-Thanksgiving surge. We saw a surge in the number of positive cases but not as many hospitalizations — a lot of people who are positive don’t have to come to the hospital,” she said.
One reason may be that the population here is younger than it is nationally, Silard said. Other reasons are frequent testing and compliance with safety guidelines, she said.
“We did 24,000 tests in the month of November,” she said. “People are finding out when they are positive and isolating. I also think people in this area are generally wearing masks and socially distancing.”
Those who end up in the hospital now benefit from what doctors learned in the spring, when Stamford was the epicenter of COVID-19 in Connecticut.
“We have treatments now,” Silard said. “We have steroids, monoclonal antibodies, plasma, the drug Remdesivir, the use of high-flow oxygen and proning” – a practice of repeatedly flipping patients from their backs to their stomachs to aid distribution of oxygen in the lungs.
Fewer in ICU
The result is a significant drop in the number of critically ill COVID patients. According to hospital statistics, 32 percent of COVID patients spent time in the ICU in April and May. In October and November, it was 8 percent.
At the hospital, which has treated about 1,000 COVID patients to date, the road has been rough but getting smoother, Bernstein said.
The virus has created apprehension even among ICU professionals used to wearing masks, gloves and gowns and treating contagious illnesses.
“Anyone who isn’t a little scared of getting COVID is being cavaliere,” Bernstein said.
And now there is a vaccine. “When I got the Pfizer vaccine a week ago, I felt relief,” he said.
The feeling is hospital-wide, Silard said.
“The staff is excited about the vaccine.
We have vaccinated 769 people so far,” she said Wednesday. “I think it was very sad at the height of the pandemic, but now that we have more options, the staff is feeling more hopeful. They are seeing so many patients go home.”
Weighing risks
Doctors now use ventilators sparingly, substituting other protocols, Bernstein said. One is steroids, though they, too, come with a price.
“Steroids have prevented some patients from having to get on a ventilator, but they have lots of side effects – they can cause a lung to collapse or drive blood sugars off,” Bernstein said. “For people who get critically ill with COVID, it’s a miserable experience.”
A big difference between now and the spring is the hospital’s focus on treating non-COVID patients, he said. People who were afraid to come to the hospital for surgery and other needs are less so now, Silard said.
“Some patients have delayed care – oncologists are seeing more advanced cancers and cardiologists are seeing more advanced heart disease,” she said. “We are working hard to get the word out that we are able to isolate COVID-positive patients and provide the other care people need.”
Ultimately, Silard said she feels “so much more hopeful than in the spring, when everyone was so overwhelmed with sick patients. Now we have resources, a trained staff, treatment regimes, and a vaccine.”