Calm in a hospital belies COVID-19 dangers
Election Day wasn’t a day off for tired hospital staff
MADISON, Wis. – A deceptive calm hovers over the COVID-19 ward. The hallways are relatively quiet. Through windows, the patients look peaceful, their bodies perfectly still.
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 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-19 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-19 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-19 ward, critical care doctor Hilary Faust checks her patients’ 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.”
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 Donald Trump that the virus had turned a corner.
“People have stopped being terribly concerned about the coronavirus,” said Rob Davidson, executive director of the nonprofit 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”
“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 nonpartisan Trust for
America’s Health and former associate director of the 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.
“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 the highest risk from the 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.
Bare-bones 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 COVID-19 patients. They get used to 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-19 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 in 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 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.
“Every loss is hard. It’s especially hard knowing that patients have been mostly alone during the last weeks and days of their lives.” Hilary Faust critical care doctor