San Antonio Express-News (Sunday)
San Antonio hospitals are being pushed toward limit
Health workers especially feel strain of patient influx
Behind a glass door, a man’s chest and abdomen were rising and falling rapidly, his body wracked by labored breaths. Even with supplemental oxygen, he was gasping for air.
In the next room, a man lay slumped in his bed, a sheen of sweat coating his feverish face. Nearby, another patient was staring at the ceiling, his eyes wide and glassy. He was hooked to three machines: a ventilator for breathing, dialysis for his failing kidneys and extracorporeal membrane oxygenation to add oxygen to his blood.
All three patients were critically ill from COVID-19, fighting for their lives in an intensive care unit at Methodist Hospital. All were in their late 20s or early 30s. Elsewhere in the unit, there were other patients in their 30s and 40s.
Charge nurse Jordan McCants never had seen so many young patients in room after room, filling entire sections of an ICU. At 29 years old, she found herself shocked at how close in age they were to her.
“They’re sick. They’re very sick,” she said, walking from behind the nurses’ station and peering through the glass into their rooms. “The question is, will they ever be the same?”
Since the beginning of June,
transmission of the coronavirus has exploded in San Antonio, with hundreds of new infections now reported every day. Hospitalizations for COVID have surged by nearly 700 percent, reaching a new high of 730 people Saturday. In the past week, the number of patients in intensive care and relying on ventilators has more than doubled. On Friday, one in five hospital admissions in San Antonio was for COVID-19.
Many of the patients in this new wave of infections are far younger than the more fragile residents who were expected to fill up hospitals after the coronavirus reached San Antonio in March. When McCants and the other nurses did the math Thursday, they found the average age of the patients in this unit had dropped by 15 years, to around 45, in the past few weeks.
Every day, as coronavirus patients continue to pour in, San Antonio’s hospitals have scrambled to make room for them. They have converted section after section of rooms into COVID isolation wards. Nurses, doctors and respiratory therapists are pulling long, busy shifts.
With staff stretched thin, hospitals are trying to bring on more workers.
Under increasing strain from the coronavirus, hospitals in Texas’ biggest cities have begun cutting back on nonemergency procedures at the behest of Gov. Greg Abbott, to free up additional bed space. On Friday, Abbott also began rolling back aspects of the state’s reopening, ordering bars to close and restaurants to reduce their occupancy rates.
Still, San Antonio officials warned that the city was on a “worst-case scenario” trajectory for coronavirus hospitalizations, which were on pace to reach 1,900 by mid-August — a number that would exceed local capacity. They have readied a portion of Freeman Coliseum to serve as a field hospital, should it come to that.
Area hospital leaders on Friday released a joint letter, pleading with the public to help reduce the spread of the virus.
“We need our community to demonstrate its gratitude by taking action to reduce the spread of COVID-19 and to prevent an unmanageable surge in our hospitals,” the letter said.
On Saturday night, as San Antonio reported a record 795 new cases and 58 emergency transports related to COVID, officials sent a rare emergency alert to residents’ cellphones. It urged everyone to stay home and warned that hospitals were filling up.
The sharp spike in coronavirus cases has health care workers bracing for months of upheaval at San Antonio hospitals — and the possibility they will be pushed to the breaking point.
“It’s going to last for a while,” said Dr. Ian Thompson, president of Christus Santa Rosa Hospital. “I wish I could say how long. I don’t know. No one knows.”
Scrambling for beds, staff
Last week, in the middle of the night, facilities staff at Methodist Hospital went room by room, installing air filtration machines on the windows. The ad hoc solution would aid in infection control, preventing the coronavirus from circulating through the hospital’s ventilation system.
In a matter of hours, an entire 29-bed unit had been outfitted for the crush of COVID patients waiting to come up from the emergency room.
That was the simple part. Even after the rooms were ready, it took time to get the staffing in place, said Adam Sahyouni, a nurse who has helped managed COVID units throughout the hospital.
“We need someone to take care of them, too,” he said. “Just because we have a bed, we still have to have a capable nurse to care for that patient. We still have to have a doctor to be able to round on those patients.”
As cases have spiked throughout June, the hospital has repeated this process several times. By Thursday, Methodist had about 70 beds in four different wards dedicated to coronavirus patients, and it was prepared to add more.
While shortages of personal protective equipment and ventilators were at the center of public debate at the beginning of the pandemic, it’s adequate staffing that has emerged as the greater concern, said Allen Harrison, CEO of Methodist Healthcare.
The hospital system is working to bring on additional staff through a combination of extra shifts for existing full- and parttime workers and signing contracts with travel nurses.
Such changes take time. On Thursday morning, about 36 hours after the unit was flipped for COVID, charge nurse Robyn
Greenwood was there, helping fill staffing gaps created by the influx of patients. She normally works in intensive care, but on that morning her assignment was to help oversee the new COVID unit.
The overnight team was short staffed, so she was working a combination of day and night shifts while the hospital brings on additional staff. Other nurses are taking on more shifts than they are accustomed to, she said.
“Until we get some of the contracts in place to help with the spike, it’s really putting a drain on a lot of the nurses,” she said.
Similar scenes are playing out across San Antonio’s hospitals.
At University Hospital, staffers are converting more areas to COVID treatment, and the hospital voluntarily halted some elective procedures ahead of the governor’s order, said Dr. Bryan Alsip, chief medical officer.
Should the hospital become overwhelmed by coronavirus, he said some trauma patients could be directed to Brooke Army Medical Center, the city’s other Level 1 trauma center.
During the first few weeks of the pandemic, Northeast Baptist Hospital devoted all 24 beds in its surgical and medical ICUs to the most critically ill COVID patients. As San Antonio’s coronavirus numbers stabilized, it had downsized, splitting the ICUs evenly between those with COVID and those without.
But with the new wave of patients, the hospital has rededicated both ICUs to COVID patients. Other units have been repurposed for less sick coronavirus patients and critical patients with other conditions.
Dr. Tamara Simpson, a critical care pulmonologist who practices at Northeast Baptist, said she performed more intubations on coronavirus patients in one week earlier this month than she had during any other point in the pandemic.
“Things are worse than they’ve ever been,” Simpson said. “Not only are we having more patients, but also more health care workers that are being affected. The stakes are a little bit higher, and it’s a little more stressful than before.”
Younger are vulnerable
The massive influx of COVID patients has clarified how widespread community transmission of the virus has become in San Antonio, said Dr. Lynnette Watkins, chief medical officer of Baptist Health System. It also indicates the new wave of cases can’t be explained by increased testing.
Watkins said many of the COVID-19 patients being admitted to hospitals now already know they are infected with the virus and can pinpoint gatherings where they likely were exposed.
“There are groups of patients that are coming in, or the patient is coming in saying, ‘I was exposed at an event where there are now a group of people that are positive,’”