‘It’s going to be a long winter’: ICU doctors, nurses at YNHH share concerns about future of pandemic
As the coronavirus continues to ravage communities, more Americans than ever before are currently hospitalized with COVID-19. In an unprecedented daily death count, 3,157 patients in the United States lost their lives to the virus on Wednesday, topping the previous record of 2,607 deaths on April 15 by 20 percent.
The coronavirus death toll has already been climbing for almost nine months, but experts estimate that the worst of the pandemic is yet to come. For health care workers in intensive care units who spend their days and nights caring for the hospital’s sickest patients, this new surge has triggered immense anxiety. In interviews with the News, nurses and doctors who work in the Yale New Haven Hospital ICU shared their experiences on the frontlines since March and expressed concerns about what might be in store for the coming months.
“When we reopened the COVID ICU on North Pavilion 15, honestly it just felt like there was this invisible wall,” Fiona Wu, a YNHH ICU nurse, told the News. “Once you stepped off of the elevator you kind of had to push yourself to go on there for the first time. A lot of people have broken down with panic attacks or they cried before they had to go back up to that floor because everyone just has PTSD from what happened previously.”
Back in April, the YNHH had to repurpose some of its floors to make more room for the large influx of critical COVID-19 patients, Wu said. In the Smilow Cancer Hospital at YNHH, North Pavilion 15 — a floor that used to host cancer patients — was repurposed to accommodate COVID-19 ICU beds, which require negative pressure rooms to prevent the coronavirus from spreading through the air.
As hospitalizations tapered off during the summer, this floor at Smilow was no longer needed as a COVID-19 ICU. But when patient counts began to rise again, it had to be reopened. As of Thursday morning, there were 438 patients hospitalized with COVID-19 in the Yale New Haven Health system, with a total of 91 in the ICU.
Wu explained that however scary the pandemic was at first, people were running on adrenaline. Now, even though teams remain motivated by a strong sense of duty to their patients, this protracted stress has left them “running on fumes.”
Clemente Britto-Leon, an assistant professor of pulmonary medicine and a doctor at the YNHH ICU, told the News that in April, many health care workers were thinking about updating their wills and making plans in the event that something should happen to them.
“My worst fears are to fall ill to COVID-19 and put my peers in a situation where they’d have to care for me, or infect a loved one,” Britto-Leon said. “We’re not afraid to do the work, but we worry about the people we care about.”
Wu told the News that many of the health care workers in the ICU team have elderly parents who they care for, or sons and daughters they go home to. For them, becoming infected is especially frightening.
Now that personal protective equipment has been scientifically proven to work, Britto-Leon said, health care workers have one less source of anxiety. Before, even though people were donning their masks and gowns, data had not yet been gathered to validate that these measures were in fact protecting them.
Jean Paul Higuero-Sevilla, an assistant professor at the School of Medicine and a physician in the YNHH ICU, told the News that in the early days of the pandemic, not knowing whether his PPE kept him safe was particularly difficult as he had just become a father.
“I had my first child in February, so I was scared [of] coming home from a COVID shift and bringing it to my newborn, bringing it to my wife,” Higuero-Sevilla said. “At the beginning of the pandemic I was isolating, my family was staying at one place and I was staying at another place, and I did that for weeks.”
Now that Higuero-Sevilla knows that he is protected by his equipment, he still takes extensive precautions but no longer needs to live away from his family.
Alexa Williams, an ICU nurse at YNHH, recalled that YNHH ICU teams had medical staff from other hospital departments lending a hand in the spring, when elective procedures and outpatient services were shut down. Now these services are up and running again, meaning that there is less external help, Williams said.
She added that travel nurses — who take short assignments in hospitals that need extra help and had been brought to YNHH in the spring — are more difficult to hire now, as many health care systems all over the country are overwhelmed with COVID-19 patients.
“In general, what we find is that, as our patient population is expanding, our pool of human resources is not,” Britto-Leon said.
Britto-Leon explained that this time around, the entire country has been swept by the same surge, which limits the reserves from which resources were being drawn to compensate for personnel shortages in the spring.
According to him, another pressing concern is the fact that having physical space to admit patients does not necessarily translate into having the ability to accommodate them and deliver the care they need.
“The reality is that beds are not a static physical concept, they are more of a dynamic concept,” Britto-Leon said. “It’s a location with the full capability to deliver care to that patient, so that means that it has to be properly staffed with nurses, respiratory therapists and physicians.”
Williams said that for people working in the COVID-19 ICU, it can be difficult to not take the suffering they witness every day home with them. To decompress, she tries to shower and watch some TV after she leaves the hospital. Still, Williams said it is challenging to take her mind off of it.
Britto-Leon said that yet another challenge for health care workers is the need to communicate a patient’s condition to their loved ones. Sometimes, when their prognosis does not look good, they have to ascertain the patient’s end-of-life wishes. He said that having these intense personal conversations, sometimes several times a day, can be extremely difficult.
“The thing that people don’t realize about the work in the ICU is that it is not only a physical job, it’s a very emotionally taxing job,” Britto-Leon said. “It gets to you on a very personal level.”
Williams said that for patients who are not on a ventilator, worries about being put on such an invasive breathing device can provoke great anxiety — both for the patients and for their loved ones, who are unable to visit them while they are hospitalized.
“Usually when somebody is on a ventilator, it might be a couple of days, maybe a week or two, [but] COVID patients are on a ventilator for maybe a month, two months,” Williams said.
According to Williams, a downturn in a COVID-19 patient’s clinical state can happen quickly and unexpectedly, and some families have a difficult time understanding how their relatives became so ill.
Someone who is still going to work one week can suddenly find themselves on the brink of death the next week, Williams said. To her, part of the cruelty of this virus is that patients often die alone because of the risk of having visitors in the hospital.
“Nobody could say goodbye,” Williams said. “A nurse, who the person doesn’t even know, is the one holding their hand while they pass, not their own family, and it’s really sad.”
Jose Gomez Villalobos, an assistant professor of pulmonary medicine and an ICU physician, explained that unlike patients who fall ill with other respiratory diseases, COVID-19 patients often also have many systemic complications. According to him, clotting issues, neurological symptoms and multi-organ failure, for example, are not uncommon in COVID-19 patients.
According to Higuero-Sevilla, the road to recovery from COVID-19 can be slow. However, some lessons learned since the beginning of the year are now informing how incoming patients are treated. For example, fewer patients are being immediately intubated — many receive high-flow nasal cannulas instead, which help deliver oxygen to the patient in a less invasive manner.
Another major difference between now and the spring is that new therapies and interventions have since emerged, Villalobos said. Now, health care workers commonly place patients in a prone position — essentially, lying flat on their bellies — to help maintain their oxygen levels within a suitable range, he said. In addition, medications like dexamethasone, which helps combat the inflammation caused by COVID-19, have become part of medical protocols. Others, like hydroxychloroquine, have been proven ineffective, streamlining the list of medications that can be used.
However, Villalobos said that prevention is the greatest tool within reach for controlling the virus. Although some people think that wearing masks, avoiding gatherings and minimizing in-person interactions are small actions, he said, the effect of taking all of these precautions multiplies.
“We obviously need everyone’s help to prevent transmission,” Villalobos said. “What you do, your personal decisions, have pretty broad implications for others, including your loved ones.”
Britto-Leon highlighted that the health care system did not have to be this overwhelmed. To him, both the public and the U.S. government are not taking the virus seriously enough. Nurses and physicians are mentally and physically exhausted from the high-pressure environment that has not abated since March. If people had taken the correct precautions, Britto-Leon said, hospitalizations might not be rising so steeply.
Higuero-Sevilla also stressed that ICU patients are not the only ones whose lives may be endangered by COVID-19. Even people who do not require hospitalization while infected may develop severe complications in the long run.
“Although some people think they’re young and not at risk for dying from COVID, death is not the only bad thing that can happen,” Higuero-Sevilla said. “We have young patients that get COVID and then have chronic symptoms and chronic disabilities after even mild to moderate disease.”
As the holiday season approaches, health care workers expect that ICU patient volumes will increase. Britto-Leon voiced disappointment regarding some people’s apparent carelessness in following public health guidelines during the holidays.
To Britto-Leon, it sometimes feels like the world outside of the hospital is a “parallel universe.”
“We, unfortunately, cannot expect anything other than a very rapid rise in cases, especially after the holidays,” Britto-Leon said. “We are seeing the same number of air traveling that we saw last year, so how is it possible that there are a million people flying for Thanksgiving — have we really not learned anything?”
To Britto-Leon, the current surge in the pandemic will give people a rude awakening about the dangers of political arrogance. He also hopes when the pandemic is over, people will remember never to let politics interfere with health matters. But, for now, “It’s going to be a long winter,” he said.
Williams also said that it was difficult to fight against a pandemic when the president of the United States did not seem to have an adequate “grip on reality.” To her, Biden’s election brought hope.
Ultimately, the doctors and nurses interviewed by the News expressed their immense gratitude for working in a team that is so supportive of each other, which they said makes facing these trying times a little less devastating.
“You don’t go into health care without having a sense of duty towards helping others,” Higuero-Sevilla said. “We’re just trying to get through this.”
As of Thursday, 274,000 people have died due to COVID-19 in the United States, according to the Centers for Disease Control and Prevention.
Maria Fernanda Pacheco | email@example.com