LUTZ — The COVID-19 patients arrive with depressing frequency to the emergency room at St. Joseph’s Hospital North. The sickest have a similar complaint: “I can’t breathe. I feel like I’m drowning.”
Everyone is assessed as soon as possible, but the community hospital has only 40 treatment rooms in its ER. Some patients are returned to the waiting room, where, even with an area divided off for those infected, they put others at risk.
Over a recent weekend, the ER wait time stretched past four hours, said Dr. Brett Armstrong, the hospital’s chief of surgery. He’s heard similar stories from colleagues at other Tampa Bay hospitals.
“There’s nowhere to put patients. You can’t put them in hallways,” he said. “There’s too many sicker people that need the beds.”
As recently as April, the hospital’s doctors and nurses felt like they were finally beating COVID-19. Case numbers were low; people were getting vaccinated. Armstrong felt like he could plan a vacation for the fall and take his son to see his first Bucs game.
Four months later, Florida hospitals are filled with more coronavirus cases than at any point during the pandemic. After 17 months of fighting the ravages of COVID-19, the end is no longer in sight for doctors and nurses who say they’re risking their mental health and “burn out” dealing with this fourth pandemic wave.
On Aug. 7, Armstrong prepped two COVID-19 patients for a chest tube thoracostomy, a procedure to release pressure on their lungs that builds up when oxygen is pumped. Separately, he asked two nurses how they were coping. Both broke down in tears.
“They feel like a lot of people don’t care,” he said, “that a lot of the community cares more about their own feelings, their rights and freedoms than the health care workers having to deal with this.”
‘No one should die from COVID’
Adding to the frustration of medical frontline workers is that this surge of cases was avoidable given the availability of free, effective vaccines.
Hospitals report that about 90 percent of admissions are unvaccinated patients. Doctors and nurses now watch patients suffer and, in some cases, die from COVID-19 symptoms that are, in most cases, preventable.
That has made the recent spike in cases “heartbreaking,” said Dr. Seetha Lakshmi, medical director of Tampa General Hospital’s Global Emerging Diseases Institute.
The number of COVID-19 patients at the hospital as of Thursday morning climbed to more than 200, with 74 patients in intensive care. More than 90 percent of the beds allocated for coronavirus patients were occupied.
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Lakshmi said too many patients, especially those in their 30s and 40s, are waiting too long to seek treatment.
“Whether we like it or not, we have the front-row seat to the human tragedy that has unfolded,” she said. “The difficult part right now is really hard — no one should die from COVID; there is no reason to.”
It’s not just patients facing long waits. Once the ER is full, hospitals typically declare themselves on bypass, meaning ambulances should divert patients to other hospitals.
In recent weeks, many local hospitals have put themselves on bypass, so ambulance crews have no choice but to wait outside for emergency beds to become free.
The situation became so critical that Hillsborough County’s Emergency Medical Planning Council recently set up a website, updated hourly, showing first responders which hospitals are accepting patients.
It made for grim reading Wednesday evening. Only one hospital, St. Joseph’s main Tampa campus, reported normal operations. Six hospitals, including Tampa General Hospital, were listed as “volume bypass,” meaning the emergency department is at capacity and ambulances should expect a delay. Four were listed as “total divert.”
That means those hospitals were not accepting any patients.
‘I have put more people into body bags’
Even before this current wave of infections, the pandemic had left Kate Bergoch with memories that trouble her dreams.
The 32-year-old nurse worked in the ER at Brandon Regional Hospital during the first COVID-19 wave, when there was no vaccine. The hospital is the nearest for a large number of nursing homes. At one point, its morgue was full and a room was set aside to store additional bodies, she said. The air-conditioning was lowered to 64 degrees to slow decay.
On one summer day during the peak of infections, she said she juggled about 30 patients. The American Academy of Emergency Medicine recommends a nurse-patient ratio of no more than one nurse for every three patients. Choosing which patient to tend next that day felt like she was deciding who was going to die, Bergoch said.
“I have put more people into body bags this year than I graduated high school with,” she said.
Bergoch now works in the emergency room of a major Tampa hospital. Until the recent surge, it would treat about 100 patients per day. Now, they’re up to almost 300, she said, roughly three-quarters infected with COVID-19. Wait times to be treated have stretched to more than six hours.
She has no doubt that a year and a half of dealing with the pandemic is having a toll on her colleagues as well. It doesn’t help that a few patients — even after they arrive with respiratory difficulties — refuse to accept they have the coronavirus. Some still think it’s a hoax.
One patient, she said, accused Bergoch of being in “Biden’s pocket.”
“We’re burned out; we’re exhausted,” she said. “You walk down the hall of a medical institute, and the nurses are dead behind the eyes.”
Surveys of medical workers suggest that the pandemic has made extreme fatigue, anxiety and stress common.
Six out of 10 health care workers reported that worry or stress has had a negative effect on their mental health, according to a Washington Post-Kaiser Family Foundation survey conducted in March. About 55 percent feel burned out on their way to work. About half reported issues with sleep.
Medical professionals may experience issues for years to come. Those could include everything from problems eating and sleeping to substance abuse to the end of their marriages, said Carol Bernstein, a past president of the American Psychiatric Association and a professor at the Albert Einstein College of Medicine.
A small percentage of workers, she said, could suffer more serious mental health issues, such as depression, post-traumatic stress disorder and chronic anxiety.
“It’s awful and scary,” Bernstein said. “All of us are worried that people are going to leave the professions.”
‘We don’t want to lose our humanity’
As chief medical officer at Morton Plant North Bay Hospital, Dr. Andrew Wilson spends most of his time in his office.
But one day a week, he dons scrubs and works the ER at the BayCare community hospital in New Port Richey. His shift starts at 7 a.m. He grabs his mask, stethoscope and trauma sheers.
“What’s changed now is that I don’t take that N95 mask off the entire shift,” he said. “I’m seeing so many COVID patients, it’s not worth the time to remove it.”
The first thing he checks is how many “holds” there are, the term for patients who have been triaged and admitted but are still in the waiting room.
Morton Plant’s ER has 28 beds, not enough to deal with the persistent influx of infected patients. About 40 percent of the hospital’s 154 beds are filled with COVID cases, Wilson said.
“There is no disease process, other infections that would ever reach a volume of 40 percent,” he said. “This is unprecedented territory for sure.”
Patients arriving with non-COVID issues like a broken bone may end up in the waiting room for hours. They cannot be given pain medication, Wilson said, because nurses cannot monitor them.
The hospital is limiting patients to one visitor because of the surge in cases. They make exceptions when a patient is dying.
“We will make all attempts for the family to be there,” he said. “We don’t want to lose our humanity.”
Coronavirus patients with breathing difficulties may be put on high-flow therapy, which delivers oxygen through a cannula, or connected to a bilevel positive airway pressure, known commonly as a BiPap.
Patients with severe respiratory problems end up on a ventilator. A tube must be inserted through the trachea. The discomfort level requires that patients are sedated.
Doctors and nurses he works with are tired and frustrated that disinformation about the vaccine and the virus makes their jobs so much tougher. A handful of the sickest patients he’s treated have refused to accept they have the coronavirus — even right up to the moment when they’ve been intubated.
“They’ve been so misguided by the disinformation out there,” he said. “It’s really sad to have this happen in a pandemic. People are dying, and it’s unnecessary.”
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