A year after vaccines arrived, surge of COVID cases triggers more of the tough phone calls
Kris B. Mamula
kmamula@post-gazette.com
Alexandra Wimley
awimley@post-gazette.com
January 7, 2022
A guy on five is crashing. He’s being rushed upstairs in a bed to the intensive care unit at AHN Forbes Hospital in Monroeville, where 11 of 20 patients are all suffering from the same disease. ¶ Oxygen hisses under the man’s mask. Doctors and nurses crowd around the patient in the intensive care unit, where he is quickly sedated and connected to a breathing machine in what may be his last conscious moments. ¶ COVID-19 is killing him.
Medical staff looks over the chest x-ray of a patient being treated for COVID-19 in the intensive care unit at Forbes Hospital in Monroeville. (Alexandra Wimley/Post-Gazette)
“He’s pretty sick right now,” a nurse tells a family member on the phone, a sliding glass door away from the medical team working in a hurried ballet. “We’re giving him all the support we can. We had to move him to the ICU. Is all that OK with you?”
A year ago, when the COVID-19 pandemic was still adolescent, the biggest fears were for people in their 60s and 70s and older. Vaccines went first to nursing homes.
But nearly two years in, the pandemic has shown that no one is immune. The critically ill patient at AHN Forbes is in his mid-40s and otherwise healthy.
He is not vaccinated.
He is also not the youngest COVID-19 patient in the ICU on that day: A few doors away is a woman in her early 30s. Across the hall is a man a few years older.
Neither of those patients is vaccinated; neither is getting better.
It’s two weeks before Christmas, and AHN Forbes opens another 17-bed unit to absorb a crush of COVID-19 patients as the hospital bulges with the highest number of patients infected with the coronavirus in Allegheny Health Network’s 14-hospital system. In that moment, Forbes has 58 COVID-19 patients, with a handful more in the emergency room waiting for beds.
It wasn’t always like this. A year ago, there was hope. There was a new vaccine promising a return to eating at restaurants, drinks with friends and summer vacations without masks.
Hope went away as the year wore on, said AHN Forbes Hospital Director of Nursing Jill Direnzo, who is 34 years old. COVID-19 cases spiked again and then again in the year since, as patients coming through the hospital doors turned younger and sicker — and as death came faster for many of them.
“Everybody was so excited,” Ms. Direnzo recalled. “We have a vaccine; it’s going to get better. Maybe we’re coming to an end; and we’re not. It’s still going. There’s no end here.”
Two years of a grinding COVID-19 pandemic has exhausted nurses and doctors and pushed hospitals to the limit. Nationwide staffing shortages have grown acute, even as doctors became smarter about treating the virus. Overburdened rural hospitals, like the 10-bed Bradford Regional Medical Center in McKean County, were forced to close admissions in the fall and divert COVID-19 patients to other facilities while seeking state Health Department approval to add beds.
The only constants for caregivers are workweeks that bleed into each other and the stream of people — hacking, short of breath, scared — outside hospital doors.
Emma McLain, of Verona, waits in the emergency department waiting room for treatment of persistent COVID-19 symptoms after having the disease in mid-November. (Alexandra Wimley/Post-Gazette)
“It’s terrible,” Verona resident Emma McLain, 56, said as she struggled to catch her breath in AHN Forbes’ emergency waiting room. “I just want to get better.”
Ms. McLain, a care manager at a health insurer, was diagnosed with COVID-19 in late November. She’d gotten her second vaccine shot but hadn’t yet received a booster.
She canceled her Thanksgiving plans, stayed home and tried to get better. But by mid-December, she needed help.
“It was just getting worse. None of the over-the-counters were helping,” she said. “This is the last resort.”
Also at the hospital doors is COVID-19’s highly contagious omicron variant, still mostly just a bad dream in Pittsburgh in the weeks before a snowless Christmas. But omicron cases, which have been doubling in number every two to three days elsewhere in the world, threaten to stagger U.S. hospitals. Even if the strain causes less serious disease than earlier variants as early reports suggest, because so many more people will get sick, doctors worry that hospitals will again be flooded.
“It will overwhelm us,” AHN Forbes Hospital President Dr. Mark A. Rubino said. “We don’t see the light at the end of the tunnel.”
Medical staff monitor a patient being treated for complications of COVID-19 after his vital signs deteriorated quickly in the intensive care unit at Forbes Hospital, Thursday, Dec. 16, 2021. (Alexandra Wimley/Post-Gazette)
Hospital beds in the halls
COVID-19 hospitalizations in Pennsylvania have been soaring: the number of people receiving care in ICUs spiked 62% to 1,089 between Nov. 1 and Jan. 5, while the number of COVID-19 patients in regular hospital beds more than doubled to 6,824 from 3,092 during the same period, according to data compiled by Spotlight PA.
In the weeks before Christmas at AHN Forbes, those figures translated into 44 people being evaluated in a 35-bed emergency room — a place where four people with strokes, two cardiac arrests and three with overwhelming blood infections had already been treated in one day by 3 p.m.
Hospital beds lined halls in the emergency room, pieces of white tape stuck above the beds marked with temporary numbers. Overall, 352 patients were receiving care in a hospital that effectively had fewer than 200 beds.
“It’s like the door opened up and the pandemic rolled in,” said Kathy Sikora, interim director of emergency medical services at AHN Forbes. “It’s happening much more quickly and in younger patients.”
In the Dec. 17 weekly COVID-19 report, the state Department of Health said 3,583 people under age 60 had died from the viral infection — 10% of the total 35,183 deaths, most of whom were age 30 or under.
The crush of patients and a labor crunch in Pennsylvania have driven up temporary staffing costs, according to a new survey by the Hospital and Healthsystem Association of Pennsylvania, a Harrisburg-based trade group.
Left:Top: A nurse works on a patient in a bed in the hallway of the emergency department. | Right:Bottom: Medical staff members wheel away a bed after bringing a patient from the emergency department to the intensive care unit for treatment of COVID-19. (Alexandra Wimley/Post-Gazette
On average since 2019, hospital payments to temp agencies for registered nurses more than doubled to $123 an hour from $59 an hour, according to an HAP survey of members. The hourly rate for nurses who work in specialty units, such as the ICU, rose by 82% to $120 an hour from $66 an hour.
At some hospitals, the going rates for temp agencies keep rising — up to $180 an hour for an agency nurse at AHN Forbes, for example.
In September, the American Nurses Association asked the U.S. Department of Health and Human Services to declare the nursing shortage a national emergency. Pennsylvania is expected to need 160,300 registered nurses by 2030, according to HHS.
Like many hospitals, the staffing shortage at AHN Forbes has turned into a daily scramble to fill shifts. ICU nurse Kathy Keller, 44, of Plum, who started her career as an emergency room social worker, had worked 78 hours the previous week even as other nurses pitched in.
“The last two years have been really, really hard,” said Ms. Keller, who remembers a shift when six ICU patients died, swamping the hospital morgue.
Rachel Carter, a 37-year-old nurse from Irwin who works on Forbes’ fifth-floor COVID-19 unit, said she sat with two patients in one week as they drew their last breaths. Husbands and wives, both dying of COVID-19, have shared hospital rooms in her unit.
Upstairs from the emergency department, in the sixth-floor ICU, a man in his early 60s was losing his fight against the disease that has killed more people than the Civil War, the bloodiest in U.S. history. He was unconscious, rushes of oxygen from a machine pushing into lungs that were filling with fluid.
Critical care physician Dr. Patrick J. DiGiacomo was alone in the room with the man. A bank of medicine infusion pumps clicked and hummed at the head of the hospital bed.
“Poor guy,” Dr. DiGiacomo said softly, touching the man’s leg. “He’s not going to make it.”
Patrick DiGiacomo, a critical care doctor in the intensive care unit, on the phone with a family member, explaining their deteriorating condition. (Alexandra Wimley/Post-Gazette)
Reaching the limit
Dr. DiGiacomo met with the man’s family to review treatment options as chances of his survival slipped away. The most serious cases of COVID-19 cripple the lungs, so treatment algorithms begin with giving patients higher concentrations of oxygen in increasingly complex ways. Medicines are tried.
For many patients, the chances of survival shrink with each intervention, such as connection to a breathing machine.
Those who walk out of a hospital ICU after COVID-19 have often defied long odds.
“She was always a fighter,” families may say about a gravely ill loved one. Doctors may know better about the patient’s chances of going home but may not say.
Instead, doctors will review the care being provided and outline treatment options for families to consider, leaving critical decisions in their hands.
In the end, each family sets the limits of their loved one’s treatment, whether they get care that simply eases suffering until life ends or get what is little more than a last cast of loaded dice for a shot at going home.
Dr. DiGiacomo leaves the family meeting, and a cart piled high with clear plastic bags of fluid is wheeled into the dying man’s room to start kidney dialysis, a procedure associated with a survival rate of just 15% for such patients, according to one study. In a few weeks, the man would be dead from COVID-19.
“That’s something we’ve learned here,” a social worker said. “Not every death is pretty.”
For many patients, the chances of survival shrink with each intervention, such as connection to a breathing machine. (Alexandra Wimley/Post-Gazette)
The cost of hospital overload
Hospital overcrowding is not just inconvenient; it can cost lives.
With hospital overload comes an increased likelihood of mistakes, said Dr. John L. Hick, an emergency medicine doctor and professor of emergency medicine at the University of Minnesota, who said that as many as 1 in 4 COVID-19 deaths may be attributable to hospital overcrowding.
“At some point, small mistakes add up,” said Dr. Hick, who predicted the current surge could stretch into March. “The more crowded we get, the more deaths that occur. Hospitals struggle mightily with staffing, but beds are simply not available.
“We can’t get any help,” he said.
In December, President Joe Biden promised military medical personnel to help at hospitals that are under siege because of COVID-19 while Gov. Tom Wolf asked the Federal Emergency Management Agency to provide health care workers for short-staffed hospitals and nursing homes pushed to the limit by COVID-19.
Teams of medical workers were anticipated at hospitals in Lackawanna and York counties by early January to ease overcrowding, but plans to help other hospitals, including small community hospitals in Western Pennsylvania, were unclear.
Nursing assistant Dawn Zierden draws blood from a patient who is being treated for complications of COVID-19. (Alexandra Wimley/Post-Gazette)
Becoming ‘a better nurse’
It’s Christmas week at AHN Forbes, “Jingle Bell Rock” burbles from a nurses station radio as people fighting to breathe with the coronavirus fill beds. In the fifth-floor COVID-19 unit, nurse Lori Suhadolnik remembered the anniversary of her father’s burial after his death from the disease.
Ms. Suhadolnik, 54, a registered nurse for 34 years who lives in Apollo, said the first COVID-19 vaccine was not yet available when her mother and 82-year-old father, a self-employed welder, were infected by the coronavirus last year. Her mother, a wife of 62 years, got well.
Like many families, Ms. Suhadolnik had trouble reaching nurses to ask about her dad where he’d been hospitalized. The not knowing was searing, a crucible, she said.
“I can’t imagine one of my families not being able to come in to see their loved one, to touch them,” she said. “The day I came back to work is the day I became a better nurse.”
Ms. Suhadolnik and other AHN Forbes nurses would move the beds of dying COVID-19 patients so families could touch them — hand to hand — through closed sliding glass doors when they couldn’t otherwise reach each other.
“I can’t imagine one of my families not being able to come in to see their loved one, to touch them.”
Lori Suhadolnik
Dr. DiGiacomo, 53, a Mount Lebanon native shaped like the offensive tackle and football team co-captain he once was at the University of Dayton, said he, too, felt hope when COVID-19 vaccines became available a year ago. But the shots didn’t stop the lines of people with the disease, the endless turning of patients on their bellies to ease breathing, the grim telephone calls to families from the ICU.
What’s left in him is gentle resolve as the number of new case counts broke records and the 86% of COVID-19 related deaths in Pennsylvania were people who were not vaccinated.
People make their own choices about whether to get vaccinated, he said. Others may judge those who decide against the shots, but that’s not for him to do.
He treated COVID-19 patients before there were vaccines; he will continue treating patients without vaccinations the same now, he said.
“You’re here for a reason,” said Dr. DiGiacomo, who got sick with COVID-19 before getting a vaccine booster shot. “I have to do the best I can. It’s a difficult time.”
Kris B. Mamula: kmamula@post-gazette.com or 412-263-1699.