When coronavirus patients flooded hospitals in November and December, nurse Jackie Rehberg worked the COVID-19 unit at SSM Health St. Mary’s Hospital in Madison even as she was concerned about her own health because she was pregnant.
As she went on maternity leave in May, shortly after vaccines became widely available, cases and hospitalizations plummeted. By the time she returned last month, a surge fueled by the delta variant was underway. Her 12-hour shifts, the protective clothing she must wear and the uncertain fate of her patients remain the same, but this wave feels different.
“Before, there was a lot more fear,” Rehberg said. “This time it’s more frustrating. At times, it can feel really infuriating because there is a vaccine out there that can help prevent some of the severe illness that we’re seeing.”
Wisconsin topped 1,000 COVID-19 hospitalizations this week for the first time since early January, up from 74 patients with coronavirus infections in hospitals in early July. Amid staffing shortages and depleted patience, health care workers are exerting themselves with familiar routines, this time in disbelief.
“There’s a real sense of anger at this COVID surge,” said Dr. Doug Hobson, a palliative care specialist at St. Mary’s. “The idea that there are members of our community who will not do the bare minimum to protect themselves — but also to protect their friends, loved ones and neighbors — is so hard to understand.”
Statewide, as of Wednesday, 1,039 patients were in hospitals with COVID-19, nearly a third of them in intensive care, according to the Wisconsin Hospital Association. More than 91% of the state’s ICU beds were in use, the state Department of Health Services said.
Dane County had 88 COVID-19 hospitalizations, including 28 in intensive care and many transfers from other counties. That’s the highest level since late January and about five times the tally from two months ago, though well below the county’s peak of 179 hospitalizations in mid-November.
About 70,000 doses of vaccine were given in the state each of the past two weeks, the most since mid-June. Still, only 52% of residents are fully vaccinated, well below the “herd immunity” level of 80% or so that health officials say can prevent outbreaks. The figure in Dane County is 69.7%, the highest rate in the state.
On Tuesday, when a Wisconsin State Journal reporter and photographer visited St. Mary’s COVID-19 unit, nurse Alex Finch and respiratory therapist Kristie Reilly were in the ICU, which had eight coronavirus patients, all of them on ventilators to help them breathe. The hospital had a total of 20 COVID-19 patients, 15 of them not fully vaccinated. The five who were fully vaccinated are age 65 or older.
Finch typically works 12-hour shifts three days a week, but lately she’s been doing that four or five days a week or logging 16 hours at a time. Even on days off, as she walks her dog or reads a book, she can’t stop thinking about her unit, which she said is perpetually short staffed.
“The whole time, in my head, I think, ‘I should be at work, I should be helping,’” she said. “A day of rest isn’t really a day of healing. You feel so guilty.”
The capricious nature of COVID-19 takes an emotional toll, as patients can decline rapidly with little warning.
“You’ll see somebody get better and better, and then you’ll be off for a day or two and come back and learn, ‘Oh, they died,’” Finch said. “There’s someone else in that room and we’re starting the fight all over again.”
Among co-workers, mental health challenges are mounting. “Many of them are seeking grief counseling,” she said. “Many have started on anti-depressants. A few have been having panic attacks, at work.”
Reilly also does 12-hour shifts, moving from the COVID ICU to the regular COVID floor or wherever a respiratory therapist is needed. Each time, she has to put on and take off gloves, a gown and a face shield. She and the others also wear two face masks, including an N95, and caps on their heads.
On Tuesday, for lunch, Reilly ate half of a peanut butter and jelly sandwich before heading to another room. “There’s days I don’t drink anything,” she said. “We don’t get much of a break because the patients are so sick.”
The night before, she was tending to a COVID-19 patient when her pager went off, calling her to the emergency room to help put in a breathing tube. Afterward, she returned to the COVID floor.
“We’re exhausted, mentally and physically,” said Reilly, who worries about exposing her son to the coronavirus. He’s 11, several months shy of turning 12 and becoming eligible for the vaccine. “We can’t go through this again.”
Many of her unvaccinated patients tell her they wish they had been immunized. She recalls a Zoom meeting in which a dying, unvaccinated man begged his family to get the shots. “You just hope he got through to some of them,” she said.
Death and denial
At other Madison hospitals, staff are similarly perplexed by the surge and preparing for the worst, again.
UW Hospital recently reconverted a dozen rooms to negative air flow, for potential COVID-19 patients, after switching the rooms back to regular care in the spring, said Dr. Jeff Pothof, chief quality officer for UW Health. He said administrators are considering when they might have to postpone elective procedures, as local hospitals did twice in 2020.
UnityPoint Health-Meriter — which had 27 COVID-19 patients Wednesday, 10 of them in the ICU — is also gearing up for more of a crunch. This summer when volume was low, one doctor was in charge of seeing COVID-19 patients each shift, said Dr. Kristin O’Dell, medical director for the inpatient doctors known as hospitalists. Now it’s two, and a third may soon be needed again, she said.
“I’m heartbroken that this is ongoing at the level it is,” O’Dell said. “We’re tired.”
At St. Mary’s, Hobson helps struggling COVID-19 patients stay comfortable and families decide whether to continue life support. Denial about the seriousness of the pandemic among some people is hard to take, he said.
After one of his patients died from COVID-19 complications, he got an angry call from a family member, he said. The person asked Hobson to remove COVID-19 from the death certificate. He refused, saying that lying on the document would be against his ethics.
“Even now, a year and a half later, there’s still so much misinformation that we have not been able to breach, and that’s sad,” he said.
With 8-year-old twins at home, Hobson carries personal and professional stress from the pandemic as it picks up again. “We don’t have time to cry and debrief and support each other because we have to rush to the next patient that’s dying,” he said.
On Rehberg’s COVID-19 wing, a step down from the ICU, three patients died within 24 hours last weekend, two of them while she was on duty.
As a charge nurse who manages the floor, she’s acutely aware of the nurse staffing shortage affecting St. Mary’s and most hospitals around the state and country, especially units like hers. Many of her colleagues have fled to jobs with few or no COVID-19 patients, such as surgery departments, outpatient clinics or infusion centers.
That means her 32-bed unit sometimes has seven nurses working instead of eight, forcing some nurses to care for five patients instead of four. “They can’t hire people fast enough,” she said. “As soon as you get someone in and trained, someone else is leaving.”
Whether the current COVID-19 surge keeps escalating or wanes, St. Mary’s will do what it can to keep up, Rehberg said. But that won’t be without consequences.
“We can do this as long as we need to, but I think we are going to lose more nurses in the process,” she said.