Frontline health workers exhausted by COVID-19
By Correne Martin
Of the emergency room patients evaluated lately at Crossing Rivers Health in Prairie du Chien, Dr. Jim Jordan, ER Medical Director, said about 75 percent of them have had issues related to COVID-19.
The local surge of positive COVID-19 cases began a little more than a month ago, Dr. Jordan estimated, when regional facilities in cities like La Crosse and Madison began reaching capacity. This left Crossing Rivers, as well as Gundersen Health and Mayo clinics to determine what more they could do.
“We’ve opened Pandora’s box,” Jordan said. “We must work together, now more than ever, to slow the spread. We need the community to help us out, so we can continue to help you.”
The heart-wrenching family scenarios many were used to seeing on television and the internet are affecting the local hospital now. You’ve seen them, the ones where a nurse holds up a smartphone to a dying family member as their loved ones say their goodbyes.
“We’re making those phone calls,” Jordan shared, “and discussing with family the ethically difficult life or death decisions for their loved ones.”
“It is affecting your local hospital now. The cases are going up and we do need the help of our community to flatten the curve,” added Jenny Pritchett, Chief Clinical Officer at Crossing Rivers Health. “The incredible collaboration of our community health care partners, including public health and emergency management, has been instrumental in the response to this pandemic.”
By the numbers
“It’s definitely here,” noted Rochelle Neisius, Gundersen Health Nurse Practitioner of Family Practice in Prairie du Chien. “Our nurses have been inundated with calls, probably 40-50 in their queue that they have to call back each day, and that’s just from 8 a.m. to noon. They have the same amount in the afternoon. These are your local health professionals trying to figure out what to do to get through this.”
Neisius believes 40 to 50 percent of the clinic’s phone calls are COVID-19-related. She said the clinic tests about 10 to 15 people daily and the vast majority are positive.
In addition, the clinic is still seeing patients with issues like abscesses, heart failure and stroke, said Registered Nurse Crystal Goltz, Gundersen-Prairie du Chien Regional Manager.
At southwest Wisconsin’s Mayo Clinic facilities, a significant increase in the COVID-19 positivity rate was reported, of just under 25 percent of all individuals tested, said Dr. Amy Williams, Executive Dean of Mayo Clinic Practice, Rochester, Minn., in a Zoom video press update Tuesday. “The goal is to be about 5-10 percent or less to demonstrate a slow in the spread,” she stated.
“The capacity in our hospitals is absolutely stretched,” Dr. Williams said. To counteract that, she said Mayo has decreased its elective surgical volumes until January at some sites.
Neisius confirmed that the Gundersen Health System, at this time, is also not doing elective surgeries requiring overnight hospitalization. “There’s no room because of COVID,” she said.
Dr. Williams forewarned that Mayo administration is expecting a spike in cases stemming from Thanksgiving gatherings to show up at the end of this week and for the following two weeks.
The latest peak in local COVID-19 positives seen at the Crossing Rivers Health Clinic, according to Lora Knott, Clinic RN, is the greatest seen since July.
“What’s unique about the current situation though is that the high number of tests we’re giving now is essentially from Crossing Rivers Health clinic patients alone. Before, the clinic was accepting more orders for tests from other area facilities (that weren’t testing yet),” she commented.
While there are a growing number of patients directly affected by the coronavirus, there are also many healthy people it has impacted indirectly, added Knott, who has been a nurse for 25 years and employed at the Crossing Rivers Health Clinic for 16 years. For instance, a majority of Crossing Rivers Health Clinic’s obstetrics patients are being relocated from the clinic to the hospital’s Center for Specialty Care. This is an extra precaution implemented to keep these women safe from potential COVID-19 exposure.
Frontline views
Though it can be hard for health care workers to describe the front lines right now, Dr. Jay Afzal, Crossing Rivers Health Inpatient Specialist, tried to put it into words. From his perspective, “It feels like the whole town has COVID.”
Dr. Jay started with Crossing Rivers in January, just before the pandemic. He spends part of his time in Prairie du Chien and the other half of his time in Arizona, where he said he’s witnessed 18-year-olds die from the coronavirus.
“I see a lot of elderly who are COVID-positive. But it’s not because they’re the ones going to parties,” he emphasized. “It’s because they’re exposed to their families who aren’t sacrificing their normal ways enough.”
Recently, he said he spoke with a family member of a COVID-19 patient, who watched her loved one become weaker with the virus. “Now she’s having a real difficulty with it. It’s opened her eyes and she’s now taking it more seriously. She’s wanting to know more, and I commend her for that,” Dr. Jay said.
His colleague, Dr. Jordan, said the ER is getting a lot of “bounce back” patients, or people returning with worsening symptoms like stroke, heart issues, pneumonias—“people who are extremely weak and just not doing well.”
“It’s a very strange virus that affects people differently, from cold symptoms or drowning in their secretions, to back pain, diarrhea or lower abdominal pain,” Jordan said. “We don’t know who is going to deteriorate either. I’ve had people in their 30s come in and be transferred.”
Considering the vast number of symptoms that come into play, Knott admitted that, at Crossing Rivers Health Clinic, it’s a bit unsettling to be making some decisions over the phone when triaging patients.
“Sometimes, it’s hard to get the whole picture over the phone, to get all their symptoms and for them to be open about their entire health history,” she said. “It’s also hard to hear when they’re saying they don’t have the money for gas to go get tested.”
Of course there are patients who are asymptomatic, but no one is immune to the coronavirus. All ages are now being tested as necessary.
“I had a 12-year-old test positive Monday,” Neisius said, “and, we’ve tested as early as 6 months.”
One thing Dr. Jay has noticed that many of his COVID-19 patients have in common is that they’re more hypercoagulable. “Whether it’s a blood clot in the brain, heart or lungs, we’re seeing a lot of that. I’ve seen people who are on blood thinners still get clots with this.”
“Just knowing how it’s affected one person and not another,” Knott stated, “when people think it won’t affect them personally, how can they know that?”
Cindy Riniker, Crawford County Public Health Officer, agrees. She feels people’s disbelief in the coronavirus is one of the main reasons for the increased spread and current surge in positive cases.
“We’re up to eight deaths now,” she said.
The youngest of the deceased in Crawford County were two individuals aged 52, and the oldest was 90. Others were ages 77, 78, 80, 82 and 84. Riniker expressed her compassion toward those residents who were older in age and in the minority of people with coronavirus who are dying, pointing out that their lives were no less important than those who’ve survived.
She also shared that her staff has been working overtime for months. Some weeks, the health department workers are putting in 75 hours per week, when they’re supposed to be logging only 37.5.
“When they talk about COVID fatigue, we’re suffering from that burnout,” Riniker said. “This past Saturday was my first full day off since March.”
At the health department, they test two times each week, typically for people who don’t have insurance. She reported a 50 percent positivity rate as of late.
Doing more locally
As the overwhelmed regional hospitals have fewer capabilities to accept transfers, Crossing Rivers Health has made efficient use of the ventilators it has in Prairie du Chien. Though, some patients are requiring a level of oxygenation much higher, Jordan said, so the hospital is getting several Vapotherm machines this week. These are non-invasive respiratory support systems effective in delivering a very high flow of oxygen in the treatment of acute respiratory failure without having to intubate.
For those not already hospitalized, Crossing Rivers is hoping, according to Dr. Jay, to have access to the new monoclonal antibody treatment that is coming out now. This is an infusion available to people, mostly over age 65 with chronic conditions putting them at risk to have a poor outcome, who are having mild to moderate COVID-19 symptoms.
Dr. Williams said Mayo Clinic institutions in the Midwest region have recently infused 340 patients with the monoclonal antibodies. This has shown a decrease in symptom severity and hospitalization risk.
“The time to get this is as soon as you have symptoms,” Williams explained. “Every person in [the Mayo] system who is tested for the coronavirus, we call them and have a discussion about this possibility.”
A press release last week from UW Health in Madison said it had received a shipment of 116 doses of this treatment and was open to evaluating potential recipients within its system.
The next step, or the light at the end of this, is the vaccine.
“Everyone is over COVID, but COVID is not over,” Niesius quipped.
Do your part
“I think we’re in for another six months to a year of this,” Dr. Jordan noted. “Until then, we’re going to continue seeing surges.”
The health care providers are certainly doing what they can to care for and educate people. For example, Niesius said, “I had a patient with mild nasal congestion and ear pain. I suggested she be tested. She kinda gave me a look and pushed back. I said, ‘if you’re going to ignore your symptoms, even if they’re mild, you could be affecting others who could die from it.’”
Dr. Jordan wishes doubters would recognize the examples set forth by doctors, nurses and other public health personnel and understand that if the proper safety precautions are taken, their effectiveness is obvious. “They’re wearing masks, social distancing and washing their hands,” he said, noting the professionals aren’t the ones being infected.
He believes, if the public begins to take the coronavirus more seriously as a whole, the local communities can slow the rampant numbers.
Goltz said, at Gundersen, she has observed the gravity of the pandemic hit home when patients and families are dealing with health problems other than COVID-19. “Like, if they have heart failure or severe diabetes and there’s no room for these people, then they seem to get it,” she said. “We usually see a lot of patients who’ve hit their deductibles and elect to have a surgery at the end of the year. This year, that’s not even an option.”
With the holidays around the corner, Riniker urged, “We need everybody to do their part and to be smart and safe to keep our loved ones here through the holidays and beyond.”
Knott hopes for the same: “It’s hard not to be with your grandchildren and children for the holidays. But keep your group small if you can. We have to care a lot to really keep our distance, but we can’t be selfish about it.” She suggested remembering others, especially the elderly, this holiday season by making phone calls, sending cards or care packages, and waving from a distance.
Dr. Jay has a challenge for local residents. “What better time than the holidays to show people we can slow life down and spend time indoors with our immediate families,” he stated. “I think, as a community, we can come together and be thankful of each other, and prevent hospitalizations while we wait for the vaccine.”
Once the COVID-19 vaccine is officially released across the U.S., Dr. Williams pointed out that it will most likely be available to frontline health care workers first and high-risk individuals second.
Niesius is hopeful that her patients are willing to be vaccinated once the time arrives.
Then, when the majority become vaccinated, Dr. Jay asserted that there will be other viruses present nationally and internationally. “We need to make hand hygiene more of a habit in our daily lives.”
Continue to seek care
Though they’re exhausted, the local professionals of the multiple health care and public health venues are doing their best at stepping up to get through this collegially. They’ve worked more closely than ever before with entities such as schools, emergency management, city and county officials, etc.
“I think Crawford County has presented a unified front. We all work well together,” Riniker said.
All of them encourage anyone needing medical attention, for COVID-19 or non-COVID symptoms, to continue to seek medical care and guidance.
“In the early days of the pandemic, we saw people who were a lot sicker when they finally made it into the ER. Again now, we’re starting to see more of that for non-COVID patients,” noted Dr. Williams. “It’s still safe to seek medical care right now.”
Niesius added, “Take precautions and contact us if you have questions or concerns. We’re here and we’ll continue to be here.”
