******************** POSTING RULES & NOTES ********************
#1 YOU MUST clip all extraneous text when replying to a message.
#2 This mail-list, like most, is publicly & permanently archived.
#3 Subscribe and post under an alias if #2 is a concern.
*****************************************************************
NY Times, June 28, 2020
‘Feeling Like Death’: Inside a Houston Hospital Bracing for a Virus Peak
As young patients fill new virus wards, Houston Methodist is calling
nurses to work extra shifts and ramping up its testing efforts.
By Sheri Fink
HOUSTON — Melissa Estrada had tried to be so careful about the
coronavirus. For months she kept her three children at home, and she
always wore a mask at the grocery store. She and her daughter even
stitched face coverings for relatives and friends.
But over the weekend Ms. Estrada, 37, was fighting the virus at Houston
Methodist Hospital after a week of treatments that included an
experimental drug, steroids, intensive care and high doses of oxygen.
She probably contracted the virus while attending a dinner with
relatives who had also been cautious, she said. Within days, all four
adults and several children who had been at the gathering tested
positive for the coronavirus.
“It was really, really scary,” Ms. Estrada said of her illness. She
worried constantly about leaving her children motherless. “You hear
about it and you think it’s the older people or the people with
underlying issues,” she said. “And I’m healthy. I don’t understand how I
got this bad.”
Coronavirus cases are rising quickly in Houston, as they are in other
hot spots across the South and the West. Harris County, which includes
most of Houston and is one of the largest counties in the nation, has
been averaging more than 1,100 new cases each day, among the most of any
American county. Just two weeks ago, Harris County was averaging about
313 new cases daily.
Measures to cope with the surge and to plan for its peak were evident
over the weekend at Methodist, which called nurses to work extra shifts,
brought new laboratory instruments on line to test thousands more
samples a day and placed extra hospital beds in an empty unit about to
be reopened as patients filled new coronavirus wards.
Gov. Greg Abbott, speaking in Dallas on Sunday, said that the virus had
taken a “very swift and a very dangerous turn” in Texas, and that the
increase in the rate of positive coronavirus tests, to over 13 percent
in the past month from less than 4 percent, was an “alarm bell.” He made
the grim assessment after meeting with Vice President Mike Pence and Dr.
Deborah L. Birx, the coordinator of the White House’s coronavirus task
force, who joined the governor in urging all Texans to wear masks and
avoid close contact in crowds.
Mr. Pence, appearing at a Dallas rally celebrating religious freedoms,
threw his support behind Mr. Abbott and his efforts to reopen the
state’s economy — even as the governor made an about-face on Friday in
his phased plan by ordering bars closed and capacity at restaurants cut.
Many young people had socialized in them, standing close together, not
wearing masks, some expressing skepticism that they could become infected.
During the virus’s first peak in April, the majority of patients testing
positive in the Methodist hospital system were older than 50. Now the
majority are, like Ms. Estrada, relatively young. Nearly one-third of
intensive care patients are now under 50, much higher than in the
initial coronavirus surge.
The stress on medical institutions burst into public view last week,
when Texas Medical Center — a downtown cluster of Houston’s major public
and private hospitals, including Methodist — announced that the baseline
intensive care unit capacity across its hospitals was full, with 28
percent of beds occupied by virus patients. That was nearly twice a
threshold established by the state, which called for I.C.U.s to have a
maximum 15 percent of virus patients for hospitals to resume elective
services.
The hospitals typically operate with nearly full I.C.U.s, and had
planned to increase the number of critically ill patients they could
treat. But the next morning, the governor issued an executive order that
again restricted elective surgeries in Harris County. The order,
however, allows hospitals to continue performing surgeries and
procedures that will not deplete their capacity to care for coronavirus
patients; some hospital executives and doctors, including ones at
Methodist, said they were able to continue providing those services,
which they viewed as particularly needed after being halted during the
initial shutdown. The Texas Medical Center hospitals are collectively
treating about 1,500 coronavirus patients, according to figures released
on Saturday.
During the previous surge in mid-April, Methodist’s system had at most
just over 200 coronavirus patients. On Sunday, it had nearly 400
inpatients with the virus, and about 150 more were being tested for it.
Some models predict a peak in two to three weeks.
Roberta L. Schwartz, an executive vice president and chief innovation
officer at Methodist, who is serving as the coronavirus incident
commander, walked from unit to unit on Saturday “trolling for beds,” as
she described it. She spoke with nurses and doctors, troubleshooting to
solve problems that could delay sending patients home or transferring
them to lower levels of care when they were ready. She informed nurses
in an intermediate care unit that it would soon transition into an
I.C.U. for coronavirus patients.
She visited a huge laboratory with more than $3 million worth of new
instrumentation that she referred to as the “Taj Mahal,” a former
academic lab that was repurposed to process virus tests, and took her
first look at two recently purchased machines that can run 1,000 tests a
day. In some parts of the country, laboratories, including Methodist’s,
have experienced recent testing backlogs as demand and new cases have
increased.
The hospital is hiring traveling nurses to bolster its staff and
offering bonuses as incentives to some employees to take extra shifts.
In recent days, hospital beds and mobile computers were rolled into an
empty, 34-bed unit that had been shuttered and will now be used for
coronavirus patients. “This is why I don’t have to put trailers out
front and mobile hospitals out front,” Dr. Schwartz said. The changes
were also part of the hospital’s efforts to maintain capacity to safely
treat its many nonvirus patients.
The Methodist hospital system, with nearly 2,400 beds in service,
includes six community hospitals across greater Houston and the flagship
academic medical center downtown.
It sits near other renowned medical institutions including Baylor
College of Medicine, MD Anderson Cancer Center and Texas Children’s
Hospital, which is opening a unit to treat adult coronavirus patients.
Methodist and several other private hospitals have also agreed to accept
virus patients from Harris County’s inundated public hospitals, part of
the Harris Health System.
Tritico Saranathan, a charge nurse on one of Methodist’s virus wards,
said she had noticed that patients were younger than those first hit by
the coronavirus several months ago. “We’re seeing a lot of people in
their 30s — they’re out there partying and not wearing their masks,” she
said. “As soon as the city opened up, they were very eager to go to the
bars, to the clubs, to the restaurants, just to hang out in groups. And
no one was social distancing or wearing a mask.”
“What I’m seeing is that they’re pretty sick — the younger ones are
pretty sick,” she said. “They’re struggling a lot with respiratory
issues. They’re having a hard time breathing,” she added, “just feeling
like death.”
One of the newest coronavirus patients, Jessica Rios, 36, a mother of
four with pneumonia, was transferred to Houston Methodist by ambulance
from an urgent care center on Saturday. She said her husband was being
treated in the hospital, too. She worried about her children and was
frequently using FaceTime to call them. Her 18-year-old was looking
after her 12-year-old, who has severe asthma and has also tested
positive for the virus, and her 5-year-old twins, one of whom has
cerebral palsy and has tested positive, too. “It’s kind of hard to be
here when I have them at home struggling,” she said.
Ms. Rios had not been out partying. She said she thought she had
contracted the coronavirus while working as a clerk in a dialysis unit
for children. She said that she has allergies that make it difficult to
wear a mask, and that she would sometimes take her mask off in the unit,
where one child later tested positive for the virus. “I couldn’t tell
you if every time I talked to her I had a mask on,” she said.
In another room nearby was Curtis Ezell, 37. He had come to the hospital
to be treated for heart failure, but tested positive for the virus when
he had a routine test upon admission. He sometimes does deliveries for
DoorDash, a food delivery service, and recently moved to Houston,
staying at hotels.
He said that he had no idea how he had contracted the virus, and that he
was not experiencing common symptoms of the infection. “If you know
someone with Covid, everyone should get tested,” he said.
An even younger pneumonia patient, Alexander Nelson-Fryar, 25, was in a
new ward for 15 coronavirus patients that just opened last week. He said
that he worked training employees at a medical clinic nearby that
sometimes saw virus patients. Mr. Nelson-Fryar said that he had worn the
same mask at work every day, which he would keep in his car, and that he
did not know how he had become infected. “I go there and I go home,” he
said. “I think I got a little unlucky.”
He said he feared that people his age were not taking the illness
seriously enough, as he himself had not. “I thought younger folks are
not going to get symptoms; if I do get it, it’s not going to be a big
deal,” he said.
That was not true in his case. “It hit me like a truck,” he said. “Even
if you are young and not at risk, it’s pretty scary.”
At Methodist, the majority of the coronavirus patients are in designated
medical wards, not in the I.C.U.s.
That might be because of the increasing proportion of younger, healthier
patients. Hospital leaders say they are also getting better at treating
patients, avoiding the need to transfer them to I.C.U.s. The length of
hospital stays for virus patients at Methodist is about a day and a half
shorter this month than it was in April and May.
It remains possible that the proportion of patients in the I.C.U.s could
rise, because of the time lag between when a patient first gets sick and
develops critical illness.
On Saturday evening, after making rounds, Dr. Faisal Masud, the medical
director for critical care across all of Houston Methodist’s hospitals,
described the younger virus patients in the I.C.U.s. “Typically there
are definitely 30-year olds, 35-year olds,” he said, adding that the
most severely ill young people often are obese or have medical problems
such as diabetes, kidney disease and high blood pressure. One young
patient was on an external heart-lung machine known as ECMO.
Handmade cards thanking health care workers in the intensive care unit
at Houston Methodist Hospital.Credit...Erin Schaff/The New York Times
During the first surge, Dr. Masud said, some young virus patients came
to the hospital extremely sick and died soon after they arrived. Now, he
said, they are coming earlier, but more often.
“I think that there was a sense of being invincible or this is not their
problem, even if they caught it, no big deal,” he said. That attitude
has changed in the past few days, he said, including among his own three
daughters, who are all in their 20s. “They’re now paying attention,” he
said.
Ms. Estrada, the mother of three who was being treated for the
coronavirus, said she worried that there would be more patients like her.
“They opened up our city way too quick — our governor didn’t want to let
the bars be closed and the restaurants and functions, and they just
wanted us to get back to normal,” she said, adding, “I knew it was a bad
idea.”
_________________________________________________________
Full posting guidelines at: http://www.marxmail.org/sub.htm
Set your options at:
https://lists.csbs.utah.edu/options/marxism/archive%40mail-archive.com
