Hospitals in the Rochester area are seeing the highest numbers of hospitalized COVID-19 patients since the beginning of the pandemic. Doctors, nurses and medical staff have all taken lessons learned from the first surge in the spring to adapt their care now.
Dr. Paritosh Prasad is the director of the highly infectious disease unit at the University of Rochester Medical Center’s Strong Memorial Hospital. During the first coronavirus surge in the spring, Prasad was caring for a young patient in the intensive care unit.
“It was to the point where one day I just could not, despite everything I was trying, could not get oxygen into the blood to a level that needed to be there,” Prasad said. “And just managed to squeak through that day.”
Hour by hour, he said, the patient managed to “claw” their way through.
“The thing about being critically ill is that you have one critical illness, but along the way, there are other problems that arise. But after about a month and a half, we got this person through,” he said.
About a month after that, Prasad got a call from the same patient. They wanted to meet one of the people who saved their life.
“They still had nightmares of what they had gone through. And in their mind, their image was of being taken apart, in a sense, this idea of not being in control of what's happening,” he said. “That’s the reality of being critically ill.”
All any COVID-19 patient can see of the doctors and nurses in the ICU, he said, are their eyes through face shields and masks. Prasad said that he always talks to his patients and explains what he’s doing, even if they are sedated or in a coma, but communication is limited.
In those months since that case, doctors have learned much more about how to treat COVID-19, he said. However, people are still getting sick -- critically sick -- and there are now more than double the number of hospitalizations than at the height of the initial surge.
Unity Hospital is busier than ever, said Bryce Bishop, its director of emergency services. He said there are two key challenges in all this: staffing and space.
“In the first wave, we had a potential resource pool of nurses from other states,” Bishop said. “Well, we don’t have that resource anymore because those states are now consumed with COVID just as we are.”
The nurses on staff are working overtime, taking on more patients at a time than they’re used to, and the hospital is looking to hire more nurses to match the demand. As for creating space, he said they’ve found ways to accommodate COVID-19 patients as well as those who need other medical care.
In the Emergency Department, for instance, patients who have less critical needs are being seen in hallways, sitting in chairs to free up stretchers, he said. While it might not seem ideal, Bishop said it’s an improvement from the spring when people who needed urgent care were too afraid to go to hospitals for fear of contracting the virus.
“We’ve placed monitors in the hallways in our emergency department,” said Bishop. “Now for the inpatient setting like the ICU, that’s far less common. We haven’t gotten to that point yet."
Everyone is tested for the coronavirus when they are admitted. COVID-19 patients are placed in separate areas. The doctors and nurses who care for them are in full personal protective equipment, but so are staff in every part of the hospital.
The protocols are about the same at Strong. There, patients have electronic records that alert staff if they have coronavirus. This means that whenever a coronavirus patient gets, say, a CT scan, all precautions are in place, including sanitation to ensure that they get the care they need without compromising anyone.
Prasad said that even for staff who are at high risk of exposure, their methods work. The PPE works. What needs to happen now, he said, is something else that happened in the spring.
“What really carried the day in the first surge was not so much the efforts of the hospitals, it was what the community did. They flattened the curve,” Prasad said. “That’s what really got us through the first surge, and that’s what’s going to get us through this next surge.”
That means stay home whenever possible, and when you have to go out: social distance, mask up, and wash up.