For Dr. Marc Moss, the day begins before 7 a.m. Time for rounds.
These are anxious weeks again in the intensive care unit at UCHealth University of Colorado Hospital, where Moss works. After a decline in patients earlier this summer that the hospital’s doctors and nurses had hoped signaled the effective end of the coronavirus pandemic, the number of people in the unit sick with COVID-19 is rising again.
That means Moss and his colleagues need to spend more of their day putting on and taking off the now-familiar layers of protective gear necessary for working in highly infectious patients’ rooms. It means more time watching the data coming from sensitive monitoring gear, looking for clues whether a patient is getting better or worse. It means renewed worry about what lies ahead and when the current wave of patients will crest.
“The concern is, will they increase enough to stress the system?” Moss said.
But, something is also different this time.
There are conversations with patients and their families about the importance of vaccination — and about regrets from patients who are unvaccinated and now find themselves facing the possibility of being placed on a ventilator.
“What we hear a lot is they didn’t realize how serious it was,” Moss said. “They wished they had taken care of things earlier. They feel bad about the decisions they made in the past of not getting vaccinated.”
And, in a calm manner honed over a career of treating people on the edge of medical catastrophe, Moss says to them warmly: “You can’t change the past. Let’s just focus on the present and seeing what we can do to take care of you now.”
“That’s like Life 101,” Moss said.
But, for the health care workers on the front lines of the pandemic, it is also a special kind of exhausting. For nearly 19 months, they have toiled in the fight against COVID-19, learning more about the enemy, improving their treatment methods, getting better at saving lives. Through four distinct waves of hospitalizations, they have seen their ICUs swell with patients and held the hands of some of those patients as they died.
And now comes a new wave, the one that feels most unnecessary, most preventable. A wave of patients made up mostly of those who are sick not because there is no vaccine for the coronavirus but because they have chosen not to take the vaccines that are available.
On Tuesday, there were 676 people with COVID-19 in Colorado hospitals plus another 108 who were suspected but not yet confirmed to have the disease. Those are the highest numbers the state has seen since January.
The number of people newly admitted to the hospital in Colorado with COVID-19 has risen each week since mid-July. Last week saw a 41% increase in coronavirus hospital admissions over the previous week, which itself saw a 25% increase in admissions from the week prior.
More than 80% of patients admitted to the hospital in Colorado in the past two months have been unvaccinated.
Moss said there is no animosity toward unvaccinated patients in the ICU. He and his colleagues are there to make people better, not to judge them. Everyone receives the same level of care.
But he said the new wave is testing doctors and nurses’ emotions in ways they’ve not experienced before.
“Any suffering and tragedy we see is very difficult to deal with because there were ways to avoid it,” he said.
“We become your family”
At The Medical Center of Aurora, nurses and doctors in the ICU had expected this to be a time of relief.
“We started to see an end to the tunnel,” said Josi Hamill, a nurse ICU manager. “Everyone was getting really excited. We were down to one to two COVID patients in our unit.”
Then the numbers began to rise again. It’s not as bad as it was last spring, when as many as two-thirds of the hospital’s coronavirus patients were in the ICU. Now, it’s about a quarter — the remainder are not sick enough to need ICU care and are being treated in a general unit two floors up.
But the rise in coronavirus patients brought for nurses an unwelcome return to stresses they had hoped to leave behind. And it was up to Hamill and other hospital leaders to help the staff rise to the renewed challenge.
“Just reminding the nurses that we’ve already done this fight. We have to keep going,” she said. “We have to treat our community. And it is a really hard time. It does bring up some really sore memories for nurses.”
Hamill said the hospital has created a mentorship program and other peer-support efforts to help with the emotional toll of caring for the pandemic’s sickest. The hospital has also brought in more behavioral health specialists to look after the needs of the staff.
But, beyond the toll the pandemic has taken on nurses and doctors, Hamill most wishes people could see the toll it takes on patients.
The hospital continues to restrict visitors for coronavirus patients in the ICU — the risk of spreading the infection is just too great, meaning patients are battling the virus without their loved ones there beside them.
“So you’re fighting the fight now with a bunch of strangers,” Hamill said. “We become your family as nurses. But you don’t get your loved one to hold your hand.”
Patients say their goodbyes to family over video calls before being placed on a ventilator. If they get better, they wake up in a room filled with people covered in protective gear, with wires and tubes attached all over their own bodies. While they were under, every day for their families was agony.
“They didn’t realize that COVID was that bad,” Hamill said.
Every time Moss enters a coronavirus patient’s room at CU Hospital, he performs a solemn ritual.
N95 mask, gown, gloves, face shield, second pair of gloves — the practiced routine of preparing to treat the highly infectious. He estimates that the process of putting on the gear adds an extra 5 minutes per patient visit. When he’s finished, he said he feels like a knight suited in armor.
“I’ve done it so many times I have it down to an art,” he said.
And, then, when he leaves the patient’s room, he needs to take the gear off, carefully so as to not contaminate the hallway outside. Another 5 minutes.
Multiplied over a dozen or so patients, Moss said just the donning and doffing of personal protective equipment can add a couple hours to the work day. He says most people are working days that stretch to 13 hours now. Doctors are scheduled for shifts of seven consecutive days.
Moss said he worries about what all this accumulated fatigue and anguish will mean for the health care system. Will doctors and nurses quit? No matter how dedicated you are to caring for patients, you eventually will need to take care of yourself. And feelings of burnout, he said, are at an all-time high.
“What people have done over the last 18 months has been heroic,” Moss said. “We thought we were over it, and we’re not. I think it’s going to be very difficult for people to continue at the pace that we’re on.”
On Tuesday, there were 221 people at UCHealth hospitals across the state with COVID-19, a curve climbing upward with no peak in sight.
“I’m afraid at some point,” Moss said, “people are going to say, ‘Enough. I can’t do this anymore.’”