Frontline fatigue

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A few days ago, I spoke with an emergency room doctor. What she told me brought to mind the blues musician Mose Allison, who, in a song about his 30-year-long “almost successful” career as a performer, confessed: “I’m not discouraged; I am not discouraged … but I’m gettin’ there.”

I will call the doctor Linda. She asked me not to use her real name or identify the Rochester-area hospital where she works. 

Linda is not authorized by her employer to speak, but that is not the reason she doesn’t want to be identified. She wants to remain anonymous to keep her words from being read as an indictment of the hospital or health system she works for or taken as a criticism of her co-workers.

While the daily grind of fighting a pandemic as a frontline combatant is draining, Linda says, the system she works for is “incredibly supportive.” 

Linda loves her co-workers. Because of them, she says, despite having to don stifling PPE and worry whether she will somehow carry COVID-19 home to her own family, she still finds going to work every day “a joy.”

Still, says Linda, “they’re tired.” 

After ebbing during the summer and early fall, COVID-19 has resumed its assault on the Rochester area. This week, the state designated parts of Monroe County as orange zones—areas where in-person school instruction and indoor restaurant dining are barred, nail salons and gyms are shut down, and houses of worship are ordered to limit the number of congregants at services. 

On Nov. 19, Monroe County set a new record for single-day reports of new COVID-19 cases, logging 373 cases of the deadly virus. In succeeding days, the area’s tally of new COVID-19 cases declined, but not by much, hovering between the high 200s and low 300s. The curve is steep. The mid-November numbers compare to an Oct. 19 total of 39 new cases and a Sept. 19 new-case total of 17.

Around the world, researchers are studying the impact of COVID-19 on hospital staff. In April, after treating COVID-19 patients at New York-Presbyterian Allen Hospital, Lorna Breen M.D., medical director of the emergency department, committed suicide.

Fatigue and burnout rates among health care professionals are expected to accelerate with the rise in cases. Reports suggest frontline workers’ fatigue is more than just burnout. As of Sept. 16, at least 1,718 health care workers, including registered nurses, have died of COVID-19 and related complications, the National Nurses Union says.

Source: National Nurses Union

A fatigue factor

Robert, not his real name, is a floor nurse in the hospital where Linda works. Not authorized to speak, Robert also asked to not be identified. He echoes much of what Linda has to say.

In March, when the pandemic first hit this area and elective procedures were halted by a statewide order, Robert’s floor was converted from its usual purpose to an all-COVID unit. Some of his co-workers, dismayed at having to face the virus on a daily basis, transferred out. Only a few of the people he worked with at the start of the pandemic remain, Robert says. He stayed. 

As the pandemic subsided this summer, the floor returned to its usual function. Now, the virus has returned. Last week, Robert’s floor again was abruptly redesignated as a COVID-only unit. 

“I show up to work because I feel like I’m doing something for the community,” Robert says. But he disdains the offer of overtime pay the hospital uses to tempt nurses to cover the floor when staff is short, which is often enough.

“I work my 36 hours and that’s it,” he says. 

Like Linda, Robert worries about bringing the virus home to his wife, who is not a health care worker, and his young child. But he does not seriously consider seeking a transfer, yet. 

In the ER, says Linda, “staff was short before this started, Now, it’s worse.”

Rochester psychiatrist Jack McIntyre M.D. has counseled area health care workers at risk of burnout.

A onetime head of Unity Hospital’s behavioral and mental health services who is now in private practice, McIntyre says frontline health care workers who have been dealing with COVID-19 for some eight months “did get a break for a while” as cases subsided over the summer. But with the virus surging again, “there’s a real fatigue factor.”  

This month, COVID-19 hospitalizations across the six-hospital UR Medicine health system went from 20 to 111 in the space of one week, UR Medical Center spokesman Chip Partner told me last week.  

Rochester Regional Health’s COVID-19 census is spiking as well. The patient headcount in the system’s five hospitals rose to 117 on Nov. 19 from 46 on Nov.1. A day later, it shot to 135. As of Nov. 21, the system was treating 153 COVID-19 patients and the census was still rising, spokeswoman Veronica Chiesi-Brown says.

Michael Mendoza

Regionwide, the number of COVID-19 hospitalizations reached 289 on Nov. 22, up from 13 at the end of August. The ICU count during that period has increased more than sevenfold, to 53 from seven.

The Nov. 19 new daily case count “is a record that I don’t want to break,” said Michael Mendoza M.D., Monroe County commissioner of public health, in a weekly COVID-19 update last Thursday. 

“Unfortunately,” he continued, “we seem to be breaking records more often than not. We’ve also been continuously breaking records when it comes to hospitalization numbers and (intensive care unit) numbers and ventilator numbers.” 

Putting experience to use

If there is a kernel of good news, it lies in what the region’s health care providers have learned since the virus first invaded the area in the spring. The main fear then was that the area would run out of hospital beds, be crying for ventilators and witness ICUs being fatally overburdened. 

Such shortfalls made for a grim picture in New York City, but they never occurred in Monroe County. Mendoza thinks they are not likely to happen here even as caseloads soar past the peaks reached in the spring.

“We’re doing a much better job of taking care of these patients,” the county health commissioner says. “The proportion of them that is on the ventilator for an extended period of time is much lower. 

“We’re able to get people extubated much more quickly and we’re able to disperse them across the region,” he added. “If we are getting to the point where the hospitals are exceeding their capacity, the hospitals do this all the time. They do it every year with the flu. We find ways to create space within the hospital. The reality is (hospital) spaces can be converted quite quickly.”

Feeling stretched

For Mendoza, there is a larger question beyond area hospitals’ physical capacity: “Can we staff them?”  

Stretched staff is not strictly a matter of raw numbers. When the virus struck in the spring, hospitals across the state had been ordered to cancel all elective procedures. That freed up staff to deal with the pandemic but also created a backlog of cases hospitals and practice groups are still working off.

Staff shortages mean more stress for medical workers.

The Elizabeth Wende Breast Clinic, for example, which sometimes has to schedule hospital time for chemotherapy or surgery for patients is still working off its backlog, says Stamatia Destounis M.D., an Elizabeth Wende physician. Working through that backlog is complicated by social distancing requirements that have cut into the number of patients the clinic’s doctors can treat. 

As COVID-19 hospitalizations surge, hospitals are still clearing the spring backlog. For staff, says Linda, the ER doctor, “that means a lot of extra balls to juggle.”

As coronavirus cases have mounted, the demographic distribution of infections has changed. In the pandemic’s early days, nursing homes were particularly hard hit. A high number of deaths of residents in the 13 area Hurlbut Care Community nursing homes drew state scrutiny.

Now, all 13 of those nursing homes are completely COVID-free and have been since May, says Robert Hurlbut, president and CEO of Hurlbut Care Communities. 

Infections in the Hurlbut homes were entirely due to residents becoming infected during hospitalizations and transferred back to nursing homes without being cleared of the virus, he believes. The Hurlbut facilities’ infection rate dropped to zero shortly after Gov. Andrew Cuomo rescinded an order that had allowed hospitals to make such transfers, he says. 

Hurlbut believes his nursing homes remain unaffected because COVID-19 now is not being spread among nursing home residents but by younger community members in their 20s, 30s and 40s who are paying too little heed to injunctions to wear masks and limit social gatherings. 

Linda does not disagree.

“We learned from round one,” she says. “We know what combats the virus—social distancing, wearing masks. It is a source of frustration for me that among some people, whether to do those things is still a matter of debate. I know people are tired, but I wish there was not a debate. Why is there still focus on masks as a political issue? It’s really a health care question. Why are people still arguing?” 

Mendoza seconds her plea.

“Hospitals are becoming very full,” he says. “Nurses, respiratory therapists and doctors may be there in the same numbers as before, but they are not there in the same spirit as before. We are burnt out. We are tired and we want the community to step up and help us. Your words of encouragement, your flowers, your pizza are very nice, but what we really want is for you to do the right thing so we can take care of you and your loved ones in your time of need.”  

Will Astor is Rochester Beacon senior writer.

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