Saving Lives During COVID
A summer that began with the hope of ending COVID-19 and returning to normal ended with 556 more deaths in Mobile and Baldwin counties. Healthcare systems were stretched to their limits, and the realization settled in that the coronavirus isn’t going away.
Exhausted doctors and nurses have Post Traumatic Stress Disorder from fighting an invisible war. It’s a war they want the public to understand.
“We were running into the fire to save lives, but there was a nursing shortage and not enough of us,” said Abby Wilson, a nursing manager over a COVID unit at Springhill Medical Center in Mobile. “We were overwhelmed and running on empty, but we took extra shifts and stayed extra hours. We leaned on each other, but sometimes we held each other and cried.”
They didn’t expect the fire because they had hope in the vaccine.
“During the first year of COVID, we prayed for a miracle drug to save lives,” Wilson said. “Many of the doctors and nurses I work with were vaccinated in December. We hugged each other as we waited in line, thinking the vaccine was the beginning of the end. We were so hopeful. We didn’t realize it would get much worse.”
The Delta variant of COVID-19 swept through the Gulf Coast in July and August. Local doctors sounded the alarm, describing it as a different virus that was more contagious, more deadly and affecting younger people.
COVID peaked in Baldwin County with 181 cases per day in January and with 330 cases per day in August. It peaked in Mobile County with 284 cases per day in January and with 626 cases per day in August. The positivity rate in Baldwin County was 24.2 percent in January, compared to 33.2 percent in August. In Mobile, the positivity rate was 18.4 percent in January, compared to 37 percent in August.
Daily hospital reports showed almost all COVID patients were unvaccinated. The vaccination rate was less than 30 percent in July, one of the lowest in the country. The fully vaccinated rate in Mobile and Baldwin counties was just under 42 percent in September.
“The data shows the vaccine works and keeps people out of the hospital and alive, but so many refused to get it,” Wilson said. “We saw the negativity and misinformation on social media. Somehow, people quit trusting doctors and nurses, and we became part of the ‘fake news.’”
Wilson became a nurse to care for her neighbors, not to watch them die. The daughter of a north Alabama farmer, she grew up working with chickens and cows, then put herself through college and nursing school by working for five years at Sonic as a carhop.
She has been using her Sonic skills making milkshakes to ease nutrients into the patients who are unable to eat. Sucking on a straw also helps them breathe deeply.
“People are suffocating, and we are trying anything to help them breathe,” Wilson said.
“I can’t count how many deaths I’ve seen. We pray, try all of the medical things we can, then love them and help them die with whatever dignity they have left.”
One of those was a father about to go on a ventilator. He knew it was the end, so Wilson handed him a pen and piece of paper to write a note to his 12-year-old son.
“Before we rolled him out, he said, ‘Tell my son I love him and that I’m sorry,’” Wilson said. “How do you tell a 12-year-old kid that we tried everything, but there was nothing we could do? Children are now growing up without a parent because of COVID.”
Wilson said patients became friends and family, but there was no time for grief when they passed away.
“Emotions were pushed aside because there was always another patient who needed us.”
Ambulances arrived around the clock, sometimes two or three at a time, then waited for hours to offload patients at hospitals with no room.
Jonah Fryfogle is an ER nurse at Mobile Infirmary.
“We were using every bed we could for COVID patients, but that wasn’t enough,” he said. “People kept coming in, creating a bottleneck that backed up through the waiting rooms and out to the ambulances. Sometimes we had 30 people in the waiting room. They had the COVID cough, and we knew they didn’t feel good.”
Fryfogle said the ideal ratio in the ER is one nurse to three patients, but it became one-to-five, and more of the patients required intensive care.
“We operated under triage, treating the most critical patient first,” he said. “But sometimes we got backed up with critical patients in the waiting room. Our fear was that we couldn’t put patients into a room soon enough.
“It was a busy day when non-COVID patients sat on metal chairs in the hall because it was the only space we had,” said Fryfogle, a single dad of four kids who wore work boots on his shifts and tried to keep up the spirits of his co-workers and patients with laughter. “The halls were noisy with chatter and squeaks as people rolled through on wheelchairs and stretchers.”
When the patient load exceeded what the emergency department could promptly handle, the hospital issued a diversion request, notifying ambulances that it couldn’t take more arrivals. The ambulances would normally reroute the patients to the next closest ER.
“We had a monitor that showed for weeks every hospital on the Gulf Coast was on red for diversion,” Fryfogle said. “Everyone on diversion meant no one was on diversion. We fit people in the best we could.”
A few patients were brought in by fire trucks when no ambulances were available.
Amy McDonald is a former math and science teacher who needed a change. Now an EMT for Global Medical Response, she described the time of diversion and increased calls as “surreal.”
“I told myself this couldn’t be happening, then I focused on my patient and took it one call at a time,” she said. “I tried not to think about what I couldn’t change.”
Like hospitals, medical response teams were also short-staffed, and some of their own people were out with COVID. With fewer people responding to more calls, McDonald worked 85 hours in one week and said 60 percent of her calls were COVID-related.
“A lot of us worked overtime to fill in the gaps,” she said. “We worked 24-hour shifts with 24 on and 48 off. We napped and ate when we could.”
EMTs stood for hours at the nurses’ stations until their patients were admitted. It’s called “wall time,” and McDonald used it to get to know her patients. She eased their fears and cared for their symptoms, aware of the 911 calls that kept coming in.
“We were all tired and stressed, but we had patience with each other,” she said. “Sometimes the nurses were dealing with seven, nine or 11 patients at a time. There were patients on ventilators in the ER because there were no rooms available upstairs. But they were trying to get us turned around so we could bring in another one.”
Nurses said the COVID patients were also stressed, anxious and depressed. They were alone and isolated, trying to remain still with breathing machines on their faces. Nurses held up phones for Facetime calls, celebrated birthdays or just cheered the next breath.
Wendy Ledlow, a pulmonary critical care nurse practitioner at Thomas Hospital, cares for the sickest of the sick. She said COVID hardens the lungs until fibrotic lung tissue becomes non-compliant, hardening to the point of “trying to blow oxygen into concrete.”
“I did the intubation and inserted the breathing tube. It was a terrible time because the patient was looking directly into my face,” she said. “I tried to get as close as I could so they could hear me as I spoke with them. I will never forget the look of fear on their faces as they told me, ‘I’m scared. Don’t let me die.’”
But those on ventilators often died. “Relentless” is the word Ledlow used to describe moving bodies out and patients in.
“An open bed meant a patient died,” she said. “If I lost someone, there was someone else ready to move in as soon as the room got the one-hour ‘terminal clean.’”
Ledlow witnessed 26 deaths over two weeks, but she didn’t let anyone die alone and made sure they were as comfortable as possible. She kept a master list of all patients but didn’t remove the names of the ones she lost. She called it a memorial.
“If we made it through a day without a death, that was a good day,” she said. “We are fixers. We aren’t built for all of this death. We have PTSD, just like soldiers in war.”
It’s a war that also hit children this time around, filling the Pediatric ICU at USA Children’s and Women’s Health in Mobile.
Rene Sprague is the founder and director of the Bridge Program that helps families at Children’s and Women’s through the fatal diagnosis of a child.
“Today was the hardest day I’ve had at work,” Sprague said recently. “Some kids are here because of COVID. Others are here with another diagnosis and have COVID on top of it. We have tough cases and upset parents. Wearing PPE with a mask and shield means I can’t hug and comfort them the way they need. We also can’t have skin-to-skin contact with the babies and pull them close when they are upset.”
Most kids are resilient and survive COVID, but Sprague said she worries about the long-term effects.
One of those is MIS-C or multisystem inflammatory syndrome, a response with abdominal pain, fever and vomiting that can happen months after COVID. Sprague said it’s not just preventing COVID, but also preventing what comes after. That’s what keeps her up at night. She also worries about giving COVID to her daughter, who’s not old enough for a vaccine. She knows what can happen if she gets it.
Sprague left the hospital early in the afternoon of her son’s first football game, but still felt the heat from the fires she left behind.
“I hate that feeling, but I am learning to set very specific boundaries because that’s the only way I will leave the hospital,” she said.
Hospitals were already operating with a shortage of nurses. COVID made it a crisis. The deaths, nightmares, choosing who got care first and intense shifts with no time to eat or for bathroom breaks was more than some could take. Others left hospitals to make more money in travel nursing.
“I’ve got many open positions, and we can’t get nurses in to fill them,” said Donna Nolte, director of nursing and support services at Thomas Hospital. “Trying to find staff to be at the bedside is difficult, but COVID made it almost impossible.”
At the height of the summer surge, Nolte said, staffing was a daily, often hourly, struggle. Sometimes she brought in former nurses or nurses from local clinics to take a shift.
“I was constantly worrying about how to staff another night,” she said. “Some of our staff weren’t vaccinated, so they got COVID and had to be quarantined. If a family member got sick, they were out for 10 days. That was on top of the eight vacancies I hadn’t filled. We used traveling nurses and people from everywhere we could think of to piece it together shift by shift. Sometimes half a shift, hoping to find someone to work the other half.”
The number of infections and hospitalizations declined at the beginning of September, making Nolte’s job a little easier.
“After what we just went through, we are gun-shy, waiting to see if this holds,” she said.
“People are starting to take a few days off here and there and talking about things other than COVID,” she said. “We have a therapist on site, meeting with anyone who needs to talk. Individual departments also have group sessions to help process all that has happened. You don’t know how bad things are when you are climbing the hill. It’s only when you look back that you realize what you went through. It’s hard to go back to normal, but we have to help our medical community through this.”
Doctors predicted the Delta surge after July 4 but didn’t realize it would be this bad, said Dr. Errol Crook, a nephrologist and chair of internal medicine at the University of South Alabama College of Medicine.
“The Delta variant was even more aggressive than we expected, but Alabama’s vaccination rate was also much lower than we anticipated,” Crook said. “We didn’t provide much resistance to the spread.”
Doctors and nurses heard the reasons for not taking the vaccine: I don’t trust the vaccine; COVID wasn’t bad the first time I had it; I didn’t get around to it; COVID is no worse than the flu; the vaccine was developed too fast; I’m taking Ivermectin; I’m a Christian.
The rates of infection are trending down as the end of the natural cycle of the virus approaches, Crook said. “It spreads like wildfire until there are fewer people left to infect. The modest increase in vaccination rates helped.”
COVID also raised awareness of the challenges of caring for patients in underserved communities, he said. “We have to solve the underlying problem of access to health care, as opposed to trying to treat the symptoms.”
Crook predicted COVID will remain in some form, much like the flu, requiring an annual vaccine or booster shot. Some people also have long COVID syndrome, with symptoms that last beyond the virus.
The lingering symptoms of COVID may be even worse than the virus. Long-COVID syndrome (also called post-COVID syndrome or long-haul COVID) is so new that there is little understanding or research, frustrating both doctors and patients.
Dr. Haley Ballard, an Internal Medicine Specialist in Mobile, said it’s not rare to see long-COVID cases in her clinic. The symptoms can be fatigue, cough, muscle aches, shortness of breath, headache, palpitations or increased heart rate.
Right now, there’s still a lot we don’t know about it,” she said. “Every patient presents a bit differently, making diagnosis tricky. I tell my patients to listen to your body. If your body says stop, take a rest and allow it to recover.”
David Eckenfels caught COVID at work in July 2020 and was at Thomas Hospital for 16 days. He still hasn’t fully recovered.
“I thought COVID was a joke, then it tore me up,” he said. “I waited too long to go to the doctor. My pulse oxygen dropped into the 40s. The doctor said the x-ray looked like a bomb went off in my lungs. He immediately sent me to the hospital.”
Eckenfels doesn’t remember the ambulance ride, just that it was hard being alone in his room and away from his wife, Deana. He called her every morning to let her know he made it through the night.
“The doctors and nurses looked like mummies wrapped in plastic. They were scared of taking COVID home to their kids,” he said. “This has been hard on them, too. I think I was released when they needed the room for someone else who was worse off than me.”
Eckenels lost 40 pounds and grew a white beard during his two weeks in the hospital. Deana didn’t recognize him when she arrived at the hospital to pick him up. Their dog didn’t recognize him either.
Eckenfels thought he would be himself when he got home, but the long-COVID symptoms persist 14 months later: shortness of breath, brain fog, anxiety and tachycardia with a heart rate that spikes from just walking around the house.
Doctors tell him to give it time.
“They don’t know how to fix this,” he said. “I can’t fault them because this is new, and there’s a lot they don’t understand.”
Unable to return to work, Eckenfels lost his job and insurance. It was a tough blow for a man who has worked since he was 15.
Long-COVID is also difficult for the caretaker.
“Our roles reversed,” Deana said. “Now I am the only one with an income. I do most of the jobs around the house and have to be strong for him.”
Insurance covered much of David’s hospital stay, but the couple went through their savings and retirement and sold their home to pay the medical bills that keep coming during long-COVID.
“We’ve been married for 25 years and know how to work through the ups and downs,” Deana said. “I want my husband back, but even if he doesn’t go back to normal, he’s still my world, and we’ll make it work.”
Estimates say long-Covid could affect up to 30 percent of infected people, but the number of those infected is unclear.
COVID care not only took over hospitals and wore staff down, but the months of providing intensive care was “a financial onslaught because hospitals only get X amount of dollars, no matter how long the patient is here,” said Jeff St. Clair, CEO of Springhill Medical Center. “These patients were here a long time.”
After the first wave, Springhill received millions of dollars in federal funds from the CARES Act to assist with the outbreak and to help the hospital survive. St. Clair said financial assistance is not available this time around.
“The hospital is a good steward and saved a nest egg to rely on during times like this, but money is an issue,” he said.
Some days St. Clair walked through the hospital parking lot to talk with the families of patients. “I never imagined a month like August could happen,” he said. “Every hour the sands shifted, and you didn’t know what was going to come through the door, but it came, and our team took care of it.”
Filled with COVID patients, hospitals once again postponed elective, outpatient and non-emergency surgeries, losing multiple sources of revenue.
Doctors said missed checkups and primary care visits are missed chances for them to diagnose diseases and problems in the early stages, adding to the morbidity of COVID. Women missed their annual checkups, mammograms and pap smears during the first year of the pandemic. As a result, there was a surge in cancer diagnosis and more advanced stages of disease. Oncologists fear a new wave of advanced cancer is on the way.
Todd Cason owns Cason Funeral Service in Foley. Pointing to a tall stack of manila files on his desk, he said, “those are just the deaths for August. An average month is 30 funerals, but I just did 65. I’m in the business to make money, but I don’t want to make it this way.”
“Last year, the first wave was bad, but we were limited to 10 people at funerals,” Cason said. “Delta was twice as bad and killed folks a lot faster, but there are no funeral restrictions this time around.”
Cason said he called the governor’s office and told them funerals are getting people infected, but nothing came of it.
COVID goes through a family, and when one gets it, most usually get it, he said. Some are still sick and coughing as they hug others at the funeral.
“I have performed services for some families multiple times this past year due to COVID,” he said. “Some families say they wish their loved one had gotten the vaccine, others refuse to acknowledge the virus is real.”
During August, there were days with two to four deaths, Cason said. His busiest day was five deaths in one night. None were over the age of 60. Many families chose cremation, but he had a funeral every day for 2 weeks.
“The COVID deaths have slowed down,” he said. “I am thankful for fewer burials this week.”
As the infection and death numbers decline, acute care units with patients still on breathing machines lag behind.
“We are the last group to see the numbers go down because patients on ventilators can live for months,” said Ledlow, the pulmonary critical care nurse practitioner at Thomas Hospital. “We have folks in their 40s still intubated on our floor, but they aren’t getting any better.”
Ledlow tells the families of her ventilated patients to quit trying to understand COVID, comparing it to the devastation after a hurricane passes through.
“This is what we’re left with, even if most people can’t see the damage,” she said. “We started suiting up families and letting them on the floor to see what their loved ones are going through. This helps them make informed decisions about how to proceed from here.”
Ledlow just had her first non-COVID patient since the Delta surge began. It was a chronic obstructive pulmonary disease patient who required intubation.
“It felt so good to get her off the ventilator in two days and send her back home in better shape,” Ledlow said. “We research and study these diseases because we want to win, but COVID makes you question everything you’ve learned about medicine.
“I just want to help people heal and return to their normal lives again.”
