For Iowa Methodist Medical Center staff members, the latest COVID surge is even more exhausting than the original outbreak.
They understand the coronavirus better now than they did in spring 2020. They have much better treatment options these days and plenty of protective equipment.
But they lack the energy of the pandemic’s early months when doctors, nurses and other hospital workers were buoyed by adrenaline and public acclaim. It seemed that everyone was lauding them as “health care heroes,” leading an all-hands-on-deck struggle against a deadly threat.
Those high spirits have sunk, said Mandy Schiefert, nurse manager in the Des Moines hospital's emergency department.
“It feels like we’re running a marathon," she said. "And the finish line keeps moving.”
The number of people hospitalized for COVID-19 in Iowa has topped 500 in recent weeks. Although far below the more than 1,500 hospitalized for the disease during last fall’s peak, the current number is more than 10 times what it was in June. And the new surge comes on top of an influx of patients with other illnesses or injuries.
Since mid-March 93% of COVID-19 patients at this Iowa hospital have been unvaccinated
Kelsey Kremer, Des Moines Register
Emergency department wait times have ballooned. People who aren't critically ill sometimes must wait more than 10 hours. When the rooms are full, some patients are treated on gurneys in the hallways.
Last Friday, all 36 of Methodist's ICU beds were full. Nine of those patients had active COVID-19 cases. Several more were still fighting off the effects of COVID, even though their bodies had cleared the virus.
Iowa Methodist staffers say they still receive private thanks from many patients and families, but they also regularly face frustration and anger from others.
People become upset when they have to sit for hours in waiting rooms because of the rush of patients and a shortage of staff. Conspiracy theorists accuse doctors and nurses of lying about the coronavirus. Hundreds of thousands of Iowans have declined to be vaccinated against the virus, and they now represent most of the people being hospitalized for COVID.
Some patients still don’t grasp how serious the situation is, even after they’re hospitalized with severe COVID symptoms, Schiefert said.
“After you tell them they’re positive, they’re still doubtful. They’re like, ‘That can’t be! How could I have gotten this?’” she said. “As a health care worker, you do feel defeated."
With ICUs full of COVID patients, the tragedies keep coming
In Iowa Methodist’s intensive care unit, physician Matt Trump sees his colleagues' strain behind the face masks.
Nurses and doctors dart down dimly lit hallways, moving from one patient to the next. Usually, just one or two staffers go into a room at a time. They wear protective suits outfitted with independent air supplies. Others, dressed in masks, gloves and goggles, stand just outside each room's sliding glass door, taking notes, recording vital signs, sharing thoughts on patient care.
Everyone working in the unit was overjoyed when the first coronavirus vaccines were released last December. They expected the shots to rein in the pandemic. But with so many people declining to be vaccinated, the tragedies keep coming.
“All of the hospitals in the Midwest are full,” Trump said.
Transfer requests have come in from as far away as Texas and Montana, which is almost unheard of in normal times.
About 88% of COVID-19 patients in Iowa ICUs are unvaccinated, the Iowa Department of Public Health reported in early September. That squares with what Iowa Methodist is seeing.
In the early days of the pandemic, most of the COVID patients taken to intensive care were elderly or had serious chronic health conditions, Trump said. Now, many of the severely ill COVID patients are unvaccinated younger adults, ages 20 to 50.
“We’ve seen healthy pregnant women get it and get very sick,” he said. One of those women died.
Some families have pushed Trump to try unproven treatments on critically ill patients, he said. Their requests included that he order the veterinary drug ivermectin, which is used to deworm horses. When he has declined to do so, "people have gotten in my face," he said.
As Trump sat in the ICU waiting room, describing the summer surge, a voice came on the hospital intercom overhead. It announced a “Code Blue” in an ICU room. The doctor cocked his head and listened to the announcement.
“That’s a COVID patient having a cardiac arrest,” he said. Inside the ICU, other staffers were rushing to try to resuscitate the person.
'Like the life has been sucked from the bones'
Meanwhile, in the hospital's rehabilitation department, COVID patient Mark Galvan was reflecting on his luck. He'd survived a stint in the intensive care unit.
Galvan, 40, of Scranton, is among the many Iowans who declined to be vaccinated against the coronavirus. He thought he'd stay healthy with natural methods, including by taking vitamins and minerals. And he had concerns that vaccine manufacturers weren’t being transparent about what was in the shots.
Now he wishes he’d taken advantage of the free vaccines before he became infected in August.
At first, he thought he might just have a cold. But the illness quickly grew worse, to the point that he was coughing up blood and struggling to breathe.
“It was a horrible, miserable, miserable time,” he said from his hospital bed.
On Aug. 26, an ambulance brought him from Greene County Medical Center in Jefferson to Iowa Methodist.
Doctors there considered putting him on a ventilator, with a tube down his windpipe. But instead they put him on a high-flow oxygen line under his nose. After a couple of days, he was stable enough to be brought out of the intensive care unit and begin recovering elsewhere in the hospital.
“It’s still a pretty rocky climb even after that,” he said, pausing at times to catch his breath.
Galvan used to believe a case of COVID-19 could be manageable.
“I was pretty smug about the idea that I could treat it as any other respiratory infection,” he said. “This is like the life has been sucked from the bones,” he said.
Galvan said he'd now recommend the vaccine to others, especially if they have conditions such as diabetes that make them particularly susceptible to the disease. He supports people’s right to make the choice. But without vaccination, he said, “you’re not ready. Nobody is.”
Iowa hospitals struggle to retain nurses amid staffing shortage
The crush of patients comes at a time when Iowa hospitals are struggling to recruit and retain nurses and other staff.
Jill Heilskov, a nurse who is Iowa Methodist’s executive director for emergency, critical care and trauma, said some staffers have retired early because of the stress or left for jobs outside hospitals.
It can become a vicious cycle, she said.
“The fewer nurses we have, the more likely it is that other nurses will leave,” she said.
Some Iowa nurses have left to take more lucrative positions with “travel nurse” agencies, which supply temporary staff to hospitals in high-need areas. Those agencies also draw away respiratory therapists and radiology technicians, Heilskov said.
She said Des Moines hospitals may lose a few more employees in coming weeks as the facilities implement new COVID vaccine requirements. Workers who refuse to be vaccinated will be fired unless they obtain medical or religious exemptions.
Hospital leaders say staff COVID shots are necessary to protect vulnerable patients. But over the past few weeks, vaccine mandate protesters have picketed Iowa Methodist and two other Des Moines hospitals. A few of the protesters have worn scrubs and identified themselves as hospital employees who would rather lose their jobs than comply with the requirement.
Surge in COVID cases compounds an already busy summer for Iowa Methodist
Other illnesses, such as the viral respiratory ailment RSV, have also been peaking. And emergency departments routinely see trauma cases climb in summer. Hospital leaders say the situation would be less dire if the pandemic were under control.
Despite the crowded conditions, hospital officials don’t want Iowans to fear going to the hospital if they’re seriously sick or injured.
Patients are treated, but they may have to wait longer than usual if they’re not critically ill.
Some become frustrated and angry, said Dr. Clint Hawthorne, medical director for the emergency departments at Iowa Methodist and Iowa Lutheran Hospital. Others give up and leave. They try another hospital or simply go home.
To help ease the strain, smaller hospitals have been holding on to many patients whom they normally would transfer quickly to urban medical centers, Hawthorne said. The smaller hospitals have been asked to treat as many patients as they can and transfer only the most seriously ill or injured. Hawthorne said he and other doctors at the big hospitals have been in constant contact with colleagues in rural areas, discussing which patients most need to be brought to the cities.
As he spoke last Friday morning, 13 patients who came to the emergency department overnight had been admitted to the hospital but were waiting for beds to open up in inpatient areas. On this morning, there were enough rooms in the emergency department for all of them to stay temporarily, but that has not always been true lately.
To cope with the stress, staffers try to focus on how they're helping ease suffering, Hawthorne said.
“There’s no doubt about it, it is discouraging,” he said. “It makes me think, ‘Boy, we could have prevented this.’”
Tony Leys covers health care for the Register. Reach him at firstname.lastname@example.org or 515-284-8449.