A doctor exhausted by his work. Photo: AFP / Collanges / BSIP

This article was originally published by ProPublica.

There’s a joke I’ve seen circulating online, over and over during this pandemic, that goes along the lines of, “Months this year: January, February, March, March, March, March, March …”

My lips pull into a smile, but my heart’s not in it.

I was on the phone two weeks ago with a nurse who lives in Missouri, where cases have risen from 1,100 per day in August to about 3,400 daily in November.

Her husband works in the emergency room of a rural hospital. Every time a patient suspected of having Covid-19 walks in, the sample is sent to be tested in St. Louis, an hour and a half away. Results take eight hours or more to process.

Medical workers don’t get enough protective equipment. “They’re given one N95 mask and have to keep it in a bag to reuse for days,” the nurse said, fretting about her husband’s safety. “He should at least get a new mask for every shift, right?”

I looked at the calendar: It was October 30, but it might as well have been March.

I could still hear the voice of another nurse, Sarah, in Illinois, who poured out her fears to me on March 2, when the coronavirus was just starting to make its presence known in her city.

Sarah told me she had been instructed to write her name on a brown paper bag and put her mask in it to reuse for the week. “There’s this feeling like, we’re just going to get it,” she told me, sounding more resigned than scared.

As a health reporter covering the pandemic, I’ve experienced too many moments of deja vu. This summer, as the virus swept through the US South, news footage of overwhelmed hospitals in Houston turning away ambulances recalled similar scenes from March and April in New York City.

Now, we’re in the so-called third wave of the pandemic, with the virus slamming into Midwestern states, and this past week Dr Gregory Schmidt, associate chief medical officer at the University of Iowa Hospitals and Clinics, said his colleagues are converting 16 hospital beds into new ICU beds in anticipation of an influx of Covid-19 patients. “People in leadership are starting to say things in meetings like, ‘I have a sense of impending doom.’”

I’m exhausted and infuriated to be doing the same interviews and hearing the same stories for a third time. Why haven’t we learned? What have we been doing between March and November?

Why is Dr. Peter Wentzel, in Grafton, West Virginia, only now able to order a point-of-care test system for his community clinic, just to be told that the cartridges for it will arrive in December at the earliest? Why are clinicians at Mountain Family Health Centers in Glenwood Springs, Colorado, once again facing seven- to 10-day wait times for their patients’ test results?

I remind myself that many things have improved since March. An incredible amount of scientific knowledge has been amassed about the virus itself. Thanks to detailed contact tracing studies around the world, we’ve learned that the virus can be spread beyond six feet via small particles suspended in the air, teaching us the importance of good ventilation to decrease transmission risk. Thanks to antibody studies, we’re learning that reinfection, while possible, is likely rare.

We now use ventilators less aggressively and know the benefits of steroids like dexamethasone, while other treatments like hydroxychloroquine have lost favor thanks to rigorous studies that have debunked anecdotal hype.

An antibody therapy developed by Eli Lilly was recently granted emergency use authorization by the Food and Drug Administration. Trials have shown that it can help mild-to-moderate Covid-19 patients reduce hospitalizations.

Pfizer shared encouraging, early news from its ongoing trial, saying its vaccine was more than 90% effective in preventing people from getting sick. It is thanks to the work of so many career scientists and medical personnel that if one gets infected with the coronavirus today, the chance of survival is higher than in March.

Yet while some material supplies have increased since March (we thankfully have more Covid-19 tests, though still not enough), humans are a fixed resource, and the skilled labor of a veteran respiratory therapist or an intensive care unit nurse is hard to come by.

Before the pandemic, America already had a nursing shortage. Now, this dearth is becoming acutely felt.

Tired nurse. Model. Photo: AFP / VILLAREAL / BSIP

An emergency room nurse who lives in Wisconsin told me that her hospital is starting to run out of beds, but more urgently, it is running out of staff, in part because some workers have gotten sick and others are in quarantine. “The state keeps talking about how many beds there are, but that doesn’t mean there’s staff for them,” she said.

When no hospital beds are available, the emergency department gets full, she explained to me; she’s had to board patients there for 20 hours. Meanwhile, she wields a faulty forehead thermometer at the door. Her own temperature recently read 84.9 F — hypothermic, if true. Staff members were given plastic water bottles emblazoned with the hospital’s logo as a thank you.

“It’s so demoralizing,” she told me. “I would take getting punched on a daily basis rather than what we’re going through now.”

Tim Size, executive director of the Rural Wisconsin Health Cooperative, said some of his 43 member hospitals are seeing “significant staff shortages.” Initially, he said, they were able to hire from staffing agencies, which recruit traveling nurses to work short-term contracts, but now that the virus is surging in multiple states, hospitals all over are competing for the same personnel.

“So people are working more overtime, which is causing more fatigue, which will lead to more burnout,” Size said. “If we don’t stop the growth …” He shook his head.

Schmidt, at the University of Iowa, tells me he’s concerned not just about overwork, but also about the psychological toll on medical staff. “You watch patients who are young and who should have had good lives die without their families by them, and their families being distraught, and then you go out through your community and you see people partying and going to bars.”

He paused, then added. “We can do anything for two months,” he said. “But surge after surge, it’s hard for everybody.”

One thing that’s burned into my head is what Chrissie Juliano, executive director of the Big Cities Health Coalition, told me when I asked her whether the constant struggles to get on top of the coronavirus have simply been because this pandemic is so unprecedented that nobody could have prepared for it.

“We would be overwhelmed to some extent,” she told me. “But it didn’t have to be this bad.”

So much has fed into our quagmire: a lack of national leadership, the perpetuation of misinformation. The nurse in Missouri told me about a man with preexisting conditions who ended up in the ICU because he believed that the virus would go away by November 4 and went out to eat at restaurants. Of course, it didn’t go away that day. Instead, we hit a record high of 103,067 cases, the first time we broke six digits; 1,116 people died.

It didn’t have to be this bad.

I don’t want to hear the same stories in a fourth wave, a fifth wave, to feel like we are trapped in an endless spiral, unnecessarily repeating our own mistakes. New leadership is coming to the White House; Joe Biden’s first move as president-elect was to announce a Covid-19 advisory board. I hope it will amplify the voices of our public health leaders, depoliticize the pandemic and deliver for all of the weary front-line workers.

But we don’t have to wait until then. The best way to help our medical workers isn’t to stand at our windows at 7 p.m. cheering or to give them thank-you water bottles. It’s to stay out of their ERs and ICUs by keeping ourselves and our neighbors safe.

Caroline Chen covers health care for ProPublica. She is currently reporting on the coronavirus pandemic. Lisa Song contributed reporting.

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