Some days, Vanessa Walker leaves work frustrated.
Walker is a lung expert and critical care doctor who works in the Sutter Roseville Medical Center’s intensive care unit. “A dry lung is a happy lung,” she says. But increasingly, the lungs she is seeing are filled with fluid. Bluntly put, they’re “drowning.”
Some of the owners of those lungs infected with COVID-19 are in the hospital because “they simply wouldn’t listen. I leave work sad because somebody didn’t take it seriously.”
Others were careful, just not careful enough.
“Many were doing a great job, but just wanted to go to that one dinner party,” she said. “It just takes one time.”
It’s an emotional Christmas for Walker and other front-line critical care givers in California hospitals. The state is headed into perhaps its darkest hour of the coronavirus pandemic. Vaccines are arriving now, but it will take months for inoculations to occur among the general public.
Meanwhile, infection numbers are soaring, and so are hospitalizations. ICU patient numbers jumped from just 600 statewide two months ago to 3,827 as of Wednesday, filling the critical care areas of many hospitals.
On Tuesday, Walker joined hospital leaders and state health officials in an unusual statewide Zoom press conference pleading with residents not to have a typical Christmas family get-together. Save it for next year, hospital leaders said.
“If we do our part now, there will be more of us alive to share the holidays next year,” Walker said in the video live-feed, standing in the medical center parking lot, mask on, speaking earnestly. She was joined in her plea by other officials with Sutter Health as well as Kaiser Permanente and Dignity Health.
Later, speaking to The Sacramento Bee, Walker talked about her own hospital’s efforts to keep up with the virus, and about the tenuous emotional health of health care professionals.
“There (was) a crisis in mental health of physicians and health care providers before COVID-19,” Walker said. “The stresses of the job, the hours, then add the pandemic stressors … then I show up to work and have a list of (virus) patients doing poorly.”
Walker and coworkers see the worst cases at the worst moments.
Most people who get COVID-19 do not need medical intervention. State health chief Dr. Mark Ghaly estimates that only about 12% of people infected with the virus will end up in a hospital. But the state has been averaging 42,000 new cases a day for the last week.
Of those that are admitted to a hospital, only about 12% will be placed in the Intensive Care Unit, Ghaly estimated. Most of those ICU patients will recover, although it is unknown what long-term effects the infection may have on the human body.
ICU staffing struggles
Unlike some hospitals in California, Sutter Roseville officials say they continue to have enough beds, equipment and staff at the moment to handle COVID-19 cases. Lack of fresh staff is often the major hurdle.
That’s partly because many people suffering from COVID-19 who arrive at the hospital are now sent back home, said Dr. Peter Hull, Sutter Roseville’s chief medical officer who works in the emergency room, the entry point for COVID-19 patients in the hospital.
“It’s a misnomer if you have COVID-19 you are going to get admitted,” Hull said. If the person’s vital signs are good, an infected person may be told to convalesce at home on oxygen, even if the person is showing early signs of pneumonia.
That’s because doctors have a better sense now, based on what Walker calls “the eyeball test,” which patients are at higher risk of a worsening condition. It’s also because health care systems are taking steps to avoid being overwhelmed with patients.
That said, Walker and Hull echoed comments other health-care workers have made recently that COVID-19 patients can seem fine one minute, then deteriorate quickly.
Walker said an emergency room physician may call her when a patient arrives, reporting the patient is short of breath, but otherwise fine. Then, “suddenly the patient is on 100% oxygen, then intubation (ventilator machine). That speed, that rapid deterioration, we haven’t seen before.”
Some patients who previously would have been sent to the ICU are now being treated in less critical-care areas of the hospital, she said.
“The only people making it to ICU are the slam-dunk ICUs,” Walker said.
The treatments vary. Most COVID-19 patients will be given a steroid called Dexamethasone and supplemental oxygen. Some will get an anti-viral medicine called Remdesivir if the infection is not overly advanced. Treatments may also include blood thinners, antibiotics for secondary infections and even a diuretic to keep them from retaining too much liquid.
Hospitals have learned to roll some patients onto their stomachs, which helps the lungs work.
Some hospitals in the Sutter system have less critical-care expertise, but are taking advantage of an increasingly used element of modern tele-medicine that Sutter calls its electronic ICU. Walker, a Folsom native, is medical director of the Sutter Valley Area electronic ICU, which assists in the care of patients at both rural hospitals and larger medical centers at 10 facilities throughout the Valley.
Earlier this week, when a COVID-19 patient suffered a collapsed lung, Walker said an eICU doctor virtually mentored another healthcare provider as that person inserted a chest tube.
“That keeps them from having to transfer (patients) to Roseville, Modesto, Sacramento,” she said. “We can keep those big centers open for cardiac surgery not available at smaller places.”
‘Surge’ plans underway
Sutter Roseville, like other hospitals, has a COVID-19 surge plan ready. If the ICU gets filled, critically ill patients will be handled in the surgery center recovery area.
As a result, “at some sites, we are postponing elective procedures,” said Dr. Rishi Sikka, Sutter Health president of system enterprises, during the Tuesday Zoom call.
Walker signs death certificates when a COVID-19 patient dies. Pneumonia is often a result of a COVID-19 infection. But deaths often are listed as having multiple causes, and that’s been the case with COVID-19 as well. The infection causes the body to overreact, destroying lung tissues. Other results can be renal failure, respiratory failure, pulmonary embolisms, strokes or excessive bleeding from blood thinners to avoid clots.
Walker was among hospital workers who were given the first vaccinations last week. She posted a four-minute vlog to guide people through the vaccination experience. It relieves her of one of her personal COVID-19 worries. Her husband is a stay-at-home father.
“I’m the weak link in our bubble,” she said. When she comes home from work, “I could be introducing it to my family.”
Sutter medical chief Hull, who also got the vaccine, said his wife told him she was relieved when he got the vaccine. She feared she might get the virus and make him sick, inhibiting his work.
It’s been an interesting personal journey, Hull said. When the virus first hit, he wondered whether it could be beaten back.
“Maybe we can’t stop this, and have front-row seats to the end of the world,” he remembers thinking at one point.
Now, he says, he is pleased at least with how hospital physicians have pulled together to deal with the crisis. “We recognized we were all fighting something together.”