But with this disease, “those put on ventilators stay on for weeks, several days at a minimum,” said Ruthanne Sudderth, the top communications official with the Michigan Health & Hospital Association. “So even with the shortages, you see a surge because of the time people are on them, and that compounds the shortages.”
As hospitals began to run low on ventilators, Henry Ford leadership circulated a draft memo outlining guidelines for making life-and-death decisions that prioritized saving healthier patients. Officials there said it was an internal document outlining policies for a “worst-case scenario” that never materialized. At Sinai-Grace, doctors debated whether to offer the hospital’s 70 ventilators to those over 65 years old, said critical-care physician Lobelia Samavati. She and others strongly opposed any such policy.
“I came to medicine to take care of patients, and I don’t want to play God,” Samavati said. Sinai-Grace ultimately received 10 more ventilators and never put the policy in place, she said.
There are moral risks, but also physical ones. While health care workers would typically dispose of masks after treating each patient, there aren’t enough masks to do so right now at many hospitals. Forced to adapt, DMC infectious disease specialist Teena Chopra developed rules for folding reused masks and placing them in bags to prevent cross-contamination. DMC residents turned to GoFundMe to raise more than $32,000 to supply their emergency department with better masks and other PPE.
But many workers worry that limited supplies and high-exposure situations could lead to more doctors and nurses getting sick. COVID-19 symptoms had sidelined over 1,500 staffers in Beaumont’s system and 700 staffers at Henry Ford’s hospitals by April 5. At least four had died.
In the intensive care unit at Sinai-Grace, a team of seven doctors and residents who typically treat 18 to 30 patients at a time were now responsible for 40 to 50 patients.
DMC, which typically schedules seven to 10 emergency room techs per shift, was working with as few as two on some shifts, said Moore. To protest low staffing levels, nurses staged a brief work stoppage on April 6.
But Moore wasn’t able to join any demonstrations of discontent. She’d already gotten sick herself. She came down with a fever and cough in mid-March. When her symptoms didn’t subside, a doctor ordered her to quarantine for another two weeks. She remains off-duty until at least mid-April.
“My phone rings 24/7 and I’m still actively working from home advocating for members, fielding calls all day long, because no one else is listening or picking up the phone right now,” she said of her duties as a union steward. Moore instructs workers on what to do if they aren’t feeling well or if they feel like management is overstepping boundaries.
Each health care worker who is not adequately protected is at risk of getting sick. And every worker who gets sick is one less fighting the disease.
Chris Wasen, an RN on a COVID-19 step down floor, stands for a portrait near a window of his home in Macomb, MI.
Even when they do show symptoms, providers still have a hard time getting tested. There just aren’t enough supplies. Workers are triaged according to priority levels set by the state. For those who can’t get a test, hospitals must assume the worst and quarantine anyway. One Henry Ford nurse practitioner was exposed to co-workers who tested positive, but couldn’t get tested because the ER didn’t have enough swabs. She was sent home for four days as a precaution.
DMC’s Samavati called the early-April onslaught “the most difficult and stressful” situation she’s faced in 20 years in the ICU.
“The emotional part is affecting health care workers, physicians, residents and fellows because of the anxiety and fear that you are going to acquire it, the anxiety that you are not able to do anything about it, the anxiety that you don’t have the right protective equipment,” she said. “A lot of people — they can’t cope with it.”
Yet the conditions are creating a sense of camaraderie among health care providers, said Chopra, the infectious disease specialist. “We are all humans and we feel different kinds of emotions including sadness and ‘Why me?’ But then I also think that this pandemic has brought everyone closer.”
At Henry Ford, the clinical psychology unit now treats its hospital colleagues with a hotline and three virtual group therapy sessions a day.
When a COVID-19 patient is discharged, Journey’s “Don’t Stop Believin’” plays on the loudspeaker. At Beaumont, it’s The Beatles’ “Here Comes the Sun” when someone comes off a ventilator.
“Yesterday, they played it five or six times,” Wasen said. “That was nice.”
‘Is This Over Yet?’
Wasen has trouble sleeping before his shifts at Beaumont’s converted COVID-19 unit. But he shows up and changes into scrubs and gets his mask for the day — one to last the full shift, one that has already been used and disinfected. After a morning huddle, he keeps watch on about three patients for the next 12 hours.
He checks often on patients with high fevers, and monitors everyone’s vital signs at least three times a day. Because it’s an ortho floor, there aren’t pulse oxygen monitors in each room, so they use incentive spirometers — hand-held devices with a breathing tube and air chamber — to clear lungs. At mealtimes, Wasen checks the sugar levels of diabetics and gives them insulin. He also talks by phone with family members who can’t visit and need an update. His colleagues have had tougher tasks, like setting up video chats for dying patients.