A year later, the COVID ICU is quieter than it was, but the patients are still very sick
At the worst of the coronavirus pandemic in January, UNC Rex hospital had more than 90 COVID-19 patients. On Thursday, it had 20, and four of the eight beds in a special COVID-19 intensive care unit were empty.
The numbers reflect the dramatic improvement in the pandemic across North Carolina, where the number of people hospitalized with the disease is less than a quarter of this winter’s peak.
At the same time, as the state continues to ease restrictions on gatherings and other situations where the virus might be transmitted, the 20 COVID patients at Rex — and especially the four who are most sick in the ICU — are reminders that the pandemic isn’t over.
“I mentally prepared the best I could that it was going to be a very long winter. And then all of a sudden, it was like a switch flipped and the intensity decreased,” said Wayde Batt, the clinical manager of the COVID ICU and the adjoining neuroscience ICU where COVID patients have also been treated.
“But it still doesn’t take away from the patients in these rooms,” Batt said Thursday. “There’s fewer of them, but they’re just as sick.”
‘The sickest patients I’ve ever taken care of’
The surge in COVID-19 patients that pushed Rex and other hospitals to the brink in January followed the holiday season, when people traveled and gathered and carried the coronavirus with them. Doctors and nurses at Rex and other hospitals worry about a similar increase around spring break, though vaccines offer hope that any bump won’t be nearly as bad.
That would be a blessing for nurses and other hospital workers who are still physically and mentally exhausted from the pandemic. COVID-19 patients require more attention than most, remain in the hospital twice as long on average and, in the case of those who end up in the ICU, are often fighting for their lives.
“In my 24 years of nursing they’re the sickest patients I’ve ever taken care of,” said Jennifer Snell, a team leader in the COVID ICU.
Snell said the condition of COVID-19 patients can change quickly, without warning. Someone who seems to be doing OK one moment can suddenly need help breathing or experience organ failure the next. While the ICU was busiest this winter, she says she hit her low point after last summer’s surge, when the challenges faced by COVID-19 patients hit her hardest.
“Just seeing these patients coming in to the ICU and you’re giving a computer tablet to them to say goodbye to their family knowing that they may never see them again, it’s hard,” she said. “In nursing, I’ve never had to do that. It’s traumatic for everyone involved.”
A grueling year
Rex opened the special COVID-19 ICU unit on March 22, 2020, and moved its first patient there the next day. The eight patient rooms were retrofitted with air handling systems that create a slight vacuum, so air can be vented outside and not escape into the unit or the hospital.
Overall, Rex has treated more than 1,600 people with COVID-19 since the pandemic began. About 200 came through the special ICU unit, though more were treated in other ICU units when this one filled up.
More than 12,000 people have now died of COVID-19 statewide. At Rex, about 160 COVID patients — about 10% — died from complications of the disease, nearly half of them during the surge in December and January.
Qingxiao Cheng, a nurse in the COVID-19 ICU, says the deaths were hard on her and her colleagues.
“I’ve seen more people die in the last three months than in my 20-year career here,” Cheng said. “Almost every day we had someone we just couldn’t save.”
Fewer COVID patients, but still busy
While Rex has fewer COVID patients than it did two or three months ago, the hospital is still full, said Dr. Linda Butler, the chief medical officer. Doctors and patients are working through a backlog of procedures and treatments for other conditions that were postponed during the peak of COVID-19 this winter.
At the same time, the national demand for skilled nurses and other health care workers means Rex is short-staffed, Butler said. The hospital is offering incentive pay to those willing to pick up extra shifts, which adds to the exhaustion some feel.
She compared the situation to a winter flu season, usually the busiest time at North Carolina hospitals, that never ends.
“We basically have had a year of the worst flu season ever,” she said. “And people would like a break, but they can’t get one, because we continue to be busy. And we’re trying to hire more staff, but we’re competing for the same resources as everybody else.”
More than a year after it opened the COVID ICU unit, Rex doesn’t have any plans to shut it down. After a sharp drop in February, the number of coronavirus patients needing hospitalization on a given day has leveled off statewide at more than 900.
The number at Rex has fluctuated lately, as it does in the ICU, said Batt, the manager.
“It turns on a dime. We’ll be down to three or four patients, and the next day we’re double that many,” he said. “It’s not grotesque numbers, but every one of these patients is having the worst time of their lives. In this room in the hospital, it’s not a great place to be.”
