After weeks of record COVID-19 cases and hospitalizations, the omicron-fueled surge appears to be slowing down in the area, but the challenge of caring for such large numbers of patients has left nurses and other health care workers exhausted.
“While we are declining, we are still seeing a very high number of cases,” said Dr. Costi Sifri, UVa Health’s director of hospital epidemiology, at the medical center’s weekly briefing. “Even if the cases continue to drop, we’ll still have people in the hospital and will continue to deal with this for weeks to come. At some point [case numbers] will come down to a lower level, but until then we are in a period of high case counts and it behooves us to take precautions.”
Those precautions include getting vaccinated, wearing a high-quality mask, staying home when you don’t feel good and social distancing. The University of Virginia Medical Center and Augusta Health recently partnered on a public education campaign to encourage the community to follow the precautions.
UVa started to see the number of COVID-19 patients at the hospital drop this week to under 100, but doctors and hospital leadership have said the recent surge has pushed health care workers to their breaking points.
“There’s a group of people who have been with us in the ICU from the beginning of the pandemic, but I think for some folks, it’s become a sense of duty to see this through,” said Dr. Taison Bell, director of the medical intensive care unit at UVa Medical Center. “I wonder when this is finally over — whenever that’s going to be — I actually think we might have a wave of resignations across the country at that point.”
Area hospital leaders have described the omicron surge as the most serious challenge the hospitals have faced thus far in the pandemic. Hitting nearly two years into the pandemic, the surge has exacerbated staffing issues. Frontline health care workers were already worn out before the surge, and the more transmissible variant increased the chances that hospital staff would test positive or have to quarantine, which increased the strain on other staff members.
Bell said “there’s no escape” from the pandemic for the nurses, nurse practitioners and other staff working the ICU.
With high case counts leading to other disruptions in the community, omicron’s reach and impact on health care workers has extended beyond the hospital walls. Some might have family members who have gotten sick or become infected themselves.
“Omicron is literally affecting your life in an adverse way, then you’re trying to take care of critically ill patients who are mostly unvaccinated,” he said.
Although the omicron variant of the coronavirus has been described as mild, Bell said he’s seen very sick patients in the medical ICU.
“Many times they’re young, including 20s and 30s, people that are pregnant, people who don’t have a lot of medical conditions, and the only common linkage is that they’re unvaccinated,” said Bell.
In late January, the medical center had 131 COVID-19 patients, which is more than what the hospital has seen at other points in the pandemic. On Jan. 25, 37 of the hospital’s 101 patients were in the ICU and 22 were on a ventilator, according to a breakdown shared by UVa on social media. Since then, the patient count dropped to 89, but 28 people were still in the ICU and 17 were on a ventilator.
Dr. Kyle Enfield, director of intensive care at the medical center, said that at one point last month, half of the ICU patients had COVID.
“It’s challenging, because we’ve been running this race for two years now,” said Enfield, who is also a critical care physician. “And I think most of us at least hoped, at some level, that we would be in a different spot than we are today and would like to not be spending as much time thinking about, worrying about, and treating COVID.”
Enfield said the ICU staff is “committed but weary.”
“What they’ve gone through for the past two years would be trying for anybody, but to do it over and over again, I think takes its toll,” he said.
The exhaustion has meant that team members might be shorter with one another and less excited to come to work.
“At the same time, there’s a huge amount of professionalism in the team here,” he said. “Because of that people do keep showing up and are willing to go the extra mile for each other and for our patients, but they are tired, and you can see that in their interactions with each other and their interactions with patients.”
Inside the ICU
By almost every metric, January was the worst month of the pandemic for the Charlottesville area. The health district recorded 11,245 new cases and 191 new hospitalizations — far surpassing records set during previous surges.
Another 989 new cases have been reported this month already. The new cases added since Jan. 1 make up 30% of all positive cases in the health district since March 2020. The district is currently averaging 256 new cases over a seven-day period. The seven-day average peaked at 435 twice last month.
Determining how many died from COVID-19 takes time, but the state started to report deaths from the surge Feb. 2. So far this year, 23 people have died from COVID-19, according to an analysis of health district data.
About 73% of people in the Blue Ridge Health District who are eligible for the COVID-19 vaccine have received at least one dose, 68.5% are fully vaccinated and 36.8% have gotten the booster.
For Bell, the omicron surge has been different from other surges because the hospital staff had a good idea of who would be getting sick or critically ill at the hospital.
“Chances are I have a middle aged patient, relatively healthy, and they have severe COVID, and they’re unvaccinated,” he said. “ … It’s all preventable at this point. That’s what’s so sad about it.”
Before the pandemic, Bell said that he used to have to explain in detail to a patient what it meant to go on a ventilator. But now, his patients know.
“They understand that sentence to mean this might be my last moment alive on Earth,” he said. “That is what’s different about this moment now, because people truly understand how sick they are when they’re sick.”
Bell said they are continuing to see pregnant women critically ill from COVID in the ICU, which concerns him. That group is among the least vaccinated adult groups, he said, but the COVID-19 vaccine is safe and effective for pregnant women.
“Luckily, we’ve been able to deliver everyone with healthy babies, but there are a lot of consequences,” he said.
Those new moms’ lungs don’t function well because of COVID and they’re still on oxygen, he said.
Everyone five years and older is eligible for the COVID-19 vaccinate. To learn more or to make an appointment, go to vdh.virginia.gov/blue-ridge/covid-19-vaccination.
‘A little disoriented’
Nearly a quarter of UVa’s nursing staff turned over in 2021, spokesman Eric Swensen said. The overall staff turnover rate was 21.7%. Both rates are in line with national trends.
“For most of our leaders, this is the highest turnover they’ve ever seen in their careers,” Swensen said.
UVa is planning to spend $30 million on compensation increases this fiscal year and has boosted recruiting efforts. Swensen said UVa Health has hired 865 new team members from Aug. 25 to Jan. 11.
UVa Health recently hired a senior director for talent acquisition and retention who is tasked with crafting recruitment and retention strategies.
To increase the pool of nursing candidates, UVa also is working with Piedmont Virginia Community College. The medical center also has started in-house training programs for local community members such as one that trains new pharmacy technicians and then employs them here at the medical center.
As a temporary solution, Swensen said the medical center has also hired hundreds of travel nurses on short-term contracts to fill in as needed.
Enfield said the hospital also has opened up more overtime shifts for nurses and doctors and paused the post-COVID clinic to free up staff.
The travel nurses have helped, he said, but working with new staff creates other challenges.
“[Travelers] are often committed professionals, but they’re just not the same as the people you’ve worked with for a number of years,” he said. “And you don’t have that same rhythm with them.”
Bell echoed that. With the influx of new hires and those on temporary contracts, “everyone’s a little disoriented,” he said.
“Whether you’ve been working here for a long time, or you just started, you still don’t feel like you’re on your A game,” he added.
Enfield said that he’s working to ensure that nurses and the frontline workers have the supplies they need to care for patients and stay safe, which is one way he copes with the stress of the surge. UVa hasn’t seen a significant number of providers getting COVID from work, he said, attributing that to the protective measures.
He hopes the community will listen to the messages from UVa and Augusta Health to help ease the burden on frontline workers.
“What I can’t protect people from is sort of the emotional strain of working here,” he said.