The worst stretches of the COVID pandemic were dark days for Andrea Ryan.
A nurse in Penn State Health St. Joseph hospital’s intensive care unit, she had a front row seat to the devastation the rapidly spreading deadly disease had on Berks County.
From April to May in 2020 and from December 2020 to the end of January 2021, the two most deadly spans of the pandemic in Berks, she was witness to a seemingly never-ending stream of critically ill patients.
Those were the days before the wide availability of vaccines, and outcomes for many of those patients were grim.
Death became a common visitor.
“It was devastating,” Ryan said. “We would work really hard to save their lives and use every tool that we knew worked in the past, but nothing was helping. It was extremely frustrating because we were giving everything we had, and it still wasn’t enough.
“It was mentally taxing to come into work day after day with the same result.”
These days, a lot has changed.
The prevalence of vaccines has mitigated the currently dominant omicron variant, with those who are fully boosted typically having mild symptoms if they get COVID. Medical professionals have learned which treatments and techniques are most effective.
And hospitals have resumed other procedures that were put on hold so doctors and nurses could focus on the flood of COVID patients that filled hospital beds.
Other things, however, have remained the same.
Despite the help vaccines have provided, hospitals recently saw their numbers of COVID patients once again rise as daily case counts exploded to record highs. And more of those patients are ending up in intensive care.
Deaths, as well, have increased over recent weeks.
It’s a story all too familiar for people like Ryan working in local hospitals. It’s an unwelcome rerun that can lead to exhaustion and frustration.
An ongoing struggle
Dr. Brian Lahmann thought the end was in sight.
The chair of the department of emergency medicine at Reading Hospital said he and other medical professionals figured the creation of a COVID vaccine would thwart the pandemic. They thought it would help get things back to normal.
That hasn’t been the case.
Significant segments of the populations have refused to get vaccinated, which has drawn out the pandemic.
Plus, even vaccinated people aren’t immune. In Reading Hospital this past week, up to 35% of the patients had a minimum of two shots.
The Reading Hospital ICU was nearly 50-50. But that’s the exception, not the rule.
And in some poorer countries around the world vaccine distribution has lagged, providing fertile ground for COVID to mutate into new, potentially more dangerous variants.
And that has meant continued pressure and stress for hospital workers.
“Two years ago we thought we would get vaccinated and this would go away,” he said. “So, what I hear and what I see is that people are tired. They have worked really hard. And this has gone on for longer than they expected.”
The result is that hospitals have been stretched to their limits.
Prioritizing care
“I don’t think people quite understand that our resources are limited,” said Dr. Debra Powell, chief of the division of infectious diseases and medical director for infection prevention at Reading Hospital. “We don’t have infinite testing abilities and we don’t have an infinite amount of antibodies, so we have to allocate all our precious resources responsibly whether that be personnel or otherwise.
“We have to prioritize, and we have to make a lot of difficult decisions, but we are here and we want to take care of our patients the best we can.”
Lahmann said it’s critical that after all this time the public not let COVID fatigue set in. They need to know that it is still a major concern, that it’s still making people very sick and even killing them.
The fight is still ongoing, he said, and medical professionals need people to help.
“We’re busier this time around,” Lahmann said of the current case surge. “And we’re tired because there are so many not following the recommendations. That’s the challenging part. People have become entrenched in their beliefs, and we’re trying to move forward for our community.”
Chief among the steps people could be taking is getting vaccinated, Lahmann said.
“I think the data speaks for itself,” he said. “Every hospital system nationally is publishing the percentage of patients in the ICU who have been vaccinated and those that haven’t. And what you see is that the majority are almost always unvaccinated.
“There is no ulterior motive here, we’re just trying to provide the best possible care to the community. We, as physicians, have to push these recommendations. This is not politics. This is science.”
Ryan shared a similar perspective.
“We have seen some people who have been vaccinated in the ICU but, for the most part, the patients that we’re seeing are unvaccinated,” she said. “I think it’s frustrating for some of the nurses because we know that if they had gotten vaccinated they wouldn’t have ended up in the ICU.”
Ryan said she and her fellow nurses treat everyone the same, regardless of whether they’re vaccinated. But that doesn’t mean they don’t feel frustration knowing that many of them could have avoided the ICU by simply getting their shots.
“We want everyone to help themselves and do everything possible to prevent them from ending up here,” she said.
Taking a toll
Fighting an uphill battle against an unrelenting foe for nearly two years has not been easy.
Lahmann said people seldom stop to think about what those on the front lines of the fight against COVID are going through. People don’t ask how doctors and nurses are doing, how they’re holding up.
“Those of us on the front lines need to be asked that question,” he said. “The reason they need to be asked that question is they want people to hear them and understand them.”
Ryan said she thinks people simply forget to consider the emotional toll hospital workers face when dealing with COVID day after day.
“People ask us a lot of questions about what kind of patients we’re seeing, how we’re treating them, what the differences have been during the surges,” she said. “But I think a lot of people forget to ask how we’re doing.”
For many, Ryan said, the stress gets compartmentalized, pushed aside so they can continue to do their jobs.
“I think a lot of us are in survival mode and we’re going day by day,” she said. “And this has not stopped for us. We live it every day, so we haven’t had a chance to stop and really take it all in and know exactly how we’re feeling because we need to keep moving.”
Ryan said she has been able to find support from her colleagues.
“The ICU team here is amazing,” she said. “We all lean on each other. We have survived by all leaning on each other and we haven’t fully taken in what this has done to all of us.”
But for some hospital workers, COVID has been too much to bear. Ryan said she knows several nurses who have left their hospital jobs because of the stress of the pandemic, including some who have completely left the field of nursing.
Ryan acknowledged she has worked some particularly traumatic shifts over the past two years that have caused her to question her future. But, she said, when she sees a smiling patient leaving the hospital with their family it makes all the hard times seem a little less daunting.
“There are days when I go home and doubt why I’m doing this,” she said. “But when I see the people who have survived it makes it all worthwhile. And the family members are so thankful for the care you provided.”
She also has a support system at home with her husband and four daughters. They do a pretty good job keeping her mind off what happens at work while still recognizing her for all she does for others.
“My girls are amazing, and they make what I do worth it,” she said. “They call me a superhero, so knowing that they look up to me is definitely keeping me going.”
Turning a corner
Lahmann acknowledged the past month has been particularly stressful for those who work at the hospital as the number of COVID patients continued on an upward climb. But he was quick to add that he’s actually feeling optimistic about what the future holds.
He said there are three reasons driving that optimism: data suggesting that the region may be reaching another plateau in case numbers; conversations with family members of those who have died that have led to vaccination; and renewed focus on how we treat those on the front lines of this battle.
In fact, the case numbers are about half as high as earlier this month, and the number of hospitalized patients has turned down.
Powell said she’s optimistic as well.
“I think we’re in a much better place this year than we were last year,” she said. “We have vaccines that really do work and even though COVID mutated it hasn’t been as deadly. We have some treatments that we know work, and we have disproven other treatments.”
She encouraged people to remember that responding to a worldwide health crisis has been a challenge for everyone, including medical professionals who are continuously learning more about this deadly disease.
“We need to be more tolerant, less opinionated and realize that we are all doing the best we can with the information we have,” she said. “And this information is constantly changing. We’re here for our patients. This is what we chose to do and we love what we do. So, let’s just be nice to each other.”
