As I rummage through the N95 mask cabinet I finally find the one in my size...it's the last one. I hope when I have to change it in a few hours I'll be able to find the same one on another floor. That familiar sharp almost chemically grassy odor penetrates my senses as the mask is applied firmly to my face. I adjust it to seal tightly around my nose, trying to avoid applying maximum pressure to the bruised areas underneath.
I gown up with my mask, googles, and face shield to start rounding on my patients one by one. After seeing them I review their labs - another two are now COVID positive. That explains why Ms. C was so sleepy this morning and her toast sat untouched by her bedside. One patient who was admitted for an upper GI bleed is due to go for a special test today...provided they are COVID negative. When I called the gastroenterologist in charge to organize the test, I was told I was lucky that I only needed it now; they were unable to do it a few weeks ago because all the personnel were out with COVID and there were not enough staff available to complete the test. I hoped my patient's repeat COVID test would be negative so we can understand why they have been bleeding and can be discharged home safely.
One of my other patients - admitted for a bacteremia (bacterial infection in the blood) - needed a repeat cardiac echo (an ultrasound that looks at the movement of the heart, how the valves are working, etc.) to make sure there was no damage done to the heart. We had tried the procedure from the outside (transthoracic echo) but the image quality was poor. This patient needed something called a transesophageal echo. This is a procedure where an ultrasound probe is inserted down the esophagus to visualize the heart from the inside. However, this patient was on a ward with an active COVID outbreak. After much discussion with the cardiologist we all decided that the safest thing for everyone would be to postpone it till COVID had calmed down. The procedure can be associated with a lot of coughing and would increase the risk of COVID spread to the staff.
My evening shift in ICU started with a printout of the COVID protocol and signover for the many patients admitted to the ward - over half were there for COVID. A patient's worried daughter called asking for an update; I told her we would call her back. All the staff were in said patient's room, flipping them over for the night. Putting these ICU COVID patients on their stomach seems to help with oxygenation. I was instructed to follow up on bloodwork for this same patient that came back with concerning results. However I didn't get the chance to call my staff as a new transfer arrived with a deteriorating respiratory status from one of the wards. I read the chart "severe COVID pneumonia, patient unvaccinated". I scrambled to assess to be able to call for help early if intubation was required, having to remind myself to step out soon to call back the blaring alarms of my pager - I was being called from other areas of the hospital.
This wave feels different than the previous ones. People are less sick generally speaking due to vaccination and the properties of this new variant. However, because it is so contagious the sheer volume of people who are sick is that much more. While most will be mild cases, a small proportion - especially if unvaccinated - will end up in hospital/ICU. The issue is that when you have a huge portion of the population sick with COVID, in absolute number of severe infections still translates to more hospitalizations than during previous waves. Even more challenging are the staffing shortages created by the healthcare workers who are infected and having to stay home to prevent further spread. This impacts EVERYONE's ability to get medical care of any kind. THIS is why public health measures are necessary to curb infection rates. Our system is overwhelmed, our workers are overwhelmed, we all are overwhelmed. So please I urge you to find that strength inside you to continue to follow public health guidelines. Mask up, stay home, stay safe, stay strong.
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