SAN ANTONIO, Texas — The U.S. has just reported more than 50,000 new cases of coronavirus in a single day.
According to CDC forecasts, Texas is expected to see nearly 2,000 new hospitalizations per day by mid-July. That number is far worse than the numbers in March, April and May.
“We are having an explosion of COVID. We aren’t overrun yet, but it’s overwhelming,” said Adam Sahyouni, Nurse Manager at San Antonio’s Methodist Hospital COVID ICU.
Overwhelming now and expected to get worse in the days ahead. San Antonio’s Bexar County has seen a sharp rise in the percentage of those testing positive for the virus. In just the last 30 days, the weekly average of those testing positive has gone from 3.6% to more than 20%.
Increasingly moms-to-be are infected. Methodist Hospital now has a dedicated unit in its NICU for babies born to mothers who have the coronavirus.
In the womb, the virus isn’t typically transmitted from mother to child, but during the birthing process, the risk of infection goes up, and treating a newborn with COVID is much more complicated.
Though babies currently in the NICU have tested negative, they are treated as suspect positive. Healthcare workers wear full Personal Protective Equipment (PPE), and the babies born to moms with the coronavirus are kept separated from others.
There are five babies in the NICU now, with room for 16. Asked if she thinks they will be full soon, NICU charge nurse Meagan VanDewark said, “I do. The way things are going, we’re admitting pretty frequently.”
Christie Labastida, 36, is expecting her fourth child. Both she and her fiancée have the virus.
“Mainly, the thing that hurt the most were my bones, were just, I couldn’t lay down. It was just hurting,” says Labastida, “… like even to my pinky, my toes.”
Labastida said she took precautions and isn’t sure how she got COVID. Now, she hopes her three kids and fiancée are coronavirus free by the time she gives birth in about a month.
“I’m extremely stressed. I’m a very strong woman. I tend to do a lot, and now that I can’t and I need that help, it’s taking a toll.”
Methodist Hospital may be seeing the beginning of a sharp nationwide increase of coronavirus-infected moms giving birth.
“There’s actually some literature out there that supports up to a 30% asymptomatic rate (in expectant moms),” says OB/GYN Kelly Morales.
Pregnancy is only one piece of the coronavirus pandemic. Methodist Hospital is also treating a rising tide of critically sick patients.
“The last few weeks have just been overwhelming is how I’d describe it. There’s been more and more patients than we really know what to do with and the patients are getting younger and they’re more sick,” said Pulmonary Disease specialist Dr. Jeffrey Dellavolpe. “It’s gone from 50s and 60s for the first wave … to I’ve lost track of how many people in their 20s.”
Methodist’s COVID Unit 2 is one of three specialized COVID units in the hospital. Patient rooms are sealed off, each one turned into negative pressure chambers so staff only need to don PPE if they go into one of the bays.
All 14 rooms on the unit are filled, and there is a long waiting list. The hospital is creating more beds, but for now, this is where the sickest of the sick are treated.
“Yesterday was probably the worst day I ever had,” said Dellavolpe. “I got 10 calls. Young people who would otherwise be excellent candidates to be able to put on ECMO.”
Methodist uses ECMO, or extracorporeal membrane oxygenation, a procedure to oxygenate the blood and keep patients off ventilators.
Dellavolpe said those young people are “so sick that if they don’t get put on — if they don’t get that support, they are probably going to die.”
“I have three beds,” he said. “And just making that decision of who would benefit. It is a level of decision-making that I don’t think a lot of us are prepared for.”
The calls come from other hospitals across south Texas with patients so sick that Methodist may be their last hope.
Today, Dellavolpe is inserting large tubes in the veins of a 33-year-old. They run from the groin to the heart. The blood comes out of the body, is mechanically oxygenated, then returned back to the heart almost immediately.
“It involves taking large cannulas, they’re almost like small garden hoses is how I would describe them, they have to be able to pump two to three gallons of blood per minute through them,” said Dellavolpe. “So one is draining blood out and the other is returning.”
The Methodist team has had a lot of practice, and the procedure takes only a few minutes. The blood coming out of the patient is dark. It looks unhealthy. The blood returning is bright red, loaded with oxygen.
Almost immediately, oxygen levels in the patient’s blood go back to near normal, their chance of survival now better than if they were on a ventilator.
“We don’t quite understand why one person with lab values of X does well while a person with lab values that appear to be better doesn’t make it. And a mask is not a big ask to help save your life,” says Nurse Manager Sahyouni.
The work and stress for healthcare workers everywhere is crushing. With rates of infection rising, they expect more stress ahead.
It’s also stressful for patients who are sick, isolated from everyone. Michael Casquez, 28, works in a warehouse, and he’s not sure how he got sick.
He’s part of a new program at the hospital to get patients up and walking as soon as possible, even a little bit, helping both physically and mentally.
Vasquez isn’t sure if there will be any long-term effects to his lungs. Right now, he’s focused on getting home to his wife and 7-year-old son.
“I just miss their presence. You know, holding your wife. Kissing your son goodnight. Going to his room, making sure he’s OK. I miss that a lot,” Vasquez said.
Pulmonary critical care physician Misha Peter said, “We know that when people walk, when people sleep better, when people see bright light, they get better sooner. We know all of this. I think on some level we’re having to relearn it with COVID because of our response to it. Obviously, we need to keep ourselves safe to keep our staff safe, so it’s not unexpected that we ended up isolating people whether we meant to or not.”
Another lesson of the pandemic: Trying to reduce recovery times and free up beds that are badly needed for an expected surge of people seriously sick with the coronavirus.
Dr. Jennifer Gemmill describes the problem: “Right now, we are so full upstairs we are having some delays in getting the patients (up there) because there just aren’t beds prepared and ready for COVID patients. So we are holding a lot of them in the emergency department right now. Some for hours, some for days.
What’s driving the surge?
Doctors aren’t entirely sure, but based on what they hear from patients, there was a sense that the worst was behind us.
“I don’t think there was one specific incident that led to this spike,” said Gemmill. “I think people in March and April were extremely frustrated with being inside, and as soon as those restrictions lifted, they wanted to get out. Some protected themselves, some didn’t, and now we’re seeing the result of that.”
With the holiday weekend coming up, the fear now is that the surge of patients will become a tidal wave.
“I don’t think I have seen anything like this ever,” said ICU Nurse Manager Sahyouni. “And I would say that if you want to see Aug. 1st, then maybe you should stay indoors and isolate on July 4th.”