LEXINGTON, S.C. (AP) — Mid-morning on June 16, Dr. Philip Keith squats by the bedside of one of his severely ill COVID-19 patients and he is pleased with what he sees.
Two days earlier, his patient needed a ventilator to breathe. Now, he is sitting upright in a chair, using only half the supply of oxygen he needed the day before.
“You’re doing much better than yesterday,” Keith tells him. “Making progress everyday. Okay?”
But as one of the critical care physicians in Lexington Medical Center’s unit for the sickest COVID-19 patients, Keith knows better than to let his guard down when he sees patients improving.
“If it weren’t COVID, I would feel really confident that he’s out of the woods,” Keith said. “But we’ve seen it happen too much, where people get better and then they get worse.”
SARS-CoV-2, the coronavirus that causes the COVID-19 disease, can trigger an aggressive and erratic immune response in the people it infects. In the worst cases, the virus causes blood clots and overwhelms multiple organs, breaking down essential body functions.
And although scientists the world over are furiously racing toward a vaccine, and doctors have seen some patients improve with blood plasma treatments and medicine, there is no known cure for COVID-19. In the lifespan of this emerging illness, it is early and much is unknown, so there is no sense of relief for health care workers.
While Keith attends to his patients, cases of COVID-19 are rapidly multiplying in South Carolina, and have been for weeks. Of the tests reported on June 16, a staggering 13.7% came back positive. More than 600 South Carolinians have died from the disease, and over 20,000 have been infected with the virus. By June 18, the number of new cases in a day broke all previous records.
The numbers reflect more than just an increase in testing, according to the state Department of Health and Environmental Control. They show that people are transmitting the virus more, shooting South Carolina upward on its curve, which government leaders called a plateau just weeks ago. While much of the country starts on its downward slope of new cases, South Carolina is at the highest point it’s ever been.
But in the hospital in June, the COVID-19 headlines and numbers are replaced by a much quieter reality.
‘SOMETIMES YOU FEEL HELPLESS’
At Lexington Medical Center, that reality is a 37-year-old patient lying on her stomach, sedated, paralyzed, connected to tubes that keep her fed and hydrated and breathing. The pandemic is revealed in the way a stethoscope pressed to a patient’s chest detects his struggle to take full breaths. It is marked by the door hangers with “STOP” signs on them, by the irritated skin on the tired faces of ER nurses who just removed uncomfortable protective masks and goggles (again).
It looks like Keith, in a pastel yellow gown, two pair of gloves and a protective, air-filled cloth helmet that makes him resemble an astronaut. And then there is Alan Conner Jr., one of the youngest patients the critical care staff has treated during the outbreak.
As of June 12, the hospital had admitted 194 COVID-19 patients during the outbreak, with an average of about 20 to 25 patients in the hospital on any given day. The critical care unit each day typically treats 6 to 8 of the patients, who will need to be hospitalized for weeks. That’s where Conner is being treated.
This month, the 37-year-old Lexington resident thought for the first time in his life that he might be sick. It started with a cough and a runny nose, “nothing major,” Conner said. He had been aware of the virus, and was using hand sanitizer and trying to keep his distance from others, but hadn’t worn a face mask, he said. When he got home on June 10 from working as a manager Franklin Equipment Co., Conner slept from 5 p.m. to 7 o’clock the next morning. That’s when he knew something wasn’t right.
The morning of June 13, Conner woke up in a panic at 3 a.m. He couldn’t breathe. Conner was so weak and out of breath, he had to crawl upstairs to wake up his wife and ask her to call an ambulance, he said.
“I’ll tell ya, I don’t get scared. Not much scares me but the Good Lord. But I was scared,” Conner said on June 16.
Just a couple of days before, Conner’s liver and lungs were failing, he had incredible inflammation and was at extremely high risk for dangerous blood clots, Keith said. Doctors and nurses turned to therapeutic plasma exchange. His liver function improved significantly, said Keith.
Then, Conner received convalescent plasma — antibody-rich blood from recovered COVID-19 patients — and remdesivir, an antiviral drug that has been shown to slow down the replication process of SARS-CoV-2. Patients must meet certain requirements to receive the various COVID-19 treatments, and many don’t, often because the disease has progressed too much by the time they are hospitalized.
“In an ideal way, that would be how we treat everybody,” Keith said. “He came in at the right time, because he was probably one of the sickest ones but he got here early enough.”
For some others, like a critical care patient who died that same morning, it was too late to fix the damage.
It’s an unfairness that sits at the heart of the pandemic: So many COVID-19 patients are just fine, but others are ravaged by an invisible illness and by their own body’s response.
For months, health care workers have been flooded constantly with new information. Hospitals like Lexington Medical Center have had to quickly adapt to an unexpected situation. Doctors and nurses, accustomed to having effective tools to save patients, have had to cope with the feeling of helplessness. They have had to accept that there is no end in clear sight.
“Being up here, sometimes you feel helpless, because there’s not really anything that’s proven,” Keith said. “We do the best we can, what we think may work, and you just have to give it time. It can be draining.”
Bree Shea, 38, the charge nurse of the clinical care unit, said it wasn’t until May that she came to terms with how long this new way of living and working could last. After five years at Lexington Medical Center, she had recently been assigned to work in the cardiac ICU, until the pandemic forced the hospital to retool her unit for COVID-19 patients.
On top of the change at work, Shea and her husband, who’s also a nurse, have a young daughter.
“Having your personal life and then having to come in to a new place and a whole new process and having to wear really uncomfortable things for hours and hours without really having an end. That part was a lot,” she said.
Over time, the early chaos has settled, and staff members have been able to find a rhythm. They have even found ways to lighten the mood by labeling a changing room full of PPE the “corona clubhouse” and nominating coworkers for superlatives. This critical care unit was a new combination of nurses and doctors when it started, but everyone has grown close while trying to find their footing amid the pandemic.
‘THE UNKNOWN, PLUS COVID’
Life in the emergency department, “for better or worse,” bucks a routine, nurse manager Sarah Navarro said. But COVID-19 adds a whole new layer to that, she said.
“The ER is already the unknown, because you can get anything in the ER. But now it’s the unknown, plus COVID,” she said.
Early on in the outbreak, the ER staff tried to identify, isolate and test possible COVID-19 patients as soon as they could. A tent outside of the emergency room entrance was used to triage incoming patients and keep them away from everyone else. At that point, it took several days to get results back from a COVID-19 test.
As time passed, the initial symptoms associated with the virus — cough and fever — expanded to include a whole slew of other conditions. It got harder to predict who was infected. And although the wait time for test results has shrunk significantly, to between 90 minutes and 48 hours depending on the lab, ER staff said the virus still lingers in the background of every encounter. That’s even more true as Lexington Medical Center, which has the second busiest emergency room in the state, is beginning to see a normal volume of non-COVID-19 patients.
Nurses will go about their typical routines, tending to seemingly uninfected patients visiting the ER for non-virus concerns. A few hours later, that patient will mention some flu-like symptoms and the nurses have to quickly leave the room and pull on full protective equipment.
“We have asymptomatic positives all around the state, walking around, shopping at the Walmart,” Navarro said. “They got the positive but they look good.”
And even in situations that normally wouldn’t have necessitated a mask or gloves — like an unconscious patient brought in on an ambulance — nurses have to be as careful as possible. They can’t stop and ask a patient in cardiac arrest whether he or she has experienced flu-like symptoms.
When the nurses leave work and go home, they remove their shoes and strip down outside, or run straight to the shower. They have children and partners and loved ones they want to enjoy and protect, too.
Nurse Kim Johnson, 50, said she was afraid of the virus early in the year, before it arrived in South Carolina. Like other nurses, who sent their children early on to live with grandparents or ex-spouses, Johnson worried about exposing her teenage sons to the mysterious illness.
“I probably went — when this first came out — a whole month without hugging them,” she said. “I kissed them on the head, but probably went a whole month without (hugs), which is hard.”
By June, Johnson had seen many COVID-19 patients recover. That calmed her. She resumed hugging her children. She started going back to her church, where congregants are spaced apart, and she wears a face mask.
“I feel like we’ve got to live our lives at some point,” she said. “We can’t stay isolated forever. But I do think people need to take it seriously.”