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As the number of COVID-19 cases and deaths tick upward, frontline health care workers across Maine fear that the worst is ahead. In interviews and emails with 13 people caring for the sick, they described a competing sense of duty and worry, anxious about their own health as well as the health of others. They expressed pride in their profession but also uncertainty about how they might react if conditions worsen dramatically.
At Maine Medical Center in Portland, which is at the center of the state’s outbreak, there has been a pervasive feeling that the brunt of the storm is drawing near, said Bill White, a senior resident physician. The hospital is preparing for an influx of patients in the coming weeks, which could peak just before White begins his rotation in the intensive care unit in early May, he said.
He has his anxieties, but his coworkers are not among them. “I have a lot of faith in my colleagues across the hospital,” he said. “I’ve been pleasantly surprised by people’s openness and seriousness about this.” Whether in nursing, pharmacy or physician specialties, they “were born to do this,” he said.
He is only worried, he said, about the “non-human things,” such as whether the hospital will have enough equipment, including ventilators, which help seriously ill people to breathe.
“It’s not because I have concerns about my employer and how many they bought,” he said. Across the country, hospitals are reeling from a shortage of gear to handle the pandemic’s unprecedented surge. “I think we have estimates, but we don’t know what’s coming.”
The warnings elsewhere have been dire. On Sunday, U.S. Surgeon General Jerome Adams warned the nation could face its “hardest and saddest week” yet. Maine was one of the last states to report cases of the virus, so in the coming days states that were infected earlier could serve as a grim preview of what lies ahead. Though health officials have stressed that projections are imprecise, predictive modeling shows cases of COVID-19 in Maine could peak in late April.
“Most of us accept that we’re going to be sick or at least carriers,” said one nurse at St. Mary’s Regional Medical Center in Lewiston. “We are all expecting to get sick once the wave hits.” She spoke on the condition of anonymity to avoid reprisal, as did others who were interviewed.
“Bangor is about to explode,” said a medical assistant at a Northern Light primary care practice in Brewer. “We just don’t have the gear to keep us all safe. It’s going to get worse before we see a shred of sunlight on this.”
At the same time, the toll is difficult to quantify. As of Tuesday morning, Maine had 519 confirmed cases of the virus, up from 303 cases a week before. “The public hears the numbers and goes, ‘That’s not that bad.’ But they do not realize that we don’t test many, many people — because we know they have the disease by their symptoms — so the numbers are much higher,” said a nurse at Mount Desert Island Hospital in Bar Harbor.
About 17 percent of reported cases in Maine are health care workers, Nirav Shah, director of the Maine Center for Disease Control and Prevention, said Friday, though health care professionals are tested at a higher rate than others and are more likely to be overrepresented in official statistics. The reality on the ground, the St. Mary’s nurse said, is that hand sanitizer dispensers run out, and staff have been asked to reuse their N95 face masks until visibly soiled.
Everyone knows there isn’t enough protective gear, said a nurse at MaineGeneral Medical Center, with locations in Augusta and Waterville. But not knowing precise amounts puts staff more on edge, especially since “we haven’t even reached the peak of this pandemic.”
Hospitals have been trying to conserve their supplies. The real test will come if Maine reaches a point where frontline staff are asked to care for COVID-19 patients without protection, said a second nurse at St. Mary’s.
“There’s going to be a line drawn in the sand at some point. And if the line is in front of me, I don’t know if I am going to cross it or not. I am a nurse, and that’s what I do. But until I’m faced with it, I’m not sure what my reaction will be,” she said.
Neither the Maine CDC nor individual hospitals have released regular figures on their supplies of surgical masks, N95 masks or other necessities such as swabs, gowns or goggles.
Maine Health, for instance, is set for the short-term, but many factors are changing so quickly that any projection could quickly become inaccurate, said John Porter, a spokesman for Maine’s largest health care organization. At the same time, “We’re constantly looking for supplies,” he said.
Similarly, Dr. James Jarvis, the incident commander for Northern Light Health, said the organization’s supply chain is “as good as we can hope for,” but he is “concerned about those precious N95 masks.” That’s why the health care organization has limited their use and asked staff to reuse them, to make sure there are enough for “what we expect to be a surge of patients in the next couple of weeks,” he said.
The need for more protective equipment, combined with the desire to preserve it as long as possible, slows down the delivery of care, said a third nurse at St. Mary’s in Lewiston. For instance, the simple task of picking at a roll of tape becomes a conundrum when gloves must be preserved.
“All problems get magnified,” the nurse said. “So you have a roll of tape and can’t get the end. You got gloves on now; you have to come up with a work around for the piece of tape you just relied on forever. Now all of a sudden you have a project on your hands or have to get somebody to come by.”
While some health care organizations, such as Penobscot Community Health Care, have furloughed workers as it puts off elective appointments, others, such as Northern Light Eastern Maine Medical Center in Bangor, have not. At the same time that the decision has kept people employed, it’s also left some outpatient staff idle and needlessly exposed to each other, said one physician assistant in an outpatient practice that has seen its number of patients plummet.
It’s good that the hospital postponed elective procedures and office visits, and switched to telehealth services, the physician assistant said. But she remained uneasy as clinical outpatient staff, who do not qualify to work from home, are “crowded in small rooms, twiddling their thumbs,” due to the drop off in appointments.
The hospital has been cross training staff “to prepare for the eventuality that we may need them to do things that they don’t typically do,” said Ali Worster, vice president of human resources at the hospital.
“We’ve been fortunate that we haven’t had to look at the option of furloughs or layoffs at this point. We do want to keep our staff productively employed and working, and getting ready to care for the patients that we think are coming,” she said.
Hospitals are erring on the side of caution, changing their policies on a daily basis and taking input from providers, said a crisis worker and psychiatric nurse who works in three different hospitals, in the midcoast and southern Maine. But those measures of caution have the potential to disrupt parts of the health care system that aren’t directly treating COVID-19 patients.
“It’s turned everything upside down,” he said.
He was recently caring for a patient admitted for psychiatric care at a southern Maine hospital who suffered a chronic dry cough. While being cared for, the patient’s cough changed in nature, triggering concern from the attending physician, he said. The doctor decided to test for the virus and isolate the patient out of an abundance of caution.
The test came back negative. But the nurse worried what might have happened if it didn’t and the patient had to move to another part of the hospital, disrupting the psychiatric care. Or, what if an entire wing of people facing severe mental health crises got sick?
Patients don’t need to have COVID-19 to feel the anguish left in its wake. As a homecare and hospice nurse with Community Health and Counseling Services, Jill Bouchard of Enfield has to find ways to tell people with dementia why their loved ones can’t see them. Even then, they don’t always understand.
“You see individuals walking up the hall, repeating their spouse’s name because they’re no longer able to see them, and they’re crying and they don’t understand why,” Bouchard said. “To keep them safe, we have to keep them away from people. But to do so, that could be their demise — not the disease, but keeping them away from people.”
For Bouchard, these scenes of agony underscore why everyone must play their part to mitigate the spread of the virus, not just health care works like her. Individual behavior, such as abiding by orders to avoid other people, will determine how hard the virus hits, health officials say.
“It needs to be a team approach, from the people staying at home, to the people on the front lines,” Bouchard said.
Camaraderie also buoys spirits.
What’s helped manage the stress, said White, the senior resident physician at Maine Medical Center, is the outpouring of love from the public. He’s seen videos from places like China and Spain where crowds have applauded health care workers for risking exposure to care for their communities.
But about two weeks ago, not long after the virus officially appeared in Maine, he experienced it himself. He went for a walk along Portland’s western promenade, which overlooks the Fore River adjacent to the hospital’s campus, still wearing his hospital scrubs. At least three people stopped to thank him.
“I just had to blush and look at the ground,” he said. “It’s very powerful to feel like what we are doing matters.”
For some health care workers, their coworkers, who are sources of potential infection, are also the only people who can truly relate. When an intensive care nurse at Maine Medical Center was asked if she feels safe in her job, she said no — not because of patients but because it’s not possible to socially distance herself at work.
“We’re getting it from each other, not patients,” she said. At the same time, her colleagues are her major source of support. “Sometimes I vent to friends and family,” she said, “but really it’s my war buddies that are getting me through.”
Watch: Nirav Shah on whether you should use fabric masks