MILWAUKEE – The patient who died Tuesday morning at Aurora St. Luke Medical Center was taken out of her room under a white sheet. A nurse, holding back tears, stood silently in the hallway as the outline of the body passed – one more death in an eight-month pandemic that has no end in sight.
“Those moments struck the soul,” said Jodie Gord, a nurse manager who oversees a team of about 120 people at Milwaukee Hospital.
The Aurora St. Luke is far from the only one to be put to the test. Hospitals across the United States are reeling from the rampant spread of the coronavirus, many of which are in areas of the country that had initially been spared the worst.
As election day approaches, President Trump played down the sharp rise in cases, attributing much to an increase in testing. But the number of people hospitalized with the virus tells a different story, increasing by around 46 percent from a month ago and raising concerns about the ability of regional health systems to meet overwhelming demand.
The explosion in the number of cases indicates a new volatile phase of the pandemic, after previous waves hit major cities such as New York, then Sun Belt states like Florida and Arizona. As some of these places have started to get the virus under control, rising hospitalizations are crippling some cities with fewer resources.
In El Paso, where the number of people hospitalized for Covid-19 has more than tripled in the past three weeks, doctors at the University Medical Center have started airlifting some patients to hospitals as far as San Antonio while treating others in a field hospital in a nearby parking lot. Across the border in Mexico, the mayor of Ciudad Juárez, himself hospitalized after testing positive for the virus for the second time, is calling for a temporary ban on US citizens from entering his city.
“We’ve never seen this in El Paso,” said Dr. Joel Hendryx, chief medical officer of the University Medical Center, one of the largest hospitals along the border. Citing the need for field hospitals, Dr Hendryx contrasted starkly with the city’s earlier push in July, when mitigation measures lowered the number of cases.
Dr Hendryx’s hospital had 195 cases of the coronavirus hospitalized on Tuesday compared to 30 about a month ago. In addition to the parking lot tents, El Paso officials are converting the downtown convention center into a 50-bed hospital. Hundreds of health workers from other parts of Texas are deploying to El Paso, including an ambulance strike team with paramedics from the Houston area.
The situation is also becoming critical in states such as Idaho, Missouri, New Mexico and Utah, with frontline workers exhausted and hospitals struggling to find replacements for those who test positive every day.
At St. Luke’s Magic Valley Medical Center in Twin Falls, Idaho, where more than a third of patients have Covid-19, administrators send children to a hospital in Boise, a two-hour drive away. The influx of patients from rural areas with poor health infrastructure is also weighing on hospitals in Wisconsin, where cases are up 53% from two weeks ago.
Nationwide, the number of cases has reached frightening new levels in recent days, with the seven-day average of new cases surpassing 70,000 for the first time in the pandemic. Twenty-six states have reached or near a record high number of new infections. More than 500,000 cases were announced last week. And exactly zero states are seeing sustained declines in the number of cases.
On a per capita basis, small towns and rural counties in the Upper Midwest and Mountain West are in greatest difficulty. North Dakota, South Dakota, Wisconsin and Montana lead the country in terms of new infections per capita. Of the 12 metropolitan areas with the highest rates of new cases in the past two weeks, 10 are in North Dakota or Wisconsin.
But the dismal trend lines are not limited to these regions. North Carolina, New Mexico, Pennsylvania, Rhode Island and West Virginia recently set seven-day records for new cases. And more and more big cities are starting to take off, with alarming trends emerging in Chicago, Milwaukee and Newark.
And while the increase in the number of cases has not been accompanied by a sharp increase in deaths, that trend is starting to change. Around 800 deaths are now recorded across the country every day, far less than in the spring but up slightly from the start of the month.
Cities across the country are rushing to impose new restrictions. In Idaho, Gov. Brad Little backed off on the reopening, but stopped ahead of a statewide mask tenure. Mr Little limited indoor gatherings to 50 people, demanded masks in long-term care facilities and imposed new restrictions on how bars and restaurants could serve their customers.
In Newark, all non-essential businesses will be required to close at 8 p.m. starting Tuesday. Chicago Mayor Lori Lightfoot has imposed a curfew under which non-essential businesses must close from 10 p.m. to 6 a.m., and bars without a food license are no longer allowed to serve customers inside.
In Fargo, ND, Mayor Tim Mahoney used his emergency powers to serve the state’s first mask term. The mayors of Nixa and Ozark in Missouri have imposed mask warrants after calls from nearby hospitals overwhelmed by coronavirus hospitalizations.
On one of the floors of the intensive care unit at Aurora St. Luke in Milwaukee, the mood was grim Tuesday morning as doctors and nurses made their rounds. Twenty of the 24 beds were full and many patients were on ventilators.
But the staff put on a brave face. They gave patients in the hallways a thumbs up, entered the rooms to greet others, and helped a woman eat breakfast.
Before noon, an older woman was transferred to the ICU from the Covid-19 floor. Within 30 minutes of her arrival, a beep sounded sent staff members running into her room, frantically grabbing personal protective equipment.
The patient’s oxygen levels had dropped to dangerously low levels, and she was going into cardiac arrest. A nurse practitioner called the patient’s family, making it clear that there was a possibility that they might not.
A staff member cut back on the woman in hopes of keeping her alive. After several minutes, his condition stabilized – for now.
She was the second patient to need such care in just three hours. When the nurses and doctors moved away to breathe, the woman was lying on the bed, now intubated, her eyes glassy and her face pale. It was difficult to see clear signs of breathing.
Some of the staff patted each other on the back. Others took deep breaths. A healthcare worker came out of the patient’s room, holding a small plastic bag in his hand. Inside was jewelry to give to the family, said Ms Gord, the nurse in charge, in case the woman died.
Staff still appeared to be in shock over the death of the other patient that morning. She had become dear to the intensive care team, said Ms Gord, who stood quietly and with obvious emotion as the stretcher passed. “Bless her soul,” she whispered. “Sweet little lady.
Staff members said they were struggling with constant exhaustion. “What will happen when we can’t take care of these patients?” said Dr Pedro Salinas, an intensive care specialist, who is worried about how long the staff can take. “They are emotionally and mentally exhausted.”
The prospect of ending up in an overcrowded hospital ward makes some virus patients reluctant to register. At El Paso hospital, staff said some Covid-19 patients were arriving at the emergency room so weakened they needed it. intubation almost immediately.
Sandra Garcia, 31, an El Paso resident who tested positive for the coronavirus last week, said she had struggled with fatigue, shortness of breath and loss of taste and smell, but had refrained from seeking treatment in crowded city hospitals.
In the meantime, she is caring for a 13-year-old girl who also has Covid-19 and 5-year-old twins, who are all studying online from home. Ms Garcia said she wondered why Dee Margo, the mayor of El Paso, had not ordered the city to be closed to curb the spike in cases.
“He’s just trying to get re-elected and it’s disgusting,” Ms. Garcia said.
Last week, Mr. Margo announced new restrictions such as closing parks to the league and tournaments, but said an order for the city’s complete closure is expected to come from the governor of Texas.
Dr German Hernandez, a nephrologist who has treated patients at several hospitals in El Paso, said the situation was so dire that patients on oxygen were being kept in rooms in the trauma area of the university medical center. He said it could be devastating in the event of a disaster such as the August 2019 mass shooting at a Walmart in the city that left 23 people dead.
“God forbid that we have another shoot on August 3 because we can’t handle it right now,” Dr Hernandez said. “We don’t have a tampon.”
Giulia McDonnell Nieto del Rio reported from Milwaukee, Simon romero from El Paso and Mike Baker from Seattle. Erin Coulehan contribution to El Paso reports, Mitch smith from Chicago, and Lucy tompkins from New York.