Julie Hurlburt began a latest 12-hour nursing shift at Mercy Hospital’s intensive care unit with a hopeful objective — to maintain her COVID-19 affected person alive lengthy sufficient for his daughter to fly into city and see him.

However 10 minutes into her shift, the affected person was useless.

Hurlburt, an intensive care nurse for the previous 21 years, has cared for her share of the three,500 folks in Minnesota who’ve died from COVID-19. Every loss is tough, however this one actually stung.

“Some days I feel like I can deal with this,” Hurlburt mentioned. “Some days I have to step off the unit and cry and come back and deal with it.”

Heartbreak and loss are realities within the “red zone,” the ICU wing designated at Mercy for critically sick COVID-19 sufferers. The unit title stems from the pink tape on the ground that marks the place strict an infection prevention protocols begin. Step throughout the road and other people should put on robes, masks and gloves always to attenuate the prospect of catching or spreading the novel coronavirus that causes COVID-19.

Mercy has been busy amid the pandemic’s surge, treating greater than 100 sufferers admitted with COVID-19 on latest days. The Coon Rapids hospital is a nexus of important care to the north metro and east-central Minnesota, and is a part of the Allina Well being system that has seen an 85% rise in COVID-19 admissions since Nov. 1.

At one level on Friday, Mercy had no open beds, and 10 sufferers needing inpatient care had been ready in its emergency division for openings. The pink tape that had cordoned off eight ICU rooms for essentially the most extreme COVID-19 circumstances final week was pulled up and prolonged down the corridor to guard 12 rooms this week.

“It’s so challenging to be fighting to keep these people alive,” mentioned Dr. Matthew Klee, Mercy’s ICU medical director.

Hospitals have improved outcomes over the course of the pandemic, in accordance with a evaluate by the Minnesota Division of Well being of 6,736 COVID-19 sufferers who accomplished hospital care.

The demise charge is 10% — down from 15% in May when the well being division reviewed outcomes of the primary 1,104 hospital circumstances. Nevertheless, the info underscore the chance for the 27% of sufferers admitted to ICUs and the 14% who had been positioned on ventilators due to issue respiration and plummeting blood oxygen ranges. Of 961 sufferers positioned on ventilators, 37% died.

“I really thought we would have more effective therapies by now,” Klee mentioned.

Earlier this summer time, donor plasma from sufferers who recovered from COVID-19 was used aggressively. Shortly after it obtained emergency use authorization from the U.S. Meals and Drug Administration in August, although, knowledge emerged that questioned its broad advantages.

Mercy important care docs have began reserving that just for sufferers with weak immune programs or on immunosuppressive medication.

“With so many of these interventions,” Klee mentioned, “its been very difficult to see if they are really making a difference.”

Blood clots are sources of problems for critically sick COVID-19 sufferers, who all obtain no less than low-level doses of blood-thinner medication at Mercy to forestall these dangers. The timing of bigger, therapeutic doses for COVID-19 sufferers varies by hospital — with overuse carrying the chance of bleeding and problems.

Hennepin County Medical Middle was an early person of the steroid dexamethasone to fight the immune system’s generally deadly overreaction to an infection, and its hunch was verified by a British research displaying that the drug diminished COVID-19 mortality.

The steroid is probably essentially the most surefire possibility ICUs have proper now, mentioned Dr. James Leatherman, an HCMC important care doctor.

“Other than the steroids, it’s all about just basic ICU management,” he mentioned. “I’ve often wondered if places like New York that just got overwhelmed, if that might have had something to do with their worse outcomes early on.”

Donning the gear

Well being officers mentioned this underscores the necessity to shield caregivers from infections themselves by slowing the unfold of the virus, as a result of the supply of docs and nurses with important care coaching is what makes a distinction.

Mercy’s “red zone” is designed in order that docs and nurses don’t have to alter out and in of protecting gear a lot. One draw back of regularly carrying masks and respirator helmets is the muffled speech, which forces caregivers to talk loudly and repeatedly to be heard.

“Did you check on that heparin drip?” nurse Nicole Melich hollered to a colleague.

After a clean stare and transient pause, the nurse replied, “Oh, I know what you were saying!”

The upside is that nurses can rapidly reply and enter rooms of sufferers with out having to don new protecting garb.

In solely the primary few hours of a latest shift, Hurlburt had already helped a physician place a chest tube in her affected person, adjusted her medicines, checked her blood sugar eight instances, and flipped her from her abdomen to her again.

Rotating sufferers from their stomachs to their backs has made a distinction, stopping secretions from clogging on one facet of the lungs. The floor space of the lungs is bigger in again, so turning folks on their stomachs additionally reduces stress on that facet of the organ and will increase oxygen movement. However the course of is intensive, requiring no less than six nurses or caregivers to do it safely.

Sooner or later final week, the “red zone” employees was rotating sufferers in six of the eight rooms. Regardless of the extraordinary care, three of them died.

“Our limit in the ICU is two patients for one nurse,” mentioned Mercy ICU nurse Kyle Fondie, “but a lot of these patients are sick enough that they need a nurse for themselves. It’s hard to explain how sick these people are [to others] who can’t see them.”

Age and race are elements. The demise charge is 24% for Minnesotans 75 or older who’re hospitalized with the infectious illness, in accordance with the state well being evaluate knowledge. Amongst 72 American Indians hospitalized for COVID-19, 21 (or 29%) died.

Weight problems is a threat for extra extreme COVID-19 as properly, and was present in 36% of Minnesotans with COVID-19 admitted to hospitals. The state’s total grownup weight problems charge is 30%.

‘A long haul’

Size of keep for COVID-19 has shortened total, in accordance with state well being figures, from 9 days within the spring to 6 days within the fall. ICU stays particularly have declined from 15 days to 11 days. Nevertheless, ICU docs mentioned they’ve discovered that endurance is required with a few of the extra extreme circumstances.

Dr. Nicole Roeder of M Well being Fairview recalled one COVID-19 affected person who was on a ventilator for 90 days, and on paralyzing medication for many of that point, earlier than recovering.

“This is kind of a long haul rather than a sprint,” she mentioned.

Hospitals have responded by deferring non-urgent surgical procedures which may require ICU recoveries to keep up beds for COVID-19 sufferers.

The variety of ICU beds in Minnesota crammed with non-COVID sufferers has decreased from 1,009 on Aug. 1 to 766 final week, whereas the quantity crammed with COVID-19 sufferers has elevated from 64 to 387.

Hospitalizations all through the pandemic have elevated two to 4 weeks after lab-confirmed infections have elevated.

An infection numbers have began to say no previously few days in Minnesota, although, and hospital leaders mentioned they’re hopeful that can proceed and be adopted by declining hospitalizations subsequent month.

“These patients are difficult to manage,” Klee mentioned. “It takes a lot of expertise.”

That is the third in a sequence on Minnesota hospitals’ response to the surging COVID-19 pandemic.

Correction:
Mercy Hospital ICU nurse Kyle Fondie mentioned the ICU’s restrict is 2 sufferers to 1 nurse. Earlier variations of this text quoted Fondie incorrectly.