This summer, when the coronavirus raged for a second time and Acadiana’s hospitals filled up, Dr. Britni Hebert was sidelined. Her 2-year-old daughter gave her Covid, and she couldn’t see patients in her internal medicine and geriatrics practice or at the hospital for 12 days. Working virtually patched her through, but the exhaustion got her only sicker. The virus clawed pneumonia into her lungs that lingered for weeks.
Now dread brews about what will happen when healthcare workers get sick again, as she watches a wave of inaction and misinformation brew a third surge in Louisiana.
“We aren’t even seeing the people who are being infected today,” she says. “And we’re already seeing higher than the numbers that we saw in June. When you see the ICU numbers triple in seven days and the admission rates double, that’s not a good feeling.”
Through two tremendous spikes, Louisiana’s healthcare system narrowly avoided a crippling blow from coronavirus. Even as treatments have evolved to manage the disease itself, the threat of illness within the medical community itself keeps Hebert up at night. Hospitals, clinics and primary care offices are already stretched thin.
Pandemic fatigue, it’s said, has set in for a public tired of social distancing, washing hands, and wearing masks. We want to go back to our normal lives. Pandemic fatigue for healthcare workers means exhaustion from months of long shifts, frustration at working uphill against a landslide of misinformation and fear that we’re giving up just as the end is in sight.
“If you can hold on for a little bit longer, we’re in the second half of this,” Hebert pleads. “We have a vaccine ready to roll out, and that’s the beginning of getting it under control. But ignoring or pretending this isn’t real is only going to cause suffering for so many people in the meantime.”
And that includes the people charged with caring for those who get sick. The system is bending, but it hasn’t yet broken. Over the last few days, we’ve heard from healthcare workers as they watched helplessly while 2020 repeated itself for a third time. Hospitalization trends in Acadiana have matched or exceeded that second peak, which precipitated the deadliest stretch of the pandemic for this region. Positivity is spiking. Louisiana has ratcheted up restrictions — again.
Meanwhile, healthcare workers in both hospital systems and in the community have watched their efforts undermined by public apathy, a plague of misinformation and lack of enforcement on the part of government. They’re anxious, angry, frustrated, fed up and numb.
It’s not for lack of fighting. Hebert has taken to Facebook to tamp down myths wherever they are. She wrote a “maskifesto” to lay down the science on why masking works. When Mayor-President Josh Guillory chided the medical community for its performance to date and cynically offered bed space at parish rec centers in lieu of enforcing public health restrictions, she cooly explained how it missed the mark. The issue isn’t the number of hospital beds, she explains, it’s the people and infrastructure that support them that make it work.
She learned that first hand in New York this March. Hebert joined the second wave of medical reinforcements at what was then Ground Zero for the pandemic in the U.S. Quickly, she discovered the logistics of patient care in what amounted to a field hospital in a sports arena outside Manhattan were a nightmare. Getting labs done and prescriptions filled could take hours or days, delays that could be fatal on otherwise routine treatments.
“It all falls apart really quickly,” she says.
The problem boils down to the workforce, or a lack thereof. Louisiana entered 2020 with a nursing shortage, just like the rest of the country. What’s different about the third surge is now it’s everywhere, not localized to zones where mission-driven volunteers can hop to. They’re needed back home. And it’s getting harder to come by reinforcements.
Emma Young, an ER nurse at a hospital outside Lafayette, says she’s seen beds go dark because they don’t have the staff to manage them. Around 80% of hospital beds in the Acadiana region are in use as of this week, a figure heavily influenced by staffing, and so are 90% of the region’s ICU beds. Young says overall her workplace is doing OK so far. But contract nurses are leaving the state where they can make more money. And Louisiana’s hospitals rely on that floating workforce to fill gaps during surges.
That’s a key threat this go round, as hospital census counts creep up. But the people around them don’t get it. Even some of Young’s coworkers have thrown up their hands. She’s alienated herself with her proselytizing about masks and basic precautions. It’s not just the public anymore who aren’t listening. About a month ago, Young stopped wiping her groceries. It was the first bit of normalcy she’s allowed herself since March. Everyone’s tired.
Her family’s Covid protocols are strict by any standard. She and her husband, who also works in healthcare, have kept their kids home. Friends visit over the fence. Her 6-year-old daughter begs for FaceTime calls with her best friend.
“I’m done. I’m not done being safe. I want it to be over. I want my kids to see their friends and our friends,” she says.
Hers is a common exasperation among nurses in the state. They’re being asked to do even more than normal. And it’s showing up as burnout.
“Nurses are having to be there instead of family,” says Dr. Cynthia Bienemy, director of the Louisiana Center for Nursing. A summit on resilience in the state’s healthcare surfaced deep concern for the toll that surge after surge is taking on nurses and other healthcare workers. “Frontline healthcare workers are being traumatized because they’re seeing so much death,” Bienemy says.
Louisiana was projected to be short almost 3,800 registered nurses heading into 2020, according to a forecasting model Bienemy developed. Based on 2019 licensure data, Lafayette would be short around 250 registered nurses.
The shortage can complicate care tremendously. Young says her ER department occasionally sends Covid patients back home when they’re short beds, taking a reasonable risk they won’t need acute care. The decision comes with strict instructions: if things get worse come back immediately. In other words, the shortage impacts risk tolerance in hospital triage. Other patients can be transferred to New Orleans when the availability isn’t there.
Community organizer Alzina Dural sighs when she talks about mobilizing her volunteer health taskforce again. She’s helped facilitate hundreds if not thousands of Covid tests over the last few months for people around Lafayette’s Northside. This time, they’re saddling up to head to St. Martinville. Teens and young adults are returning to nightclubs, she says, getting the kind of familiar invincibility public health officials warned against since March.
Indeed, the demographic leading the way on this surge is people between 18 and 24. Scenes of packed clubs and blow-out parties have been met with little to no enforcement.
Meanwhile, people in her neighborhood are choosing between paying for food to last them the winter and patching roofs cracked open by Hurricane Delta.
Dural recently sat in a parking lot while her husband had surgery on a broken foot, unable to be with him after hospitals locked down on visitations.
“I’m tired. I’m just frustrated,” Dural says. “What’s the hold up, Lafayette? It’s embarrassing to have your leader say ‘use good judgment.’ No. Wear your mask.”
Even with vaccines on the horizon, optimism is tempered. Beyond the logistics of mass distribution, healthcare workers know there could be more resistance to deal with. Dr. Hebert and her office have been preparing videos and blog posts to combat anticipated misinformation about the vaccines. Many will continue to doubt how very real the threat of coronavirus continues to be, even with a vaccine in hand.
“At the core of it, we health professionals always want to help everyone, to fix everyone, to cure them,” Hebert says. “But we literally cannot do it alone this time. We need everyone’s help to conquer this.”