Staff members during morning rounds at the ICU at Providence St. John's Health Centre in Santa Monica, California. Photo / Isadora Kosofsky, The New York Times
Staff members during morning rounds at the ICU at Providence St. John's Health Centre in Santa Monica, California. Photo / Isadora Kosofsky, The New York Times
They thought the worst of the pandemic was behind them. Then a new wave of cases arrived at the ICU at Providence Saint John's Health Centre.
Two months ago at Providence Saint John's Health Centre, Dr. Morris Grabie stood at a makeshift plastic wall in the intensive care unit andprayed.
"Baruch atah, Adonai Eloheinu, Melech ha'olam," he began in Hebrew, the sterile divider behind him sealing off the patients with Covid-19 from the uninfected. "Blessed are you, Adonai our God, sovereign of all, who has kept us alive, sustained us and brought us to this season."
Around the physician at the hospital, located in Santa Monica, California, a small army in scrubs — doctors, nurses, technicians — bowed their heads, bearing witness to what seemed to be the beginning of the end of the pandemic. Sixty-nine lives on the ward had been claimed by the virus. Pain and grief, life and death, fear and loss — month after grinding month — all of it had unfolded behind that thin divider.
And yet on this day, not a single patient in the Saint John's ICU had tested positive for the coronavirus. Grabie turned, and the ICU's medical director, helped by a respiratory therapist, zipped the wall open.
"We were all in awe," recalled the medical director, Dr. Terese Hammond.
It was 7:56am on June 1, a Tuesday.
Now the ward's Covid section is back and sealed off again.
Covid is surging once more, at Saint John's and in the world around it, driven by vaccine resisters and the virus's hypercontagious delta variant. In California, new infections are appearing at a rate not seen since February. Governments, schools and businesses are starting to require masks indoors and vaccinations.
Vickie Gaddy, a nurse at the intensive care unit with a 44-year-old patient who later died. Photo / Isadora Kosofsky, The New York Times
Los Angeles County is recording more than 2,500 new cases daily, and among the unvaccinated, hospitalisations and deaths are mounting. Even in affluent Santa Monica, where about 80 per cent of residents are now vaccinated, dozens of people each day are testing positive for the virus, and hospitals such as Saint John's — a 266-bed facility that typically serves the ordinary needs of the beach communities around it — are being inundated again.
Last week, so many Covid patients were in intensive care that the space behind the plastic wall was not enough. The hospital had to reconfigure and expand the unit. Bonifacio Deoso, a nurse on the unit, was down to one weary question: "When will this ever end?"
For the past three weeks, the 23-bed ICU has been packed, Hammond said. Eight patients on the ward were being treated for the virus or related infections as of Sunday morning. Four were being treated with ECMO, a particularly labour-intensive, round-the-clock protocol.
As ICU staff members work amid the pandemic, they are also treating people with severe illnesses unrelated to Covid, which is straining the ICU even more. Photo / Isadora Kosofsky, The New York Times
Seven other patients were in the step-down ICU on supplemental oxygen as they recovered from infections. "People are coming in sicker," Hammond said. At least six people have died from Covid in intensive care at St. John's since June 1.
The wave of new cases is particularly challenging because it accompanies another surge — patients who had put off elective surgeries and other health care during the pandemic. In addition to the Covid cases, Hammond's staff has been caring this time for people with severe illnesses unrelated to the pandemic, except to the extent that missed doctor's appointments and postponed routine screenings helped to land them in intensive care.
The patient demographics this time are different as well. Earlier in the pandemic, most were transfers from other Providence health care centres. Now many more are local and younger, Hammond said, and are being sent to intensive care after emergency room visits.
Given Santa Monica's high vaccination rate, she said, the influx is "disconcerting."
Edwin Trito, respiratory therapist, returned to the ICU after a break. Photo / Isadora Kosofsky, The New York Times
While vaccinated people appear to be getting far less sick from infections, the superior powers of the delta variant are allowing the virus to proliferate in their systems and to spread, lethally, to the unvaccinated. About 20 per cent of Santa Monica residents — and nearly 40 per cent of those in the county around it — have not yet been fully inoculated, despite the entreaties of public health experts.
"You're here to take care of the human regardless of the decision they make," said Vickie Gaddy, a nurse in the unit. But the new rush of infected patients, so soon after the optimism of June 1, has been crushing for Hammond's exhausted staff members.
"As an ICU nurse, you know you're going to see a certain amount of death," said Masha Crawford, who also works with the hospital's Covid patients. But, she said, "in this pandemic, you see people who should not be dying die."
Crawford said that before the pandemic, she loved working out. Now she has no appetite for exercise or self-care.
"The new wave" of cases, she said, "has taken that energy."
Dr. Terese Hammond, the ICU medical director, said given Santa Monica's high vaccination rate, the influx of Covid patients is "disconcerting." Photo / Isadora Kosofsky, The New York Times
Dr. Brian Tu, an emergency medicine physician, said he is concerned about the hospital workers outside the unit who now are being exposed to the virus, a result of so many cases being detected through emergency room visits.
Dr. Stefania Pirrotta said the sheer relentlessness of the new surge has made her "angry."
Just two months ago, she said, she was hopeful. Now there is no end in sight.
