Another Christmas of death and distress in America's ICU

INDIANAPOLIS (NYTIMES) - Of all the Covid-19 patients that Ms Ronda Stevenson is treating over Christmas, there was one she cannot stop thinking about.

The patient has been hospitalised for 10 months, and in all that time, his seven-year-old daughter has never once been allowed to visit, prohibited from the hospital by age restrictions that keep families separated. Situations such as this are bringing even veteran healthcare workers to tears.

Ms Stevenson, an intensive care unit nurse at Eskenazi Health in Indianapolis for the past seven years, cries as she talks about her patients and their families, making clear the grinding toll of the Covid-19 pandemic on already exhausted hospital workforces.

"We're pretty short-staffed," Ms Stevenson said, adding: "It's getting harder."

Instead of taking holiday vacations this weekend, workers at strained hospitals across the nation are working 16-hour shifts.

Some have been on the job every day for weeks. Festive meals have been replaced with protein bars and sports drinks.

This Christmas weekend, with the United States facing another surge of illness stoked by a proportion of the population that remains unvaccinated, front-line workers are again sacrificing time at home with family to tend to Covid-19 patients.

In Indiana, which has among the highest rates of hospitalisation and lowest rates of vaccination in the country, the situation is especially acute.

"A lot of people, including myself, had scheduled time off but are now being asked to come in and pick up shifts to cover for one another and meet the increased demands of patient care," said Dr Graham Carlos, executive medical director at Eskenazi, which is at capacity and has had a backlog of patients in the emergency room.

He worries that it will only get worse.

"If the numbers continue as they are, a tidal wave of infections is going to hit hospital systems, putting us in dire straits," he said.

Nearly two years into a pandemic that shows no sign of abating, doctors, nurses and other front-line workers have already faced the emotional toll of mass death in their hospitals.

They have endured the frustration of pleading with the public to take precautions only to watch outbreaks unfold as people ignored the call for help. They have suffered the moral distress of not being able to give patients the ideal level of care.

But this season, there is a new strain on the system: Many workers who persisted through the first year of the pandemic have departed jobs because of burnout and anxiety.

And with the Omicron variant pushing case numbers up dramatically, the caregivers who remain are getting infections, too, straining staff levels in unpredictable ways.

"This is the worst I've ever seen it," said Ms Maureen May, a nurse with 37 years of experience who serves as president of the Pennsylvania Association of Staff Nurses and Allied Professionals.

She cancelled her own holiday plans to pick up a shift on Christmas Day so that a co-worker could have time away.

Facing urgent concerns about hospital staffing shortages, the Centres for Disease Control and Prevention this past week shortened the isolation periods for infected healthcare workers, allowing them to return to the job in seven days, instead of 10.

Also, President Joe Biden said that 1,000 military doctors, nurses, paramedics and other medical personnel would be deployed to shore up staffing levels at hospitals in the coming weeks.

At IU Health Methodist Hospital in Indianapolis, the National Guard has been helping with tasks such as transporting patients and cleaning.

Now, a 20-person navy team is arriving to help supplement the medical staff, which is depleted in part because about 350 workers across the broader hospital system are out with Covid-19 or because they have been exposed to the virus.

Across the nation, there are about 70,000 people hospitalised with Covid-19, up about 50 per cent from early November. Health experts fear hospitalisations could increase with the rapidly spreading Omicron variant.

At Eskenazi, the critical Covid-19 patients in the intensive care unit (ICU) are those who have not been vaccinated, Ms Stevenson said. Across Indiana, just 52 per cent of the population is fully vaccinated.

She herself had been wary of getting the vaccine and did not do so until she was required to for her job. Since then, she has grown thankful for it, as she watches so many unvaccinated patients roll into the ICU.

With the burden on hospitals potentially growing, there is also fear that the pandemic's relentless toll on medical workers will bring fundamental challenges that could linger well beyond the pandemic.

Surveys have detailed widespread burnout among workers, and a study this month found that the impact of that burnout is just starting to unfold, with 20 per cent of physicians and 40 per cent of nurses reporting that they intend to leave their jobs.

Those who are still working are figuring out how to cope.

Dr Carlos said that recently, after working for three weeks straight in the ICU, he was asked to pick up a Saturday shift at a large hospital in Indianapolis. He had promised to do some Christmas shopping with his eldest daughter that day. And at home, the gutters needed cleaning.

He ended up declining the shift. But as he was Christmas shopping, he was consumed with guilt that his decision was causing more work for his colleagues. That feeling ruined the time away.

"I hate that feeling," Dr Carlos said. "When I'm at work until 9 o'clock, I feel guilty for not being at home. And when I take a day off, I feel guilty for not being here."