Breakthrough: The Covid Fortress

people with underlying conditions, such as diabetes. The hospital staff go to great pains to try to get rid of the infection without causing panic or revealing their own mistakes. Canada Horse is highly dangerous and immune coupleized patients. Half the people will get it die. The coronavirus actually makes a brief appearance in the episode We're Lucky is not in irriable, and like the coronavirus, his dad is not at risk, but the patients could be, but it doesn't

really figure into the plot anyway. One of the writers behind this episode is named Daniella Lamas, and around the time of the ears the episode starts to feel like reality for her. That's be As. In addition to being a TV show script writer, she's an ICU doctor at Brighaman Women's Hospital in Boston. Initially, this sort of odd feeling of truth being stranger than fiction, and and for feeling slow to kind of realize that this was real.

You know, I have friends who work in New York, like we saw what was happening there, but even so it took a little bit of time to to to realize, oh my gosh, this is this is happening. Reality was following an alternative script in which a coronavirus was the arch villain. Swaved in Ppe, Lamas was taking care of patients with a previously unknown disease COVID. Nineteen hundreds across Massachusetts became sick, with the disease piling into the hospital

in unforeseen numbers. Brigham Women's has a sixteen floor patient tower, but across the street there's a newer cardiology building with a number of rooms with negative airflow that can be useful for keeping viruses under control. So the cardiology building became a COVID facility. It was in one of those rooms that Lamas took care of the patient. She'll never forget.

There's a room that will always be a guy in his thirties with developmental delay who got COVID in his group home and who was on a lung bypass machine to keep him alive. But when it was clear that that was not going anywhere, and we had to tell his mother that that he was was going to die, and she asked us not to take him off the machine on Mother's Day, which was a Sunday, so we waited until Monday morning. I was off that Monday morning.

It was no longer my time on service. Normally, interns and training were generally kept at a distance from COVID patients because of the risk of catching the disease. But on the morning that Lamas's patient died, she wasn't in the hospital. So an intern who had been involved in his care put on protective gloves, a gown and mask and went into the room with him, and she held the phone to his ear, and you know, his family said goodbye and told him apparently what heaven would be like.

And remember sure he telling her me that that night, and I felt so short of guilty that she had been in there and gotten that experience. Um it also said it was good because she realized she had never

really seen the patient before. Because we kept the interns from examining, from being in the rooms as possible, you know, we sort of did the exams as attendings, and so she's like, I've been caring for him for weeks since was the first time I saw his face, and so sort of those moments, I think, you know, are things that will always be in our minds. Even doctors had difficulty believing what they were seeing happen in front of

their eyes. COVID was changing everything. But there was a big difference from Lamas's show, where doctors were trying to hide the infection in the hospital. Now they were trying desperately to make clear to the rest of the world what was really happening within their walls and how COVID was changing your rules collide Ishmael is a colleague of Lamas is. We specializes in taking care of lung disorders.

This like a big conspiracy, I know. I think once we start to hear these things on the out side and see what's happening on the inside, I mean, I think that really affected, you know, the way I see things. And you know, I usually don't post much on on social media, and I went, actually I had like a post about people please listen and please follow recommendations for prevention and PPE and mask and social distancing and all

of that. Now, Lamas and Ismail are both working in a Brigham clinic where they take care of people with long COVID, a mysterious syndrome they can affect people months after they've been infected, even if their cases aren't serious. Bit by bit, COVID is altering the space where they work. Hospitals have long occupied a singular place in the community and in the imagination. There are a place where discoveries are made, where friends and relatives come to be with

a sick where medical miracles can happen. But that's changing. Increasingly, hospitals are becoming fortresses that must carefully limit who enters and who exits, no matter how many gowns and masks they have. Now, workers are feeling overburdened with caring for COVID patients who may stay for months needing highly intensive care. Miracles are getting harder and harder to perform, and many

healthcare workers now feel less trusted than ever before. I'm John Lawerman, and I'm a journalist with Bloomberg News from the Prognosis podcast. This is Breakthrough Riemond Women's the hospital where scriptwriter Danielle Allamas works as a doctor is one of the most storied in the world. It can trace its history back almost two years when it was one of the first American maternity hospitals. Come doctors actually developed the idea of the intensive care unit in the nineteen fifties.

You're in Boston um and at the Brigham. Yes, we definitely have critically ill, unvaccinated patients, but not to the extent that there are in other places in the country. In our vaccine rights are good here in Massachusetts, and there's some outlying hospitals who have been a lot more hit than we are. My father is a doctor in Miami, and so the hospital he works at is just full of one vaccinated, super sick on vaccinated COVID and and I think, you know, there's a different tone to it.

The pandemic is making health workers feel like they're on an island. On the outside, the hospital looks pretty much the same as it always did, banners, the glass and steel, the emergency room, parking lot. On the inside, it's become a very different place, one of constant stress and worry and feeling like there's no way out. Late this summer, Idaho was overrun with COVID cases. At one point there

were more than six people hospitalized. That about more than in December, when COVID was running rampant across the US and vaccines weren't yet available. Staffing shortages were limiting hospital's ability to provide good standards of care. Even today, only Idaho residents are fully vaccinated. Washington's Governor j Insley appealed to Idaho residence to wear masks because the Idaho crisis was spreading west into his state. Jim Susa is a

pulmonologist at St. Luke's Hospital and catch him Idaho. He says it's difficult to find enough beds and to keep them staffed, where we're just experiencing an unprecedented wave of acute illness, and that acute illness is all COVID and it is almost exclusively in unvaccinated individuals. They checked the statistic right before our interview today, and of our intensive care unit patients who are in the hospital with COVID,

of them are unvaccinated. There's a small handful that are vaccinated, including organ transplant patient, cancer patient and and so on. On the zoom call, Jim looks tired. He talks about constantly dawning and daffing personal protective equipment as he and his team go from one SAG room to the next. Jim also says the actual interior of the hospital has had to change to accommodate more COVID patients. Just like Briggerman Women's. This wave has has caused us to change

where we're providing care. So we've opened up surge units. We had one surge unit which was a cardiac observation unit that we turned into a nine bed intensive care unit. We filled it today, but still more COVID patients come into doo Are and today is this day is probably going to be the day that we spill over into our next surge unit, which is a telemetry unit. And you know, for those who know something about this, intensive care unit rooms are specifically designed to meet the needs

of those patients. Very large rooms to accommodate all of the machinery, equipment, monitoring, etcetera that's needed, all of the people that might need to be in the room to care for a patient. A telemetry room is not designed for that, but we're gonna We're gonna do our best. Adding to all this, though, is the open hostility that he and other workers encounter some patients tell them that COVID is a hoax, and they demand that the word

be kept out of their relatives death certificates. Many of these people have been getting their information about COVID from different sources, Jim says. So they come with a different mental model about this disease ease, and they come with a different belief system about this disease. And as they do that, they're coming with a bit more hostility, which, which I got to say, is a really unique thing in healthcare. We are very used to taking care of

all comers. I mean we right, we take care of We take care of lots of folks who have chronic problems that they've decided not to manage. Doctors don't resent patients for their beliefs about COVID, Jim says. We take care of, you know, prisoners, We take care of good people, bad people. We just take care of people. That's our job.

And what what helps you have that sort of um cool indifference to the um the individual characteristics of the patient you're caring for is the fact that almost all of the time, what you get back from the patient is an overwhelming sense of appreciation for the efforts being applied to try to return them to health. So to be met with hostility is unusual. And I don't want you to think that that is pervasive, but even when in small doses it it does take a toll. And

then there are the meetings of the school board. We were invited by the school board and the request was to speak about the wisdom of a mask requirement as they started school, um whether we should or shouldn't do that, and we shared our pros and cons and we were not going to share an opinion unless they asked for it, and they did ask for it, and you know the the it's just jeers, booze. Those jeers and booze came after Jim and as Kylie recommended the use of masks

in schools. Jim wasn't able to actually see the audience, but his wife is at the meeting in person and told him afterwards what she'd seen. The moderator did an excellent job, by the way it was she was trying to mitigate that and what the way she did that. And my wife's a school teacher, so she had she admired this technique. She said it was a very school teacher type thing to do. She said, Look, I know people are going to have different opinions about what our

experts are saying. You know, if if you don't like it, you can kind of do this. Jim is waving his hands. If you like it, you can do this. Now he's giving a thumbs up. So apparently while we were talking, there was all kinds of crazy gesticulation happening in the audience. You know, that sense of disconnectedness between hospitals and the communities they care for has perhaps never been so strong

or uncomfortable. It's making the job of working in hospital harder all the time, and this means healthcare workers are starting to burn out and leave. That threatens to create an entirely new crisis in hospital understaffing. Wendy Dean is the co founder of a group called Moral Injury of Healthcare. The group focuses on healthcare workers, who they say are forced to work under conditions that violate their sense of right and wrong. She says COVID has pushed that to

a boiling point, and hospitals are the focus. It is a much less comfortable space. That's what I'm hearing from across the country. I'm hearing more more clinicians now who say I cried all the way to work. I didn't want to get up this morning. I love my job, I usually love my job. I don't want to go to work. It's too hard. It's too much watching thirty year old on thenolators that you know of chance for

a chance of not getting off. That is excruciating, and we don't just leave it when we walk out of the hospital. One of the key points of frustration is vaccination. Many people about those coming to the hospital with COVID have refused to get shots. Doctors and nurses still feel

compassion for them, but the frustration is extreme. There are all kinds of reasons why patients can't get the vaccine or don't have access to it, but at the same time, it's frustrating to us that we can't make it more available and that we can't no matter how how much we encourage people to get it or ask them to come with us, come to us with questions that it's that turning that corner so that there's there's less vaccine hesitancy has been really hard, and I think that is

that's becoming more frustrating for healthcare workers. Doctors are often at pains to help people understand that COVID isn't a fantasy, that it can be life altering or even lethal, and that it's threatening their lives every day. Katie Muro Johnson is an infectious disease doctor in Denver, where hospitals have also been hit hard. She says she recently bumped into a neighbor on the street whose friend was sick with

COVID and on a ventilator. The neighbor asked Johnson how she thought her friend might do and I looked at her. I said he's probably gonna die. I said, there's there's very low chance he's going to survive. Johnson says her neighbor's face went white. I felt bad walking away from that that I was so honest, But I said, she asked what was what what I thought? Because I think

people are asking what do you think about this? And if I say something such as that they're gonna die, you know, um, it scares people and they don't know how to grasp that that's a possibility, and that's hard. The neighbor's friend was only in his forties and with no underlying medical problems. But there's often little that can be done by the time someone is on a ventil latter, and I don't want to be that person. It feels hard to uh, um, for them to look at me

in the same way, you know, with saying things like that. UM. But when you're around it every day, UM, I don't, you know, I don't feel it is that gravity that they do. It's a strange feeling for doctors not being able to be heard. They're used to being the voice of authority, the last word on medical issues and experts on life and death. But this is how it is in the time of COVID. One reality inside the hospital

and one outside and not enough communication in between. And I think you know, going forward, UM, there is a disconnect still with UM. There's a substantial amount of people getting admitted with these long sixty day hospital admissions, unvaccinated, and we are using our highest resources possible to keep them alive. And and it's hard, UM, it's hard, UM.

Venolatory support you know, ivy medicines daily and some of them taking a flight for life plane from other you know, other states even to come here, which is you know, um, which is desperate, which is uh yeah, that's kind of what we're what we're dealing with now. Just a few months ago, it looked like the pandemic would fade, at least in the US as vaccines rolled out. So far,

that hasn't happened. In the states where vaccine uptake is low, unvaccinated people, particularly those with chronic illnesses, are still getting sick. Kate says there's still a lack of good treatments to take care of people who get really sick. I think, from the health care provider standpoint, UM, we want this to be over UM just as much as everyone else does. UM.

And UM. I do think that if we can increase vaccination worldwide, which is the goal, is the only way we're going to bring us to an end, UM and protect all of our most vulnerable people UM in the US M from continually to be you know, coming to

the hospital, be sick and and ultimately die. UM and so UM I think from our standpoint, we were giving treatments that we have high quality evidence for but are not willing to risk using other things that UM have low quality evidence or or are negative have negative studies behind them. And UM, I think that UM, if there was something that we thought would cure someone, we would be giving it. Drugs with poor quality evidence behind them

include ivermectin and hydroxy chloroquine. Hydroxy Chloroquine is a drug from malaria that was touted by former President Donald Trump as a cure for COVID early in the pandemic, when there were even fewer options than there are now. Studies have shown it doesn't work, but there's still a large segment of the population that puts its trust in the drug. Ivermectin is another drug for parasites that hasn't shown effectiveness. Many patients in their families come into hospitals demanding it.

Katie says the controversies over COVID treatment are eroding trust in hospitals and health professionals. I still think that we are used as a way to take care of acute illness and hopefully turn it around. But I do think people, certainly a certain certain um subtype or our subpopulation of folks are not coming to the hospital because they're worried that somehow the hospital is going to make them worse. Now, doctors sometimes have hard time treating patients because of mistrust

no matter where they're cared for. Patients who do get sick, are very worried and often mistrustful. What we have is an invisible war, uh and where the war is being conducted is on the insides of the hospitals and in our clinics. Those places are on fire right now with sick patients. The rest of the community doesn't see that. That's Ted Epperley, a doctor and CEO of residency program

based in Boise. When we talked, Idaho had the second lowest vaccination rate of any state, and residents were just starting to return to events like state fairs and football games, most of them unmasked. I was a family medicine physician of the physician in the Army for twenty one years. I've been in a war and the first Golf War, and did a lot of work in the Gulf War

at a mash hospital with emergencies, UM and UM. The analogy I like to use for this is that if tanks were rumbling down the streets here and there are bombs going off, planes flying over in helicopters, smoke fire, everybody would get it, and everybody would be appropriately concerned and pulling together as a team. That's not happening. That

says the invisibility and isolation of hospitals. Plate is particularly deep and some very rural, very conservative communities, people are kind of uh, you know, stacking up like logwood, like cordwood in the UH in their waiting areas. They've had fairly significant amounts of bad cases that are right in front of them that they can't do much for. And what that leads to is a sense of both isolation,

fear and loneliness. Um, they feel like they're out on an island trying to manage all of this and with all the resources the United States has to offer around them, but not being able to get anything accomplished. So it's that that's sense of disillusionment that the whole system is kind of shutting down and breaking that. I think it's part of the dynamic and the tragedy of this that we're going through in Idaho right now. Ted says he thinks this could be the case for a long time.

I think this could go on for quite a while. And what I mean for quite a while maybe or forty years um. And I know that sounds almost like you gotta be kidding. That just sounds unbearable. But Ted studies pandemics and says some have lasted from forty to a hundred years. Now, science and technology wasn't like it was back in those times. But we currently have another pandemic simultaneously ongoing that's been ongoing for forty years already simultaneously.

That's the HIV epidemic pandemic. We've not resolved that, and the reason we haven't is that we haven't developed a vaccine for it. Um. What could happen in this scenario because we only have about three to four percent of the world that's been vaccinated, A key problem is the lack of access to vaccination in many parts of the world in resistance to it in the US it's a

very low percent. Is that this continues to reverberate in populations of people with low vaccination rates, and new variants UM get spun off of that reverberation, so that different

variants continue to slam populations. We have one, as you well known now called the new variant that's coming out of South America that has immune of Asian properties, which means that the vaccines and the plasma of the serum plasma that we have right now may be ineffective against this variant, meaning that we go through another whole cycle of infection and illness only to spawn another AUNT that

kicks off from the process. So um, the optimist in me, and I tend to be an optimist, would like to see this resolve and the team months to twenty four months. The potential realist in me, h really says that this could be forty year experience that we all just learned to manage. Jim Susa, the Idaho pulman ologist, has been trying to get local politicians to come to St. Luke's and see what's really happening. He says many have had their eyes opened and gone back out to the community

to talk about the desperate situation and hospitals. But another thing, he wants them to talk about his vaccination and its benefits, because that's the only way he and his colleagues see out of this situation. I'd like them to talk about the fact that this is real. I mean, there's all this stuff on social media that our hospitals are filled with patients who have gotten the vaccine and gotten COVID from that, and that's why I'm like, people are pulling

that this stuff out. I'm talking thin air here, so talk about it's real, talk about your own vaccine. That separation between what people say outside the hospital and what actually happens inside, between beliefs and scientific facts, remains a huge challenge to hospitals and the workers. At the end of Daniello Llamas's Resident episode, the vital information about the deadly fungus gets out, people start to take precautions, and

things go back to normal more or less. That's what Lamas would like to see happen with COVID, but it may take a long time. It ended and tied with a boat though, So that's the difference between fiction and reality. Said, when you're tired of a plotline, you can say, let's put that one to bed, let's just move on. And here we are unable to do that. Caring for deathly ill, contagious patients with a poorly understood disease is always a difficult job. An absence of trust makes it even harder.

COVID is not only doing damage to patients, it could poison the atmosphere of many hospitals for years to come. Next week, on Breakthrough, we're going to look at how COVID revolutionized medicine with the development of the m r and A vaccines. We'll meet Catline Carrico, Hungarian biochemist. Two decades of early work, sometimes making two dollar an hour, paved the way for vaccines that could go from idea

to immunization in just a year. This was incredible. Yeah, this boss just wait taking and in this moment we understood, Hey, there's a vaccine for mankind and corna is a problem that can be soft. That's next time on Breakthrough. This episode of Prognosis. Breakthrough was written and reported by me John Lowerman over four is our senior producer. Carl Kevin Robinson Jr. Is our associate producer. Our theme music was composed and performed by Hannas Brown. Rick Shine is our editor.

Francesca Levie is the head of Bloomberg Podcasts. Be sure to subscribe if you haven't already, and if you liked this episode, please leave us a review. It helps others find out about the show. Thanks for listening.