Parkview Regional Medical Center ICU Director Dr. Hariom Joshi puts on a mask before seeing patients in a screencapture taken from a video log he made in May 2020 about his experiences treating COVID-19 patients.
Parkview Regional Medical Center ICU Director Dr. Hariom Joshi puts on a mask before seeing patients in a screencapture taken from a video log he made in May 2020 about his experiences treating COVID-19 patients.
FORT WAYNE — These days, doctors and nurses treating COVID-19 patients scarcely have a minute to relax.

With hospitals across Indiana at or nearing full capacity, the health care workers caring for patients have little option but to run at full capacity.

And it’s burning them out.

Compared to two months ago, there are now four times as many patients in hospitals for COVID-19 in northeast Indiana.

Total patients in hospitals across Indiana Health District 3 — which covers the four-county area, Allen and Whitley counties and five counties to the south of those — have risen from 94 on Oct. 1 to as high as 448 on Dec. 1.

The number of patients in intensive care units has likewise quadrupled, from 36 on Oct. 1 to 145 on Dec. 1.

That’s put a lot of strain on the doctors and nurses who are caring for those patients 24/7, said Dr. Hariom Joshi, an intensivist and medical ICU director for Parkview Regional Medical Center in Fort Wayne.

“You are on your toes all the time. You barely have a chance to go grab a bite or you need to think twice before using the restroom,” Joshi said.

As cases have surged in the community, hospitalizations have surged. And as hospitalizations have surged, critical care wards have filled up and take a long time to thin out.

According to the Regenstrief Institute, which tracks hospitalization data for the state, the average patient stay in a hospital for COVID-19 in northeast Indiana is about eight days, although closer to 10 on average if that patient requires ICU care.

That’s a little shorter than the statewide average of 12 days, although average length of stay has been as high as 15 days in the past. Average length may be dropping because either hospitals are turning out patients quicker in an effort to free up more beds for new patients or that more patients are dying and thus having shorter stays.

“Other patient populations get out and get better faster, but COVID patients stay much longer,” Joshi said.

Running hospitals at such high volume for so long comes with two major drawbacks:

First, Joshi doesn’t shy away from sharing with the public this simple fact — when there are more patients to try to treat with the same number of health care workers, outcomes for patients are likely to drop.

Clinical workers can’t be in two places at once and as hospitals convert wards from their normal use to COVID-19 care in an effort to try to treat everyone who needs it, it stretches resources and staff.

“You don’t want to overwhelm your system,” Joshi said. “If you overwhelm your system, a patient who would have a good prognosis may not have a good prognosis.”

Second, and something Joshi and his staff are dealing with more and more often lately, there is a human cost to the medical workers on the front line.

In April, northeast Indiana had close to 200 people hospitalized for COVID-19, but those numbers fell as summer set in. But Joshi notes that they never went away — even at the best points of the summer when COVID-19 activity was at its lowest, there were still anywhere from about 65-100 people admitted and there’s never really been a point where there were fewer than about 30 COVID-19 patients in ICU care.

That never went away and now, since about late October, those numbers have multiplied.

“We want to get over this, but COVID is not done with us yet,” Joshi said. “We in the U.S., we always had COVID patients in the ICU all the time so we didn’t get a respite from that.

“It has caused a lot of us to tire out. Everyone is a human being. They are not machines. We are at a place where we didn’t have any respite or rest,” Joshi added.

Lately, that’s meant Parkview has had to devote some resources to treating another kind of person — its own staff.

Health care is undeniably a stressful job on any day, but throwing more patients at workers — patients who are often very critically ill and patients who are very frequently dying — that takes it toll.

“They are trying to be actively managing the concept of burnout. I have been personally telling my coworkers, ‘I don’t want anyone to leave this profession because they have burnout,’” Joshi said. “It’s OK to accept that you are burned out because the last thing I want is the next year when I need them I don’t have the supply of physicians or nurses.”

Parkview has provided its Employee Assistance Program offering free counseling to anyone who feels like they need it in order to help maintain their physical health. Whether that involves some scheduled counseling sessions or just an occasional drop-in to vent from time to time, keeping doctors and nurses in a good head space is critical in order to have them keeping up their best work for the patients they serve.

But the rising cases and the rising death toll also take an emotional toll.

Because of the nature of COVID-19, hospitals have to keep patients in isolation and lately have had to restrict access to their buildings even more to keep visitors from potentially bringing the virus into facilities unknowingly.

Joshi called it a “sore point” of treating COVID-19 patients, that the process unfortunately is very lonely for the patients.

The isolation, the loneliness, can quickly degrade a patient’s emotional and psychological state, which in turn can cause physical problems that only complicates the already difficult task of treating COVID-19.

Aside from providing medical care, staff are also filling in as the one human connection patients get day-to-day, although even that is not anywhere close to a normal interaction.

“They all have the gowns and masks, there is no facial recognition behind the mask,” Joshi said, stating staff members have tried to find other ways to make those connections with their patients. “We started holding their hand, talking to them, listening to them, spending more time explaining to them what is going on.

“We are trying to help them as much as possible, asking (patients) to do more videoconferences with the family, family tries to drive by and the patient looks through the hospital window if they can,” Joshi said. “We (doctors) kind of make sure that we are talking to the family member every day, we try to call them two times per day.”

And, ultimately, that often means nurses or doctors are the only one there when a person loses their battle against COVID-19.

“We have a policy at Parkview that nobody dies alone. We make sure there is somebody else with the patients,” Joshi said.

In the last 60 days, the 11 counties in Health District 3 have lost 298 COVID-19 patients. That’s nearly as many as had died in total across the first seven months of the pandemic — 307.

That’s been a lot of loss to compress into a short period of time.

Joshi, who spoke to KPC Media Group back in July about what doctors were learning and how they were treating COVID-19 patients, reiterated a point he made then as it’s something physicians and nurses are still hearing from skeptics in the community — many of these patients would still be alive today if they hadn’t caught the novel coronavirus.

Just because someone is in their 60s, 70s or even 80s and older and even if they have other medical conditions doesn’t mean all or even most of them are on the verge of death.

Having other health problems can and certainly does complicate treatment for people who also contract COVID-19, but often those other conditions in and of themselves are not what’s causing people to become critically ill and die.

“Most of the people who require hospitalization and ICU care are having some kind of comorbidity,” Joshi said, noting that the medical community is still gathering and parsing information about what conditions may be more or less lethal in combination with COVID-19. “But just because someone has kidney failure doesn’t mean that person should be dying because of COVID. That’s kind of a wrong attitude. That’s the wrong way to look at the science.”

The recent surge over the last two months have occurred despite Indiana coming out of some stair-stepped restrictions on businesses and gatherings and have occurred even with a statewide mask mandate in effect.

State and local health officials have continued to plead with everyday Hoosiers to buckle down and do their part to slow the spread of the virus.

But people who wear their masks, try to social distance and reduce their exposure already may be scratching their heads on what else they can really do at this point.

Joshi said he appreciated that, although some people will refuse to take even the most basic steps, he knows that most people are trying to do the right thing.

“A majority of them are following the local guidelines and we appreciate that and keep doing that,” Joshi said.

But he did offer three additional tips that can help out healthcare workers:

First, reduce or stop gathering with people from outside your household. Health officials are concerned about whether they’ll see a renewed burst of COVID-19 activity after Thanksgiving if people carried on and had family gatherings for the holiday.

Bringing people from multiple households together greatly increases the chance that an asymptomatic carrier who doesn’t even realize they have it will chain the virus to others.

“There is no reason you should be having any form of a party or some form of dinner inviting other people at home at this point in time,” Joshi said.

That advice flows into Joshi’s second tip, “think that every person you meet might be a COVID carrier,” he said.

Don’t drop your guard because you’re visiting your siblings or parents or neighbors or because you work with a person at the office every day. The people that you come into contact with from outside your household — even the people you come into contact with inside your household if you and your spouse work different places and your children go to school — come into contact with many other people throughout the day and if they’re not physical distancing properly, they might pick up an infection.

And third, don’t delay your regular medical care because of COVID-19.

This one may seem paradoxical considering health officials need to relieve stress on the health care system, but skipping doctor appointments or ignoring symptoms can actually lead to a much more serious medical need and, therefore, add a non-COVID patient to the overburdened critical care system.

“We don’t want them to postpone their care because they are scared,” Joshi said. “If you need help just come top the hospital.”

Health care is already sitting in a precarious position as winter approaches and one continuing concern is that the onset of seasonal flu might be what breaks the dam.

So far, flu activity across the state has been low, according to the Indiana State Department of Health’s weekly monitoring, which is typical for this part of the year.

But flu activity typically starts rising toward the end of the December and stays at its highest points through about early March.

Joshi said health care providers haven’t started seeing many people with flu yet, but that could change if a flu outbreak hits on top of COVID-19.

The good news is that, based on observations from the flu season in the southern hemisphere in places like Australia, doctors reported less impact from flu this year, likely because the interventions people were taking for COVID-19 also have helped to reduce spread of seasonal flu.

Flu typically keeps doctors busy during the winter months, but hasn’t been nearly as deadly as COVID-19.

Seasonal flu generally has a mortality rate of about 0.1%, while COVID-19 has been most recently estimated to be around 0.3%, based on a study by researchers at the IUPUI Fairbanks School of Public Health.

Although those overall mortality rates are close, the difference in severity between the two has been that COVID-19 has been far more widespread than the average seasonal flu in the state and, as was proven earlier this year, coronavirus doesn’t disappear when the weather turns warmer.

Indiana had 336 deaths from flu in 2017-18, the most serious flu season in recent history. But that’s little compared to COVID-19, which has hit about 5,800 deaths since March.

The comparison isn’t close, Joshi said, as he and his staff head back to work today to try to save as many patients struggling from COVID-19 as they can.

“I wish this was just the flu,” he said.
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