July 16, 2020
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"Sense of death": inside a hospital in Houston, preparing for the peak of viral cases

“Sense of death”: inside a hospital in Houston, preparing for the peak of viral cases

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Melissa Estrada, who believes she signed a contract with Covid 19 to attend one dinner at her hospital room at the Houston Methodist Hospital in Houston, June 27, 2020. (Erin Schaff / The New York Times)
Melissa Estrada, who believes she signed a contract with Covid 19 to attend one dinner at her hospital room at the Houston Methodist Hospital in Houston, June 27, 2020. (Erin Schaff / The New York Times)

Houston – Melissa Estrada tried to be very careful with the coronavirus. For several months, she kept her three children at home, and she always wore a mask at the grocery store. She and her daughter even sewed face coverings for relatives and friends.

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But on the weekend, the 37-year-old Estrada fought the virus at the Houston Methodist Hospital after a week of treatment, which included an experimental drug, steroids, intensive care and high doses of oxygen. She probably contracted the virus when she attended dinner with relatives, who were also careful. Within a few days, all four adults and several children attending the meeting tested positive for coronavirus.

“It was really very scary,” Estrada said of her illness. She was constantly worried about leaving her children without a mother. “You hear about it and think it’s older people or people with major problems,” she said. “And I’m healthy. I don’t understand how bad it is for me. ”

Cases of coronavirus are growing rapidly in Houston, as in other hot spots in the south and west. Harris County, which includes most of Houston and is one of the largest counties in the country, daily records an average of more than 1,100 new cases among most counties in the United States. Just two weeks ago, an average of about 313 new cases were recorded daily in Harris County.

Measures to cope with this outburst and plan its peak were obvious over the weekend at the Methodist, who encouraged nurses to work extra shifts, plugged in new laboratory tools to test thousands of samples per day, and placed additional hospital beds in an empty unit. about to reopen when patients filled new chambers of coronavirus.

Governor Greg Abbott, speaking in Dallas on Sunday, said the virus received a “very fast and very dangerous turnaround” in Texas and the increase in the number of positive coronavirus tests – up to over 13% last month from less than 4%, was a “wake-up call “. He made a dismal assessment after meeting with Vice President Mike Pence and Dr. Deborah L. Birks, White House Coronavirus Task Force Coordinator, who joined the governor, urging all Texans to wear masks and avoid close contact in the crowd.

Pence, speaking at a rally in Dallas on religious freedom, supported Abbott and his efforts to restore the state’s economy – even though the governor took a step-by-step approach on Friday, ordering bars to close and reducing restaurant capacity. Many young people communicated in them, standing close to each other, without masks, some expressed skepticism about the fact that they could become infected.

During the first peak of the virus in April, most patients with a positive reaction in the methodological hospital system were over 50 years old. Now the majority, like Estrada, are relatively young. Almost one third of intensive care patients are now under the age of 50, which is much higher than the initial burst of coronavirus.

Stress in medical facilities became known to the public last week when the Texas Medical Center, the center of Houston’s large public and private hospitals, including the methodologist, announced that the basic capacity of the intensive care unit in all of its hospitals was full, with 28% of the beds occupied by viral patients. This was almost twice the threshold set by the state, which required that intensive care units have a maximum of 15% of patients with viruses so that hospitals could resume elective services.

Hospitals typically work with nearly full intensive care units, and planned to increase the number of critically ill patients they could treat. But the next morning, the governor issued an order that again restricted election operations in Harris County. The order, however, allows hospitals to continue with operations and procedures that will not reduce their ability to care for patients with coronavirus; Some hospital managers and doctors, including methodologists, have stated that they can continue to provide these services, which they consider to be especially necessary after stopping during the initial outage. According to data released on Saturday, about 1,500 patients with coronavirus are being treated in hospitals at the Texas Medical Center.

During the previous outburst in mid-April, there were no more than 200 patients with coronavirus in the Methodist system. On Sunday, he had about 400 inpatients with the virus, and about 150 were tested for it. Some models predict a peak in two to three weeks.

Roberta L. Schwartz, Executive Vice President and Chief Innovation Specialist at Methodist, who serves as the commander of the coronavirus incident, went from one unit to another on “bed trolling” on Saturday, as she described. She spoke with nurses and doctors, solving problems, to solve problems that might delay sending patients home or moving them to lower levels of care when they are ready. She told nurses in the emergency department that she would soon move to the intensive care unit for patients with coronavirus.

She visited a huge lab with over $ 3 million in new equipment that she called the Taj Mahal, a former academic lab that was redesigned to process virus tests, and she first looked at two newly acquired new machines that could run 1,000 tests per day. In some parts of the country, laboratories, including Methodist ones, have experienced recent testing delays as demand and new cases increase.

The hospital employs traveling nurses to support its staff and offers bonuses as incentives for some staff to accept additional shifts. In recent days, hospital beds and mobile computers have been collapsed into an empty 34-bed unit, which has been closed and will now be used for patients with coronavirus. “That’s why I don’t have to put trailers in front and mobile hospitals in front,” Schwartz said. The changes were also part of the hospital’s efforts to maintain the potential for the safe treatment of many non-viral patients.

The Methodist Hospital system with nearly 2,400 beds includes six public hospitals in Greater Houston and a leading academic medical center in the city center.

It is located next to other well-known medical institutions, including Baylor College of Medicine, Cancer Center. M.D. Anderson and Children’s Hospital of Texas, which opens a department for the treatment of adult patients with coronavirus. The Methodist and several other private hospitals have also agreed to accept patients with viruses from the flooded Harris County public hospitals, which are part of Harris’s healthcare system.

Tritiko Saranathan, a nurse at one of the Methodology’s viral departments, said she noticed that patients were younger than those who first suffered from coronavirus several months ago. “We see that many people in their thirties — they have parties and don’t wear their masks,” she said. “As soon as the city opened, they really wanted to go to bars, clubs, restaurants, just hang out in groups. And no one was involved in social distances or wearing a mask. ”

“What I see is that they are pretty sick – the younger ones are pretty sick,” she said. “They struggle a lot with breathing problems. “It’s hard for them to breathe,” she added, “just feeling like death.”

One of the newest patients with coronavirus, Jessica Rios, 36, the mother of four children with pneumonia, was transferred to Houston by a methodologist on an ambulance from the emergency center on Saturday. She said her husband is also being treated at the hospital. She worried about her children and often used FaceTime to call them. Her 18-year-old child looked after her 12-year-old child, who has severe asthma and who also tested positive for the virus, and the 5-year-old twins, one of whom has cerebral palsy, and they also had a positive result. “It’s hard for me to be here when I fight them at home,” she said.

Rios was not at the party. She said she thought she had contracted a coronavirus while working as a clerk in a dialysis unit for children. She said that she had an allergy that made it difficult to wear a mask, and that she sometimes took off her mask in the ward, where one child later tested positive for the virus. “I could not tell you if I had a mask every time I spoke with her,” she said.

In another room nearby was Curtis Ezell, 37 years old. He arrived at the hospital for the treatment of heart failure, but tested positive for the virus when he had a routine test upon admission. Sometimes he delivers to DoorDash, a food delivery service, and recently moved to Houston, staying at hotels.

He said that he had no idea how he contracted the virus, and that he did not have common symptoms of infection. “If you know someone with COVID, everyone should get tested,” he said.

An even younger patient with pneumonia, 25-year-old Alexander Nelson-Friar, was in the new department for 15 patients with coronavirus, which had just opened last week. He said that he trained employees at a nearby medical clinic, where patients with viruses sometimes met. Nelson-Freyar said that every day at work he wore the same mask that he kept in his car, and that he did not know how he had become infected. “I’m going there and going home,” he said. “I think I’m a little unlucky.”

He said that he was afraid that people of his age did not take the disease seriously enough, as he himself did not. “I thought that young people would not have symptoms; if I get it, it will not matter much, ”he said.

This was not true in his case. “He hit me like a truck,” he said. “Even if you are young and not at risk, it’s pretty scary.”

In the methodologist, most patients with coronavirus are in specialized medical departments, and not in intensive care units.

This may be due to an increase in the proportion of younger and healthier patients. Hospital managers say they also do better in treating patients, avoiding the need to transfer them to intensive care units. The length of hospital stay for viral patients at the Methodist this month is about one and a half days less than in April and May.

It is still possible that the proportion of patients in intensive care units may increase due to the time interval between when the patient first becomes ill and a critical illness develops.

On Saturday night, after the rounds, Dr. Faisal Masoud, medical director of the intensive care unit at all Houston methodologist hospitals, described patients with a younger virus in the intensive care unit. “Typically, these are definitely 30-year-olds, 35-year-olds,” he said, adding that the most seriously ill young people are often obese or have medical problems such as diabetes, kidney disease, and high blood pressure. One young patient was on an external pulmonary device known as ECMO.

Masoud said that during the first outbreak, some young patients with the virus came to the hospital in an extremely serious condition and died shortly after their death. Now, he said, they come earlier, but more often.

“I think there was a feeling of invincibility, or it’s not their problem, even if they caught it, it’s okay,” he said. This attitude has changed over the past few days, he said, including among his own three daughters, all of whom are 20 years old. “Now they are paying attention,” he said.

Estrada, a mother of three who was treated for coronavirus, said she was worried that there would be more such patients than her.

“They opened our city too quickly – our governor didn’t want the bars, restaurants and functions to be closed, and they just wanted us to return to normal,” she said, adding: “I knew it was a bad idea .

This article originally appeared in New York Times,

© 2020 The New York Times Company

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