This is what a lull looks like.
Florida was a hot spot of the coronavirus pandemic this summer. More than 722,000 Floridians have so far been infected with the virus — with a daily high of more than 15,000 cases reported July 12. The state’s intensive care units, including those at Tampa General, were pushed to the brink as the virus spread out of control. The spike came weeks after Gov. Ron DeSantis (R) quickly reopened much of the state, casting it as a return to normalcy.
By late August, when The Washington Post visited Tampa General, cases statewide had sharply declined, and treating 22 critically ill patients was a reprieve of sorts for the hospital’s staff. The downstairs garage that was transformed into a spillover triage unit during the surge was empty, and a few beds were open in the ICU. Take your vacations now, hospital executives urged doctors and nurses. The break was not expected to last.
Tampa General could serve as a case study for hospitals across the country that have been tested by the coronavirus. Like others, the hospital is bracing for another likely surge now that students and staff are back in school. Flu season is on the horizon. No one knows what hurricane season, which ends Nov. 30, will bring. And state rules to help curb the virus have been phased out.
DeSantis lifted statewide virus restrictions Sept. 25, a day when more than 2,800 Floridians were diagnosed with the coronavirus and 122 deaths were recorded. In an executive order, the governor, a close ally of President Trump, allowed bars and restaurants to operate at full capacity and suspended the collection of virus-related fines and penalties, such as those against people who are not wearing masks. DeSantis mused that week about establishing a “bill of rights” of sort to protect college students from facing punishment for violating campus social distancing orders. Hundreds have tested positive on Florida campuses, many after attending massive parties.
“That’s what college kids do,” DeSantis said of partying students.
Some local governments — including Tampa — said mask mandates are still in place.
In the meantime, doctors here and elsewhere are still mystified by so much about the disease: How many of the coronavirus patients who survive intensive care will suffer long-term health effects? Why do some patients deteriorate so quickly, while others with seemingly identical health profiles fare well? These questions still vastly outnumber those that can be answered with certainty.
Morale ebbs as staffers face the relentless task of confronting a disease that has dramatically upended their lives inside and outside the hospital. In both places, staff battle pervasive misinformation about the virus and distrust of the medical system, even from some of the sickest patients. Large numbers of health-care workers are falling ill — at least 420 Tampa General staffers have tested positive for the virus since March, though it is unclear where they contracted it.
“It’s an absolute grind. It’s a grind on people physically. It’s a grind on people mentally,” said John Couris, the hospital’s president and CEO.
'There's just no predictability'
When the coronavirus first arrived in Florida, doctors Andrew Myers and Seetha Lakshmi treated those suspected of having the virus from a hodgepodge of notes they compiled each morning from the latest guidance, which changed every day. Protocols changed constantly. The staff tried dozens of treatments, some of which offered promising results, others that were duds. Eventually, they learned how to use ventilators more sparingly and to minimize the number of times staff would have to enter and exit a patient’s room to minimize exposure to the virus. Fluid bags, for instance, are now placed outside so nurses can monitor them without stepping into a patient’s room.
A learning curve that would normally play out over years has been compressed, by necessity, into weeks and months. Doctors and nurses now know some treatments that might help — the names of medications including remdesivir, dexamethasone and morphine are often scrawled across the glass walls of patient rooms. Fewer admitted patients seem to die. Staff are far more confident than they once were, and less fearful, too.
But one of the most frustrating things about covid-19, the disease caused by the virus, is how unpredictable it remains.
Most people who die are elderly, and chronic conditions such as diabetes and heart disease are common in the sickest patients.
But shocking inconsistencies remain.
“In these covid patients, there’s just no predictability,” said Kim Cao, a pulmonologist. “You can put two patients that look exactly the same next to each other and they’ll both behave differently.”
It takes several minutes for Myers to put on personal protective gear to attend to a man who arrived in the emergency room overnight. Myers, 35, is in charge of the hospital’s coronavirus response. He read “The Andromeda Strain” and “The Hot Zone” as a child and decided he wanted to be the doctor who parachutes into deadly outbreaks to try to stop the pathogen. He spent a year in Sierra Leone treating Ebola patients. The face shields he wears to treat coronavirus patients make him nostalgic for the remote clinic.
The patient, who tested positive earlier in the week, came to the hospital for chest pain. He survived one heart attack and was scared coronavirus was causing another.
The patient’s oxygen levels looked okay. His heart sounded fine. Bloodwork didn’t turn up anything unusual. Doses of nitroglycerin and morphine seemed to help. Myers thinks the chest pain might have been related to anxiety. The man is slated for discharge.
But some patients can quickly take a turn for the worse. The second coronavirus patient Myers treated came into the hospital looking more or less fine. By the next morning he was on a ventilator in the ICU.
“The most impressive thing, at least for me, with these patients, is how quickly they can go downhill,” Myers said.
'Still in the thick of it'
The crushing reality of the virus has taken a toll on staff, who have tried various ideas to keep up morale. The infectious-disease doctors dubbed themselves the “Covengers.” A lab tech made her colleagues Boy Scout-style patches with titles like “Covid-19 Detective.” The hospital brought in a live DJ to spin hits on the sidewalk at 7 a.m., as the staff filed in. Nurses working with coronavirus patients got a 20 percent boost in pay.
The work is still grueling, frightening and never-ending.
“I don’t think any of us expected that in August we would still be in the thick of it,” said Candace Amato, the ICU nursing director.
One nurse was denied a dental appointment after breaking a tooth, because the dentist didn’t want to have contact with someone who worked with coronavirus patients. Some of the nurses, including a few who were pregnant, were unable to weather the strain and left the unit, or the hospital. Others have become resigned to a familiar, if everpresent, anxiety.
“It’s hard, it’s frustrating and it’s exhausting,” Vanessa Arroyo, an ICU nurse, said of the constant tension between her life on the outside — with a husband and young children — and the risks of her job.
Before the coronavirus, the hospital bustled with activity — visitors, people being dropped off for elective procedures or checkups. Now, the hallways are almost empty and silent.
Nurses assess patient symptoms on a ramp outside the emergency room. Staff use a separate entrance than the public, gliding past an automatic temperature check that registers on a screen. Hospital chaplains deliver last rites through face shields. Giant robots zap empty intensive care rooms with microbe-killing UV rays.
Everyone’s face is shielded behind a mask. The hospital is piloting an effort to make patients feel more comfortable by giving staff giant pictures of themselves to wear clipped to their clothes. Patients can’t see what the staff’s faces actually look like, but will get an idea from a headshot taken before March 2020.
Florida’s case counts have continued to dip from the highs of July, but no one is taking it for granted. The work won’t stop.
“We’re not taking our foot off the pedal one bit,” Couris said.
While staff members are bracing for a difficult, emotional fall and winter, they know it will one day end — but things will not return to the way they were.
“There was a time before 9/11. There was a time before World War II. And there’s going to be a time before covid,” Lakshmi said.
'We don't trust in the medicine you're giving me'
Doctors and nurses see the reality of coronavirus at work each day — and the fatigue with, and disdain for, measures such as social distancing and mask-wearing while they are off-duty.
The politicization of the virus has added a dimension of complexity to an already vexing disease. When they run errands or spend time with their families on off-days, staff pass by people ignoring social distancing recommendations. Lakshmi, an infectious-disease specialist, once posted about the importance of wearing a mask on Facebook. She was met with vitriol.
“I am a little frustrated by some people still not believing it’s real,” said Cao.
Lakshmi, who came to the United States from her native India as a medical resident, has always felt a personal admiration for the American ideals of freedom. But she believes there are aspects of pandemic behavior where that freedom has felt misplaced, including in resistance to wearing masks and in the plethora of conspiracy theories and misinformation she sees circulating on social media.
“That is really one of the hardest things, beyond the everyday madness we deal with. We are trying to communicate what we know, the lessons learned. And on the other side, we’re battling misinformation,” she said.
Doctors are grappling with a pervasive mistrust of the medical system, particularly from Black and Latino patients who are disproportionately sickened by the virus here and across the country. A breakdown of the state’s coronavirus cases by Zip code shows that the areas of Hillsborough County with the highest rates of the virus also tend to be areas with the largest minority populations, according to U.S. Census data.
“We are dying, literally dying, at 2½ times the rate of our White counterparts,” Kevin Sneed, a Black pharmacy professor at the University of South Florida, recently said on a call with Black and Latino community leaders.
Many have preexisting health conditions, struggle to access health care, live in multigenerational households or work jobs that cannot be done from home. Some wait too long to seek treatment because of suspicion of hospitals, lack of insurance or confusion over public messaging about the virus. For others, the nation’s history of medical victimization and racism is front of mind.
“We’ve had instances where patients say, ‘No, we don’t trust in the medicine you’re giving me,’ ” Lakshmi said.
Orlando Gudes, a Tampa City Council member who was treated for the coronavirus at Tampa General this summer, said even though he and other loved ones have suffered severe effects of the virus, as a Black man he understands why people have such pervasive mistrust at a moment when doctors are trying experimental treatments.
“I would be fearful of — if I’m being honest — taking a medicine that is being trial-tested,” he said in an interview. “I can see a lot of African American and Hispanic people probably being fearful, especially Black males,” he said.
Christopher Denson, a rapper and radio show host from south Tampa, was one of the first coronavirus patients to participate in a clinical trial of an antibody cocktail by the pharmaceutical company Regeneron. When he arrived in the intensive care unit at Tampa General, he felt like he was breathing through a straw.
He doesn’t remember the name of the drug he received — just that in his memory, it was so powerful that he seemed to feel better instantly. He now toys with the idea of becoming an evangelist for a coronavirus vaccine — in large part because he was leery of such things before it happened to him. Now, he tells his story to others who are skeptical.