Dr. Andra Blomkalns can’t stop looking at the numbers.
She checks the coronavirus case counts and hospitalizations every night before bed and first thing in the morning. “I wake up in the middle of the night and look at them,” she said. “I’m just watching this, slowly taking over everything.”
The pandemic is swelling across the Bay Area, likely to reach record case levels in the next few weeks and potentially overwhelm hospitals with a crush of post-Thanksgiving patients. Even before the holiday, hospitalizations had begun to rise — nearly 40% over just the past week. More than 600 COVID-19 patients were in Bay Area hospitals, and several counties said they could hit capacity in just two to three weeks.
And no one is more fearful of the pending onslaught than health care providers like Blomkalns, who is chair of emergency medicine at Stanford.
Doctors, nurses and other health care workers are dealing with unprecedented levels of stress as they brace for a possible winter surge. Though Bay Area hospitals have never been overwhelmed during the pandemic, health care providers say the coming weeks are likely to be the worst so far, and they already are exhausted from nearly a year of anxiety and challenging work conditions.
Many fear burnout could be a factor in the region’s preparedness for this wave of patients. “It’s not that we won’t meet the challenge,” said Dr. Jahan Fahimi, an emergency room doctor at UCSF. “But it’s going to take a toll on our workforce.”
The stress of working through a once-a-century pandemic has shifted over time, waxing and waning and altering course. In the spring, many health care workers were terrified of becoming infected while doing their jobs. They worried about lack of resources, especially face masks and other protective gear. They expected their hospitals to be overrun at any moment, to watch people needlessly die from inadequate care.
Many say they still worry about being exposed to the virus at work. They fear for themselves, but also worry about bringing it home to their families. Cases of health care providers becoming infected by patients are rare but not unheard of. Every cough, every hint of a sore throat or a flush of potential fever can cause a spike of anxiety.
Emergency room nurse Mawata Kamara, who has a 5-year-old daughter and is pregnant with her second child, said she was so stressed early on about becoming infected that she took two leaves from San Leandro Hospital.
She loves being a nurse, Kamara said. “I’d do it again in a heartbeat,” she said. “But a sick nurse who goes back home can infect the community. We have to take that seriously.”
In the early months of the pandemic, health care providers were fueled by adrenaline and that helped them deal with the stress, said Dr. Jeanne Noble, an emergency room physician at UCSF. They were the front-line heroes, literally donning battle gear — their N95 masks and their goggles, gowns and gloves — to confront the pandemic head-on while most everyone else sheltered in place.
But that kind of hyper-vigilance takes a toll. In the summer, as they prepared for another possible surge in patients, the fatigue settled in. And it’s never really dissipated.
“That initial ‘rising to the challenge’ has transferred to ‘when is this ever going to end?’” Noble said. “Psychologically, it is really hard. We’ve been at this for 10 months. We are exhausted.”
That exhaustion manifests in different ways. Some people may feel irritated or depressed. They may have trouble sleeping. A UCSF survey of emergency room doctors found high levels of moderate to severe stress and emotional exhaustion related to COVID-19.
Some also are coping with anger and frustration — that people still refuse to take the pandemic seriously, that they won’t wear face coverings or that they insist on gathering together, for holidays or any other reason.
“I understand there is a mental anguish for people. They miss their loved ones,” said Dr. Rosny Daniel, an emergency room physician at UCSF who had COVID-19 in March, and understands better than most how serious the illness can be. “There are reasonable ways to get through this. I’m just asking and hoping that people are thoughtful and remember it’s not just about them.”
And health care workers aren’t immune to the general pandemic fatigue that’s afflicted most everyone else. They’re slipping up, too, sometimes.
Local providers pointed to the recent outbreak of coronavirus cases among health care workers at the Mayo Clinic in Rochester, Minn., where more than 900 staff have been infected — not from treating patients, but from letting their guard down in the community and even in their own break rooms. Several local doctors said they’ve had lapses of judgment, even if it was just standing too close to a coworker during a coffee break.
“It’s those moments where you want to sit down for a minute, figuratively put your feet up, forget about how stressful everything is, and take off your mask and have that cup of coffee. That’s where the risk is,” Noble said. “It’s relentless. You can’t forget about it. You can’t ever let your guard down. You can’t do it even just for that cup of coffee.”
With the pandemic exploding across the United States, Bay Area health care providers can’t rely on backup from other states, or even their neighboring counties. Indeed, most health care workers say they expect to work more hours than ever in the coming weeks if hospitalizations climb dramatically.
Many say they are trying to rest now while they can: They are taking a few vacation days, spending time with their families, even just going outside to breathe some fresh air.
“I had a weekend off and just used it for time of reflection and nature. I went to Wine Country and drove around a little bit,” said Dr. Peter Chin-Hong, an infectious disease expert at UCSF. “Then it’s time to brace ourselves.”
Providers said they hoped that people in the community had listened to public health advice and kept their Thanksgiving celebrations small and safe. Many said they had canceled or scaled back their plans, or that they’d been scheduled to work that day.
“It’s absolutely my favorite holiday,” said Fahimi, whose sister usually hosts a huge dinner with extended family. She was recently exposed to the virus at work, though, and had to quarantine for two weeks. And, increasingly, it seemed like a bad idea to get together with relatives from across generations. “We all decided to cancel Thanksgiving this year,” he said.
Daniel, the UCSF emergency room doctor, also called off Thanksgiving with his family. He planned to spend the day mostly on his own and talk to family by phone, or perhaps visit with some friends in San Francisco — from a safe distance, and wearing a mask.
“That will fill my cup,” he said. He hopes it will be enough. Next week, he’s back at work, facing what could be a long, grim winter.