*Original post released 1/20/2022
Between the reality and façade of what the media portrays in regard to the pandemic, it can be difficult to discern whether or not the incidence and severity of Covid infections is improving within the public. Health organizations report data that doesn’t necessarily correspond with the soundness of their recommendations. Political leaders make judgments and form infection control policies which appear to support economic needs rather than the health of their constituents. Hospital administrators and healthcare professionals are doing their best to squeeze every last drop of hypothetical lemonade out of bruised and rotten lemons. So, what is really happening with the pandemic? Are conditions truly improving, unchanged and underreported, or worsening? While I may not be able to speak for the entire country as a whole, I can provide insight about the conditions I’ve witnessed and worked under, first hand, over the past year and now as we lead into the new 2022 year.
First, I want to discuss some of the blatantly noticeable differences we as nurses and healthcare professionals see between Covid patients whose status is vaccinated versus unvaccinated. These differences I’ll be discussing are those noted over the past year as primary vaccinations and boosters have been made available to the general public. For instance, throughout my time as an ICU nurse in 2021, I have observed vaccinated individuals to typically have less severe illness as a result of infection with coronavirus. This results in a shorter length of stay in most cases. Also important to note, I have seen lesser incidence of vaccinated covid patients within the ICUs I’ve worked; while these patients still tend to require supplemental oxygen use, their oxygen demands are typically low enough for intubation to not be necessary. Again, these are generalizations made from a year’s worth of observations and there will always be exceptions.
For unvaccinated patients, the exact opposite seems to be more the norm. These patients, when infected with coronavirus, are usually more severely and acutely ill. The severity of their illness often results in an increased length of stay. If these patients aren’t directly admitted to the ICU upon processing at the hospital, the incidence of rapid response scenarios involving unvaccinated patients seems to be higher than with their vaccinated counterparts. Their need for supplemental oxygen use increases rapidly and typically results in intubation, from which I have seen very few extubated to recover successfully. So, while many patients still contract the virus, it appears as though the severity of and duration of the course of their illness is mitigated by the vaccination.
As we lead into the start of a new year, especially after having a vaccine publicly available for nearly the entirety of the previous year, there are some notable statistics recently published by the CDC. The incidence of new hospital admissions related to Covid infection are at the highest they’ve been in a year with over 20,000 patients currently in the ICU. As of the beginning of January, the daily rates for newly diagnosed cases are at more than 800,000, leaving total cases for the entire United States at over 57 million currently with resultant deaths totaling over 830,000 since the pandemic began. 10% of all patients entering emergency departments are testing positive for Covid as January 2022 continues; 5% of which are of the delta variant and 95% are of the Omicron variant.
In terms of vaccinations, vaccination status appears to have a direct correlation on the person’s likelihood of contracting the virus and their subsequent outcome. For instance, the CDC estimates that vaccinated persons are 5 times less likely to test positive and 14 times less likely to die from Covid. For those having also received their booster vaccine, they are 10 times less likely to test positive and 20 times less likely to die from Covid. To put this into a different perspective, less than 10 per every 100,000 vaccinated patients with the virus are actually admitted to the hospital for treatment.
To end this article, I want to discuss some of the more harsh realities that aren’t really publicized about being hospitalized with Covid. Much of what is discussed in the media about hospitalizations with the virus is in regard to the severity of the illness and survival rates; however, throughout my time with these patients, I have to come to realize the vast extensiveness of its reach to other aspects of a person’s quality of life and healthcare measures provided. These observations are not going to be sugar coated in any way nor are they going to be withheld for the appeasement of others.
Depending on the facility a patient is admitted to, there may be regulations in place regarding medical treatments. In my experience over this past year, I have seen treatments such as convalescent plasma infusions and antiviral medication administration (Ex: Remdesivir) withheld based solely on the patient’s severity of illness at the time of admission. In one facility, if the patient required more than a nonrebreather mask for supplemental oxygen use at the time of admission, they were excluded from such treatment options.
Before admission even takes place, these patients are immediately isolated and experience highly limited interactions with staff and healthcare professionals. Even now, after nearly two years of this pandemic and adequate PPE available, healthcare providers often refrain from entering a patient’s room unless the circumstances are extenuating. Instead they opt for relying solely on report from nursing staff about bodily system overviews and the viewing of monitor data from outside the patient’s isolation room. This is not good for the patient’s plan of care, their health, or their emotional and social well being. Sadly, this generalization doesn’t only apply to physicians. There are many nurses I have worked with this past year that limit their interactions even when they require routine hygiene care that affords the most basic form of dignity to patients. As a result, tasks such as brushing teeth, changing soiled linens, bed baths, etc. are deferred until the next time a nurse enters the room, the end of shift, or worse yet – deferred entirely.
A well known policy of many hospital facilities currently is the restrictions placed on visitation. Patients are either limited in the number of visitors and their duration of visit or they are simply not allowed altogether. If you are a patient with Covid, the chances of having a visitor are miniscule at best; this restriction is even more regulated for those admitted to ICU. Typically, in my personal experience as an ICU nurse, for Covid patients on their death bed visitation is limited to a few minutes with family members unable to make contact with their loved ones. The patients are seen through room windows/doors or via video chat. Closure in the event of death via Covid infection is rarely achieved as families are unable to touch, kiss, or hold their loved one as they pass. The patient dies with a stranger at their bedside in an isolated room without those comforts typically afforded in death.
An unintentional, but very real, consequence of restricting visitors so heavily lies in the making of decisions for patients who may have become incapacitated. When a patient is no longer alert enough to make decisions for themselves, the decision-making role is often deferred to the next of kin or whoever the patient designates as their healthcare proxy if they’ve done so. With Covid, the mind altering effects of hypoxia can set in fairly quickly resulting in the need to use the patient’s surrogate decision maker. As a result of visitation restrictions, these decision makers often do not have sufficient insight about the patient’s health status to make sound life or death decisions. Physicians are often biased about such decisions and spend minimal time educating decision makers on their alternative options. As a nurse, I have also come to realize that family members approach decisions differently if they’ve been able to see the patient, the extent of medical support they require, and can visualize the likelihood of a prognosis.
When a patient is hospitalized with Covid-19 infection, they are at an incredibly high risk for a slew of complications such as acute renal failure, heart attack, stroke, pulmonary embolism, deep vein thrombosis, pneumothorax, pressure sores, and poor nutritional intake among other conditions. This virus attacks the body in a way that is extensively systemic. Hypercoagulable blood and increased clotting times combined with hypoxia, immobility, and dehydration set the stage for these complications to take over and result in multiorgan dysfunction syndrome.
Finally, the majority of hospital facilities are strapped for resources both in terms of physical supplies and available personnel. The lack of supplies and need to ration/prioritize them can impact the quality of care these patients receive in the hospital setting. The effects of the limited availability of personnel is multifaceted. When the staff to patient ratios are too high, meaning there are not enough healthcare professionals to care for admitted patients, delays in care are quite common. And I’m not just talking about delayed pain medication administration…
Additionally, there is a surge in the risk for complications to the patient related to units being short staffed. An example recently experienced personally in the ICU setting involved three nurses staffed for a 12 bed unit. I had four critical care patients under my watch and my two coworkers each had three ventilated patients as well. Between 1-2 am, one of the patients experienced a code blue situation where two of us were involved in their resuscitation attempt. This left me to tend for the remaining nine patients on my own. If an emergency happened with one of those nine patients, the likelihood of that patient passing was unnecessarily increased. If I had to attend to a patient while another’s IV pumps stopped infusing, death may have resulted. Situations like these are all too common at the moment, and this is something the hospitals and media do not make well known to the public.
Now let’s return to the original question, is Covid in the hospital setting improving? In my opinion, the answer is a double edged sword. For those who are vaccinated, their outlooks during infection and hospitalization do seem improved. For their unvaccinated counterparts, it feels as though no true improvement in outcomes has occurred throughout the pandemic. While we might be able to support these patients on ventilators and with vasopressor use for more extended periods of time, I would argue that their quality of life has remained minimal or even declined. To me, that’s not improvement. Prolonging an ill patient’s life for the sake of simply accomplishing that feat does not equate to improved quality of life. Share this article with someone you love to help them see the harsh realities involving the care of hospitalized Covid patients. And please, vaccinate yourself and your loved ones, take precautions, err on the side of caution more times than not, and keep others’ health in mind when you plan social activities.
Until next time, happy studying.
Andra Alyse
The Study Nurse 