For 18 months, Mary Ann Lozano has worked in the acute care unit at University Health caring for patients with COVID-19.
Ever since the first person sick with the virus was admitted to the hospital on March 16, 2020, the medical-surgical technician has monitored, bathed, fed, and comforted an untold number of people.
But Lozano had thought those difficult and frightening days, weeks, and months were behind her.
Over the past month, University Health and other hospital have seen a sharp rise in COVID-19 admissions, with the number of hospitalized patients jumping more than 30 percent in a week. Emergency rooms are packed and COVID-19 care units are filling to capacity.
Nearly 1,000 people are being treated for the illness in San Antonio hospitals, including children sick from COVID-19 and other respiratory viruses, forcing University Health to call a temporary halt to all non-urgent surgical admissions.
In Texas, there are over 8,000 lab-confirmed COVID-19 patients in hospitals, according to data from the Department of Health and Human Services, and about the same number of available beds.
But stress on the health care system and the people who work there comes not necessarily from a lack of hospital beds, but a shortage of skilled providers.
“We do have alternative facilities available to us in the event that we need them, but right now it’s not an issue of beds and ventilators, it’s about nurses,” said Mayor Ron Nirenberg during a briefing on Aug. 4.
Forecasters say the stress is likely to grow worse. On Aug. 2, the Centers for Disease Control and Prevention published models showing the number of new daily confirmed COVID-19 hospital admissions expected to increase over the next four weeks, with 6,700 to 24,000 new confirmed admissions likely to be reported on Aug. 30.
‘On the front line’
The rise in hospitalizations means Lozano is back to volunteering for extra shifts when she can, going home exhausted each time, especially when having cared for the sickest patients.
During one shift in the acute care unit, an elderly patient couldn’t be stopped from trying to get out of bed, so Lozano stood next to him and held his hand — for nearly 12 hours. It’s what the man’s wife would have done if she could, his daughter told nurses.
Later that night, the patient died, Lozano said. “But I was happy to be there, on the last day of his life, holding his hand. That will stay in my heart forever.”
Lozano left a career in accounting five years ago for the health care field at a time when no one foresaw the pandemic. She happily cared for eight or nine patients a day, she said, checking vital signs, serving meals, and providing basic care to patients before and after surgery.
Despite the struggles of the last year-and-a-half — despite contracting the virus herself late last year — it’s a choice she would make again.
“In the beginning, when the pandemic started, it was so overwhelming and shocking in that we didn’t know what we were doing but we still went in there and did it,” she said. “My job is on the front line, but I wouldn’t have it any other way.”
Yet Lozano, a mother of two grown kids, rejoiced with her coworkers when the pandemic and hospitalization rates began to wane in the spring.
“We thought we were done with COVID,” she said. “We were happy we were going into the [patient] rooms without our gowns and just walking into a room and we’d tell each other, ‘Man, it feels so good to go into a patient’s room without having to get gowned up and have a normal sick patient,’” one without COVID-19.
Seeing the finish line
Matthew Saxon-Barbo, a charge nurse at University Health who works with Lozano, said that although there hasn’t been a day without COVID-19 patients on the Sky 5 floor of the hospital, he thought they had seen the finish line.
“And then within a few weeks, we went back to where we were,” he said.
Now, Lozano’s patient load looks more like it did during previous pandemic surges, increasing to about 15 patients per shift.
Yet this surge is different, she said, with many suffering more from the severe respiratory distress common in the delta variant of the disease than other symptoms.
“I wish that people could see the severity of some of these people’s illnesses,” Lozano said. “To see a person with eight IVs going through them, a mask and tubes and being prone, it’s unbelievable that people don’t realize how severe this illness is.”
And when a patient is that sick, it’s frightening for both patient and the medical team. “Because a patient can take a turn from being ill to being severely ill in a matter of minutes,” she said. “You go in [the room] one time and their respiration is fine and you go in there 20 minutes later, and they’re having an episode where they can’t breathe.
“It’s hard because what can you do to make it better?”
‘If I have to run, I will’
On the day Saxon-Barbo spoke to the San Antonio Report, he was working to answer that very question for a staff member he supervises.
“My nurse had a moment where she called me [and said] I don’t know what to do,” he said. “I remember being a young nurse and not knowing what to do myself. It’s not something you want to feel when you’re in charge of patient care.”
Saxon-Barbo has worked in critical care for over a decade, inspired by his grandmother to pursue a job caring for others. His experience, along with the assistance of a “phenomenal” rapid-response nurse, he said, makes it possible for nurses to solve problems quickly when needed.
“My staff knows, when they call me, if I have to run, I will run,” he said.
But managing care on a COVID-19 unit is in many ways unlike caring for other critically ill patients. While the bustle of two dozen doctors, nurses, and others going from nursing station to patients’ rooms is swift and constant, there’s an emptiness as well, Saxon-Barbo said.
“Even though we’re completely full and completely staffed, it almost feels empty because we’re not seeing the loved ones being able to come in and be with their family,” he said.
In a study of health care workers published by the medical journal The Lancet in May, researchers found high stress scores in almost half of those working during the pandemic. The report stated stress and burnout were associated with fear of exposure to the coronavirus or transmission, self-reported anxiety and depression, and work overload.
Saxon-Barbo said he has seen some employee turnover on the unit since the pandemic began, but many like Lozano have stayed, he said.
He keeps morale up by encouraging the nurses to take their lunch breaks rather than skip them and tries to recognize them for going above and beyond. The hospital chaplain also visits often, an acknowledgment that not only the sick need comfort as the crisis drags on.
“We just try to take care of each other, lift each other up, and be there for each other,” Saxon-Barbo said.
Though they’re not where they expected to be by now, with the virus held at bay by a vaccine, face masks, and social distancing, Lozano believes the pandemic and its resurgence has made everyone more aware of how vulnerable we are.
Patients often tell her they don’t know how they were exposed to the virus.
“Well, it could have been anywhere — it could have been easily hugging somebody,” she responds.