Like many Nebraskans, Dorene Spies thought COVID-19 would blow over in a couple of weeks.
Spies, the administrator of Greeley Care Home & Assisted Living in Greeley, Nebraska, moved into the center March 16 so she wouldn’t pick up the virus in the community. A number of staff members did the same.
Two weeks became five, then five weeks became eight.
“We all thought it was kind of fun back then, before reality hit,” said Spies, who finally went home after Mother’s Day.
Now 10 months into the global pandemic, the nation is battling a surge of cases. While new cases and hospitalizations have decreased in Nebraska since the November peak, the virus still is far from contained.
And at the Greeley home, November brought what Spies and her staff had fought so hard to keep out: COVID-19.
By mid-December, about 90% of the home’s residents and more than a half-dozen staff members had been infected. Three residents died. Spies herself had contracted the virus and was isolating at her house. By Dec. 21, she was back at work.
Across the state, thousands of health care workers have cared for Nebraskans ill with COVID-19. Supporting them have been thousands more people — public health workers tracking the virus’s spread, lab workers who run tests on weekends and holidays and researchers developing tests and treatments.
In a year unlike any other in the past century, The World-Herald honors all the health care workers who are battling the pandemic. They are the newspaper’s Midlanders of the Year for 2020.
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Nebraska was introduced to COVID-19 relatively early. In early February, 57 Americans who returned to the U.S. from the outbreak epicenter in Wuhan, China, were housed at the Nebraska National Guard’s Camp Ashland. Later that month, health care workers in Omaha monitored and cared for passengers rescued from a stricken cruise ship.
But it was the state’s first local patient, a 36-year-old Omaha woman, who brought the reality of the virus home.
Dr. Brian Boer, section chief for critical care medicine at the Nebraska Medical Center, began caring for Emma Hutchinson hours after she arrived at the hospital in an isolation pod.
People were worried. Boer initially tended to coronavirus patients while wearing an air-purified suit and multiple layers of gowns and gloves. Soon after, experts learned that less gear could protect health care workers, so caregivers abandoned the suits for gowns, gloves, N95 masks and face shields.
Boer, also medical director for the hospital’s COVID and medical intensive care units, is used to caring for patients too ill to communicate with their families. But because of visitor restrictions aimed at preventing viral spread, critically ill COVID-19 patients don’t have the comfort of having family in the room.
“They’re all alone in their rooms,” Boer said, “fighting for their lives.”
It also has been difficult for health care workers to connect with patients’ family members to make important decisions that otherwise could be made on-site. Sometimes, they have had to speak to a different family member every day. Language barriers also have strained communications.
“To do it over the phone makes it impossible to establish the proper rapport,” Boer said.
Those factors and others add up to a heavy workload. Changing protective gear between rooms takes extra time. At some especially busy times, hospitals have treated more patients who are more acutely ill than the ones they usually see. Even during the lull between the spring surge and the fall spike, COVID-19 patients made up a bigger share of patients in the ICU. In November, the state had nearly 1,000 patients hospitalized with COVID-19. By last week, the number was down to just above 500, a figure not seen since late October but still more than twice the count during the spring peak.
Caregivers see wins when people pull through and losses when they don’t. Boer said all the providers in the units have stories about being the only person in the room with a dying patient. Sometimes, family members are ill with the virus and can’t come.
Two or three times, Boer has cared for elderly people who know they aren’t going to do well and don’t want to go on life support. They have hard conversations with them and hope they get better.
But in the end, the patients just want someone to sit with them, and, in some cases, to give them a hug.
“You just imagine your own loved ones. … I can’t imagine them being stuck here and going through it,” he said. “It’s awful.”
Nurses, he said, have it particularly hard. Boer pops in and out of rooms; nurses get to know the patients and pour their efforts into making them well.
“It’s the same story over and over and over,” he said. “And I think that’s where the people get the fatigue.”
Helping to sustain the providers are camaraderie and teamwork, as well as support from hospital leadership, which includes the hiring of some traveling staff.
And there is hope, albeit hope tempered by the prospect of several rough months ahead before the general public is vaccinated.
“I truly believe by spring we are going to be in such a better place,” Boer said. “We just have to get through the next couple of months. But at the same time, I feel like we’ve been saying that since March.”
Dr. Nikhil Jagan, a pulmonary and critical care physician at St. Francis Hospital in Grand Island, also was at the forefront of the spring surge, which hit Grand Island and other cities with meatpacking plants particularly hard.
While some patients have died, seeing people who have recovered go back to work has been gratifying for Jagan.
But the other thing that sticks with him is how he and his fellow providers came together as a team.
“COVID disrupted everybody’s lives in some way or the other,” he said. “The goal was to be unified.”
A particular challenge, especially in those early days, was keeping up with all of the research emerging about the virus and how best to care for patients while being mentally and physically exhausted.
Jagan, like many health care workers, was looking forward to getting the vaccine. “And really looking forward to the world getting back to where we were pre-COVID-19,” he said.
Frank Freihaut, respiratory care coordinator at the Nebraska Medical Center, has faced nasty infectious diseases before.
He has been a member of the group staffing the Nebraska Biocontainment Unit since 2005. In 2014, he was part of the team that cared for three patients with Ebola. Those Ebola fighters were The World-Herald’s 2014 Midlanders of the Year.
Freihaut was there in February, when the medical center monitored 15 people who had been passengers on a cruise ship where a COVID-19 outbreak occurred. Several of them spent time in the biocontainment unit after becoming ill.
Freihaut also helped transport Emma Hutchinson to the medical center.
Born with defects that hamper her breathing, Hutchinson’s lungs were filled with fluid. Later on the evening of her arrival, a med center team threaded a breathing tube down her trachea and connected her to a ventilator. It would be one of many such procedures doctors and respiratory therapists would perform on COVID-19 patients in the months to come.
Hutchinson, who had become an early symbol of the virus at its worst, faced a grim prognosis. But she rallied, and Freihaut and Boer were there to remove her breathing tube.
“That was probably a great joyful moment, to get her off life support and breathing,” Freihaut said. “That’s always one of the joys of our job.”
Since then, he and his fellow respiratory therapists have been busy. While physicians order treatment, the therapists maintain the machines that provide vital oxygen. Often, they make recommendations about pressures and other details.
With COVID-19, patients face a variation on acute respiratory distress syndrome, or ARDS. While therapists are used to dealing with that, they learned early on that COVID-19 patients don’t require as much pressure as a typical ARDS patient. They also learned that they can improve oxygenation by proning, or placing patients on their bellies.
Turning patients, however, is a time-consuming process given that the teams have to maneuver breathing tubes, intravenous lines and catheters.
Because therapists maintain the machines, they’re also the ones to turn them off.
It’s hard enough when family members are there, Freihaut said. He wants the room quiet and peaceful, so he turns off the alarms, walks out and says a little prayer.
“It’s tough now when there’s nobody there,” he said. “It’s you and the nurse and the game is over, and you turn it off and you’re all by yourself. You say a little prayer there when you’re turning it off.”
Those are the tough days. Fortunately, Freihaut said, caregivers also see little miracles and hopeful signs, including days when they send home more people than not.
Since the COVID-19 peak in November, the number of patients on ventilators has decreased. Therapists also have been able to keep some patients off ventilators by using high-flow oxygen through the nose.
Fortunately, Freihaut said, Nebraska’s surge occurred after those in New York and Washington. By then, therapists had learned techniques to help while minimizing the risk of spreading the virus. At the medical center, they also learned to trust their protective gear and to safely transfer patients within the hospital.
Freihaut and others, particularly those who had dealt with Ebola, had drilled to face just such challenges.
“It wasn’t easy, but it wasn’t a crazy task,” he said. “I never saw the negativity. People were always positive: ‘Yep, we can do this.’ ”
After the pandemic began, it soon became clear that advanced age was one of the key risk factors for the virus. Long-term care facilities soon became the sites of deadly outbreaks.
Dorene Spies and her staff at Greeley Care Home & Assisted Living in Greeley were determined to try to prevent that. The center has 26 nursing home beds and 12 more in an attached assisted-living wing.
The staff and residents are like family. Some, in fact, are related. Spies’ 90-year-old mother-in-law lives at the care home. She contracted COVID-19 but since has recovered. Three generations of women from one family all work at the home.
Those close ties, Spies said, make it particularly hard on staff to repeatedly say no to family requests for visits with the residents. The residents, who were confined to their rooms during the outbreak, resumed communal activities just last week.
During the outbreak, Spies had to wait until one of the residents was near death before she could let his wife travel roughly 20 feet from the connected assisted living facility to see him.
She also had to make calls to families to tell them they could come spend a last hour with a loved one.
“That’s my job,” she said. “Can you imagine that being your job? Same with the girls in the hospitals. I don’t think anyone is thinking what that does to people.”
Spies said members of her “amazing” staff do their best to break up the days. For Christmas, they hung a little bag on each resident’s door. Every day, Santa and his elves left a little treat.
But Spies also misses hitting the road for outings in the center’s bus.
Spies recently missed her best friend’s funeral, choosing not to go because of concerns about crowds and viral spread. But later, she was relieved she had opted not to go. She tested positive for COVID-19 the next day.
The vaccine is bringing a glimmer of hope. When the vaccine becomes available to nursing home staff and residents, she said, “we’re ready.”
Spies said Greeley residents agreed to leave their Christmas lights up after the holiday. If staff and residents get their vaccinations as planned, they will drive around and look at them.
“We’re making plans for the future,” Spies said. “We’ve got things we’ve got to do.”
Before long-term COVID-19 patients can be released from the hospital, caregivers need to help them regain function and prepare them to resume their lives.
That’s where a triad of therapists comes in — occupational, speech and physical.
KC Humphrey, an occupational therapist at Omaha’s Methodist Hospital, said she and her teammates initially didn’t think they would get many therapy orders for COVID-19 patients.
But during the surge, nearly everyone in the department was working with such patients. They included infected people who initially were hospitalized for other reasons, such as after a cesarean section or other surgery.
Therapists typically interview patients when they’re admitted to learn what they need and want to be able to do, Humphrey said. They get to know patients and share their loneliness and fear, which can be compounded by being on a lot of oxygen or suffering from dementia.
“We’re compassionate people,” Humphrey said. “You can’t help (but) feel that in your heart.”
The therapists are used to seeing patients when they’re on the rebound. With COVID-19, they are seeing sicker ones. And in spite of their best efforts, they’re losing more people than they did in the time before COVID-19. They can look through the obituary notices and see former patients.
The virus sometimes seems to defy logic. Some patients in their 90s do fine, while others in their 30s, 40s or 50s do not. “It is extremely unpredictable, which can be pretty hard to stomach,” she said.
The therapists’ jobs are physical, including helping patients up, helping them dress, helping them walk. But now, the therapists are wrapped in protective gear.
Early on, Humphrey said, she would help a patient shower and find herself sweating like she had never sweat before. After a while, she hardly noticed it.
One of the most difficult tasks for her has been working with patients with dementia who don’t understand why they’re in the hospital, why they’re hooked to oxygen and intravenous lines, why they’re alone.
The positive side of therapy in the time of COVID is that patients are excited to see the therapists. They seem to enjoy the therapy more and require less convincing.
“Sometimes, that’s the most beneficial thing we can do is sit with them and talk with them and provide a few minutes of companionship,” Humphrey said.
To help engage the largely isolated patients, therapists have tapped the hospital’s leisure closet, a stash of phone chargers, reading glasses, books and puzzles, and organized some fun things.
Humphrey worked with food service staff to send up ice cream sundaes for patients. Earlier this fall, therapists broke out construction paper and scissors during their breaks to craft Christmas decorations for a patient who particularly enjoys the holidays. To connect with patients who are confused, Humphrey will start playing music on her iPhone in the hall, tuck it under her protective gear and enter the room. “Pretty soon,” she said, “if they’re not singing, they’re relaxed, they’re smiling.”
One positive is that battling COVID has pulled the staff together. “I’ve gotten to work very closely with people I hadn’t before,” Humphrey said, “and (to) see people really shine in this time.”
In between patients, someone has to do the work of getting rooms cleaned and ready for the next person. In Methodist Hospital’s emergency room, those people have included cleaning technician Ruben Sanchez Sr.
Sanchez has some regular daily tasks. But when his pager goes off, he goes in. He wipes down everything in the room, makes the bed, mops the floor and removes the trash. It takes 15 to 20 minutes.
He wears two masks, a hood with an air pack, and a gown and hat. The garb isn’t required, but he wants to be safe and avoid taking the virus home to his wife and kids. When he gets home, he leaves his clothes in the garage.
“COVID has made my job harder,” Sanchez said. “But I decided not to be scared of it.”
The nurses in the ER make him feel at home. He makes people laugh. He has nicknames for several of the doctors. Dr. Joseph McCaslin, the department’s medical director, is “Dr. Slim.” There’s also “Dr. Hockey” and “Dr. Go,” who’s always on the go.
“Life’s too short to be grumpy,” he said, crediting his sunny outlook to his late mother.
Sanchez is known as Baby Boy Sanchez, the name he found on his birth certificate when he took it to apply for a passport. When he was born, his parents had wanted a girl. They had picked the name Rebecca. Baby Boy wound up on Sanchez’s birth document.
Sanchez, 66, retired Dec. 31. “They say, ‘I don’t know what we can do without you.’ I say, ‘I’ve got to go. ... It is my time to retire.’ “
Tatjana McDonald was looking to ease back into the workforce when she started in June as a medical laboratory technician at St. Elizabeth Hospital in Lincoln, working for TestNebraska.
Her part-time job quickly turned into a full-time gig, plus weekends and holidays, at the lab that processes tests for the state’s COVID-19 testing program.
At first, the lab was processing 600 to 1,000 samples in 24 hours. Since then, the lab has increased to 4,000 to 6,000 samples and is ramping up to 10,000.
At first, the influx was overwhelming, McDonald said. When they got the first samples from long-term care facilities, lab workers faced coolers full of biohazard bags containing the little vials used to transport the now-familiar long swabs.
Testing needs increased so quickly, McDonald said, that staff had to jump in where needed. Like most other labs, they also had to work through technical difficulties and supply shortages.
In other states, she said, people don’t have the option of getting free COVID tests. Tests instead require a doctor’s order. It can take days to get results.
A lot of people are involved in the effort, McDonald said, from testing-site nurses and drivers to the people who receive and log the samples and use pipettes to drop the liquid onto plates for extraction and testing. Her job picks up with the PCR testing itself.
“I’m not going to lie, it’s very repetitive,” McDonald said. “I’m doing the same test over and over for eight to 10 hours a day. ... I feel so helpless with the pandemic. This is my way to kind of help have this pandemic go away faster.”
Today, the lab has more people and the process runs more smoothly. But lab staff worked Thanksgiving and Christmas Day to make sure people would get their test results back as soon as possible. The work, McDonald said, is a small but important part of fighting the pandemic.
“At least that’s what keeps me going even on the hard days,” she said. “I do feel like it’s important, and I’m proud of what we do.”
Some of the hardest work of the pandemic has fallen to nurses working in the region’s intensive care units.
Dani Smith, registered nurse coordinator in the ICU at Great Plains Health in North Platte, said she handles stress pretty well. But seeing the emotional toll the work has taken on colleagues is another matter.
She and another nurse were intubating a patient recently when the other nurse said she was emotionally spent and tired of helping people say goodbye to their relatives.
“I feel like I can handle it myself,” Smith said. “Watching my co-workers struggle through that has really been hard.”
Early on, nurses would hold iPads while family members talked with them via video chat to say their goodbyes. Later, the hospital allowed relatives to come in at the end of patients’ lives. “That really lifted the spirits of the staff,” Smith said.
Normally, the hospital draws from an area that dips into Kansas and runs north into South Dakota. But with the shortage of hospital beds in the region during the November surge, Great Plains also has gotten patients from Wyoming, Colorado and Oklahoma.
Some workers have left their jobs at the hospital because of stress, Smith said. The hospital also has struggled in a competitive market to secure traveling staff.
But there have been bright spots, including the opportunity to learn and do new things and the new treatments now being tested. The hospital’s pharmacy director estimated that bamlanivimab, a monoclonal antibody treatment approved for patients at high risk of severe symptoms or hospitalization, has prevented 60 admissions.
When the hospital discharged its first patient who had been on a ventilator for an extended period, they wheeled him out to cheers and presented him with 13 roses — one for each day of his stay in the COVID-19 unit — to give to his wife. Recently, a co-worker saw another former patient walking down the street. The patient had been on a ventilator for a long time and needed intensive rehabilitation.
“Seeing those people back out in our community and well really is a bright spot,” Smith said.
Mandi Clauss, an ICU nurse at Mercy Hospital in Council Bluffs, also has dealt with stress and fatigue.
“It’s been a tired like I’ve never felt before, because it’s been so physically, emotionally and mentally challenging to take care of these patients,” Clauss said. “It’s also been rewarding to see what we can do.”
While the year has been a blur, some moments stand out, she said, such as losing one couple and seeing whole families fighting the disease. It also has been hard hearing someone say they think they infected the parent or loved one who was in the hospital.
“We comfort them and say, ‘It wasn’t your fault,’ “ Smith said. “And there’s no way of knowing where it came from. We see a lot of that.”
Smith, who usually works part time, has been working full time, typically picking up a shift a week. Even when she’s at home, she’s checking in and wondering whether she should be helping.
“We’re a team,” she said, “and you just can’t leave your team.”
She, like other health care workers, praised hospital leaders for getting them the supplies they need. People from other departments have come to help.
And she credited community members for their support, from sending cards to wearing masks. At one point, kids created chalk art outside the hospital. It brought her to tears.
“It means everything to know people support what we’re doing,” Clauss said. “Because what we’re doing is so hard.”