Hospital workers in Nevada this spring trained their eyes on New York and held their breath.

Facilities across the state dramatically reduced their hospital censuses, postponed elective surgeries and prepared overflow bed spaces, including, in one instance, in a hospital parking garage. Health care workers watched the news reports of their counterparts across the country struggling to treat a deadly illness they knew little about as refrigerated trucks lined up outside hospitals to gather bodies of coronavirus victims.

Everyday Nevadans were ordered to stay home to prevent the spread of COVID-19. All non-essential business were shuttered across the state.

The hospital workers waited and waited, but the surge never came.

So, as spring started to turn into summer, salons, restaurants and retail businesses reopened, soon followed by bars, gyms and churches. People gathered with friends and family for Memorial Day and Fourth of July barbecues. Casinos reopened and tourists flocked back to Las Vegas. Public health officials at the state and local levels encouraged Nevadans to wear face masks but didn’t mandate it.

Then, cases began to rise. One hundred new cases a day at the beginning of June became 500 by the end of June and a thousand by the end of July. The number of COVID-19 patients in Nevada hospitals at a given time tripled from the end of May to the end of July.

Where there used to be one or two code blues — signaling hospital staff of a life-threatening medical emergency, like cardiac or respiratory arrest — in a 12-hour shift, there would be five or six, one nurse at a Las Vegas hospital said. Multiple doctors described feelings of “hopelessness” and “defeat.”

“We were losing multiple patients a day. The hospital was completely full. We were stretched very thin. A lot of our colleagues and health care workers were getting sick, some very severely sick,” said Dr. Matthew Stofferahn, chief of emergency medicine at Henderson Hospital, speaking on behalf of himself, not the hospital. “It seemed very dark.”

In response to the climbing cases and hospitalizations, the state implemented a mask mandate in late June, shuttered bars in some counties in early July and generally boosted enforcement of health and safety mandates at businesses throughout the summer instead of enacting more sweeping closures like the state saw in the spring. 

But what they couldn’t control was what people did outside of those businesses, whether people wore masks and practiced social distancing with friends and whether tourists chose to don or doff their masks while walking the Las Vegas Strip.

“There was sort of this public perception that the worst had passed because the lockdown was over when nothing could have been farther from the truth,” Stofferahn said.

More than a half dozen Nevada hospital workers, some of whom asked for anonymity to speak freely about their experiences, shared with The Nevada Independent what life was like this summer as hospitals battled a wave of COVID-19 coupled with a crush of patients who had delayed seeking medical care this spring and could wait no longer. 

Some say their hospitals were well prepared, having used their time this spring to secure personal protective equipment and ramp up their testing capacity. Others feel that while their hospitals have taken some steps in the right direction, they haven’t gone far enough.

Though all of the workers said that the situation in their hospitals has improved over the last month as COVID cases and hospitalizations have decreased statewide, they’re also already preparing for another surge this fall and winter as flu season layers on top of the coronavirus pandemic. Others are bracing for an increase sooner, as a result of gatherings over the Labor Day holiday.

“I went out to dinner on Saturday and the Strip was just packed,” said Erika Watanabe, an HCA health care worker, in an interview last week. “I think we look at it differently. We’re not even thinking flu season right now. We’re just thinking two to three weeks from right now.”

The July surge

The situation in the hospitals over the summer was a “mess,” Dr. Dean Polce, an anesthesiologist and partner with U.S. Anesthesia Partners, said.

Not only were hospitals battling an uptick in coronavirus cases, but they were struggling to treat other patients who delayed seeking medical care in the spring, afraid of contracting COVID-19.

“You had a spike in coronavirus cases and then you had a spike in people who hadn’t seen a doctor in six, seven, eight weeks when they should’ve,” Polce said. “At MountainView, you had patients lining the hallways everywhere, every night. It was a total mess.”

Stofferahn, the emergency medicine chief at Henderson Hospital, said it felt like they “literally couldn’t physically stuff another person into a hospital” this summer.

“There was a collision between elective surgeries and COVID patients,” Stofferahn said. “We had all these things colliding and we were overwhelmed. Morale was pretty low. We were defeated. Fortunately, it has gotten better, but July was kind of our New York moment, I feel like.”

When COVID-19 cases started climbing, hospitals, particularly in Southern Nevada, started taking steps to prepare. Dr. Dan McBride, chief medical officer of the Valley Health System, said that Henderson Hospital, for instance, opened an additional 25-bed observation unit in July to boost its bed capacity, while hospitals across the system increased their intensive care unit staffing and added additional negative pressure rooms to isolate COVID patients.

“These measures reduced the numbers of patients requiring ICU level of care and ventilator support by almost half from the levels noted in the early phase of the pandemic,” McBride said in a statement.

University Medical Center, the county-run hospital in Las Vegas, put teams in place to activate alternative surge space throughout the facility, including using extra space in a large recovery unit to care for non-COVID patients. Dignity Health, which runs three acute-care hospitals in Southern Nevada, reported making “internal adjustments” as needed.

Mike Forson, a pediatric critical care registered nurse at an HCA hospital in Las Vegas, said that his department slowed down over the summer as COVID cases increased, though staff floated over to help on the adult side. Forson, fortunately, said he was floated to the adult burn unit, not the adult COVID unit, as others were.

Watanabe, another HCA health care worker, voiced frustration at the fact that her hospital does not test all patients for COVID, as UMC does. She said not knowing whether a patient is COVID positive means that health care workers aren’t always wearing the appropriate level of personal protective equipment, known as PPE, when treating them.

“I will tell you that situation has happened to me, that after having contact with a patient it has been found out days later that the patient was COVID positive,” Watanabe said.

HCA did not answer specific questions from the Independent about which patients receive COVID-19 testing or in which situations PPE is available. Todd Sklamberg, CEO of Sunrise Hospital and Medical Center, one of HCA’s hospitals in Las Vegas, in a statement instead touted the hospital’s decision to “strategically” locate PPE distribution centers across its campus to more quickly deliver supplies and appoint a PPE steward to oversee “priority deployment” of equipment “when and where it is needed most.”

“We are confident in our inventories of personal protective equipment (PPE), including PAPRs, the highest level of COVID protection during aerosolizing procedures,” Sklamberg said. “We remain proactive in our preventive measures that follow regulatory agency protocols, including those for PAPRs.”

One doctor with patients in several Las Vegas hospitals still brings privately-purchased PPE on rounds inside facilities, not knowing what will be available on any given visit. For instance, the doctor said that PPE is available sitting out on the desk at the St. Rose Dominican Hospital, Siena Campus, a Dignity Health facility, but “in the HCA system, I still think we could do better.”

“To be honest with you, I bought my own personal protective equipment because I didn’t feel safe,” the doctor said. “I don’t feel secure that when going to the hospital that I’m going to find something that’s available.”

Stofferahn said that his hospital was “always able to keep pretty well equipped” with PPE.

“There were times when we were running pretty low on certain things, N95, masks, gowns,” he said. “But we were never in a crisis situation, and we were never unprotected. That was not something that we had to deal with.”

Another nurse at a Las Vegas hospital reported being “very blessed” to receive one new N95 mask per day.

The September stabilization

Fortunately, the situation in the hospitals is no longer as dire today as it was this summer. As of Friday, the most recent day for which hospitalization data is available, there were 443 people hospitalized with COVID-19 statewide, down from a high point of 1,165 at the end of July.

For some, it feels like COVID has again all but disappeared from the hospitals.

“At Southern Hills Hospital two weeks ago there was a census of 65 patients. Last Wednesday, it was seven,” Polce said. “There’s only three patients that they’re following at MountainView now. It used to be 20 something.”

MountainView spokeswoman Jennifer McDonnell, in an email on Monday, said that the hospital’s numbers have “fallen dramatically” in September after a surge of patients in July but that the hospital has yet to have fewer than 20 confirmed or suspected COVID-19 patients at any given time.

Stofferahn said that his emergency department is seeing “far fewer sick COVID patients, or even COVID patients at all.”

“The big thing is that we’re definitely on a down slope,” he said. “The peak from July has definitely passed.”

McBride said not only are the levels of COVID-19 patients in Valley Health System hospitals about 50 percent what they were in late July and early August, but hospitals have also seen “marked reductions” in lengths of stays and “improved outcomes” for patients who do require hospitalization. 

Dr. Rodney Buzzas, Dignity Health’s chief medical officer, said in a statement that while the situation is “a bit calmer” than it was this summer “the intensity of our work remains.” Buzzas also noted that difficult protocols, such as continued visitation restrictions, are still in place and “something we will never become accustomed to.”

Six months into the pandemic, there’s also a sense among health care providers that while there are still many unknowns about COVID — including the long-term health challenges it may pose — it is much more of a known quantity today. 

For instance, doctors note that proning — putting patients in a swimmer’s position on their stomach — is now a common practice to help COVID patients breathe and keep them off of ventilators. They also know what isn’t effective, like treating patients with a combination of hydroxychloroquine and azithromycin.

There’s also less of a sense that they’re heading into a life-or-death situation at work every day treating COVID patients.

“We’ve all treated dozens if not 100 or more patients with COVID at this point, and we’re pretty comfortable being in the same room with them, giving them the appropriate treatment they need,” Stofferahn said. “We know when to start using different ventilatory techniques, which treatments are likely to work, which are not likely to work. There’s a feeling that it’s just like treating somebody with emphysema or asthma or pneumonia. It’s one of those things where we know what to do, and we feel comfortable doing it.”

Some still, however, have fallen ill. One health care worker at MountainView Hospital, for instance, reported falling ill after being coughed on by a COVID-positive patient.

“I had everything — the fever, the shortness of breath, the bronchial spasm, the weakness, getting winded out — I had everything,” the health care worker said. “But I’m glad I didn’t have any underlying conditions.”

An approaching flu season

What remains uncertain is what kind of an impact the flu season is going to have on the pandemic. Talk to some hospital workers, and they’ll tell you that flu season could overwhelm the health care system as hospitals struggle to separate the flu patients from the COVID patients.

“As health care professionals, we do discuss it amongst ourselves, and we are bracing for a pretty bad winter with the flu and with COVID still with us,” Forson, the pediatric critical care nurse, said. “Most health care workers, when we have had the discussion, we’re bracing for a pretty bad winter.”

Others are hopeful that social distancing and mask-wearing protocols will not only continue to guard against COVID but will lessen the severity of the flu season this year as well. But there’s also a concern that pandemic fatigue may be setting in just as people need to start being the most vigilant.

“I’m reasonably optimistic that we might have a mild flu season,” Stofferahn said. “On the other hand if people are sick of doing those things or flagrantly disregarding those recommendations we could be in for a disaster.”

Hospital officials, in the meantime, say they are closely keeping an eye on case counts, continue to monitor their PPE levels and have plans in place should there be another surge. They are urging Nevadans to not only continue to wear masks, avoid large gatherings, practice social distancing and frequently wash their hands but also get the annual flu vaccine.

“These simple measures will save lives by helping to prevent new cases of COVID-19 and influenza in our community,” said Scott Kerbs, UMC spokesman, in an email.

Renown Health President and CEO Anthony Slonim, in a statement, said that attendance at drive-thru and walk-up flu shot events is already at an "all-time high."

Some health care workers, like Polce, are matter of fact about what the flu season is likely to bring.

“The flu season is coming, and people die every year from the flu. I anticipate that’s going to happen again,” he said. “Patients come in and I’m like, ‘You just named eight problems, and any four of those are not compatible with life in a few months.’ The COVID was part of it, but that patient isn’t going to make it through 2020.”

But health care providers are, by and large, hoping that people continue to follow social distancing and mask-wearing protocols. Stofferahn said that the “most discouraging thing” to see as a health care provider is people “just completely disregarding mask wearing and social distancing.”

“They really are putting their lives at risk and the lives of their families and friends at risk,” Stofferahn said. “It’s almost like figuratively spitting in the face of health care workers who are trying to do everything they can to stay safe and save lives.”

Updated 9-21-20 at 11:59 a.m. to add comments from MountainView Hospital about the number of COVID patients currently in the hospital.