WENATCHEE, CHELAN COUNTY — Promptly at 4 p.m., eight hospital workers garbed in gowns, masks and face shields file into a room of the third floor of the intensive care unit.
They gather around a COVID-19 patient, comatose and intubated — three on each side with one near the head to keep an eye on the ventilator.
As a nurse at the foot of the bed reads instructions, gloved hands disconnect lines to monitoring equipment and gather the sheets around the patients. The team carefully hoists and flips the patient onto his stomach — in the prone position — to give his battered lungs a better chance at healing.
Jackie Whited, the director of intensive care here at Central Washington Hospital, watches the team through a window in the hallway. This is the first of three patient flips that have become part of the daily rhythm as the hospital struggles to keep alive its sickest COVID patients.
“Because as the sicker they get, the stiffer their lungs get, and it takes more pressure for the ventilator to get the oxygen through,” says Whited.
Like medical centers across rural Washington, the fifth pandemic wave has overwhelmed the hospital in this river town of 36,000.
Part of the Confluence Health system, Central Washington Hospital is the largest serving Chelan, Douglas, Grant and Okanogan counties. Outbreaks have slammed the region throughout the pandemic, sending COVID patients from all four counties here.
The hospital’s predicament is not unique. Washington’s fifth wave has hit rural counties particularly hard, swamping medical systems and forcing the transfer of hundreds of patients to King County hospitals to manage the load.
About 74% of Washingtonians 12 years and up have gotten at least one vaccine shot; Chelan County even beats that percentage. The other three counties in the hospital’s usual service area, however, lag. At the bottom rung is Grant County, with only 62% of that age group having started vaccination.
High hospitalization levels have collided with a workforce of burned-out nurses, doctors and assistants. Beds have run low, staffers come from other departments to help in the ICU and crucial procedures like heart surgeries are being delayed.
The grim marathon of medical triage has also left workers seething that more people haven’t gotten the vaccinations that might have blunted this surge.
On this day last week, about one-third of the hospital’s 153 beds available for adults are filled with COVID patients. Of the 51 patients with the virus, 44 were not vaccinated.
Gone is the hero’s welcome given freely during the early COVID days, like the gifted sign that hangs near one hospital elevator. It reads “THANK YOU HEALTHCARE WORKERS!” with another dozen “thank yous” scribbled beneath.
And in the face of Gov. Jay Inslee’s vaccine mandates, which require some hospital workers to get their shots or lose their jobs, there have been semiregular protests outside the health care campus.
Up in the ICU, Whited and others witness people who were hesitant to take the vaccines, and encounter patients who doubt the very nature of their diagnosis.
“It’s astounding to me the number of people that we have intubated, that right up until the time we put those in, they are fighting with you to say this is not real,” says Whited, adding: “Or, ‘Can I have the shot now?’”
‘The virus thrashes your lungs’
On this day, a record 15 COVID patients lay in the 20-bed ICU, where tan-colored hallways have taken on a cluttered look that in normal times would seem unthinkable.
A portable barrier divides the hallway separating the COVID patients from others, so workers know where extra protection is needed. Pinned to it are detailed instructions for treating COVID patients.
Plastic flaps hang in front of hallway entrances to help with negative airflow. Clustered around patient room doors are computer stations, storage units stocked with protective gear, and even the dials to change patients’ medication levels, so workers can minimize trips into rooms.
The three patients are being flipped by an assorted team that includes Brandon Johnson, who wears a flower-print shirt beneath his protective gear.
In pre-pandemic times, Johnson, 29, would be working as a quality intervention specialist to keep the hospital up to speed with federal regulations.
Since spring of 2020, he’s also worked on and off as an assistant for personal protective gear. That includes stocking the hallway shelves with gloves and gowns that health care workers change into every time they enter a COVID patient’s room.
With the recent wave, he’s also been coming to the ICU to help flip the patients, says Johnson: “Pretty much it highlights how short-staffed we are.”
Sometimes they flip five or six a day, which might take the team up to a full hour.
That’s more flips in a day than the hospital otherwise might see in a year, says Dr. Michael Johnson, a physician in the ICU who wears a WSU Cougars bandanna on his head.
“Normally, we’ll prone two or three or four people a year,” says Dr. Johnson, who is who is not related to Brandon.
The doctor describes using drugs like Remdesivir and steroids to keep patients off ventilators, where chances of survival dwindle.
“When the virus thrashes your lungs, then what’s left is lung damage, and your body just has to heal that on its own,” he says. “There’s nothing we can give medication-wise that’s going to get people through this.”
‘I have no beds’
When the pandemic began, Whited, 54, told her husband she needed two things.
“I need food when I come home — and don’t ask me when it’s going to be — and I need dishes done,” she said. “Because that stresses me out if I don’t have clean dishes at home.”
A 31-year veteran of the hospital, Whited worked as an ICU nurse before ultimately directing the unit. Now, she works long hours, balancing atop a perpetually shifting seesaw of incoming patients and staffing plans strained by shortages.
Around 3 p.m. each day, Whited has to make decisions with physicians eager to push through a backlog of heart surgeries cropping up during shortages of ICU beds and staff.
In normal times, those surgeries — including open-heart procedures where a patient might spend more than one day in a bed — would probably be scheduled further in advance.
Now, Whited waits each day to see whether a bed comes open.
“We’ve got a backup of like 30 cases that need to be done,” she says. “So they wanted to do one Tuesday, Wednesday, Thursday this week,” she says. But, “I have no beds, I will have one clean bed in the ICU.”
Whited herself got the virus last November, before the vaccines became available. She spent 10 days at home with a fever and missed three weeks of work, Whited says, “Which I felt horrible for.”
She never had asthma before COVID, Whited says, now she does. “And there’s a very real likelihood that I now have a lifelong issue.”
It’s also hard for her to hear people disparaging the public-health measures, like the statewide mask mandate.
Whited recounts being in the bakery section recently of the Albertsons grocery store. And, “This guy and this gal talk about all the sheep that were there in the store, just a bunch of sheep,” she recalls them saying, referencing the term some masking opponents call those wearing face coverings.
“And I just had to walk away,” she says.
‘Fighting for your life’
Just in the month of September, 27 patients at Central Washington Hospital have died from COVID.
Those who survived the ICU — or managed to avoid it during their stay — often spend time in beds on other hospital floors, reckoning with their future.
For Alyssa Escalante, that includes bouts of anxiety that she never had before six weeks of hospitalization for COVID.
Escalante, 28, sits up in her bed, taking oxygen from a nasal cannula and occasionally from an additional face mask. She tells about falling ill in early August, along with her mother and two brothers.
The brothers weren’t as sick and quickly recovered from their symptoms. But Escalante and her mother went to the hospital in Quincy, Grant County, where they live. The hospital didn’t have beds for the women, she says, and they were transferred here.
Escalante, who works at an orthopedics center, dodged the ventilator a few times, she says, though she spent time in the ICU and the hospital sent palliative care to speak with her.
Her mother was, for a time, put on a ventilator in the ICU, says Escalante, but she survived — and is now recovering in a room just down the hallway.
Escalante says she wasn’t vaccinated, but had planned to get one after a consultation appointment with a rheumatologist to make sure the vaccine was OK for her immune system.
Her COVID diagnosis came just days shy of that appointment. In the depths of her illness, Escalante recalls thinking how crazy it was for someone her age to be stranded in the hospital for two months, “fighting for your life the entire time.
“That’s what I remember thinking in the very pit of it, I haven’t really lived my life, so this is what I’m fighting for, that’s exactly it,” she says. “Just don’t take anything for granted.”
On another floor, Margaret Zerbel, 77, looks to have made it past the worst of the virus. Her husband of 41 years did not survive his bout with COVID — family members held his funeral while Zerbel was still hospitalized.
The couple roamed the country in an RV for more than 25 years as part of their retirement, Zerbel says. For years they returned to Republic, Ferry County, for their summers after discovering it while attending an RV rally.
“It’s miles from anywhere, there’s no fast food, there’s no car dealers, it’s slow, it’s quiet, it’s small,” she says. “I love small towns. I hate big cities.”
Ferry County — where Zerbel was first hospitalized — is also one of the least-vaccinated places in Washington. There, only 45% of people 12 and up have gotten at least one shot.
Zerbel says she and her husband were “kind of iffy” on getting vaccinated. But they had planned to get their shots once the U.S. Food and Drug Administration gave full approval to the Pfizer vaccine.
That approval came Aug. 23, just weeks before the couple fell ill, says Zerbel, adding “we didn’t get there in time.”
“I don’t know if we maybe should have gotten vaccinated sooner — well I know we should have, because we were going to,” she says. “But then I don’t know, this may be God’s plan for us, and whatever. I can’t look at God’s timeline.”