Intense Coronavirus Outbreak Battled at Small Georgia Hospital

Ambulances were pulling up into the emergency bay as the frontline nurse and director of emergency services at Phoebe Putney Memorial Hospital fit an N95 mask under her surgical mask and huddled with staff to prepare.

by Jenny Jarvie, Los Angeles Times / April 8, 2020
AP

(TNS) — Before Mandy Hall lined up to have her temperature taken, don a surgical mask and step through the glass doors of the hospital, she recited a line from the Old Testament.

Perhaps this is the moment for which you were created.

It was not yet 7 a.m., and the small emergency room was already crammed with dozens of COVID-19 patients struggling to breathe.

Ambulances were pulling up into the emergency bay as the 47-year-old frontline nurse and director of emergency services at Phoebe Putney Memorial Hospital put on freshly laundered Caribbean blue scrubs, fit a N95 mask under her surgical mask and huddled with staff to prepare for the coming onslaught.

Soon, her unit would have no available beds and start lining critical patients in gurneys along a back hallway.

"What if patients continue to flood in?" she said as paramedics delivered a man on a stretcher. "What if, at some point, we don't have a place to fit them? I don't think it's a matter of if it happens. It's a matter of when."

Far from the big coastal hubs of Seattle, Los Angeles and New York, this hospital in the remote southwest Georgia city of Albany — more than 35 miles from an interstate highway and 180 miles from a major international airport — is struggling to treat a community afflicted with one of the most intense coronavirus rates in the nation.

With 973 cases in Dougherty County, about one in 90 residents of this poor, predominantly black community has tested positive for COVID-19 — significantly more than the one in 1,450 residents Los Angeles County, for example. Already, 56 people have died, about 75% of whom are African American, according to Michael Fowler, the county coroner.

The lethal virus came to Albany earlier than to other pockets of the Deep South and it has taken a particularly heavy toll on black residents in this city of 75,000, many of whom already suffer from chronic medical conditions that compromise their immune symptoms: diabetes, lung disease, high blood pressure, hypertension and heart disease.

"Sometimes you wonder if this was planned by a villain to wreak maximum damage," said Demetrius Young, an Albany city commissioner who represents the mostly black neighborhoods south of downtown.

While nearly a third of Albany residents live below the poverty line, he estimates the number is higher than 50% in his ward, where residents have just one grocery store that sells fresh produce and little access to adequate healthcare. Georgia, he noted, is one of 14 Republican-led states that have not expanded Medicaid to cover lower-income adults.

"This isn't Hollywood, California, where everyone has a 7% body fat and is eating avocados," said Christopher S. Cohilas, chairman of the Dougherty County Commission. "We are saddled within a very large food desert. The choice for a healthy snack is sometimes Cheetos and Dr Pepper."

In the last week, Phoebe Putney has rushed to open up a fourth COVID-19 intensive care unit, expand its critical care beds from 38 to 49 and dedicate a total of 176 beds to COVID-19 patients. But it is not enough. With ventilators, ICU beds and critical care nurses and physicians in short supply, the hospital has been forced to transfer more than 100 patients to hospitals across Georgia and Alabama.

"There is no room at the inn," said Evelyn Olenick, the hospital's senior vice president and chief nursing officer.

As doctors and nurses have fallen sick — some ending up in the emergency room — Gov. Brian Kemp has dispatched the National Guard to bolster Phoebe Putney's staff.

Still, Hall and her colleagues are working 12- to 18-hour days.

One afternoon last week, paramedics wheeled in a rush of seven critical patients in an hour and a half. All were gasping for breath and requiring immediate intubation.

With just two physicians, 13 nurses and one respiratory therapist on duty, the emergency team scrambled to gather extra staff and supplies to fulfill the complicated task of putting patients on ventilators — over and over again.

"Is this the ball dropping?" Hall wondered as she rushed to tend to a 60-something woman with high blood pressure whose oxygen was perilously low even with an oxygen mask on. "Is this where it gets really bad and stays really bad?"

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No one suspected COVID-19 when a man from the Atlanta area arrived at Phoebe Putney's emergency room Feb. 29 complaining of shortness of breath.

The man, who was 67 years old, had chronic lung disease and had not traveled to China or the West Coast.

He had come to Albany to attend a funeral for Andrew Jerome Mitchell, a retired janitor. After more than 100 people gathered at Albany's Martin Luther King Memorial Chapel for the service, many then crammed into Mitchell's small three-bedroom home for a potluck meal of fried chicken, greens and cornbread.

"We hugged, we talked, we cried together," said Alice Wise Bell, the daughter of Mitchell's longtime partner, Emell Murray. "We didn't think anything of it."

Before she went to bed, Murray started feeling chills. The next day, Bell rushed her mother, who is diabetic and has high blood pressure, to the hospital with a fever of 103. Staff told her they suspected a urinary tract infection.

Before long, a cascade of sick people — including Bell's aunt and cousin — trickled in to the emergency room.

It was not until March 10, after the Atlanta area man was transferred to a hospital in Marietta, Ga., that Phoebe Putney staff found out he had tested positive for COVID-19. He died two days later on March 12.

By the time hospital and local officials realized the deadly virus was in the community, it had already spread from the funeral home to churches, the county courthouse and the hospital.

Sheriff's deputies, teachers and caregivers to the elderly were among those who tested positive for the virus, along with more than 60 hospital employees.

At one point, Phoebe Putney was so short-staffed that employees were advised to continue coming to work even if they tested positive and were asymptomatic.

After consulting with the Georgia Department of Public Health and the Centers for Diseases Control and Prevention, the hospital is now urging any employee who tests positive to self-quarantine for seven days.

Administrators began to prepare for a potential outbreak of COVID-19 back in December, said Scott Steiner, president and chief executive of Phoebe Putney Health System. But after stockpiling what would usually be six months' worth of personal protective equipment, when the outbreak escalated, the hospital burned through its supplies in seven days.

Officials then turned to the black market, paying more than three times the normal price for a shipment of 200,000 protective gowns from Mexico — only to find they were not made out of the correct material and failed to protect staff from liquids.

Facing a dire need for masks and face shields, administrators rushed to convert offices into a makeshift factory, mobilizing about 100 staff to sew tens of thousands of fabric masks and construct face shields out of plastic, foam and elastic bands.

Meanwhile, patients continue to come in to the ER, their lungs clogged with mucus so thick that, even with ventilators, they struggle to get enough oxygen.

"It strikes so fast," Hall said. "As soon as they walk in the door, we're having to make a life-altering decision."

After waking up one morning barely able to breathe, Melita Nichols, a 48-year-old manager at a senior center who has diabetes and Crohn's disease, summoned an ambulance to take her to Phoebe Putney.

The next day, her 27-year-old daughter, Qunia Roberts, was admitted to the hospital. The day after that, her brother.

Last week, Nichols returned home with an oxygen tank, but Qunia remains in intensive care attached to a ventilator.

"She's never been a sick child," Nichols said. "The only thing is she had severe allergies. When the pollen comes out, she's like a wheezing puppy, but she has no underlying medical conditions. She's just a 27-year-old free fancy girl!"

Several of Nichols' former childhood friends and fellow congregants at Gethsemane Worship Center are now dead, along with the owner of a downtown art cafe, a probate court judge and the pastor who delivered the eulogy at Mitchell's funeral.

"It's like something out of a very, very frightening movie," said Young, who has diabetes and began to isolate himself at home with his 17-year-old daughter in mid-March, a week before Dougherty County officials ordered residents to shelter in place.

"I felt like the guy who saw the monster coming and got himself holed up and tried to warn people who were still going on with their daily activities, not really understanding what was out there."

After working as a nurse for 20 years, Hall calls emergency medicine her first love. But COVID-19 has brought unprecedented challenges — not just in juggling vast numbers of critically ill patients, but figuring out how to treat those who have been stricken by the new and relatively unknown virus and how to protect staff.

"We know when we're treating a heart attack that we're following the appropriate medical guidelines and we know when we're treating trauma that we're following trauma protocol," she said. "With coronavirus, we know so little about it. We feel completely helpless."

Late last month, Hall watched a physician cry as he intubated their secretary, Shawndel, a woman in her early 40s who served as the glue of their department. The X-rays showed so much mucus filling her lungs that doctors didn't think she would ever come off the ventilator.

The nurses squeezed her hands, through nitrile gloves, and told her they loved her.

On Monday, everyone lined the halls to cheer and clap as Shawndel was wheeled out of the hospital. She had an oxygen tank by her side, but she'd made it to the point where doctors feel confident she'll make a full recovery.

When Hall returns home after long days of intubating patients who cannot breathe — taking care to remove her clothes and shoes in the garage, spraying her shoes with Lysol and throwing her clothes in the laundry — she is shocked to scroll through Facebook and see pictures of casual family gatherings.

"It's very frustrating," she said. "The community at large doesn't understand the severity of the situation and how drastic it is that they stay at home."

Over the last week, local city and county officials have pleaded with the public not to gather on basketball courts, host large cookouts, and crowd grocery and hardware stores. They have also threatened to dole out citations.

While stay-at-home orders have brought everyday activities in a vast swath of the country to a halt, cellphone location data shows that people in the Southeast, including Dougherty County, have not practiced social distancing as much as people in most other parts of the country.

Hall has lived apart from her own son, Charlie, who is 12, for three weeks.

After sending him to live with his dad because she did not want to risk exposing him to the virus, their only contact is via Facetime.

"This virus, we still don't know a lot about it, but the susceptible population are people that we visit every day — our grandparents, our mother, our father," she said. "We really need to self-quarantine and keep ourselves away."

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