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San Diego Reflects on What’s Been Lost During the Coronavirus Pandemic

Today, the nation is expected to record its 200,000th death from COVID-19. As of Monday, 760 of these people died in San Diego County. As the nation marks this milestone, we spoke to several county residents on how the pandemic has changed their lives.

by Gary Warth, Pam Kragen, The San Diego Union-Tribune / September 22, 2020
(TNS) - The COVID-19 pandemic has largely been a story of numbers.
Daily reports tell us the number of new cases, the number of hospitalizations, the number of outbreaks and the number of deaths.
The numbers are a dispassionate, point-in-time measure necessary to track the footprint of the deadly coronavirus as it continues its advance into homes, businesses, churches, even hospitals.
But they can't quantify the sense of loss that has pervaded life since the pandemic began six months ago — the loss of intimacy, tradition, confidence, and economic well-being.
Today, the nation is expected to record its 200,000th death from COVID-19. As of Monday, 760 of these people died in San Diego County. As the nation marks this milestone, we spoke to several county residents on how the pandemic has changed their lives.
Priest's faith a solace when he lost a friend A Catholic priest whose role it is to provide comfort to the mourning, the Rev. Edmundo Zárate has faced a painful, frustrating challenge during the COVID-19 era.
As pastor of the Catholic churches St. Jude Shrine of the West in Southcrest and St. Anthony Parish in National City, he routinely is asked to perform services for parishioners who have died of the virus.
In normal times, a crowd of family and friends would gather to remember the lost loved one. People would hug one another and cry together. But there were no hugs for the victims of the coronavirus pandemic, and the gatherings were limited to 10.
"It was just extremely hard to do those services," he said.
Zárate himself felt the grief of losing a loved one to COVID-19, with the death of the drummer in his Christian band, Lumen.
"He was a very positive, joy-filled person," Zárate said about Jorge de Alva, who was 51 when he died in April. "Always had a smile on his face. He was the sort of person who could light up a room. Everyone misses him a lot. It's hard to believe he's been gone. "
Zárate said his fellow band member was in good health, and when de Alva was hospitalized, his friends and family got updates on his condition, expecting him to pull through.
"Unfortunately, he didn't make it," Zárate said of his friend, who left behind two daughters and a fiancée.
"Where is God in all of this, and what's the best we can do in difficult times?" he said. "You just have to kind of look within and find the inspiration and grace and strength to do what you're supposed to do."
Too many losses Dr. Jess Mandel, a pulmonologist and chief of the division of pulmonary, critical care and sleep medicine at UC San Diego Health, will mark his 30th year in the field next year.
"This is just so different than anything I've lived through, and that includes the early days of HIV, which were horrible in their own way," he said.
UC San Diego is a referral center for patients whose lives might be saved through the use of a machine that adds oxygen and removes carbon dioxide from the blood of patients facing respiratory distress.
The treatment can be a lifesaver, but the patients who need it are already gravely ill. When asked how many patients he's lost, Mandel can't remember the exact number.
"Ten, 15, 20. Too many, that's for sure," he said.
Still, the survival rate is among the best in the country. Remembering that helps Mandel and his colleagues get through the tough times.
"It's such a great feeling when you see someone who has been here for weeks, and then to get better and progress toward rehabilitation," he said. "That's something you just carry with you for days and days. Weeks. It's great to see patients later. They'll come back and visit. It's amazing to see people walk around and getting to be normal."
He has been working 12-hour days, and twice as many nights and weekends as usual. In normal times, Mandel said, 12 patients would be in intensive care. This year, the number has been in the mid-20s.
"Obviously, we're not staffed for that," he said. "We're staffed for normal times."
Patients also are staying longer in the ICU than they used to, which Mandel said makes it harder for family members who aren't allowed to visit.
Zoom conferences and phone calls can build relationships between family members and doctors. That can make it even more painful when a doctor has to deliver bad news.
"We'll be Zooming with them, day after day, week after week," Mandel said. "You really get to know the family well. Get to know the dynamics well. And it's very hard when you lose a patient like that."
The death of companionshipAt age 95, Richard Marshall said the physical isolation and loss of human touch that the pandemic has placed on seniors has been "excruciatingly difficult."
A retired newspaper advertising executive and Air Force veteran, Marshall moved into Escondido's Cypress Court retirement community 10 months ago after the death of Elaine, his wife of 46 years. Before she passed, the San Marcos couple had an active social life of dinner parties with many friends. When he moved into Cypress Court, he enjoyed the staff, the many social activities and the friends he met there. But when the pandemic arrived, strict safety protocols to protect this high-risk population drained the enjoyment from his life.
Since early March, most of Marshall's meals have been delivered to his doorstep because the dining room has been closed. He hasn't left the property once. His daughter in Texas hasn't been able to visit him yet, but he had several socially distanced visits from friends in the community's welcoming room.
To pass the hours and days, Marshall works jigsaw puzzles, takes short walks and enjoys reading the occasional thriller. But he tries to keep the TV turned off. He can't stand to watch the news because the nonstop political back-and-forth is depressing and the recent death of Supreme Court Justice Ruth Bader Ginsburg will only make those battles worse, he said.
Some of his neighbors at Cypress Court are staying positive, but Marshall said others are struggling emotionally with the social distancing guidelines. He has had no trouble following the rules because he learned strict discipline skills in the military. Marshall was a fighter pilot in the European theater for 13 months during World War II. He served 14 years on active duty and six years in the reserves.
When the pandemic is finally over, Marshall said he looks forward to checking out a new flight simulator at a friend's home nearby and maybe someday enjoying dinner again at his favorite restaurant, Jake's Del Mar.
"I'm looking forward to the day things are normal again, whenever that will be," he said. "I just hope that people can regain some common sense about fighting the disease, keep their hands clean, stay in touch with the political scene and vote."
Making the hard choicesDr. Robert Owens, a pulmonary and critical care specialist at Jacobs Medical Center in La Jolla, works closely with the team that uses ECMO, a device that oxygenates the blood, and has cared for a number of COVID-19 patients this year.
Patients who are referred for ECMO treatment are likely to die without it, and Owens said the team has had to make tough calls about who gets the treatment because there are a limited number of machines available, and patients usually are on them at least three or four weeks.
"You can go to bed with a very unsettling feeling," he said. "Did we make the right call or not? This isn't something you think about in your medical training."
Owens said this year has been trying both emotionally and physically. The bridge of his nose sometimes bleeds because of the hours he's worn a mask.
Dealing with family members remotely can create a sense of distance and detachment, but memories of some patients still weigh heavily on Owens. One who stands out is the man who was on a ventilator while his mother also was hospitalized with COVID-19. He started to recover the day she died, and family members believe she had somehow sacrificed herself so he could get better.
When the caregiver needs careAround the end of June, Dr. Alex Rose was feeling tired after working several night shifts. She also had symptoms that made her suspect her allergies were acting up.
"I couldn't taste my coffee and I couldn't smell anything," she said. "And then I realized what it was, and I was so horrified."
She had contracted COVID-19. Rose said she at first thought she was going to die, and then her fears turned to worry that she had exposed her husband and 19-month-old daughter.
While only 36 years old, Rose said she felt wiped out by the disease. Looking back, she now considers her case to have been mild.
Her husband and daughter did not get the disease, and Rose said she shares her story with her COVID-19 patients at Jacobs Medical Center who worry they may have passed along the disease to their family members.
"COVID-related deaths are really tragic, and they're really hard," she said. "I've cared for some of these patients for weeks. Some of them two months or longer, and they die of this disease."
Rose said most of her patients who have died from COVID-19 are in their 40s and 50s.
"It's crazy to me that people make the assumption that younger people can't die from it," she said.
Helping COVID patients die with dignityWhen nurse Deena Drake was hired a year ago as a palliative care clinical nurse specialist for the intensive care/emergency department at Sharp Chula Vista Medical Center, the first thing she did was build a dedicated end-of-life unit where families could freely gather by the bedsides of their loved ones before they died.
She opened the unit in mid-February to rave reviews from staff and patients' families. Then she was forced to shut it down three weeks later to revamp the room for critically ill COVID-19 patients. What was once a welcoming place for large gatherings suddenly became a high-security no-man's land where patients died alone without any visitors allowed. For Drake, the change was devastating.
"We had this special area set up where they could gather separate from other families and it was a really beautiful experience for them," Drake said. "Then weeks later, no one can come in at all. There is a huge Latino and Filipino population here, and the hallmarks of those communities is their extended families. The level of suffering expressed by these families was horrific and off the scale. They were literally crying just outside, begging to come in. I'd have to go out and talk to them to de-escalate them. It was horrible."
Instead, the staff used phones and tablet devices to allow patients to FaceTime with family members before they died. Eventually they were able to allow some small family groups — dressed in full hazmat suits — to visit loved ones' bedsides in their final hours.
The most poignant gathering was for a husband and wife, married more than 60 years, who were both admitted to the ICU with COVID. The husband was over 90 years old and had a do-not-resuscitate order. The wife was in her 80s and in very frail health. On the day he died, several family members in hazmat suits gathered by his bed, but his wife was too ill to join them. After he died and family members left, she was wheeled over to his bed so she could say goodbye. She died a week later.
Being surrounded by so many sad, solitary deaths came at an emotional cost, Drake said. For the first month of the pandemic, she said she felt as if she was in a state of shock. Then, as the death toll climbed, she started taking long walks after her shifts to decompress with her spouse, a chaplain, who counseled her to focus on her mental, spiritual and physical health. Finally, when the pressure became too much bear in August, Drake took a brief leave of absence.
"I needed to try and recharge. It took me almost 10 days to not wake up feeling exhausted and sad and grieving," Drake said. "By the 12th day, I was ready to come back."
Keeper of the numbersPerhaps no health official in San Diego County has lived and breathed the pandemic's toll more than the county public health officer, Dr. Wilma Wooten. Since Feb. 14, 44,925 people in San Diego County have been diagnosed with the virus and 760 have died. Wooten said she never loses sight of the meaning behind those numbers.
"I am keenly aware that every death leaves a wake of broken hearts," she said in an email. "It doesn't take losing someone close to you to COVID to feel that weight. Every life cut short by this disease is uniquely special."
With more than 30 years in the medical and public health field, Wooten has seen her share of infectious disease outbreaks, including H1N1, E. coli, hepatitis A and resurgences of mumps and measles. But the novel coronavirus that causes COVID-19 is unique in that it's new, so she and other health officers have been learning as they go, developing strategies to battle the virus.
"When I make a decision that is going to impact people's lives and livelihoods, I rely on medical science and data, but never without the awareness that the effects can be profound on people's lives," she said. "Throughout the COVID-19 pandemic, as with other disease outbreaks, my decisions are based on the most current information available and the best-established public health measures to stop or slow the virus' spread."
Many of these decisions — face mask requirements, social distancing rules, hand-washing hygiene — have been clearly proven to stop the virus. But some pandemic-weary residents continue to resist public health orders, and their personal actions affect the community as a whole. The pandemic, she said, is "not over by any stretch."
"I make it a priority to emphasize to every member of our community that their individual and collective actions matter," she said. "And, for better or for worse, they all add up to shape the direction we go as a region."
Because of her high public profile at frequent county press conferences, Wooten has become a target of vitriol from county residents and business owners.
"A challenge I share with public health officials worldwide is not internalizing attacks on my character," she said. "I fully understand and appreciate this is an inordinately stressful time, and sympathize with the frustration, hardship and other complicated feelings around its impact on our lives.
"Every once in a while, an attack is so personal and so off-base that it does feel unfair. When that happens, I take a breath and remind myself that this person is likely struggling, and all my actions and attention need to be focused on helping everyone cope with today and prepare for tomorrow."
©2020 The San Diego Union-Tribune
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