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'The ER never stops': On the front lines of the COVID-19 spike
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'The ER never stops': On the front lines of the COVID-19 spike

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MUSCATINE – With a 12-hour shift in front of them and a waiting room full of patients — many showing signs of being infected with COVID-19 — emergency room lead nurse Tasha Tovar and Dr. Rhonda Sowards, medical director of the UnityPoint Trinity Muscatine emergency room, don the protective gear they hope will keep them safe.

For over a week, traffic through the emergency room has rarely let up. While numbers have held steady, the increased need to change protective gear has doubled the time it takes medical providers to see patients.

As Tovara and Sowards dressed in their masks, one-use-only gloves, gowns, masks and face shields, they remembered these precautions were necessary to stop the spread of a disease that has so far killed more than 259,000 people in the United States.

“We are seeing a much more challenging time with this,” Tovar said on the statewide spike in cases. “We are seeing a higher rate with this than we were in the spring. It is seeing an uptick for sure.”

The recent spike in COVID-19 in Iowa has made the state one of the highest areas of infection — estimates are Iowa will see 100,000 new cases in November — and an area with one of the highest death rates. Throughout the state the record-high number of hospitalizations has made treating patients more difficult, with the lack of bed space throughout the state leading to longer waits for treatment.

At UnityPoint-Muscatine, an area previously used as a waiting area has been altered to add two additional treatment beds to the 11 normally offered.

Sowards said over the past month the acuity of the patients coming to the emergency room has increased. Saying that fear of COVID-19 keeps some people from coming to the hospital for care, she said people are seeking treatment after the disease has progressed and they are much more ill than they would have been if it had been addressed sooner.

The pair have seen COVID-19 patients running the spectrum of symptoms from the mild to the severe. Tovar said children with COVID-19 seem to have very few symptoms, if any.

The elderly population is affected more heavily.

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According to the Iowa Department of Public Health, over half of Iowans who have died of COVID-19 have been over 80 and more than 62 percent who have died have had a confirmed pre-existing medical condition.

In treating the disease, the staff quickly learned any symptom a patient may have could indicate COVID-19. Tovar said when someone comes into the emergency room with a cough or shortness of breath, COVID-19 is automatically suspected. They have learned if someone comes in with diarrhea, that person could also be a COVID-19 patient. She says any symptom can be consistent with COVID-19.

The amount of staff on duty during the spike has remained the same due to illness and staffing concerns, and Tovar said there are times when more staff could be used. She believes this is the same for every hospital in the U.S. right now, especially in Iowa. She said during Thanksgiving week the schedule has been padded to allow additional workers in the emergency room at times.

“There is going to be some challenges for patients and that is why we want to be sure the right people are coming to the emergency room,” Tovar said. “We want to make sure sick people who have emergency conditions are coming to the emergency room instead of patients with mild symptoms that can be treated in urgent care or a care clinic — that would certainly help.”

Sowards said consistently since the beginning of the spike the emergency room beds are full by the afternoon and there is a wait for treatment. She said one contributing factor is intensive care units throughout the state are full, meaning the patients need to stay in the emergency room longer while they are waiting for an ICU bed to open.

Both medical professionals believe the reason for the spike is simply because people became too lax in their precautions. They relaxed as the state was beginning to open up and people stopped wearing masks and social distancing. Large gatherings has also become more common. Sowards said as the state was opening, the numbers of cases began to climb, and an eventual spike was not unexpected.

“The holidays are coming up and that is scary for us because we know there are those people — and we don’t want to insult the people who believe this is a hoax or believe it is a political thing — but the reality of it is that people are sick and people are dying,” she said. “We just need to remind people to maintain social distancing, wear a mask, wash your hands and avoid large gatherings. Just stay safe and keep others safe.”

With Thanksgiving coming up, Sowards and Tovar hope the spike won’t get worse, but in a way they believe it is inevitable. Tovar said there is a lot of mental fatigue from social isolation and she feels people want to move ahead with their normal lives. Sowards warns that there are so many asymptomatic cases, all it would take is a child to hug their elderly relative and the disease could be spread.

As they prepared to see patients, the emergency room workers took the time to remember why they do what they do and the thing that makes all the effort worthwhile. They thought of the patients who recover and seeing them walk out of the hospital to resume their normal lives.

“The ER never stops,” Sowards said. “There are people in the ward at 2 or 3 in the morning and there are many more at 2 or 3 in the afternoon. There are up and down times, but there is always something happening here at all hours.”

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