Inside the COVID-19 ward: In desperate need of oxygen

The closet inside the coronavirus intensive care unit at Galilee Medical Center stores a large box of silver tanks, each with a small spigot. They look like helium tanks that could fill a bouquet of balloons for a child’s party. Rather, they are oxygen tanks – the lifeblood of the sickest COVID-19 patients, the air that fills their lungs. Without it, they will die.The patients – 13 in serious condition – are lying almost lifeless in their beds. Their chests move up and down, one infusion of oxygen after the other. Their eyelids are slits above the tubes and wires that protrude from their noses and mouths – tentacles wrapped around their bodies.The air is stifling and humid from the sweat of the staff members who are fighting for these patients’ lives. A team of nurses and doctors slip around the unit like astronauts in their white plastic boot covers and full-body protective suits.A package of adult diapers sits on a trolley.The rooms are silent except for the ever-present audio wallpaper of monitors – beep, burb, buzz.The metal churning of the wheels of a hospital bed interrupts the silence. A 26-year-old boy is being transferred to the other side of the unit so he can be intubated. He was admitted to the hospital two weeks ago with COVID-19. Before the virus, he was healthy, including having no known underlying medical conditions.His name is Elias.The young man with his skinny legs, dressed in gray shorts, is trying to talk to his family on his cellular phone. His voice cracks, like a frog gasping for air.“I feel no pain,” he tells The Jerusalem Post. “But I can barely breathe.”He does not know how he caught coronavirus, but he said he never imagined that if he did it would “be like this.” He starts to cough, and one of the white astronauts comforts him.“He is receiving 70 liters of oxygen per minute,” the unit’s senior nurse, Eyad Jeries, told the Post. Before coronavirus, most intubated patients received between three and 10 liters per minute, Jeries explained. To combat COVID-19, seven times as much oxygen is needed.“I just explained to him what is going to happen,” the nurse said. “He has to accept it because there is no choice. If we do not do it, he will die.“Breathing should be a basic part of life,” Jeries added.The coronavirus ICU at Galilee Medical Center (Photo credit: Marc Israel Sellem)ELIAS IS the hospital’s youngest coronavirus patient to date. But Jeries said that since the start of the second wave, the patients have gotten younger in general. Many are in their 40s and 50s.There are also many more patients. In the first wave, GMC treated 73 coronavirus patients, two who were intubated and only one who died.In this wave, the hospital has treated around 450 patients, including more than 80 current patients representing a cross section of Israeli society. Some 41% of patients are Jewish and 59% are Arab or Druze.The average age of the patients is 62.The center, in Nahariya, is considered a medium-sized hospital. With 723 beds it is around the size of Shamir Medical Center in Tzrifin or Wolfson Medical Center in Holon. But it serves a population of some 600,000 who live north of Haifa.“As director of the largest hospital in the Galilee and the second-largest north of Tel Aviv, I am supposed to give service to any patient – especially when we are talking about an extreme situation,” said the hospital’s director-general, Masad Barhoum. “We close, we open departments – we do what we need to do.”But he said that the hospital has struggled to make it work. It had to close down the geriatric ward, the rehabilitation center and two internal medicine wards to accommodate the growing number of coronavirus patients. The intensive care unit (ICU) is housed in the rehabilitation ward, and it could not be reestablished anywhere else on the premises. As such, he said, patients who need rehabilitation could have to travel as far as Haifa during this crisis.“Our health system was plummeting, starving, collapsing, in a terrible state for the last decade or more,” Barhoum told the Post. “It should have been prepared when we were living in normal times. Now, we are experiencing a critical event, and we were not prepared enough.”He said the current closure should have happened weeks earlier to help take down the infection rate before the staff was so overburdened. He said this is especially true in the periphery, where hospitals are starving for specialized medical personnel, and they cannot just open new coronavirus wards even if the Health Ministry gives them money and equipment.“In order to prepare a doctor to be in the intensive care unit, I need six years. For a nurse, I need four to five,” he said. “I say this now, because we have to think about the future.... The Health Ministry has to give us the funding for these positions now so the health system of Israel will be ready for the next 10 or 20 years. This will not be our last critical event.”The coronavirus ICU at Galilee Medical Center (Photo credit: Marc Israel Sellem)BUT THE pandemic is taking a toll on the existing personnel.Jeries said that staff members are supposed to spend up to only two hours at a time inside the ward, because it is so challenging to work with an N-95 mask and the multiple layers of clothes and other shields they must wear to help prevent getting infected themselves.“Because we are so busy with so many patients, we stay here much longer,” he said. “Today, looking at my patient list, I assume I will be in here most of the day.”He said that working in the ward for several hours feels like being underwater, and when he submerges he often gasps for air.“Sometimes I have heart palpitations, from the heat, from the busyness, from the stress – it happens to others, not just me,” he said.Jeries explained that one of the most difficult challenges has been the members of staff who end up in isolation. Although only a few have been infected with coronavirus, many have come in contact with someone and had to quarantine. When that happens, the staff has to shuffle to fill the slots.“It’s really stressful because you are going into another unit, you don’t know how to work with the staff as well,” he explained.On Thursday, the ministry reported that some 2,290 medical personnel from across the system were in quarantine.He also said it is a struggle to watch the patients in so much pain. This week, GMC reported that four patients died within a few hours of each other.“It really weighs mentally on the staff to treat patients who are so sick and in such complicated states – to fight so hard for their lives and then to watch them die,” Jeries said.He estimated that around 55 GMC coronavirus patients have died since the start of the pandemic. On Thursday morning, the death toll in Israel stood at 1,846.On Tuesday, Jeries said three patients needed emergency CPR. Conducting CPR for patients in a coronavirus ward requires special equipment to ensure that patients do not spray the staff members while they are examining the air pathway.“I have been working in the ICU for 10 years, and I have never seen such complicated patients. The coronavirus is breaking the health system.”The staff also has the added burden of being the support system for the hospitalized, whose families can rarely – if ever – enter the ward, due to the risk of infection. He said that on a daily basis there is no one but the nurses and doctors to stand by the patients and hold their hands.“It is not the same as a son who comes and holds his mother’s hand,” Jeries said. “I can hold her hand, but she cannot even see me. There is no difference between me and any other doctor or nurse with all this gear. We have no faces.“It is a daily war,” he continued. “It is a war to save as many patients as possible.”Preparing to enter the coronavirus ICU at Galilee Medical Center (Photo credit: Marc Israel Sellem)THOSE WHO caught corona and were admitted to the hospital are the ones who understand what Jeries described.
A 46-year-old patient who had recently resurfaced from a coronavirus coma and was now being treated with a portable oxygen tank told the Post that the virus is “psychotic. If it catches you, it catches you hard.”The patient, who asked that his name not be printed, said that people think if they get coronavirus, they will have a light fever, take some Acamol.“But it is not like that for everyone,” he said. “For some people, it gets into your lungs and you cannot breathe. It is like death.”A nurse is standing by the bedside of an older patient. He told the Post that that patient was a close family friend.“It is hard to believe: You speak with him one day and then the next you see him intubated,” the nurse said. “It is not easy.”Awi, a man in his 50s, has been in the ward for nearly a month. His mother is intubated a few rooms away, and his wife, who also has coronavirus, is in a separate coronavirus ward.“I have no idea what is happening to her,” he said of his mother, whose room is only 100 meters away from his. Because he is hooked up to oxygen, he cannot leave his room to check on her.A hospital sociologist, Einas Shaaban, recalled a situation in which an elderly woman and her husband were both hospitalized but in different units. Staff members knew she was about to die, so they found a way to transfer her to her husband’s bedside.“We put the beds next to each other and she said goodbye to him that way,” Shaaban recalled. “It just tore you apart to watch. I will never be able to get that image out of my mind.”Jeries said the unit does not leave the workers even when they go home.“I am afraid to hug my son because I could have coronavirus on my body,” he told the Post. “I have not seen my parents for more than two months. They are 63 and 64 and at high risk. If I would get them sick, I would be guilty.”His son drew a picture of their family. In the image, the boy, his brother, sister and mother were holding up the coronavirus with a rope. The nurse was stabbing corona.“He sees the coronavirus as something cruel, and he sees me as the person who is trying to kill the virus,” Jeries said. “Until I saw that photo, I didn’t understand how much the virus was affecting him.”Some of the staff said they wear masks at home, too, just in case.Galilee Medical Center director-general, Masad Barhoum (Photo credit: Marc Israel Sellem)BARHOUM SAID that the hospital is starting to see the first stages of the closure’s impact, as the number of patients is declining. But he said that in his hospital there are still an equal number of serious cases. He hopes that the lower number of people getting infected will ultimately translate to fewer patients. And he thanked his staff, who he said work with dedication and commitment.He noted, however, that as Israel prepares its exit strategy, it must look at the country not as a whole but as regions and sectors.“When we are talking about the North, the rise in the number of patients was because of weddings and schools,” he said. “The schools are closed, and the weddings are getting less and less, though I am not sure they have stopped.”He said that while the infection rate in the Arab community had declined, he knows it is because of the lockdown. But he said he does not believe that all of the Arab population is following the ministry restrictions.“Like in the Jewish community, some are more disciplined than others,” said Barhoum, who is a Christian Arab.The ministry said that around 9% of Arabs who have been screened for coronavirus in the last week tested positive.The key to keeping infection down in the Arab community will be regulating weddings, he explained. The question is how the government will do it.“If we are talking about an exit strategy, this is one of the biggest questions in the North.”He said Israel will have to learn to live alongside the virus, which he predicts will be with the world for a minimum of another two years. And he said that even when a vaccine is developed and approved, “I am not sure it will solve our problems with coronavirus.”He said there are questions, such as whether a vaccine will work for all people, how many boosters will be needed, how long will the antibodies stay in one’s blood, and how many mutations of coronavirus will there be, such that these mutations could render the vaccine ineffective. There are also still questions about whether people who get coronavirus have long-term immunity.“We do not know,” he said.Barhoum said sometimes people complain that the government regulations are confusing. He said the restrictions would not be needed if people would wear their masks, keep distance and wash their hands.“There are still people who don’t believe in coronavirus,” added the sociologist Shaaban. “There is coronavirus, people, and it kills. Protect yourselves and others – follow the restrictions.”