A remodeled hospital wing with a labyrinth of chambers separated by zippered plastic curtains belies the front line of COVID-19 care at one small Houston hospital.
After stepping through the United Memorial Medical Center’s first makeshift entry secured against the wall with painter’s tape, clinicians change from street clothes into hospital scrubs.
Joseph Gathe is one of two doctors leading colleagues in the treatment of COVID-19 patients.
“We walk into another chamber where we put on ‘bunny suits’ — the impervious suits that zip up and have a hood on them,” he said of the first layer of personal protective equipment (PPE). “We wash our hands and then we go through a third zippered door where we are at the nursing station.
“At the nursing station, we wash our hands and put shoe covers on,” he continued. “That’s where we can look at charts. That’s where we can talk about patients and vital signs and things like that. When it is time to go to the patients, we put a blue gown on to protect the bunny suit. We put on two pairs of gloves, we put on a second pair of shoe covers, we put on a N95 mask and a face shield. Then, we walk into the COVID-19 unit.”
Gathe is a pioneering infectious disease clinician. Fresh out of medical school in 1981, he cared for patients with HIV, which disproportionately infects and kills Black people in Houston. Nearly 40 years later, the seasoned Black doctor is having a similar experience with COVID-19.
The patients treated in the 40-bed COVID-19 unit find a place staffed by doctors, nurses and other medical staff of color “where they feel safe—where they don’t have to worry about being discriminated against,” Gathe said. “In Houston, we are not getting the surges of very sick people like New York or maybe New Orleans or Detroit got, thank God.”
The COVID-19 unit delivers specialized care around the clock. Clinicians change gloves between patients as they travel from one negative pressure room to another.
“I have to have somebody tell me sometimes what room I’m walking into, because you can’t wipe your glasses off to read the name,” Gathe said. “It’s a very difficult way to take care of patients, but we feel safe when we’re doing this. They can’t really see you, which is why we put our pictures on a lanyard over us, so they will know what we look like under all of this. You miss the patient-doctor interaction because you can’t shake hands with them.”
What’s in steady supply, however, is the focus on patients. Many of the patients show up with underlying issues of hypertension, diabetes and obesity. Others are pictures of health without pre-existing conditions—another strange reality that makes COVID-19 so confounding.
“Having said that, I have never seen a more grateful group of patients that appreciate that we are doing all of this for them,” Gathe said. “That is such a touching thing.”
The lack of interaction means Gathe and his colleague, Joseph Varon, rely on experience.
That’s why the team treats symptoms and anticipates the course of the illness with or without formal COVID-19 test results—a good fraction of which produced false negatives. Gathe and Varon have developed an innovative treatment protocol that allows patients to recover without relying on ventilators or succumbing to a cytokine storm, an over-exuberant immune system response where the body attacks its own tissues and cells instead of fighting the virus.
“We give you an antiviral to try to slow the virus down,” Gathe said. “We also give you something to try to block the cytokine storm, which is a steroid medicine, and we give you blood thinners so that if the cytokine storm is blocking the blood vessels, we can mitigate that to some degree. When we’ve done that, we’ve been 100 percent successful in getting people to walk out of the hospital.”
They are particularly proud of Ida Price, 89, who overcame coronavirus despite metastatic colon cancer. Recovered patients also include the relatively young, such as businessman Jeffrey L. Boney, a 40-something council member in the Houston suburb of Missouri City, Texas, who is the associate editor of the Houston Forward Times.
Varon, with multiple specialties, including pulmonology and critical care medicine, convinced the UMMC CEO to remodel a wing that established the COVID-19 unit. When he connected with Gathe, he asked: "Can we make a difference for patients?"
“Where everybody else is intubating patients because they are getting very sick, we have prevented that from happening by using a combination of medications,” Varon said. “There is no question: Blacks are being affected more. Of the patients I have in the hospital, over 90 percent of them are African Americans. More importantly are the African American people I get who are young, African American males without any prior history."
Varon, who is of Mexican-Jewish heritage, said he is sleeping a few hours a night “on a good day” and is overeating.
“We don’t have time to cope. We are so busy,” he said. “I know that my blood pressure is up and I know that I am gaining weight, but I cannot let people get in trouble and I cannot let people die.”
A Comforting Hand
At another Houston facility, Carrundlas “Donta” Mathews cares for COVID-confirmed patients and persons under investigation for COVID-19 on a cardiac unit.
A nurse at Memorial Hermann Health System’s 260-bed Greater Heights Hospital, he sweated heavily before COVID-19. Suiting up in PPE four or five times every 12-hour shift leaves him “drenched,” he said.
“I’m naturally overheated,” Mathews explained. “I had to buy a fan that wraps around my neck for when I come out of those rooms.”
He said COVID-19’s uncertainty takes an emotional toll on him. In addition, worried patients can’t have in-person visits, so social workers circulate with iPads for teleconferences with relatives and friends to improve mental health.
“It gives them a soothing feeling,” Mathews said. “I spend a little bit more time with them. I don’t want them to feel so isolated. ...I hold their hand. I try to make a connection even though I’m looking like a space suit man.”
He’s celebrated COVID-19 survivors and mourned those who perish.
“That’s the hardest because it happens so quickly. You’re trying everything you can to hold on to those patients,” Mathews said.
When the end approaches, there’s often no time to contact loved ones.
“That’s the thing that breaks my heart,” he said. “Sometimes they pass alone. That’s the part that hurts the most. No one wants to die alone, but in these times, that’s what’s happening.”
Another thing that’s happening is some people are simply staying away -- whether they are facing a corona-related illness or something else.
Some are too afraid to seek care, according to Houston neurologist Anjail Sharrief-Ibrahim.
“Your risk of dying from a stroke is much higher than your risk of dying from coronavirus,” she said. “I think it’s really important for people not to forget about regular preventive care based on the risk factors that they have. Having uncontrolled blood pressure and not having your diabetes under control … is really going to kill more people.
“People aren’t calling 911 when they are having stroke or heart-disease symptoms because of fear of COVID,” she continued. “I don’t want to downplay the impact of the pandemic, but on the other side, I see my patients who struggle anyway, struggling a ton more—and that’s what I’m really worried about.”
Sharrief-Ibrahim, an associate professor of neurology at The University of Texas Health Science Center at Houston’s McGovern Medical School, runs the stroke outpatient program and conducts health disparities research. She has turned to telemedicine to stay in touch with patients—particularly those recently discharged after surgery.
She also notes a reported dip in children showing up for vaccines.
“We don’t want to have an outbreak of something else preventable because we’re not thinking about preventive care,” Sharrief-Ibrahim said.
But there are high points, too, as communities build new avenues out of this pandemic. The crisis has revealed some of the Black community’s fortitude and self-reliance.
Meedie Bardonille, a nursing leader at a Level I Trauma Center in Washington, D.C., notes the groundswell of goodwill toward health care workers-turned-heroes.
“I have been supported as a front-line leader,” the registered nurse said. “Black and brown people have to start looking inward at how we are going to help each other. ...I have definitely been supported by my sorority sisters … and my church family. The majority have been Black and brown individuals that have helped me feed my team every day. (They are) stressed out, nervous and scared.”
Trained as a cardiac nurse, Bardonille directs 60 people at work and serves as the interim chair of the D.C. Board of Nursing. She said the pandemic also has forced front-line workers to evaluate their self-care routines and professional efficiency.
“It has been humbling, rewarding, information overload and emotionally and physically tiring, but we are still here working and caring for patients,” she said.
Testing has been a serious impediment for front-line workers who need the tool to properly treat patients. Even doctors who have become sick have had difficulty getting tests.
Robert M. Phillips Jr., a doctor in charge of walk-in clinics for the Henry Ford Health System in Detroit, attended the National Brotherhood of Skiers summit in Idaho during the first week of March. Close contact on the slopes and while socializing in lodges resulted in dozens of cases across the country and with members of at least one international chapter.
“A week after I got back, I had one day of fever and chills,” Phillips said. “I was kind of in denial. I took some Tylenol and Mucinex and went to bed and felt pretty good the next day.”
Days later, his wife developed more severe symptoms: cough, shortness of breath, fever, chills, malaise. She was sick for two weeks.
“We heard something on TV about the loss of taste and the loss of smell and we looked at each other and said: ‘We have coronavirus,’” Phillips said.
His wife, who has asthma, later tested positive for COVID-19.
“There were many patients who we saw in the walk-in clinics who we were not able to test, but we were convinced they had COVID-19,” Phillips said. “Most people who weren’t sick enough to require hospitalization were sent home with just instructions for supportive care and were told if they were to get worse, they needed to go to the emergency room.”
In leaving the COVID-19 unit at United Memorial, Gathe begins with removing the blue gown, one set of shoe covers and gloves. His hands are washed and covered with fresh gloves before going back through the zippered doors to the nursing station. In the next room, the “bunny suit” and second pair of shoe covers are removed and tossed in a hamper. Scrubs are ditched in another room before he showers then dresses.
“We have to be cognizant of how many times we come in because we don’t want to use all of the PPE,” he said. “Those bunny suits are expensive, and we don’t have many, so we like to try to limit the people who go in so we can make sure we have enough PPE for the people who need it.”
United Memorial Medical Center has multiple levels of COVID-19 care at its main facility.
“We have an outpatient clinic, we have a testing site where you can come and get tested for free, we have the inpatient unit and we have follow-up with telemedicine,” Gathe said.
Lessons learned during the early days of the HIV/AIDS crisis would be wisely acknowledged for this pandemic, he said, and those on today’s front lines should heed them now.
“We stigmatized the testing during the HIV epidemic—you need to meet these criteria to get tested—while the disease was running rampant in people who didn’t meet the criteria. That’s why everyone needs to be tested for COVID-19,” Gathe said.
Cindy George is a journalist based in Houston.