Virus cases taking a toll on caregivers

Jamil M. Madi, medical director of the ICU for Valley Baptist Medical Center, stands outside hospital entrance Wednesday at Valley Baptist Medical Center Brownsville. “Every few days I know of someone, a colleague of mine, who got sick,” Madi said. (Denise Cathey/The Brownsville Herald)

Doctors, nurses and hospital staff on the leading edge of the front line in the fight against COVID-19 continue to have to pay for the actions of others as the number of cases of coronavirus continues to increase in Cameron County.

For several weeks, the city of Brownsville’s and Cameron County’s orders to shelter in place, limit travel, socially distance and wear facial coverings succeeded in keeping the virus spread to a minimum, because a sufficient majority of residents complied with the orders. Then came Gov. Greg Abbott’s order to begin phased reopening starting May 1 while also stripping local governments of their authority to enforce local mandates.

While plenty of people continued taking the same precautions as before the governor’s order, a significant number — especially younger people, according to health experts — decided the danger had passed and everything was back to normal, or didn’t care one way or another. They congregated in bars, on beaches and in backyard gatherings. Memorial Day weekend was a blowout. Facial coverings were often scarce, as was social distancing.

The result is what public health experts predicted would happen if reopening were not accompanied by widespread testing, and what we’re seeing right now: a huge spike in COVID-19 cases, which has caused Abbott to pause his reopening plan, order bars closed again and mandate facial coverings statewide — that everyone wear a facial covering in public.

The city and county had reimposed a curfew and mandates to wear facial coverings and limit travel to essential business in an attempt to get control of the virus, when Abbott on June 2 announced a mandatory mask order for every county with 20 or more COVID-19 cases.

Until it is under control, medical professionals who staff the county’s hospitals are bearing the brunt, fearful of contracting the virus through constant exposure to infected patients and taking it home to their loved ones.

Jamil M. Madi, critical care physician for Valley Baptist Medical Center’s hospitals in Brownsville and Harlingen, said he worries about it “every single day, every single hour” that he’s at work.

“Every day I have to take precautions,” he said. “Going to the hospital, obviously I’m as sterile as I can be. Coming back from the hospital I have to presume that I’m as dirty as I can be. When I get home I take off my shoes, my clothes. I’m almost buck naked before I enter the house.”

Madi takes a shower before even seeing his wife and son, who turns 2 this month but won’t get a party because of the pandemic. It’s a stressful way to live, he said, and it’s affecting all Madi’s colleagues.

“They all have families,” he said. “They all have loved ones they go to. Some of them have mothers and fathers and grandmothers and grandfathers and nannies who are older, a vulnerable population. Some of them have actually isolated themselves more strictly than I have by locking down in a certain room or area of the house, completely physically isolated from the rest of the family.”

Despite taking every precaution and wearing Personal Protective Equipment while at the hospital, several of Madi’s coworkers across departments have gotten sick, he said.

“The numbers have increased,” Madi said. “Every few days I know of someone, a colleague of mine, who got sick.”

While some may have caught it outside the hospital, the reality is that these caregivers spend a great deal of time around people who are extremely sick with COVID-19.

“We are exposed to these patients on a daily basis,” Madi said. “The longer your exposure, the more you see all these patients, the more risk in terms of contracting the disease. We’re all taking precautions. We’re all wearing PPE. It’s not a shortage of PPE that’s the problem. It’s the influx of patients coming to the hospital and our interaction with them. That number is increasing day by day.”

Noting that he’s among the small number of intensivists (doctors who specialize in caring for critically ill patients) in the Rio Grande Valley, Madi said he’s discussed with VBMC administration “how many of us can get sick without this tipping over.”

“It might happen that more of us will get sick, and we’ll have to stay home and quarantine ourselves, and then we’ll need people from outside to help us out, take care of the (ICU) unit, our patients and the hospital,” he said.

All four hospitals in Cameron County have asked for and received assistance from the state in the form of contract nurses from around the country to help handle the load. Harlingen Medical Center CEO Matt Wolthoff said in a June 30 press conference that COVID-19 patients require more nurses than typical patients, adding to the stress on hospital capacity, and expressed gratitude to the state for responding quickly for HMC’s request for nurse backup.

Fifty percent of the patients at HMC on June 30 were COVID-19 related, he said. Wolthoff said it’s very important that people who think they may have the virus contact their doctor rather than just showing up the emergency room, noting that HMC’s 20-bed emergency department was already holding 25 COVID-19 patients.

Art Garza, CEO of Valley Regional Medical Center, said at the same press conference that COVID-19 patients constituted about 70 percent of his hospital’s total patient load and presented over 20 percent of daily admissions.

“I cannot stress enough the pressure that the emergency rooms are experiencing right now,” he said. “Same for the ICUs. Same for those critical care arenas that house these very, very sick individuals. They’re doing a tremendous job.”

Garza called COVID-19 a “very ugly disease, a very ugly virus” that’s creating a great deal of havoc in the community.

“It takes everyone to be united against this virus,” he said. “It takes everyone’s … discipline to make sure we’re safe. Community transmission is very, very high right now. I’m appealing to everyone. … We have a human responsibility to try to care for each other and to help reduce the spread of this virus.”

Madi said the disease exhibits a spectrum of pathology in different patients, depending on how severely they’re afflicted.

“We unfortunately have seen the worst part of this in terms of being in the ICU, where they end up with respiratory failure and then are put on ventilators or high-flow (oxygen) machines, or are requiring multiple support of their other organs,” he said.

Even with hospital capacity stretched nearly to the limit, non-ICU units being taken over to accommodate COVID-19 patients, and doctors, nurses and staff overworked, overwhelmed and becoming ill in increasing numbers, Madi isn’t expecting the situation to improve soon.

“What’s ironic about this is what we’re seeing right now are the effects of people’s actions around two to three weeks ago,” he said. “So if you consider it, people have been doing the things that they’ve been doing now for the last two weeks. They’re starting to change their behavior in the last few days, maybe less than a week.

“So we will continue seeing this rising surge for a few weeks until people change their behavior. There is a lag between what people do and what happens in the hospital, a two- to three-week lag period. If people change today, I won’t see this until two weeks from now. In the meantime, everyone’s going to continue dealing with what we’re dealing with right now.”

Madi implored every member of the public to “look into their hearts” and do what’s best for their fellow humans and the community by taking every precaution to stem further spread.

“I just want the public to do what they’ve been asked to do, and they don’t even need to be asked to do so,” he said. “It’s just the human thing to do.”