Dr. Wing Province was in New York City in April, part of a team who traveled to aid the city’s overburdened medical system at the peak of what has become the indelible image of the pandemic in America.
Tractor trailers parked outside of hospitals, their refrigerators running to keep the bodies cold. Mass graves. People dying in hospital hallways with no bed available and not enough staff to serve them.
As an emergency department doctor, Province is used to seeing death. But what he saw in New York City was something different, and with the way COVID-19 is spreading in Utah and hospitals here nearing capacity, he is cautioning the public to follow health guidelines to prevent similar circumstances unfolding here.
“I saw and experienced things there that make you want to wish you could take your memories and put it in someone else’s mind who doesn’t believe that this is a legit disease, or the ‘scamdemic’ as they say, so they can recognize how horrible this can be on individuals or families,” said Province, the medical director at Park City Hospital.
He served at one of the hardest hit emergency departments in Manhattan, he said, a hospital that received the nickname “Dunkirk” because of the number of bodies there. He recalled it as something like a war zone.
“There’s a sight and sound and smell to COVID I’ll never forget. See people that are drowning but they’re not underwater, but they’re breathing like they’re underwater. Patients on a monitor, can hear their oxygen saturation levels going down. … I can’t describe the smell but it’s the smell of near death,” he said. “And you have nurses and doctors who are stretched to the max. My medical director there, the doctor in charge of the whole emergency department, when I was there, she took her own life.”
The situation in Utah isn’t anywhere near as dire, Province said, but there’s a building sense of urgency in the requests from health officials when they ask members of the public to wear masks, maintain social distance, avoid large groups and wash their hands often.
Gov. Gary Herbert’s administration has effectively ordered a mask mandate in 23 of Utah’s 29 counties, though he has resisted calling it that. The state’s epidemiologist has had moments of public exasperation. As of Friday, more than 75% of the state’s intensive care unit beds are filled with patients, according to the Summit County Health Director.
Despite recent warnings that health care systems in the state are preparing to ration care, Province said the Intermountain Healthcare system continues to have capacity to care for patients, and that officials are not curtailing services or canceling what are referred to as elective surgeries.
“We’re not rationing care now,” said Province. “What we are seeing is if the numbers are continuing to rise and if the public refuses to wear masks and social distance and maintain those groups of no larger than 10 socially, then we may get to that point where we have to ration care.”
He said 80% overall hospital utilization is a key number in public health. Any more than that, Province said, and nurse-to-patient ratios can be stretched and wait times and bed availability can be impacted.
“The rate of transmission COVID has, not just linear but exponential, can quickly go from 75% (hospital utilization) to 80% to 90% in a matter of days or weeks,” he said. “It’s really staff to beds: We can have as many beds as we want, but if we don’t have nurses, they’re coming down sick, a 60% (hospital utilization) number, a 70% number is a lot more scary.”
Province said 20% to 30% of nurses statewide have been diagnosed with COVID-19 and forced to quarantine, putting additional stress on a workforce that has already been asked to do so much.
“We’re physically and emotionally fatigued for sure,” he said, adding that morale at the Park City Hospital generally remains high. “I think some folks would like it to be a relay race, hand the baton off to someone else to take it from here, but there’s no one else.”
Province stressed the importance of following public health guidelines to maintain capacity in Utah’s hospitals and to help frontline health care workers. He hearkened back to his experiences in New York, and his desire that they not be repeated here.
“What I saw there was death and dying everywhere. As an emergency physician, I’m used to that, but not at the scale and level that I saw there,” he said. “Oftentimes, I was the last person that someone saw before they died. Because of the visitors restrictions we had there … oftentimes I was calling people on Facetime and holding the iPad for those family members to say goodbye to their loved ones. You hang up, you hold their loved one’s hand until you feel them pass and you move on to the next one.”
He said caregivers generally don’t resent members of the public for their handling of a disease, pointing out that most people don’t have the training that nurses and doctors do, nor their medical expertise.
“What we do find frustrating is when they’re educated but they make it a political issue, refuse to wear masks, spread it to other folks. (That) increases risk we could potentially get it and go home to our families,” he said. “… It’s not a political issue. I took care of just as many Democrats as I did Republicans there.”