One year of COVID-19 on the South Shore: What weve learned; doctors reflect – The Patriot Ledger

First of five parts.

More than a year ago, on March 2, the state announced that a woman from Norfolk County had the second presumptive case of COVID-19 in Massachusetts. In her 20s, she had just come back from traveling to Italy, state officials said. Health officials at the time said the risk for the general population was low.

Nine days later, on March 11,the World Health Organization declaredCOVID-19 a global pandemic. Two days after that,Gov. Charlie Baker closed local schoolsand banned indoor dining. By March 23, the state had a stay-at-home order in place andbusinesses that were not consideredessential were told to close.

Since then, more than 525,000 people in the United States have died because of COVID-19, and no one's life looks like it did one year ago. Favorite restaurants have shuttered, kids have missed out on a year of being in classrooms full time, jobs were lost, weddings and high school proms were canceledand grandparents and loved onesdied alone.

A nurse helps a nursing home resident have a virtual visit with a family member during the COVID-19 pandemic.AARP Photo

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Many people are working from home, but others dont have the luxury. People are more isolated, families have missed important milestonesand birthdays, anniversaries and holidays have been celebrated alone.

A year of COVID-19 haswrought unprecedented upheaval on the South Shore and around the world, and experts say the ramifications will be felt for years.

For Joyce Babineau, the hardest part of her day now is driving home to New Bedfordfrom her jobat Stop & Shop to an empty house. Her husband, Paul Babineau, is not there to greet her, ask about her day or make her coffee.

Paul Babineau, 76, died from COVID-19 in October, one of more than 16,000 peoplekilled by the virus in Massachusetts.

He was admitted into the hospital. I was quarantined at home. So of course we couldn't see each other, Joyce Babineau said. My husband ended up dying alone.

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Babineau is a scanning coordinator at the Stop & Shop in Dartmouth, and a union steward for United Food and Commercial Workers Local 328, which represents Stop & Shop workers from Quincy to Rhode Island.

She said when the pandemic started, she was afraid because of her husbands health.

I was afraid that I would bring it home to my husband. My husband's 76 years old and he's retired and he hadhealth issues, Babineau said. So my fear was always that I would end up bringing it home, which I did. It's something that I have a very hard time living with because I know I gave it to my husband.

Babineau said she believes she got sick from a co-worker who came to work with the virus.

Babineau said she first met her husband decades ago, when he was playing guitar in a band. She fell for the guitar player.

They were married for nearly 40 years.

I was going to retire at the end of the year, so we could spend time and travel together. But now I have nothing, she said.

Studies have shown that life in lockdown and thefear and nervousness that come with it have taken a toll on the nations mental health. A study from Boston University showed that symptoms of depression were three times more prevalent during the pandemic in a group of more than 1,400 participants. Lower income andhaving less than $5,000 in savings were associated with a greater riskfor depression, the study found.

The U.S. Census Bureau, in collaboration with the U.S. Centers for Disease Control and Prevention, hasalso been monitoring depression and anxiety in U.S. households amid the pandemic. The federal bureaus estimatethat about 11 percent of American adults had symptoms of anxiety disorder or depressive disorder before the pandemic. The number of people expressing symptoms of those mental health issues rose above 42 percent in December.

Brenda Burke of Holbrook and husband Mike Flagg wave to her mom Mary, 91, through her window at the Queen Anne Nursing Home in Hingham.Greg Derr

What we're seeing is a significant increase in depression and anxiety, said Luana Marques, a clinical psychologist at Massachusetts General Hospital and a professor at Harvard Medical School. We're also seeing reports of first responders having symptoms of post-traumatic stress disorder and acute stress disorder.

Marques said the length of the pandemic, something people may not have prepared for mentally, may be a factor in the stress.

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I think people sort of adjusted as quickly as they possibly could, but it's become a marathon with no end in sight, Marques said. The chronic stress that the brain is facing is certainly leading to feeling emotionally exhausted, feeling like it's hard to keep going, and some of the protective factors like social support, of course, they're not there to the extent that they had been before. I am seeing a decrease in resilience for the majority of people.

Dr. NassirGhaemi,a professor of psychiatry at Tufts University School of Medicine, said social isolation is a chief factor in rising levels of depression.

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"Social distancing means social isolation,"Ghaemi said. "There's a huge literature in medical research for decades that social isolation is associated with medical and psychiatric illnesses. It increases the risk of diabetes, heart disease, obesity among medical illnesses."

Ghaemi said that increased harm,like the side effects of depression, could have a major impact spread over such a wide swath of people.

"The thing about public health is it only takes a small, negative harm, when applied to the large population, to give you real, noticeable, social harms," Ghaemi said. "When half the population is a little depressed, that means that the people who are already a little depressed at the extremes are going to get more non-functional, whereas before maybe they might've handled it. That's the issue."

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Marques said right now she is focusing on prevention and building resilience.

Will there be long-term effects? Absolutely. What do they look like? I don't think we can predict, Marques said.

CynthiaSierra, the chief executive officer of Manet Health Community Health Center, said the beginning of the pandemicgalvanized the state and its health systems' emergency preparedness to deal with a threat that they had spent years getting ready for.

The best-laid plans, however, don't always turn out as expected, she said.

We realized very, very early on, in January into early February, that we need to make greater investments in personal protective equipment and disinfection supplies, Sierra said. "We are a very fiscally disciplined charitable community health center, so we didn't have a lot of surplus.

Manet Community Health Center is a nonprofit health and social services provider based in Quincy, Hull and Taunton. It has served the South Shore for more than 40years. Sierra said her team faced supply shortages andhad to bolster its telehealth offerings and communication effortsquickly to help address the pandemic.

Mayor Thomas Koch and Cynthia Sierra at the Manet Community Health Center's Houghs Neck location in Quincy.Greg Derr/The Patriot Ledger

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We learned early on that it was going to be (phone) calls. It was going to be person-to-person outreach. It was going to be video conference meetings, Sierra said. It was a lesson learned for us in a very positive way to be a little bit less electronic because that's how you're really going to be able to communicate the most pressing priorities and then also leave room for engagement and questions.

She said the role of a community health center that treats people regardless of their ability to paywas vital during the pandemic. Sierra said it was especially important in the early days of last March to ramp up testing.

"We had to find those pathways to do the testing because our principal role was to be a shock absorber for the hospitals, Sierra said. If we could screen and test and educate and isolate or quarantine, if necessary, patients and (other people), we're contributing to the broader health of the community by stopping the spread, but also keeping those hospitals and those hospital emergency departments, in particular, available and open."

Manet Community Health Center's Dr. Lily Yung, talks with 102-year-old Quincy resident Dorothea Neal as she gets her first COVID vaccine.Lisa Aimola, City of Quincy in partnership with Manet

Dr. Richard Nesto, chief medical officer of Beth Israel Lahey Health, said that a lesson he took away from the pandemic was the need for a more centralized response.

I never, a year ago got up in the morning and said to myself, what if we have a pandemic? ... And yet it's not like this hasn't happened before in recent memory to a lesser degree, like with H1N1, for instance," Nesto said. There needs to be a more centralized, dedicated effort for us to get ahead of these things. Because I think the hallmark of the spring was the lack of preparedness for something that everyone said is a once in a lifetime that actually may not be anymore.

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Nesto said that his health system, which includes hospitals in Boston, Needham, Milton and Plymouth, essentially turned into one large hospital to deal with the pandemic.

We made all of the beds from Plymouth to Newburyport available to any patient in our geography that needed a hospital bed, Nest said. We actually broke down traditional referral patterns that patients and providers were used to.

He said each hospital also had to adjust to accepting many more emergency patients than usual.

Emergency room nurse Megan Cataldo of Marshfield gets a computer ready in the treatment area of South Shore Hospital's mobile integrated health unit on Tuesday, March 17, 2020.Greg Derr

We had to learn how to expand our hospitals to accommodate a huge influx of sick patients through our emergency rooms, Nesto said. Ordinarily, hospitals have many more patients because of elective surgeries and other procedures that are planned. That was a huge, huge hill to climb.

He said the pandemic also showcased the importance of community hospitals, which helped absorb many sick patients.

Dr. Jason Tracy,chief of emergency medicine at South Shore Hospital, said that besides the influx of patients and the need for personal protective gear, another big hurdle was the mysteries surrounding COVID-19.

I think the biggest issue that we grappled with was the unknown, and quite frankly, the very deep fear of our own personal safety and the safety of the staff taking care of our patients, Tracy said. It was coming and seeing patients and what that meant for me and others in terms of going home and seeing our families. Do we shower before we get into the house? Do we sleep in the basement away from our family members? All of the stuff that, again, fortunately, has become less of a concern, primarily through vaccination, but alsolearning more about the disease. But it was a very scary time in those early days."

Emergency Room Chief Dr. Jason Tracy stands in South Shore Health's auxiliary outdoor emergency room on Tuesday, March 17, 2020.Greg Derr

The hospital and South Shore Health's network faced the coronavirus crisis head-on byrelying on incident training done over the years in coordination with the federal government. The hospital set up an auxiliary outdoor emergency room in a tent and pivoted its mobile health unit to help with the pandemic.

The mobile unit, with trained paramedics, was set up before the pandemic for people who might not be able to make it to a hospital or doctors office. Administrators said the unit was a huge help because many patients were avoiding care because of the pandemic.

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You have a bunch of patients that have chronic diseases that typically we would manage pretty actively, whether that's in the primary care world or in a specialist's office, or there are patients that are here in the hospital frequently, and suddenly we weren't seeing any of them, said Dr. Kelly Lannutti, South Shore Healths chief of urgent care. I think we all recognized that we needed to do things differently for those patients, and I think for us, having mobile integrated health ready to go was obviously a huge blessing.

William Tollefsen, South Shore Healths vice chair of emergency medicine and urgent care, said they had one patient, a 95-year-old woman, who had been discharged from a nursing home with a wound that needed to be evaluated. She wouldnt come to see a doctor because of the pandemic, but did allow a paramedic to visit her and help assess the wound. He said she hadnt been enrolled in mobile health before the pandemic andserves as an example of how the service adapted.

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Tollefsen said one thing the pandemic reinforced was the importance of preventive care. He said that many of the non-COVIDpatients who came in would be in worse shape than they would be before the pandemic because they delayed seeking help.

While we had almost 50 percent of the number of patients in the emergency department, the acuity of the patients that we had with non-COVID illness was palpable, Tollefsen said. We had a significant increase in sudden cardiac death. We had increases in patients with sepsis. We had increases in other types of illnesses.

The first COVID-19 vaccine arrived at South Shore Hospital on Tuesday, Dec. 15, 2020.Greg Derr/The Patriot Ledger

Tracy said despite all the planning and success in fightingthe pandemic, COVID-19 has still taken an immense toll on the staff.

One of the roles that I have here is going and rounding on the floors and interacting with the staff on these COVID-dedicated areas, and the tears that come from people's eyes as they start to talk about their day, their week, their month, their year, is heartbreaking because people are sad. They have been really hurt by this. We've never had to manage a patient dying with a family member on Zoom, Tracy said. That's heartbreaking. And you could do that multiple times a day.

The state's vaccination efforts continue with 703,676 fully inoculated as of March 8. That's positive news. However, Tracy said there is still a lot to learn.

I still remain worried about what's to come. Until we can get to the point that our population is vaccinated, we're always going to be learning more about this. That's the one thing we've learned about this virus, is there's more to learn, Tracy said. As a system and as health care providers, we have to be nimble and understand that things are changing and going to continue to change. We are in this for the long haul. This is going to be our new normal. I think as we anticipate going into the future, there'll be some element of masking and a vaccination program and patients with COVID-19 in our system for a while to come. It will be here for a while.

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On Monday, the U.S. Centers for Disease Control and Prevention said it was safe forfully vaccinated Americans to gather without masks or to visit a small group of unvaccinated family members so long as they weren't in a high-risk category.The agency said that fully vaccinated people should still use social distancing measures and masks in crowds and in public, however.

Tollefsen said going forward, people will have a lot more insight into their risk tolerance in terms of going to a packed restaurant or attendinga concert. He said people who live with a sick family member might continue to avoid crowds. Tollefsen said his own behavior as a physician will change.

Maryann Salvatore kisses her husband Mario through the protective plastic at the Dwyer Home in South Weymouth.Greg Derr/The Patriot Ledger

I can't see walking into a room with a patient with respiratory distress or having some respiratory symptoms, now until forever, not wearing (personal protective equipment), Tollefsen said.

Lannutti said some elements of health care will also change. Telehealth, for example, will likely be a larger part of how people interact with doctors.

Sierra, from Manet Health, said the resiliency people have shown over the past year is a sign of hope.

It's definitely been a challenging year but it's also demonstrated the strength in the community and truly our ability to be tested and I think to rise to that call, Sierra said. I think in the end, honest to goodness, it's about the purity and the goodness of the community."

Joe Difazio can be reached at jdifazio@patriotledger.com. Follow him on Twitter @jldifazio.

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The coronavirus pandemic upended the lives of everyone on the South Shore one year ago. From those in day care to those in nursing homes, no life looks the same today as it did in March2020. Dozens of local businesses have closed, hundreds of South Shore residents have died, thousands of students remain out of school and tens of thousands face unemployment. March 10 markedthe one-year anniversary of Gov. Charlie Baker's state of emergency order in response to the coronavirus pandemic, and we arelooking back on a year of chaos and confusion with this five-part series.

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One year of COVID-19 on the South Shore: What weve learned; doctors reflect - The Patriot Ledger