Category: Covid-19

Gary Carden, 63, has owned and managed Nespelem's only tavern for about 25 years. Earlier this year, he spent a month in the hospital with COVID-19. Eilis O'Neill/Eilis O'Neill hide caption

Gary Carden, 63, has owned and managed Nespelem's only tavern for about 25 years. Earlier this year, he spent a month in the hospital with COVID-19.

Gary Carden sits on the reclining chair in front of the tavern he's owned and managed for two and half decades in the north central Washington town of Nespelem, on the Colville Reservation. The 63-year-old is on the concrete porch with his two dogs, Sissy and Harold.

"She's the older dog," he says, "and that's probably the best thing that happened to her is finding her a small buddy, 'cause he's so active and keeps her active."

Carden's normally active too, not just running the tavern but riding horses and motorcycles. But, one day this past June, he felt out of breath and exhausted.

"And my sister came walking in," Carden recalls. "And she says, 'God, brother, you don't look good. Do you want me to call the ambulance?' " He replied, "Yeah, I think you better. There's something wrong."

Carden thought he had heat exhaustion. But it was COVID-19. He was transferred to a hospital about 100 miles away, in the city of Wenatchee, Wash.

He spent a month there a week of that time on a ventilator.

"It's tough," Carden remembers. "It was tough. I was even ready to give up."

The Colville Tribal Council has been doing its best to insulate its community from the pandemic.

In mid-March, the council closed the reservation to non-essential travel. And, when members tested positive for the coronavirus, the council helped them isolate by providing portable toilets, mobile homes and even hotel rooms as needed.

But COVID-19 cases are hitting record highs throughout the state. And the reservation's borders are fluid, so even the tribe's extensive precautions haven't been enough to fully protect Colville members. About 300 people on the Colville Reservation have tested positive for the coronavirus.

That's a big hit for a small community of 5,000 people. The infection rate on the reservation is twice that of Washington state's most populous county.

"We got hit so hard," says Larry Smith, a doctor on the reservation who runs two of its four clinics.

Smith says it was scary to see so many COVID-19 patients.

"Probably 80% of the people that I see have some risk factors whether it's hypertension, diabetes, or autoimmune disease," he says.

To Smith, the numbers have been overwhelming.

"For six weeks, we were seeing four to five cases every single day," he says.

Vice-chair of the tribal council Joel Boyd says when cases are up in neighboring communities, it's difficult hard to keep the virus out.

"When you do go off-reservation, there's communities that almost pride themselves on not wearing masks, and it's a serious danger," he says.

Boyd says the most serious outbreaks came from tribal members going off-reservation.

The current outbreak started when a group of about 10 people from the Colville Reservation went to a nearby town in mid-November, before Washington state's governor closed indoor dining again.

"Everyone was getting in their last little hurrah, I guess you would call it," Boyd says. "And unfortunately, that was all it took for us to get a nice little outbreak."

Many people on the reservation live in large, multi-generational households, so the virus spreads rapidly within families.

To try to contain the reservation's current outbreak, the tribal council took a new step: It imposed a curfew to try to keep people from gathering after work.

"A lot of people that have got it recently they're being pretty vocal about, you know, how they got it and that they're sorry for spreading it," Boyd says. "And I'm thankful that they're sharing that to prevent it from happening again."

Boyd says people telling their stories about how they got infected is an important way to spread the word on the reservation about need to take precautions.

Tavern owner Gary Carden says he often shares the story of how he almost died so others on the reservation can learn from what happened to him.

Carden says that during his time in the hospital, "I even told them doctors, you know, 'Hey, I quit. Pull these tubes out.' "

A young intern sat down at his bedside and gave him a pep talk.

"He says, 'Gary, don't give up,' " Carden recalls. " 'You've made it through the hard part. You've got 20-plus years still to go. Hang in there. You've almost got it licked.' "

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Colville Reservation And COVID-19: 'Last Hurrah' To Keep The Pandemic At Bay - NPR

Nerissa Black works as a telemetry nurse at the Henry Mayo Newhall Hospital in Valencia, Calif. Since early December, she's been tasked with caring for six critically ill patients per shift instead of four. Nerissa Black hide caption

Nerissa Black works as a telemetry nurse at the Henry Mayo Newhall Hospital in Valencia, Calif. Since early December, she's been tasked with caring for six critically ill patients per shift instead of four.

California's telemetry nurses, who specialize in the electronic monitoring of critically ill patients, normally take care of four patients at once. But ever since the state relaxed California's mandatory nurse-to-patient ratios in mid-December, Nerissa Black has had to keep track of six.

And these six patients are really sick: they all need constant electronic heart monitoring and many of them are being treated simultaneously for a stroke and COVID-19, or a heart attack and COVID-19. With more patients than usual needing more complex care, Black says she's worried she'll miss something or make a mistake.

"We are given 50% more patients and we're expected to do 50% more things with the same amount of time," says Black, who has worked at the Henry Mayo Newhall Hospital in Valencia, Calif., for the past seven years. "I go home and I feel like I could have done more. I don't feel like I'm giving the care to my patients like a human being deserves."

We are given 50% more patients and we're expected to do 50% more things with the same amount of time.

Nerissa Black, telemetry nurse

As COVID-19 patients continue to flood California emergency rooms, hospitals are increasingly desperate to find enough staff to care for all them. The state is asking nurses to take care of more patients simultaneously than they normally would, watering down what many nurses and their unions consider their most sacrosanct job protection: a law existing only in California that puts legal restrictions on the nurse-to-patient ratio.

"We need to temporarily very short-term, temporarily look a little bit differently in terms of our staffing needs," said Gov. Gavin Newsom, after he quietly allowed hospitals to adjust their nurse-to-patient ratios on Dec. 11. Normally, California law requires a hospital to first get approval from the state before tinkering with those ratios; Newsom's move gave hospitals presumptive approval to work outside the ratio rules immediately.

Since then, 170 hospitals, mainly in Southern California, have been operating under the new pandemic ratios: They can require ICU nurses to care for three patients instead of two. Emergency room and telemetry nurses may now be asked to care for six patients instead of four. Medical-surgical nurses are looking after seven patients instead of five.

This is catastrophic and we cannot dodge this math. We are simply out of nurses, out of doctors, out of respiratory therapists.

Carmela Coyle, President and CEO, California Hospital Association

Nurses have taken to the streets in protest, holding socially distanced demonstrations across the state, shouting and carrying posters that read: "Ratios Save Lives." The union, the California Nurses Association, says the staffing shortage is a result of bad hospital management, of taking a reactive approach to staffing rather than proactive: laying nurses off over the summer, then not hiring or training enough for winter.

"What we're seeing in these hospitals is their just-in-time response to a pandemic that they never prepared for: just-in-time staffing, just-in-time resources, not staffing up, calling nurses in on a shift at the very last minute to boost profits," says Stephanie Roberson, the government relations director for the California Nurses Association. "And we're seeing how nurses are being stretched even thinner."

Unionized nurses in California held a rally Aug. 5 as part of a National Day of Action to increase awareness, they say, of ways nurse staffing ratios in hospitals can have an impact on patient safety. Nerissa Black hide caption

Unionized nurses in California held a rally Aug. 5 as part of a National Day of Action to increase awareness, they say, of ways nurse staffing ratios in hospitals can have an impact on patient safety.

But hospitals say this is an unprecedented crisis that has spiraled beyond their control. In the current surge, four times as many Californians are testing positive for the coronavirus compared to the summer peak. As many as 7,000 new patients could soon be coming to California hospitals every day, according to Carmela Coyle, who heads the California Hospital Association.

"This is catastrophic and we cannot dodge this math," she says. "We are simply out of nurses, out of doctors, out of respiratory therapists."

The state has asked the federal government for staff, including 200 medical personnel from the U.S. Department of Defense, and it's tried to reactivate the California Health Corps, an initiative to recruit retired health workers to come back to work, but that has yielded few people with the qualifications needed to care for hospitalized COVID-19 patients.

Hiring contract nurses from temporary staffing agencies or other states is all but impossible right now, Coyle says.

"Because California surged early during the summer and other parts of the United States then surged afterward," she says, "those travel nurses are taken."

Hospitals' next step is to try "team nursing," Coyle says, pulling nurses from other departments, like the operating room, for example, and partnering them with experienced critical care nurses to help care for COVID-19 patients.

Joanne Spetz is an economics professor who studies health care workforce issues at the University of California, San Francisco. She says hospitals should have started training nurses for team care over the summer, in anticipation of a winter surge, but they didn't, either because of costs hospitals lost a lot of revenue from canceled elective surgeries that could have paid for that training or because of excessive optimism.

"California was doing so well," she says. "It was easy for all of us to believe that we kind of got it under control, and I think there was a lot of belief that we would be able to maintain that."

The California Nurses Association has good reason to be defensive when it comes to the integrity of the patient ratio law, Spetz says. It took 10 years of lobbying and activism before the bill passed the state legislature in 1999, then several more years to overcome multiple court challenges, including one from then-Gov. Arnold Schwarzenegger.

"I'm always kicking their butt, that's why they don't like me," Schwarzenegger famously said of nurses, drawing broad ire from the nurse's union and its allies.

Nurses prevailed in the court of public opinion and in law; rules that put a legal cap on the number of patients per nurse finally took effect in 2004. But the long battle has made nurses fiercely protective of their win. They've even accused hospitals of using the pandemic to try to roll back ratios for good.

"This is the exercise of disaster capitalism at its finest, where [hospital administrators] are completely maximizing their opportunity to take advantage of this crisis," says Roberson.

Hospitals deny they want to change the ratio law permanently, and Spetz says it's unlikely that they'd succeed if they tried.

The public can see that nurses are overworked and burned out by the pandemic, she adds, so there would be little support for cutting back their job protections once it's over.

"To go in and say, 'Oh, you clearly did so well without ratios when we let you waive them, so let's just eliminate them entirely,' I think, would be just adding insult to moral injury," Spetz says.

See the article here:

California Is Overriding Its Limits On Nurse Workloads As COVID-19 Surges - NPR

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The deaths involved three men in their 70s: two from Wasilla and one from Anchorage, the state health department said.

Wednesdays and Thursdays identical case counts were slightly higher than the trend of fewer cases reported in recent weeks after a surge through November and into early December. State health officials have expressed cautious optimism about the overall decline, though more recently they expressed worry that holiday-related travel and celebrations could drive case numbers up again.

We know that some people are still gathering for the holidays, so we could start to see an uptick in cases starting as early as the next week or two, so were really just encouraging Alaskans to continue to be vigilant, said Joe McLaughlin, an epidemiologist with the state health department.

Residents in the Yukon-Kuskokwim region accounted for more than a quarter of the cases reported by the state Thursday. Tribal health authorities separately reported 43 new cases in the region on Wednesday and 26 cases on Tuesday, including 18 in Bethel, 13 in Akiachak and 12 in Chefornak over that two-day period.

Coronavirus-related hospitalizations remain lower than they were in November. Health officials say a hunker-down order in Anchorage thats moving to a less restrictive phase Friday played a role in the decline, as did voluntary actions taken by people around the state. The number of tests completed statewide in recent weeks has also been down.

In total, 205 Alaskans and one nonresident with COVID-19 have died this year. Alaskas overall death rate per capita is among the lowest in the country, but officials say the states vast geography and vulnerable health care system make it difficult to compare with other states.

The state was promised more than 60,000 doses when Alaska received its first shipments of COVID-19 vaccine in mid-December. Hospital workers, emergency personnel, and residents and staff at long-term care facilities were prioritized to receive the first doses. State officials said they expect more than 50,000 doses next month and on Thursday announced that the next group of people eligible to receive the vaccine would include Alaskans over 65, followed by frontline essential workers.

By Thursday morning, 13,271 Alaskans had received vaccinations, according to the states vaccine information site, which has not been updated since Monday. Health officials say they expect the pace of vaccine distribution will pick up in next month.

Around the state, 73 Alaskans with COVID-19 were hospitalized as of Thursday and another six were suspected to have the virus. Just over 8% of adults in Alaska hospitals have COVID-19. In Anchorage, where the sickest patients are often treated, there were 18 intensive care unit beds available out of 69.

Of the 367 infections reported Wednesday among Alaska residents, there were 130 in Anchorage plus six in Chugiak, seven in Eagle River and one in Girdwood; 27 in Fairbanks; 20 in Wasilla; 10 in Palmer; 10 in Juneau; 10 in Bethel; seven in North Pole; six in Kodiak; four in Utqiagvik; three in Soldotna; two in Homer; two in Kenai; two in Houston; two in Petersburg; two in Unalaska; one in Sterling; one in Delta Junction; one in Sutton-Alpine; and one in Ketchikan.

Among communities smaller than 1,000 people not named to protect privacy, there were 51 in the Bethel Census Area; 50 in the Kusilvak Census Area; three in the Fairbanks North Star Borough; two in the Valdez-Cordova Census Area; one in the northern Kenai Peninsula Borough; one in the Southeast Fairbanks Census Area; one in the Yukon-Koyukuk Census Area; one in the Northwest Arctic Borough; one in the Yakutat plus Hoonah-Angoon region; and one in the Bristol Bay plus Lake and Peninsula boroughs.

There were seven cases reported among nonresidents, including one in Anchorage, one in Utqiagvik and five in Unalaska.

While people might get tested more than once, each case reported by the state health department represents only one person.

It is not clear how many of the people who tested positive for the virus were showing symptoms. The Centers for Disease Control and Prevention estimates about a third of people with COVID-19 are asymptomatic.

The statewide test positivity rate as of Thursday was 4.92% over a seven-day average. Health experts say anything above 5% can indicate inadequate testing and potentially widespread community transmission. The state reached a peak of over 9% test positivity in mid-November.

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Tracking COVID-19 in Alaska: 3 deaths, 374 infections reported Thursday - Anchorage Daily News

News Release

Wednesday, December 30, 2020

Results from a study of 19 deceased patients suggests brain damage is a byproduct of a patients illness.

In an in-depth study of how COVID-19 affects a patients brain, National Institutes of Health researchers consistently spotted hallmarks of damage caused by thinning and leaky brain blood vessels in tissue samples from patients who died shortly after contracting the disease. In addition, they saw no signs of SARS-CoV-2 in the tissue samples, suggesting the damage was not caused by a direct viral attack on the brain. The results were published as a correspondence in the New England Journal of Medicine.

We found that the brains of patients who contract infection from SARS-CoV-2 may be susceptible to microvascular blood vessel damage. Our results suggest that this may be caused by the bodys inflammatory response to the virus said Avindra Nath, M.D., clinical director at the NIHs National Institute of Neurological Disorders and Stroke (NINDS) and the senior author of the study. We hope these results will help doctors understand the full spectrum of problems patients may suffer so that we can come up with better treatments.

Although COVID-19 is primarily a respiratory disease, patients often experience neurological problems including headaches, delirium, cognitive dysfunction, dizziness, fatigue, and loss of the sense of smell. The disease may also cause patients to suffer strokes and other neuropathologies.

Several studies have shown that the disease can cause inflammation and blood vessel damage. In one of these studies, the researchers found evidence of small amounts of SARS-CoV-2 in some patients brains. Nevertheless, scientists are still trying to understand how the disease affects the brain.

In this study, the researchers conducted an in-depth examination of brain tissue samples from 19 patients who had died after experiencing COVID-19 between March and July 2020. Samples from 16 of the patients were provided by the Office of the Chief Medical Examiner in New York City while the other 3 cases were provided by the department of pathology at the University of Iowa College of Medicine, Iowa City. The patients died at a wide range of ages, from 5 to 73 years old. They died within a few hours to two months after reporting symptoms. Many patients had one or more risk factors, including diabetes, obesity, and cardiovascular disease. Eight of the patients were found dead at home or in public settings. Another three patients collapsed and died suddenly.

Initially, the researchers used a special, high-powered magnetic resonance imaging (MRI) scanner that is 4 to 10 times more sensitive than most MRI scanners, to examine samples of the olfactory bulbs and brainstems from each patient. These regions are thought to be highly susceptible to COVID-19. Olfactory bulbs control our sense of smell while the brainstem controls our breathing and heart rate. The scans revealed that both regions had an abundance of bright spots, called hyperintensities, that often indicate inflammation, and dark spots, called hypointensities, that represent bleeding.

The researchers then used the scans as a guide to examine the spots more closely under a microscope. They found that the bright spots contained blood vessels that were thinner than normal and sometimes leaking blood proteins, like fibrinogen, into the brain. This appeared to trigger an immune reaction. The spots were surrounded by T cells from the blood and the brains own immune cells called microglia. In contrast, the dark spots contained both clotted and leaky blood vessels but no immune response.

We were completely surprised. Originally, we expected to see damage that is caused by a lack of oxygen. Instead, we saw multifocal areas of damage that is usually associated with strokes and neuroinflammatory diseases, said Dr. Nath.

Finally, the researchers saw no signs of infection in the brain tissue samples even though they used several methods for detecting genetic material or proteins from SARS-CoV-2.

So far, our results suggest that the damage we saw may not have been not caused by the SARS-CoV-2 virus directly infecting the brain, said Dr. Nath. In the future, we plan to study how COVID-19 harms the brains blood vessels and whether that produces some of the short- and long-term symptoms we see in patients.

This study was supported by NIH Intramural Research Program at the National Institute of Neurological Disorders and Stroke (NS003130) and an NIH grant (NS109284).

NINDS (https://www.ninds.nih.gov) is the nations leading funder of research on the brain and nervous system.The mission of NINDS is to seek fundamental knowledge about the brain and nervous system and to use that knowledge to reduce the burden of neurological disease.

About the National Institute on Aging (NIA):NIA leads the U.S. federal government effort to conduct and support research on aging and the health and well-being of older people. Learn more about age-related cognitive change and neurodegenerative diseases via NIAsAlzheimer's and related Dementias Education and Referral (ADEAR) Centerwebsite. For information about a broad range of aging topics, visit themain NIA websiteandstay connected.

About the National Institutes of Health (NIH):NIH, the nation's medical research agency, includes 27 Institutes and Centers and is a component of the U.S. Department of Health and Human Services. NIH is the primary federal agency conducting and supporting basic, clinical, and translational medical research, and is investigating the causes, treatments, and cures for both common and rare diseases. For more information about NIH and its programs, visit http://www.nih.gov.

NIHTurning Discovery Into Health

Lee MH, Perl DP, Nair G, Li W, Maric D, Murray H, Dodd SJ, Koretsky AP, Watts JA, Cheung V, Masliah E, Horkayne-Szakaly I, Jones R, Stram MN, Moncur J, Hefti M, Folkerth RD, Nath A. Microvascular Injury in the Brains of Patients with COVID-19. New England Journal of Medicine, December 30, 2020 DOI: 10.1056/NEJMc2033369.

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NIH study uncovers blood vessel damage and inflammation in COVID-19 patients' brains but no infection - National Institutes of Health

Year in Review: Timeline of COVID-19 pandemic, local health leaders have hope for 2021  WWMT-TV

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Year in Review: Timeline of COVID-19 pandemic, local health leaders have hope for 2021 - WWMT-TV

He couldnt get the vaccine, so I thought let me get it for him, in honor of him, said Brigid Roberson.

HOUSTON Brigid Roberson is one of the 15,000 healthcare workers to get the COVID-19 vaccine at Memorial Hermann Hospital.

She got the shot to honor her grandfather, who died from COVID-19 earlier this month.

Roberson describes her grandpa, James Avery, as 92 years young. He was living in a nursing home, so she hadnt touched him or held his hand since January due to COVID-19 restrictions.

Sometimes he went from depression to being mad. He would call and say, 'You dont love me.' He felt we put him there and left him there. Our hands were tied, because we couldnt get into the nursing home to see him, said Roberson, the regional director of security for Memorial Hermann Hospital.

She hoped the COVID-19 vaccine would change that. But earlier this month, her beloved grandfather got the virus. He died the same morning the first shipment of vaccines arrived at Memorial Hermann Hospital. She was in the room watching when the first frontline healthcare worker in Houston received the vaccine.

When he sat there and got his shot, it was so emotional for me. I literally was sitting there with these big tears on my face, because I thought if they had just had the vaccine a little earlierit could have helped (my grandfather) to maybe live, Roberson said.

Nursing home residents in Houston are getting their shots now. Just this week, Texas moved on to phase 1B of vaccine distribution, so people 65 years old and older and people with underlying conditions can get vaccinated, too.

Roberson proudly got her vaccine wearing a T-shirt honoring her grandfather.

He couldnt get it, so I thought let me get it for him, in honor of him, Roberson said.

She hopes everyone eligible to get the vaccine right away, because every shot thats administered gives everyone else hope for the future.

Excerpt from:

Grandfather dies of COVID-19 two weeks before vaccines arrived at nursing homes - KHOU.com

Harrisburg, PA - The Pennsylvania Department of Health today confirmed as of 12:00 a.m., December 31, that there were 8,992 additional positive cases of COVID-19, bringing the statewide total to 640,325.

There are 5,962 individuals hospitalized with COVID-19, near double the peak in the spring. Of that number, 1,178 patients are in the intensive care unit with COVID-19. Most of the patients hospitalized are ages 65 or older, and most of the deaths have occurred in patients 65 or older. More data is availablehere.

The trend in the 14-day moving average of number of hospitalized patients per day has increased by nearly 5,500 since the end of September.

Statewide percent positivity for the week of December 18 December 24 stood at 15.1%.

The most accurate daily data is available on the website, with archived data also available.

As of 11:59 p.m. Wednesday, December 30, there were 306 new deaths reported for a total of 15,978 deaths attributed to COVID-19. County-specific information and a statewide map are available on the COVID-19 Data Dashboard.

Mask-wearing is required in all businesses and whenever leaving home. Consistent mask-wearing is critical to preventing the spread of COVID-19.

There are 54,828 individualswho have a positive viral antigen test and are considered probable casesand 637 individualswho have a positive serology test and either COVID-19 symptoms or a high-risk exposure.

There are 3,265,129 individuals who have tested negative to date.

In nursing and personal care homes, there are 53,220 resident cases of COVID-19, and 9,730 cases among employees, for a total of 62,950 at 1,470 distinct facilities in all 67 counties. Out of our total deaths, 8,872 have occurred in residents from nursing or personal care facilities. A county breakdown can be found here.

Approximately 19,256 of our total cases are among health care workers.

COVID-19 Vaccine Distribution

Pennsylvania hospitals began receiving shipments of the Pfizer-BioNTech COVID-19 vaccine the week of Dec. 14 and Moderna COVID-19 vaccine the week of Dec. 21.

Through Dec. 31:

A spreadsheet of facilities that have received vaccine can be found here.

Statewide The Wolf Administration has since noon, Dec. 30:

The Wolf Administration stresses the role Pennsylvanians play in helping to reduce the spread of COVID-19:

Updated Coronavirus Links: Press Releases, State Lab Photos, Graphics

All Pennsylvania residents are encouraged to sign up for AlertPA, a text notification system for health, weather, and other important alerts like COVID-19 updates from commonwealth agencies. Residents can sign up online at http://www.ready.pa.gov/BeInformed/Signup-For-Alerts.

MEDIA CONTACT: April Hutcheson - RA-DHpressoffice@pa.gov

# # #

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Department of Health Provides Update on COVID-19: 5,962 Patients Hospitalized and 1,178 Patients in the Intensive Care Unit - Pennsylvania Pressroom

POQUOSON, Va. (WAVY) As the coronavirus pandemic continues, thousands of Americans have had to process grief and loss.

A Poquoson man survived getting covid-19, only to lose a close family friend to the virus.

Many families worldwide are dealing with losing loved ones from the virus, and are looking for better days. 79-year-old Poquoson resident Erbin Lender beat COVID-19, but lost his friend as well.

He passed and I survived, Lender said of his friend, Al McKinney.

In September, Lender and his wife Jane went to Shreveport, Louisiana, to visit the Mckinneys, who are family friends.

They had been to a funeral the week before we got there, and they had contacted COVID, they did not know it at the time when we arrived, Lender said.

Lender was a patient at Willis-Knighton Pierremont in Shreveport, just 15 miles from Willis-Knighton Medical Center North for eleven days. He was taken care of by Dr. Jennifer Prime, who is in charge of the COVID-19 unit.

We treated him with everything we have medically available for COVID-19, Prime said.

Lender was on specialized oxygen for seven days, and then he was put back on regular oxygen.

The doctor told me that it looked like I had come through the hardest part. My lungs were responding, were recovering, Lender said.

Although things were looking up for him, Prime explained to Lender that the ventilator was his only hope of staying alive.

But Lender elected not to go on the machine.

Lender says the hospital staff tried different ways of treating COVID-19 for patients. Some of the methods of treatment worked for him, some did not.

He did require what we call an Airvo that is a oxygen delivery system, Prime said.

In Lenders case, the heating of oxygen was his life saver.

Mr. Lender was able come down off his oxygen requirements and ultimately improve and go home, which was a miracle, Prime said.

However, McKinney, Lenders friend who contracted COVID-19 at the funeral before Lender visited, was also hospitalized at Willis-Knighton North while Lender was in the other hospital.

MKinney died from kidney failure on Sept. 20.

Lender is a survivor, but it still heartbroken over the loss of his friend.

It was a sad circumstance. Thats your friend that youve known all these years, Lender said.

Still, Lender is grateful for the hospital staff for saving his life.

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Poquoson man survives COVID-19, but is heartbroken after losing friend to the virus - WAVY.com

Yellowstone National Park: "Yellowstone visitation statistics for October 2020."

Environmental Research: "Blue space, health and well-being: A narrative overview and synthesis of potential benefits."

Scientific Reports: "Spending at least 120 minutes a week in nature is associated with good health and wellbeing."

Evidence-Based Complementary and Alternative Medicine: "Effects of Walking in Bamboo Forest and City Environments on Brainwave Activity in Young Adults."

NPD Group: "America Outdoors: Consumers Are Flocking to These 5 Activities."

J.J. Clause, retired school music teacher, South Lake Tahoe, CA.

Jeff Stafford, Danville, IN.

John Norcross, PhD, professor of psychology, University of Scranton, Scranton, PA.

Matt Powell, adviser, NPD Group, Port Washington, NY.

Ben Page, forest therapy guide, founder of Integral Forest Bathing, Los Angeles.

Denise Lu, education coordinator, Los Angeles County Arboretum & Botanic Garden, Arcadia, CA.

David Sabgir, MD, cardiologist, Columbus, OH.

Manuela Siegfried, forest therapy guide, Santa Ana, Costa Rica.

Philadelphia Inquirer: Anthony Fauci talks with Jefferson doctors about coronavirus vaccines, herd immunity, and how long well need masks

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Get Out: Nature Is the Fix for COVID-19 Stress - WebMD

Doyle Coleman, chief medical officer, begins to layer on protective gear to treat a COVID-19 patient. All of the gear must be put on before entering the room, and taken off immediately after leaving. Nick Mott for NPR hide caption

Doyle Coleman, chief medical officer, begins to layer on protective gear to treat a COVID-19 patient. All of the gear must be put on before entering the room, and taken off immediately after leaving.

When the coronavirus hit the U.S., hospitals issued strict limitations on visitors. Nurses and doctors started acting as liaisons to the sick and dying for family members not allowed at bedsides. As deaths reach new daily highs, that work is not getting any easier. The emotional toil of adapting to new dynamics with patients and families at one rural hospital in Livingston, Mont., is a case study of what health care workers are grappling with all over the country.

Framed by the rugged Absaroka Mountains in south-central Montana, Livingston HealthCare looks more like an upscale ski chalet than a medical facility. It's one of more than 1,300 critical access hospitals in the U.S., which are federally designated to increase health care access in rural areas. Here, the hospital has 25 beds and serves a huge region about twice the size of Rhode Island but with a population just shy of 17,000.

Livingston HealthCare is one of more than 1,300 critical access hospitals in the U.S. Built in 2015, it serves an area twice the size of Rhode Island, home to about 17,000 people. Nick Mott for NPR hide caption

Livingston HealthCare is one of more than 1,300 critical access hospitals in the U.S. Built in 2015, it serves an area twice the size of Rhode Island, home to about 17,000 people.

It's about an hour drive north of Yellowstone National Park, and the walls are dotted with images of trout and breathtaking vistas.

On this windy, wintry mid-December day, three beds here are occupied by COVID-19 patients.

End-of-life care

Assistant Director of Nursing Jenn Schmid is in one of Livingston HealthCare's two ICU rooms. Before COVID-19, Schmidt's job was mostly administrative but she stepped in to fill the hospital's need during the area's coronavirus surges. One duty she took up was spending time with families as they said farewell to loved ones through the ICU's glass windows. Nick Mott for NPR hide caption

Assistant Director of Nursing Jenn Schmid is in one of Livingston HealthCare's two ICU rooms. Before COVID-19, Schmidt's job was mostly administrative but she stepped in to fill the hospital's need during the area's coronavirus surges. One duty she took up was spending time with families as they said farewell to loved ones through the ICU's glass windows.

Jenn Schmid, the assistant director of nursing, is standing outside large windows that offer a view inside the hospital's two ICU rooms. This is the epicenter of the pandemic in the hospital where the worst cases are. The beds are empty and neatly made. Soft, yellow light is pouring in from outside. But a few weeks ago, the scene here would have looked very different. Over the past several months, cases in the area ebbed and flowed and they were in the midst of the biggest spike they'd seen so far.

"My job consisted of 24/7 begging people to try to come in to get help, coming in to try to staff it myself, just because we didn't have enough nurses," Schmid says.

The CDC recommends that hospitals limit visitation, especially during times of community spread. Figuring out how to do so requires balancing safety with the emotion and trauma faced by patients and their families.

Here, the hospital banned visitors, but there are exceptions. When patients near the end of their lives, their closest relatives are allowed to say their goodbyes from a distance through those windows that look into the ICU. Schmid sat outside the room with families. She says that glass barrier between patients and their loved ones made farewells an even more emotionally devastating experience.

"Having to sit out here with family and try to be their support and give them that affection or that caring when you yourself have to stay 6 feet away and they can't see their dad or their husband for the last time and you have to watch that, it's gut-wrenching," she says. "And I don't think I'll ever get used to that. I've seen a lot of death and I've held multiple peoples' hands while they're dying. But I've never had anything that has affected me like that. It's so foreign. And it's tragic."

Respiratory therapist Mary Graham sets up a ventilator at the height of the pandemic at the facility. Three critical patients were on those machines while the hospital had only two dedicated ICU rooms. Ordinarily, the hospital would be able to transfer its worst cases to larger facilities in the area, but COVID-19 had pushed those over capacity too. Nick Mott for NPR hide caption

Respiratory therapist Mary Graham sets up a ventilator at the height of the pandemic at the facility. Three critical patients were on those machines while the hospital had only two dedicated ICU rooms. Ordinarily, the hospital would be able to transfer its worst cases to larger facilities in the area, but COVID-19 had pushed those over capacity too.

Respiratory therapist Mary Graham says all 265 health care workers at the hospital are taking on more responsibility to care for patients. "The hardest thing is watching them go without their family members," she says.

She's been in the room twice when this happened. She says she holds the patient's hand and says a prayer. She hopes that can give families an ounce of closure. "It's tough," she says.

Patients and families

A canvas photo of Lori Schmidt and her late husband Jerry on vacation. The photo was a gift after Jerry passed away of COVID-19 in Livingston HealthCare on Nov. 15. Nick Mott for NPR hide caption

A canvas photo of Lori Schmidt and her late husband Jerry on vacation. The photo was a gift after Jerry passed away of COVID-19 in Livingston HealthCare on Nov. 15.

Doctors and nurses experience that isolation very differently than patients and family members, who maintain connection with each other only through screens and glass. Last month, Lori Schmidt's husband Jerry was in one of those ICU rooms.

"If I had known that I would never get to hold his hand or anything again, oh my gosh, I would've done things so differently," Schmidt says. "But I guess naively I really didn't think Jerry was gonna die from this."

She's 59, a retired banker and calls herself a "glass-half-full" kind of person. Her husband was 74.

While Lori Schmidt's husband Jerry was in the hospital, she was unable to visit him. "If I had known that I would never get to hold his hand or anything again, oh my gosh, I would've done things so differently," Schmidt says. "But I guess naively I really didn't think Jerry was gonna die from this." Nick Mott for NPR hide caption

While Lori Schmidt's husband Jerry was in the hospital, she was unable to visit him. "If I had known that I would never get to hold his hand or anything again, oh my gosh, I would've done things so differently," Schmidt says. "But I guess naively I really didn't think Jerry was gonna die from this."

"He was an amazing man," she says. "He could build, fix, wire. He was an electrician. He could do anything he could rebuild a Mustang from start to finish."

One night in early November, her husband fell down in their house. He had a fever and was throwing up. She called the paramedics, who took him to the hospital. It was the last time she saw him face to face.

Schmidt says at Livingston HealthCare, nurses would call her from her husband's cellphone on FaceTime.

"When Jerry pops up on my phone, there's a big daisy and when I would see that, no matter how bad I felt, I felt renewed," she says. "It was like 'Jerry's calling!' I was so excited."

With her husband in isolation, it was the closest she could get to human contact. When it became clear it was the end, the hospital brought the family into the ICU, where they could see Jerry through the window.

She says nurses were at his side. They sang him songs to help him feel at ease, and helped relay what Schmidt and her family were saying.

"[They were] trying to make him feel like he didn't have to hold on anymore because he was so tired," she says.

Schmidt says Jerry passed peacefully on Nov. 15 after 12 days in the hospital. As we talk, it's been one month, to the minute, since his death.

Schmidt's thankful for the health care workers who made sure her husband felt less isolated. Screens, windows and all the small efforts of health care workers are a saving grace for Schmidt and people like her.

"I mean, that made all the difference in the world."

Bedside manner

The emergency department at Livingston Healthcare. The Absaroka Mountains just outside the facility run south toward Yellowstone National Park. Nick Mott for NPR hide caption

The emergency department at Livingston Healthcare. The Absaroka Mountains just outside the facility run south toward Yellowstone National Park.

"Nursing is touching and interaction," says Per Gunness, an ICU and medical surgical nurse at Livingston HealthCare. "To hide the part of your face which shows your emotions, your intentions, your fear, your humor. You try to smile really hard so your eyes show it. That's been incredibly bizarre."

Health care workers layer up in masks, protective glasses and other gear to stave off the spread of the disease. Instead of smiles and facial expressions, only their eyes perched above an N95 can show emotion and establish connection.

"It makes me sick to my stomach thinking about that, like, so many people are dying alone and their nurse has maybe known 'em or a couple of days is the last person they see," medical floor nurse Kristy Blaine says.

She says she recognizes the emotional work it takes to keep patients feeling connected.

Travel nurse Michael Niynaku, tasked with treating COVID-19 patients for the day, at a nurses' station in front of baggies containing staff members' N95 masks. Nick Mott for NPR hide caption

Travel nurse Michael Niynaku, tasked with treating COVID-19 patients for the day, at a nurses' station in front of baggies containing staff members' N95 masks.

"You also, you know, feel bad for your patients because these Martians are coming in, looking so different," Blaine says. "You know, you literally look like an alien and you're trying to care for your patients, and they just feel like lepers."

Blaine does what she can to make the hospital feel less sterile for her patients. She keeps a squishy, pink-haired unicorn dangling from a keychain on her ID badge. When you squeeze it, she demonstrates, a little brown bubble forms on its backside.

"It poops," she whispers, laughing." I like to joke around and I like to have fun and I feel like we all only get one trip on this Earth and it might as well be part of a good old laugh. You know nurses always ask about poop."

Blaine says that for nurses, adaptability is part of the job description. With only eyes peering out behind a mask, that pooping unicorn is one way of bringing joy into a world of isolation.

Limits on visitations in hospitals across the country are unlikely to change much until this spring or summer, when vaccines are widely available. Until then, health care workers will continue to adapt, to innovate, and to find reasons to smile.

Read more from the original source:

COVID-19 And End-Of-Life Care: A Hospital Is Case Study For Mental Toll - NPR