WEBVTT - Breakthrough, Part Five: The Covid Fortress 0:00:01.600 --> 0:00:03.240 What were you doing in there? I'm making sure they 0:00:03.279 --> 0:00:05.840 clean don Long's event. I don't want one more person 0:00:05.920 --> 0:00:08.280 getting a super bug might be too late for that. 0:00:08.480 --> 0:00:12.400 In March, an episode of a Fox Network television show 0:00:12.440 --> 0:00:16.280 called The Resident appears about a lethal fungus spreading through 0:00:16.280 --> 0:00:20.360 a fictional hospital. The fungus has an ability to attack 0:00:20.400 --> 0:00:25.120 people with underlying conditions, such as diabetes. The hospital staff 0:00:25.200 --> 0:00:26.680 go to great pains to try to get rid of 0:00:26.760 --> 0:00:31.040 the infection without causing panic or revealing their own mistakes. 0:00:31.960 --> 0:00:36.519 Canada Horse is highly dangerous and immune coupleized patients. Half 0:00:36.560 --> 0:00:40.040 the people will get it die. The coronavirus actually makes 0:00:40.040 --> 0:00:42.960 a brief appearance in the episode We're Lucky is not 0:00:43.000 --> 0:00:45.400 in irriable, and like the coronavirus, his dad is not 0:00:45.440 --> 0:00:48.640 at risk, but the patients could be, but it doesn't 0:00:48.680 --> 0:00:51.640 really figure into the plot anyway. One of the writers 0:00:51.640 --> 0:00:55.000 behind this episode is named Daniella Lamas, and around the 0:00:55.040 --> 0:00:57.560 time of the ears the episode starts to feel like 0:00:57.840 --> 0:01:00.800 reality for her. That's be As. In addition to being 0:01:00.800 --> 0:01:03.880 a TV show script writer, she's an ICU doctor at 0:01:03.880 --> 0:01:08.200 Brighaman Women's Hospital in Boston. Initially, this sort of odd 0:01:08.240 --> 0:01:12.720 feeling of truth being stranger than fiction, and and for 0:01:12.920 --> 0:01:15.360 feeling slow to kind of realize that this was real. 0:01:15.440 --> 0:01:17.119 You know, I have friends who work in New York, 0:01:17.160 --> 0:01:21.119 like we saw what was happening there, but even so 0:01:21.640 --> 0:01:25.120 it took a little bit of time to to to realize, 0:01:25.120 --> 0:01:29.480 oh my gosh, this is this is happening. Reality was 0:01:29.520 --> 0:01:32.679 following an alternative script in which a coronavirus was the 0:01:32.880 --> 0:01:36.840 arch villain. Swaved in Ppe, Lamas was taking care of 0:01:36.880 --> 0:01:41.880 patients with a previously unknown disease COVID. Nineteen hundreds across 0:01:41.920 --> 0:01:45.319 Massachusetts became sick, with the disease piling into the hospital 0:01:45.400 --> 0:01:50.559 in unforeseen numbers. Brigham Women's has a sixteen floor patient tower, 0:01:51.040 --> 0:01:53.840 but across the street there's a newer cardiology building with 0:01:53.880 --> 0:01:57.040 a number of rooms with negative airflow that can be 0:01:57.120 --> 0:02:00.880 useful for keeping viruses under control. So the cardiology building 0:02:00.880 --> 0:02:03.880 became a COVID facility. It was in one of those 0:02:04.000 --> 0:02:07.280 rooms that Lamas took care of the patient. She'll never forget. 0:02:07.720 --> 0:02:10.240 There's a room that will always be a guy in 0:02:10.280 --> 0:02:12.959 his thirties with developmental delay who got COVID in his 0:02:13.080 --> 0:02:16.240 group home and who was on a lung bypass machine 0:02:16.400 --> 0:02:19.079 to keep him alive. But when it was clear that 0:02:19.080 --> 0:02:21.520 that was not going anywhere, and we had to tell 0:02:21.600 --> 0:02:23.960 his mother that that he was was going to die, 0:02:24.040 --> 0:02:27.520 and she asked us not to take him off the 0:02:27.520 --> 0:02:29.560 machine on Mother's Day, which was a Sunday, so we 0:02:29.560 --> 0:02:32.560 waited until Monday morning. I was off that Monday morning. 0:02:32.560 --> 0:02:36.359 It was no longer my time on service. Normally, interns 0:02:36.360 --> 0:02:39.000 and training were generally kept at a distance from COVID 0:02:39.000 --> 0:02:42.040 patients because of the risk of catching the disease. But 0:02:42.160 --> 0:02:45.160 on the morning that Lamas's patient died, she wasn't in 0:02:45.160 --> 0:02:47.840 the hospital. So an intern who had been involved in 0:02:47.840 --> 0:02:51.600 his care put on protective gloves, a gown and mask 0:02:52.080 --> 0:02:54.040 and went into the room with him, and she held 0:02:54.040 --> 0:02:57.720 the phone to his ear, and you know, his family 0:02:57.800 --> 0:03:00.480 said goodbye and told him apparently what heaven would be like. 0:03:00.600 --> 0:03:03.359 And remember sure he telling her me that that night, 0:03:03.919 --> 0:03:06.359 and I felt so short of guilty that she had 0:03:06.360 --> 0:03:10.200 been in there and gotten that experience. Um it also 0:03:10.280 --> 0:03:11.760 said it was good because she realized she had never 0:03:11.760 --> 0:03:14.400 really seen the patient before. Because we kept the interns 0:03:14.440 --> 0:03:17.040 from examining, from being in the rooms as possible, you know, 0:03:17.160 --> 0:03:20.000 we sort of did the exams as attendings, and so 0:03:20.080 --> 0:03:21.839 she's like, I've been caring for him for weeks since 0:03:21.880 --> 0:03:24.040 was the first time I saw his face, and so 0:03:24.160 --> 0:03:26.040 sort of those moments, I think, you know, are things 0:03:26.040 --> 0:03:29.520 that will always be in our minds. Even doctors had 0:03:29.560 --> 0:03:31.840 difficulty believing what they were seeing happen in front of 0:03:31.880 --> 0:03:35.680 their eyes. COVID was changing everything. But there was a 0:03:35.720 --> 0:03:39.000 big difference from Lamas's show, where doctors were trying to 0:03:39.080 --> 0:03:42.240 hide the infection in the hospital. Now they were trying 0:03:42.280 --> 0:03:44.360 desperately to make clear to the rest of the world 0:03:44.840 --> 0:03:48.080 what was really happening within their walls and how COVID 0:03:48.160 --> 0:03:51.680 was changing your rules collide Ishmael is a colleague of 0:03:51.720 --> 0:03:54.920 Lamas is. We specializes in taking care of lung disorders. 0:03:55.480 --> 0:03:58.200 This like a big conspiracy, I know. I think once 0:03:58.200 --> 0:04:00.200 we start to hear these things on the out side 0:04:00.240 --> 0:04:01.960 and see what's happening on the inside, I mean, I 0:04:02.000 --> 0:04:06.320 think that really affected, you know, the way I see things. 0:04:06.440 --> 0:04:10.000 And you know, I usually don't post much on on 0:04:10.000 --> 0:04:12.520 social media, and I went, actually I had like a 0:04:12.560 --> 0:04:17.440 post about people please listen and please follow recommendations for 0:04:17.600 --> 0:04:21.240 prevention and PPE and mask and social distancing and all 0:04:21.279 --> 0:04:26.279 of that. Now, Lamas and Ismail are both working in 0:04:26.320 --> 0:04:28.159 a Brigham clinic where they take care of people with 0:04:28.240 --> 0:04:31.599 long COVID, a mysterious syndrome they can affect people months 0:04:31.680 --> 0:04:34.880 after they've been infected, even if their cases aren't serious. 0:04:35.960 --> 0:04:39.120 Bit by bit, COVID is altering the space where they work. 0:04:40.080 --> 0:04:43.360 Hospitals have long occupied a singular place in the community 0:04:43.600 --> 0:04:47.080 and in the imagination. There are a place where discoveries 0:04:47.080 --> 0:04:49.599 are made, where friends and relatives come to be with 0:04:49.640 --> 0:04:55.760 a sick where medical miracles can happen. But that's changing. Increasingly, 0:04:55.960 --> 0:04:59.760 hospitals are becoming fortresses that must carefully limit who enters 0:04:59.839 --> 0:05:02.880 and who exits, no matter how many gowns and masks 0:05:02.920 --> 0:05:06.240 they have. Now, workers are feeling overburdened with caring for 0:05:06.279 --> 0:05:10.160 COVID patients who may stay for months needing highly intensive care. 0:05:11.480 --> 0:05:15.600 Miracles are getting harder and harder to perform, and many 0:05:15.600 --> 0:05:20.240 healthcare workers now feel less trusted than ever before. I'm 0:05:20.320 --> 0:05:23.440 John Lawerman, and I'm a journalist with Bloomberg News from 0:05:23.440 --> 0:05:47.400 the Prognosis podcast. This is Breakthrough Riemond Women's the hospital 0:05:47.440 --> 0:05:50.919 where scriptwriter Danielle Allamas works as a doctor is one 0:05:50.960 --> 0:05:53.440 of the most storied in the world. It can trace 0:05:53.480 --> 0:05:56.600 its history back almost two years when it was one 0:05:56.640 --> 0:06:01.400 of the first American maternity hospitals. Come doctors actually developed 0:06:01.440 --> 0:06:05.159 the idea of the intensive care unit in the nineteen fifties. 0:06:05.760 --> 0:06:08.640 You're in Boston um and at the Brigham. Yes, we 0:06:08.720 --> 0:06:12.640 definitely have critically ill, unvaccinated patients, but not to the 0:06:12.680 --> 0:06:14.919 extent that there are in other places in the country. 0:06:15.000 --> 0:06:17.560 In our vaccine rights are good here in Massachusetts, and 0:06:17.600 --> 0:06:19.640 there's some outlying hospitals who have been a lot more 0:06:19.720 --> 0:06:22.200 hit than we are. My father is a doctor in Miami, 0:06:22.279 --> 0:06:24.520 and so the hospital he works at is just full 0:06:24.640 --> 0:06:28.600 of one vaccinated, super sick on vaccinated COVID and and 0:06:28.640 --> 0:06:31.000 I think, you know, there's a different tone to it. 0:06:31.400 --> 0:06:34.080 The pandemic is making health workers feel like they're on 0:06:34.080 --> 0:06:37.800 an island. On the outside, the hospital looks pretty much 0:06:37.800 --> 0:06:41.320 the same as it always did, banners, the glass and steel, 0:06:41.839 --> 0:06:45.440 the emergency room, parking lot. On the inside, it's become 0:06:45.480 --> 0:06:49.240 a very different place, one of constant stress and worry 0:06:49.360 --> 0:06:53.080 and feeling like there's no way out. Late this summer, 0:06:53.160 --> 0:06:56.600 Idaho was overrun with COVID cases. At one point there 0:06:56.640 --> 0:07:01.280 were more than six people hospitalized. That about more than 0:07:01.320 --> 0:07:05.000 in December, when COVID was running rampant across the US 0:07:05.040 --> 0:07:10.160 and vaccines weren't yet available. Staffing shortages were limiting hospital's 0:07:10.200 --> 0:07:15.360 ability to provide good standards of care. Even today, only 0:07:16.440 --> 0:07:21.480 Idaho residents are fully vaccinated. Washington's Governor j Insley appealed 0:07:21.520 --> 0:07:25.320 to Idaho residence to wear masks because the Idaho crisis 0:07:25.720 --> 0:07:29.920 was spreading west into his state. Jim Susa is a 0:07:29.920 --> 0:07:33.160 pulmonologist at St. Luke's Hospital and catch him Idaho. He 0:07:33.200 --> 0:07:36.440 says it's difficult to find enough beds and to keep 0:07:36.480 --> 0:07:42.480 them staffed, where we're just experiencing an unprecedented wave of 0:07:42.520 --> 0:07:48.200 acute illness, and that acute illness is all COVID and 0:07:48.400 --> 0:07:55.840 it is almost exclusively in unvaccinated individuals. They checked the 0:07:55.960 --> 0:08:02.640 statistic right before our interview today, and of our intensive 0:08:02.640 --> 0:08:07.360 care unit patients who are in the hospital with COVID, 0:08:09.200 --> 0:08:14.920 of them are unvaccinated. There's a small handful that are vaccinated, 0:08:15.000 --> 0:08:21.560 including organ transplant patient, cancer patient and and so on. 0:08:21.560 --> 0:08:25.160 On the zoom call, Jim looks tired. He talks about 0:08:25.200 --> 0:08:28.640 constantly dawning and daffing personal protective equipment as he and 0:08:28.680 --> 0:08:30.400 his team go from one SAG room to the next. 0:08:31.160 --> 0:08:34.280 Jim also says the actual interior of the hospital has 0:08:34.320 --> 0:08:37.440 had to change to accommodate more COVID patients. Just like 0:08:37.480 --> 0:08:43.199 Briggerman Women's. This wave has has caused us to change 0:08:43.240 --> 0:08:47.800 where we're providing care. So we've opened up surge units. 0:08:48.520 --> 0:08:51.520 We had one surge unit which was a cardiac observation 0:08:51.679 --> 0:08:54.520 unit that we turned into a nine bed intensive care unit. 0:08:55.360 --> 0:08:59.679 We filled it today, but still more COVID patients come 0:08:59.679 --> 0:09:03.440 into doo Are and today is this day is probably 0:09:03.440 --> 0:09:06.040 going to be the day that we spill over into 0:09:06.120 --> 0:09:11.840 our next surge unit, which is a telemetry unit. And 0:09:12.320 --> 0:09:17.000 you know, for those who know something about this, intensive 0:09:17.000 --> 0:09:20.800 care unit rooms are specifically designed to meet the needs 0:09:20.800 --> 0:09:24.240 of those patients. Very large rooms to accommodate all of 0:09:24.280 --> 0:09:28.840 the machinery, equipment, monitoring, etcetera that's needed, all of the 0:09:28.920 --> 0:09:30.679 people that might need to be in the room to 0:09:30.760 --> 0:09:34.160 care for a patient. A telemetry room is not designed 0:09:34.200 --> 0:09:36.440 for that, but we're gonna We're gonna do our best. 0:09:37.200 --> 0:09:40.240 Adding to all this, though, is the open hostility that 0:09:40.280 --> 0:09:44.160 he and other workers encounter some patients tell them that 0:09:44.200 --> 0:09:47.280 COVID is a hoax, and they demand that the word 0:09:47.320 --> 0:09:50.320 be kept out of their relatives death certificates. Many of 0:09:50.360 --> 0:09:53.000 these people have been getting their information about COVID from 0:09:53.120 --> 0:09:57.400 different sources, Jim says. So they come with a different 0:09:57.480 --> 0:10:01.600 mental model about this disease ease, and they come with 0:10:01.760 --> 0:10:06.760 a different belief system about this disease. And as they 0:10:06.880 --> 0:10:12.560 do that, they're coming with a bit more hostility, which, 0:10:13.520 --> 0:10:16.320 which I got to say, is a really unique thing 0:10:16.480 --> 0:10:21.720 in healthcare. We are very used to taking care of 0:10:22.040 --> 0:10:25.760 all comers. I mean we right, we take care of 0:10:26.400 --> 0:10:28.400 We take care of lots of folks who have chronic 0:10:28.440 --> 0:10:31.920 problems that they've decided not to manage. Doctors don't resent 0:10:32.040 --> 0:10:35.760 patients for their beliefs about COVID, Jim says. We take 0:10:35.760 --> 0:10:40.440 care of, you know, prisoners, We take care of good people, 0:10:40.559 --> 0:10:43.520 bad people. We just take care of people. That's our job. 0:10:45.000 --> 0:10:49.360 And what what helps you have that sort of um 0:10:50.559 --> 0:10:57.240 cool indifference to the um the individual characteristics of the 0:10:57.280 --> 0:11:01.160 patient you're caring for is the fact that almost all 0:11:01.160 --> 0:11:03.960 of the time, what you get back from the patient 0:11:04.240 --> 0:11:08.280 is an overwhelming sense of appreciation for the efforts being 0:11:08.280 --> 0:11:11.280 applied to try to return them to health. So to 0:11:11.320 --> 0:11:14.520 be met with hostility is unusual. And I don't want 0:11:14.600 --> 0:11:18.760 you to think that that is pervasive, but even when 0:11:18.800 --> 0:11:23.160 in small doses it it does take a toll. And 0:11:23.200 --> 0:11:25.640 then there are the meetings of the school board. We 0:11:25.720 --> 0:11:29.000 were invited by the school board and the request was 0:11:29.080 --> 0:11:34.719 to speak about the wisdom of a mask requirement as 0:11:34.760 --> 0:11:39.079 they started school, um whether we should or shouldn't do that, 0:11:39.200 --> 0:11:41.880 and we shared our pros and cons and we were 0:11:41.920 --> 0:11:44.080 not going to share an opinion unless they asked for it, 0:11:44.160 --> 0:11:47.960 and they did ask for it, and you know the 0:11:47.960 --> 0:11:53.959 the it's just jeers, booze. Those jeers and booze came 0:11:54.000 --> 0:11:56.800 after Jim and as Kylie recommended the use of masks 0:11:56.800 --> 0:12:00.400 in schools. Jim wasn't able to actually see the audience, 0:12:00.440 --> 0:12:02.280 but his wife is at the meeting in person and 0:12:02.320 --> 0:12:05.680 told him afterwards what she'd seen. The moderator did an 0:12:05.720 --> 0:12:08.959 excellent job, by the way it was she was trying 0:12:08.960 --> 0:12:13.120 to mitigate that and what the way she did that. 0:12:14.360 --> 0:12:16.360 And my wife's a school teacher, so she had she 0:12:16.440 --> 0:12:19.000 admired this technique. She said it was a very school 0:12:19.040 --> 0:12:22.520 teacher type thing to do. She said, Look, I know 0:12:22.600 --> 0:12:24.480 people are going to have different opinions about what our 0:12:24.520 --> 0:12:29.360 experts are saying. You know, if if you don't like it, 0:12:29.480 --> 0:12:32.360 you can kind of do this. Jim is waving his hands. 0:12:32.600 --> 0:12:35.160 If you like it, you can do this. Now he's 0:12:35.200 --> 0:12:37.920 giving a thumbs up. So apparently while we were talking, 0:12:37.960 --> 0:12:41.440 there was all kinds of crazy gesticulation happening in the audience. 0:12:41.440 --> 0:12:46.160 You know, that sense of disconnectedness between hospitals and the 0:12:46.160 --> 0:12:49.720 communities they care for has perhaps never been so strong 0:12:50.040 --> 0:12:53.640 or uncomfortable. It's making the job of working in hospital 0:12:54.000 --> 0:12:57.400 harder all the time, and this means healthcare workers are 0:12:57.400 --> 0:13:01.679 starting to burn out and leave. That threatens to create 0:13:01.760 --> 0:13:17.199 an entirely new crisis in hospital understaffing. Wendy Dean is 0:13:17.240 --> 0:13:19.880 the co founder of a group called Moral Injury of Healthcare. 0:13:20.360 --> 0:13:23.920 The group focuses on healthcare workers, who they say are 0:13:23.960 --> 0:13:26.360 forced to work under conditions that violate their sense of 0:13:26.480 --> 0:13:29.520 right and wrong. She says COVID has pushed that to 0:13:29.600 --> 0:13:33.640 a boiling point, and hospitals are the focus. It is 0:13:33.679 --> 0:13:37.120 a much less comfortable space. That's what I'm hearing from 0:13:37.160 --> 0:13:42.920 across the country. I'm hearing more more clinicians now who 0:13:43.000 --> 0:13:46.360 say I cried all the way to work. I didn't 0:13:46.360 --> 0:13:48.080 want to get up this morning. I love my job, 0:13:48.600 --> 0:13:51.040 I usually love my job. I don't want to go 0:13:51.080 --> 0:13:56.319 to work. It's too hard. It's too much watching thirty 0:13:56.360 --> 0:14:03.240 year old on thenolators that you know of chance for 0:14:03.280 --> 0:14:10.240 a chance of not getting off. That is excruciating, and 0:14:10.280 --> 0:14:12.360 we don't just leave it when we walk out of 0:14:12.400 --> 0:14:17.160 the hospital. One of the key points of frustration is vaccination. 0:14:18.320 --> 0:14:22.040 Many people about those coming to the hospital with COVID 0:14:22.440 --> 0:14:26.400 have refused to get shots. Doctors and nurses still feel 0:14:26.400 --> 0:14:31.360 compassion for them, but the frustration is extreme. There are 0:14:31.400 --> 0:14:34.400 all kinds of reasons why patients can't get the vaccine 0:14:34.480 --> 0:14:37.280 or don't have access to it, but at the same time, 0:14:37.920 --> 0:14:40.160 it's frustrating to us that we can't make it more 0:14:40.160 --> 0:14:44.640 available and that we can't no matter how how much 0:14:44.720 --> 0:14:48.320 we encourage people to get it or ask them to 0:14:48.360 --> 0:14:52.480 come with us, come to us with questions that it's 0:14:52.800 --> 0:14:58.800 that turning that corner so that there's there's less vaccine 0:14:58.840 --> 0:15:05.280 hesitancy has been really hard, and I think that is 0:15:05.560 --> 0:15:09.840 that's becoming more frustrating for healthcare workers. Doctors are often 0:15:09.840 --> 0:15:13.760 at pains to help people understand that COVID isn't a fantasy, 0:15:13.920 --> 0:15:17.440 that it can be life altering or even lethal, and 0:15:17.440 --> 0:15:21.240 that it's threatening their lives every day. Katie Muro Johnson 0:15:21.600 --> 0:15:25.280 is an infectious disease doctor in Denver, where hospitals have 0:15:25.360 --> 0:15:28.360 also been hit hard. She says she recently bumped into 0:15:28.360 --> 0:15:30.600 a neighbor on the street whose friend was sick with 0:15:30.680 --> 0:15:35.120 COVID and on a ventilator. The neighbor asked Johnson how 0:15:35.240 --> 0:15:38.160 she thought her friend might do and I looked at her. 0:15:38.160 --> 0:15:41.840 I said he's probably gonna die. I said, there's there's 0:15:42.000 --> 0:15:46.040 very low chance he's going to survive. Johnson says her 0:15:46.120 --> 0:15:49.560 neighbor's face went white. I felt bad walking away from 0:15:49.560 --> 0:15:51.880 that that I was so honest, But I said, she 0:15:51.960 --> 0:15:56.520 asked what was what what I thought? Because I think 0:15:56.560 --> 0:15:59.440 people are asking what do you think about this? And 0:15:59.480 --> 0:16:03.120 if I say something such as that they're gonna die, 0:16:04.000 --> 0:16:07.240 you know, um, it scares people and they don't know 0:16:07.720 --> 0:16:11.640 how to grasp that that's a possibility, and that's hard. 0:16:12.200 --> 0:16:15.320 The neighbor's friend was only in his forties and with 0:16:15.360 --> 0:16:19.360 no underlying medical problems. But there's often little that can 0:16:19.400 --> 0:16:21.680 be done by the time someone is on a ventil latter, 0:16:22.720 --> 0:16:26.400 and I don't want to be that person. It feels 0:16:26.440 --> 0:16:31.400 hard to uh, um, for them to look at me 0:16:31.440 --> 0:16:37.200 in the same way, you know, with saying things like that. UM. 0:16:37.240 --> 0:16:42.120 But when you're around it every day, UM, I don't, 0:16:42.240 --> 0:16:44.920 you know, I don't feel it is that gravity that 0:16:44.960 --> 0:16:52.120 they do. It's a strange feeling for doctors not being 0:16:52.120 --> 0:16:54.680 able to be heard. They're used to being the voice 0:16:54.720 --> 0:16:58.360 of authority, the last word on medical issues and experts 0:16:58.360 --> 0:17:00.800 on life and death. But this is how it is 0:17:00.840 --> 0:17:04.440 in the time of COVID. One reality inside the hospital 0:17:04.880 --> 0:17:09.639 and one outside and not enough communication in between. And 0:17:09.680 --> 0:17:14.600 I think you know, going forward, UM, there is a 0:17:14.640 --> 0:17:20.720 disconnect still with UM. There's a substantial amount of people 0:17:20.760 --> 0:17:27.200 getting admitted with these long sixty day hospital admissions, unvaccinated, 0:17:27.520 --> 0:17:34.040 and we are using our highest resources possible to keep 0:17:34.040 --> 0:17:42.040 them alive. And and it's hard, UM, it's hard, UM. 0:17:42.280 --> 0:17:47.560 Venolatory support you know, ivy medicines daily and some of 0:17:47.600 --> 0:17:50.840 them taking a flight for life plane from other you know, 0:17:50.880 --> 0:17:56.000 other states even to come here, which is you know, um, 0:17:56.040 --> 0:18:01.639 which is desperate, which is uh yeah, that's kind of 0:18:01.640 --> 0:18:04.840 what we're what we're dealing with now. Just a few 0:18:04.880 --> 0:18:07.679 months ago, it looked like the pandemic would fade, at 0:18:07.760 --> 0:18:11.760 least in the US as vaccines rolled out. So far, 0:18:12.040 --> 0:18:15.400 that hasn't happened. In the states where vaccine uptake is low, 0:18:16.600 --> 0:18:21.680 unvaccinated people, particularly those with chronic illnesses, are still getting sick. 0:18:22.600 --> 0:18:25.159 Kate says there's still a lack of good treatments to 0:18:25.240 --> 0:18:29.160 take care of people who get really sick. I think, 0:18:29.240 --> 0:18:33.520 from the health care provider standpoint, UM, we want this 0:18:33.600 --> 0:18:37.360 to be over UM just as much as everyone else does. UM. 0:18:37.520 --> 0:18:42.400 And UM. I do think that if we can increase 0:18:42.520 --> 0:18:47.760 vaccination worldwide, which is the goal, is the only way 0:18:47.760 --> 0:18:51.120 we're going to bring us to an end, UM and 0:18:51.240 --> 0:18:55.439 protect all of our most vulnerable people UM in the 0:18:55.560 --> 0:18:58.960 US M from continually to be you know, coming to 0:18:59.040 --> 0:19:02.760 the hospital, be sick and and ultimately die. UM and 0:19:02.800 --> 0:19:07.040 so UM I think from our standpoint, we were giving 0:19:07.280 --> 0:19:11.880 treatments that we have high quality evidence for but are 0:19:11.960 --> 0:19:16.480 not willing to risk using other things that UM have 0:19:16.720 --> 0:19:20.040 low quality evidence or or are negative have negative studies 0:19:20.040 --> 0:19:25.600 behind them. And UM, I think that UM, if there 0:19:25.680 --> 0:19:28.760 was something that we thought would cure someone, we would 0:19:28.760 --> 0:19:32.600 be giving it. Drugs with poor quality evidence behind them 0:19:32.600 --> 0:19:37.960 include ivermectin and hydroxy chloroquine. Hydroxy Chloroquine is a drug 0:19:38.000 --> 0:19:41.399 from malaria that was touted by former President Donald Trump 0:19:41.800 --> 0:19:44.880 as a cure for COVID early in the pandemic, when 0:19:44.880 --> 0:19:49.440 there were even fewer options than there are now. Studies 0:19:49.440 --> 0:19:52.240 have shown it doesn't work, but there's still a large 0:19:52.240 --> 0:19:54.760 segment of the population that puts its trust in the drug. 0:19:56.160 --> 0:19:59.879 Ivermectin is another drug for parasites that hasn't shown effectiveness. 0:20:00.760 --> 0:20:03.719 Many patients in their families come into hospitals demanding it. 0:20:04.800 --> 0:20:08.240 Katie says the controversies over COVID treatment are eroding trust 0:20:08.280 --> 0:20:13.600 in hospitals and health professionals. I still think that we 0:20:13.720 --> 0:20:18.120 are used as a way to take care of acute 0:20:18.160 --> 0:20:22.040 illness and hopefully turn it around. But I do think people, 0:20:22.760 --> 0:20:28.879 certainly a certain certain um subtype or our subpopulation of 0:20:29.080 --> 0:20:32.760 folks are not coming to the hospital because they're worried 0:20:32.920 --> 0:20:37.879 that somehow the hospital is going to make them worse. Now, 0:20:38.200 --> 0:20:42.080 doctors sometimes have hard time treating patients because of mistrust 0:20:43.119 --> 0:20:46.120 no matter where they're cared for. Patients who do get sick, 0:20:46.280 --> 0:21:01.320 are very worried and often mistrustful. What we have is 0:21:01.359 --> 0:21:05.200 an invisible war, uh and where the war is being 0:21:05.240 --> 0:21:08.480 conducted is on the insides of the hospitals and in 0:21:08.520 --> 0:21:13.240 our clinics. Those places are on fire right now with 0:21:13.359 --> 0:21:18.240 sick patients. The rest of the community doesn't see that. 0:21:18.240 --> 0:21:21.560 That's Ted Epperley, a doctor and CEO of residency program 0:21:21.640 --> 0:21:25.800 based in Boise. When we talked, Idaho had the second 0:21:25.840 --> 0:21:29.480 lowest vaccination rate of any state, and residents were just 0:21:29.520 --> 0:21:32.919 starting to return to events like state fairs and football games, 0:21:33.440 --> 0:21:37.600 most of them unmasked. I was a family medicine physician 0:21:37.600 --> 0:21:40.240 of the physician in the Army for twenty one years. 0:21:40.280 --> 0:21:42.560 I've been in a war and the first Golf War, 0:21:42.640 --> 0:21:44.960 and did a lot of work in the Gulf War 0:21:45.520 --> 0:21:51.320 at a mash hospital with emergencies, UM and UM. The 0:21:51.359 --> 0:21:54.480 analogy I like to use for this is that if 0:21:54.560 --> 0:21:57.040 tanks were rumbling down the streets here and there are 0:21:57.080 --> 0:22:00.919 bombs going off, planes flying over in helicopters, smoke fire, 0:22:01.160 --> 0:22:05.000 everybody would get it, and everybody would be appropriately concerned 0:22:05.040 --> 0:22:09.159 and pulling together as a team. That's not happening. That 0:22:09.280 --> 0:22:14.000 says the invisibility and isolation of hospitals. Plate is particularly 0:22:14.080 --> 0:22:18.239 deep and some very rural, very conservative communities, people are 0:22:18.320 --> 0:22:21.560 kind of uh, you know, stacking up like logwood, like 0:22:21.640 --> 0:22:26.920 cordwood in the UH in their waiting areas. They've had 0:22:27.119 --> 0:22:33.280 fairly significant amounts of bad cases that are right in 0:22:33.359 --> 0:22:36.520 front of them that they can't do much for. And 0:22:36.800 --> 0:22:40.679 what that leads to is a sense of both isolation, 0:22:41.800 --> 0:22:45.800 fear and loneliness. Um, they feel like they're out on 0:22:45.800 --> 0:22:50.360 an island trying to manage all of this and with 0:22:50.520 --> 0:22:54.200 all the resources the United States has to offer around them, 0:22:54.520 --> 0:22:58.680 but not being able to get anything accomplished. So it's 0:22:58.720 --> 0:23:03.760 that that's sense of disillusionment that the whole system is 0:23:03.840 --> 0:23:07.920 kind of shutting down and breaking that. I think it's 0:23:08.000 --> 0:23:12.040 part of the dynamic and the tragedy of this that 0:23:12.119 --> 0:23:15.399 we're going through in Idaho right now. Ted says he 0:23:15.480 --> 0:23:17.680 thinks this could be the case for a long time. 0:23:18.119 --> 0:23:20.160 I think this could go on for quite a while. 0:23:20.440 --> 0:23:23.960 And what I mean for quite a while maybe or 0:23:24.000 --> 0:23:28.359 forty years um. And I know that sounds almost like 0:23:28.440 --> 0:23:31.760 you gotta be kidding. That just sounds unbearable. But Ted 0:23:31.800 --> 0:23:34.960 studies pandemics and says some have lasted from forty to 0:23:35.400 --> 0:23:40.560 a hundred years. Now, science and technology wasn't like it 0:23:40.680 --> 0:23:44.760 was back in those times. But we currently have another 0:23:44.800 --> 0:23:50.440 pandemic simultaneously ongoing that's been ongoing for forty years already simultaneously. 0:23:50.440 --> 0:23:54.320 That's the HIV epidemic pandemic. We've not resolved that, and 0:23:54.359 --> 0:23:57.760 the reason we haven't is that we haven't developed a 0:23:57.840 --> 0:24:02.240 vaccine for it. Um. What could happen in this scenario 0:24:02.560 --> 0:24:04.760 because we only have about three to four percent of 0:24:04.800 --> 0:24:08.720 the world that's been vaccinated, A key problem is the 0:24:08.800 --> 0:24:11.480 lack of access to vaccination in many parts of the 0:24:11.520 --> 0:24:15.159 world in resistance to it in the US it's a 0:24:15.320 --> 0:24:22.280 very low percent. Is that this continues to reverberate in 0:24:22.400 --> 0:24:26.520 populations of people with low vaccination rates, and new variants 0:24:27.200 --> 0:24:32.120 UM get spun off of that reverberation, so that different 0:24:32.200 --> 0:24:36.359 variants continue to slam populations. We have one, as you 0:24:36.440 --> 0:24:39.280 well known now called the new variant that's coming out 0:24:39.320 --> 0:24:44.080 of South America that has immune of Asian properties, which 0:24:44.119 --> 0:24:48.359 means that the vaccines and the plasma of the serum 0:24:48.400 --> 0:24:52.960 plasma that we have right now may be ineffective against 0:24:53.040 --> 0:24:56.240 this variant, meaning that we go through another whole cycle 0:24:57.040 --> 0:25:00.879 of infection and illness only to spawn another AUNT that 0:25:01.119 --> 0:25:05.119 kicks off from the process. So um, the optimist in me, 0:25:05.240 --> 0:25:08.359 and I tend to be an optimist, would like to 0:25:08.400 --> 0:25:11.639 see this resolve and the team months to twenty four months. 0:25:11.840 --> 0:25:16.800 The potential realist in me, h really says that this 0:25:16.840 --> 0:25:21.280 could be forty year experience that we all just learned 0:25:21.320 --> 0:25:31.679 to manage. Jim Susa, the Idaho pulman ologist, has been 0:25:31.720 --> 0:25:34.200 trying to get local politicians to come to St. Luke's 0:25:34.720 --> 0:25:37.920 and see what's really happening. He says many have had 0:25:37.920 --> 0:25:40.240 their eyes opened and gone back out to the community 0:25:40.600 --> 0:25:45.119 to talk about the desperate situation and hospitals. But another thing, 0:25:45.160 --> 0:25:48.800 he wants them to talk about his vaccination and its benefits, 0:25:50.000 --> 0:25:52.600 because that's the only way he and his colleagues see 0:25:52.600 --> 0:25:56.560 out of this situation. I'd like them to talk about 0:25:56.600 --> 0:26:01.479 the fact that this is real. I mean, there's all 0:26:01.480 --> 0:26:03.840 this stuff on social media that our hospitals are filled 0:26:03.840 --> 0:26:06.919 with patients who have gotten the vaccine and gotten COVID 0:26:07.000 --> 0:26:10.760 from that, and that's why I'm like, people are pulling 0:26:10.800 --> 0:26:14.879 that this stuff out. I'm talking thin air here, so 0:26:15.720 --> 0:26:21.439 talk about it's real, talk about your own vaccine. That 0:26:21.600 --> 0:26:25.320 separation between what people say outside the hospital and what 0:26:25.440 --> 0:26:31.359 actually happens inside, between beliefs and scientific facts, remains a 0:26:31.440 --> 0:26:35.560 huge challenge to hospitals and the workers. At the end 0:26:35.560 --> 0:26:40.280 of Daniello Llamas's Resident episode, the vital information about the 0:26:40.280 --> 0:26:44.240 deadly fungus gets out, people start to take precautions, and 0:26:44.320 --> 0:26:47.639