A State of Dis-Ease.
AS THE CORONAVIRUS CONTINUES ITS DEADLY SPREAD, MARYLANDERS ON THE FRONT LINES RISK THEIR OWN HEALTH TO HELP OTHERS.
BY RON CASSIE
ON THE WEEK OF St. Patrick’s Day, the Johns Hopkins Hospital intensive care unit where veteran nurse Kathleen Bailey works was silent and empty. Over several shifts, each patient in the two-dozen-bed unit had been moved to another ICU section on the East Baltimore campus. Bailey’s floor had been cleared as a precaution against a potential influx of COVID-19 patients, the first of whom from Maryland were just being diagnosed at associated Hopkins hospitals in Bethesda and Washington, where the capital region’s outbreak was in its alarming, beginning stages. “Within 24 to 48 hours, we were full,” she says. “Patients were arriving by ambulance and helicopter already intubated.”
Months later, Bailey’s unit remains full, and is still eerily quiet. Normally, the ICU’s private rooms and waiting area bustle with concerned parents, adult children, and siblings. Now, with visitation prohibited, families see their sick loved ones via iPads, placed on the bedside tables. With many of the infected heavily sedated, family members are left to simply stare at their unconscious loved ones, hooked to cumbersome breathing masks, as they pray for the best. “One family asked if we can stream 24 hours a day,” Bailey says. “Just watching them breathe, even with the help of a machine, provides so much solace.”
The 38-year-old Pasadena mother of two worked through the H1N1 virus outbreak a decade ago, but COVID-19 has changed everything, including her own daily ritual. She discards her protective gear after each shift and leaves her scrubs at the hospital to be laundered, showering and changing into her own clothes before heading home. She worries about bringing the virus back to her husband and children—her family reckoning with isolation like everyone else. The hardest part, Bailey says, is the helplessness in the ICU. Given that there’s no treatment for COVID-19, all staff can do is try to mitigate the disease’s devastating attack on the respiratory system—at its terrifying worst, a feeling of suffocation—and buy time for the body’s immune system to win the fight. “As an ICU nurse, you’re accustomed to people dying,” she says. “With this, people stay on a ventilator for three, four, five weeks, struggling to stay alive. I’ve cried. I’ve been a nurse for 15 years. I’ve never seen anything like it.”
BY THE END OF MAY, less than three months after the first confirmed case in the state, the pandemic had claimed the lives of more than 2,500 Marylanders, disproportionately in the state’s Latino and African-American communities. It’s a figure already more than double the number of Marylanders who died in the Vietnam War, with another 1,200 fatalities projected by the start of August. When the United States passed the grim milestone of 100,000 deaths from COVID-19 over Memorial Day weekend, the news came as some public health experts were warning that the novel coronavirus—much like influenza or measles—may never be fully eradicated, even after a vaccine is developed. Such diseases are referred to as endemic, and while their consequences are lessened, they remain resistant to eradication. There’s a newly approved vaccine for malaria, for example, which requires four shots, yet still has a poor-efficacy rate. For HIV, of course, no vaccine has ever been found. In Baltimore, a COVID-19 hotspot, it seems everyone already knows someone who has been infected or died from this new virus.
“In my lifetime, AIDS is the only other comparable pandemic and the valuable lesson there is that we need accurate testing, we need contact tracing, and we need education—in regards to social distancing, masks, and handwashing,” says Dr. Robert Gallo, the co-discoverer of the HIV virus, which causes AIDS. The director of the University of Maryland’s Institute of Human Virology and co-founder of the Global Virus Network, Gallo says COVID-19 is not likely to “just go away.”
IN RESPONSE to the tragic toll, Marylanders, for the most part, abided previously unimaginable restrictions put in place by Gov. Larry Hogan as restaurants, schools, and businesses were closed, and a stay-at-home order was issued on March 30. Baseball’s Opening Day, a tradition since the 1880s, was canceled along with other iconic spring and summer Baltimore events—the American Visionary Art Museum’s Kinetic Sculpture Race, the Maryland Film Festival, Flower Mart in Mount Vernon Place, Artscape, the annual African-American heritage festival AFRAM, and the July 4 Inner Harbor fireworks display. High school and college spring sports seasons were nixed along with proms and graduation ceremonies. The annual Balticon convention was held virtually. HONfest was scheduled to do the same. Preakness was postponed until October. The status of Pride Weekend remains up in the air.
Meanwhile, the extraordinarily contagious nature of the novel coronavirus impacted everyday life in innumerable ways, both quotidian and profound. Nursing homes suddenly became frightening places for our parents and grandparents to reside. Funeral services, along with grieving, moved online. Mundane things, like trips to the grocery store, became fraught experiences. Parents spent more time with their children, but were also forced to transition into at-home school teachers. Summer travel plans were scrapped; weddings postponed. At minimum, a gnawing stir craziness took hold. Jake Smith, the owner of the Baltimore Boxing Club in Fells Point, began going for extra milelong walks with his dog to ward off anxiety. “The whole family has been walking the dog like crazy,” Smith says with a laugh. “The dog is like, ‘I need a break.’”
Other issues rising from the forced isolation had more serious consequences. There has been a dramatic increase in calls to the state’s domestic violence hotline as victims stayed in lockdown with their abusers, fearful of coronavirus infection to the point where they’ve been unable to seek medical treatment for their injuries. As people stayed at home and alcohol sales skyrocketed, concerns about mental health and substance abuse rose amid the isolation—a particularly dangerous environment for those with addiction issues. In Baltimore, most of the hundreds of weekly Narcotics and Alcoholic Anonymous meetings moved to online Zoom platforms, though those in recovery say it doesn’t replace the face-to-face connections necessary for healing. “Recovery is all about social contact,” says Mike Gimbel, a former heroin addict and Baltimore County’s former top drug treatment official.
In the wake of Great Depression-level unemployment, thousands of parents across the state also suddenly struggled to feed their children. Others feared, and still fear, going to work.
“What this crisis is doing is starkly exposing the holes in our safety net,” says Susan Esserman, director of the SAFE Center at the University of Maryland’s School of Public Health in Baltimore, which works with trafficking survivors. Many essential employees in low-income jobs have had no choice but to keep going to work with little protection, she notes.
Patrick Moran, the president of AFSCME Maryland, the state’s public employee union, highlighted that many state workers serve in front-line jobs that were physically and emotionally stressful prior to the COVID-19 pandemic. For example, corrections officers in prisons, which have seen outbreaks of the virus, are at a particularly high-risk for contracting the disease. “They’re already shorthanded,” Moran says. “And now they lack adequate protection and testing to do their jobs.” In Maryland’s nursing homes, where resident deaths represent the majority of fatalities in the state, at least 18 staff members have also died as of press time.
As the state approached 60,000 confirmed infections in June, a number that would nearly fill M&T Bank Stadium, miraculous recovery stories emerged as well. Michael Green, one of the first COVID-19 cases in Baltimore, survived 49 days on a ventilator at Mercy Medical Center. The 63-year-old lawyer, believed to have contracted the virus in New York the first weekend of March, remained in rehab into June. “There were times when it did not look like he was going to make it,” says his wife, Gail Green, who has seen her husband just twice during the entire ordeal, including briefly during his transfer from Mercy by ambulance to a rehabilitation center where he is still slowly being weaned off the ventilator and receiving physical therapy. By then, he’d lost 50 pounds and the ability to sit or stand. “The staff at Mercy was incredible,” says Green. “No matter how tired or overworked everyone was, a doctor called me every day. I talked to a nurse every shift. The chaplain, when she found out Michael was Jewish, lit Sabbath candles every Friday night and learned a Jewish healing prayer, which she said over him. The staff read messages to Michael from our two adult children— our daughter is expecting our first grandchild—once the breathing tube was removed from his mouth and placed in his trachea, and he was alert.” The Mercy staff also gave Green a celebratory sendoff and parade, the video of which went viral. “As much as that meant to us,” says Green, “I think that was for them, too.”
Among the countless anonymous heroes is Anne Arundel County ICU nurse Megan Pitt, who answered a plea for nurses in New York during the height of the outbreak there. She has three kids, which made the decision easier in some ways, harder in others.
“My husband is retired on disability from the military and so he could take care of the kids and our dog,” says Pitt, who at one point in New York was swabbed for the virus after a co-worker accidently knocked off her mask. “I’d been coming home from work here, changing and bagging my clothes in the garage, and putting them straight into the wash. I’m more afraid of getting them sick than me. My husband supports me 100 percent. He understands sacrifice. He was stationed overseas when we were first married. He calls it my ‘deployment.’”
IN THE FOLLOWING pages, we look at the people on the front lines of this deadly pandemic. Some, like doctors, nurses, and police officers, have chosen a life of public service. Others, like an intrepid group of makers producing hand sanitizer, took it upon themselves to step into the fray. And still others became accidental “essential” workers, forced, often by necessity or fear of losing a job, to serve the general public. For all of them, this virus has been unprecedented and daunting, but not without glimmers of optimism and hope. We hope you read and honor their stories.
MATTERS OF LIFE AND DEATH
THE JOHNS HOPKINS HOSPITAL’S EMERGENCY DEPARTMENT DIRECTOR, GRAPPLES WITH PROTECTING HIS TEAM, HIS PATIENTS——AND HIMSELF.
In the early aughts, when Mustapha Oladapo Saheed was in medical school at Cornell University, emergency medicine didn’t resonate with him right away. “It was a mess, it was sensory overload,” he says. But later, during a related elective, he had a lightbulb moment. “I started to see the rhythm behind what looked like chaos,” he recalls. “All of a sudden, the cacophony started to sound like a symphony, and everything made sense. I chose to go into emergency medicine—and I never looked back.” In the time of the coronavirus crisis, and as medical director of The Johns Hopkins Hospital’s Department of Emergency Medicine, the Nigerian-born, Laurel-raised doctor is conducting one of the unruliest orchestras of his life.
Since early March, as patients have poured through the doors of 1800 Orleans Street in East Baltimore, those with mild symptoms have been sent home for self-monitoring, while others have ended up being admitted for echocardiograms, chest X-rays, or CT scans. Among them, the sickest get intubated before being placed on a ventilator—one of the most dangerous jobs in the hospital, as the work requires Saheed and his team to get close to the patient and a potential blizzard of viral droplets. “It’s been an extraordinary experience for the nation, for everybody, and certainly for those of us in the emergency department,” says Saheed, 42.
As non-COVID patients avoid the emergency room, both at Hopkins and across the country, the total number of patients is actually down.
But while Baltimore area hospitals have largely been spared from the scenes that have played out in hotspots like New York, the work is still incredibly painstaking. “Before you go into a room, you’re washing your hands, you’re Purelling, you’re donning your mask, you’re social-distancing,” says Saheed. “All of those things take a physical and cognitive toll. I could easily see 10 patients in the time that it now takes to see one—we’ve all been living at the hospital.”
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