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Iowa's Joe Wieskamp drives to the basket past Nebraska's Thorir Thorbjarnarson during a Feb. 8 game last season.

topical alert
'The ER never stops': On the front lines of the COVID-19 spike

MUSCATINE — With a 12-hour shift in front of them and a waiting room full of patients — many showing signs of being infected with COVID-19 — emergency room lead nurse Tasha Tovar and Dr. Rhonda Sowards, medical director of the UnityPoint Trinity Muscatine emergency room, don the protective gear they hope will keep them safe.

For over a week, traffic through the emergency room has rarely let up. While numbers have held steady, the increased need to change protective gear has doubled the time it takes medical providers to see patients.

As Tovara and Sowards dressed in their masks, one-use-only gloves, gowns, masks and face shields, they remembered these precautions were necessary to stop the spread of a disease that has so far killed more than 259,000 people in the United States.

“We are seeing a much more challenging time with this,” Tovar said on the statewide spike in cases. “We are seeing a higher rate with this than we were in the spring. It is seeing an uptick for sure.”

The recent spike in COVID-19 in Iowa has made the state one of the highest areas of infection — estimates are Iowa will see 100,000 new cases in November — and an area with one of the highest death rates. Throughout the state the record-high number of hospitalizations has made treating patients more difficult, with the lack of bed space throughout the state leading to longer waits for treatment.

At UnityPoint-Muscatine, an area previously used as a waiting area has been altered to add two additional treatment beds to the 11 normally offered.

Sowards said over the past month the acuity of the patients coming to the emergency room has increased. Saying that fear of COVID-19 keeps some people from coming to the hospital for care, she said people are seeking treatment after the disease has progressed and they are much more ill than they would have been if it had been addressed sooner.

The pair have seen COVID-19 patients running the spectrum of symptoms from the mild to the severe. Tovar said children with COVID-19 seem to have very few symptoms, if any.

The elderly population is affected more heavily.

According to the Iowa Department of Public Health, over half of Iowans who have died of COVID-19 have been over 80 and more than 62 percent who have died have had a confirmed pre-existing medical condition.

In treating the disease, the staff quickly learned any symptom a patient may have could indicate COVID-19. Tovar said when someone comes into the emergency room with a cough or shortness of breath, COVID-19 is automatically suspected. They have learned if someone comes in with diarrhea, that person could also be a COVID-19 patient. She says any symptom can be consistent with COVID-19.

The amount of staff on duty during the spike has remained the same due to illness and staffing concerns, and Tovar said there are times when more staff could be used. She believes this is the same for every hospital in the U.S. right now, especially in Iowa. She said during Thanksgiving week the schedule has been padded to allow additional workers in the emergency room at times.

“There is going to be some challenges for patients and that is why we want to be sure the right people are coming to the emergency room,” Tovar said. “We want to make sure sick people who have emergency conditions are coming to the emergency room instead of patients with mild symptoms that can be treated in urgent care or a care clinic - that would certainly help.”

Sowards said consistently since the beginning of the spike the emergency room beds are full by the afternoon and there is a wait for treatment. She said one contributing factor is intensive care units throughout the state are full, meaning the patients need to stay in the emergency room longer while they are waiting for an ICU bed to open.

Both medical professionals believe the reason for the spike is simply because people became too lax in their precautions. They relaxed as the state was beginning to open up and people stopped wearing masks and social distancing. Large gatherings has also become more common. Sowards said as the state was opening, the numbers of cases began to climb, and an eventual spike was not unexpected.

“The holidays are coming up and that is scary for us because we know there are those people — and we don’t want to insult the people who believe this is a hoax or believe it is a political thing — but the reality of it is that people are sick and people are dying,” she said. “We just need to remind people to maintain social distancing, wear a mask, wash your hands and avoid large gatherings. Just stay safe and keep others safe.”

With Thanksgiving coming up, Sowards and Tovar hope the spike won’t get worse, but in a way they believe it is inevitable. Tovar said there is a lot of mental fatigue from social isolation and she feels people want to move ahead with their normal lives. Sowards warns that there are so many asymptomatic cases, all it would take is a child to hug their elderly relative and the disease could be spread.

As they prepared to see patients, the emergency room workers took the time to remember why they do what they do and the thing that makes all the effort worthwhile. They thought of the patients who recover and seeing them walk out of the hospital to resume their normal lives.

“The ER never stops,” Sowards said. “There are people in the ward at 2 or 3 in the morning and there are many more at 2 or 3 in the afternoon. There are up and down times, but there is always something happening here at all hours.”

MCSA encourages residents to donate funds virtually this holiday season
  • Updated

MUSCATINE — The holidays are a time for giving, but the pandemic may make trips to food banks to drop off donations seem like a risk.

The Muscatine Center for Social Action (MCSA) has developed a safer way for people to donate money this season.

On Friday, a new Muscatine County Food Support Fund was established through the Community Foundation of Greater Muscatine.

"Our goal for this fund is that various food pantry and agencies that distribute food around the county can leverage funds and share donations to better meet food needs in our area," Jenny Leirness, Resource Development Officer for MCSA said.

The website for the fund offers residents a quick and easy way to donate directly online.

"We want to offer an opportunity for folks to join in on physical food drives during the holidays, but we also want to describe what our agencies can do with donated funds," Leirness said.

According to Leirness, through regional food bank partnerships, the MCSA is able to purchase large quantities of food for a cheaper amount, allowing them to stretch their funds and provide more food for more people.

"For example, we were able to purchase 25 cases of cereal for only $50, resulting in about 18 cents per box," she said.

For people who don't wish to donate funds online, or would rather donate non-perishable food, they will still be able to do so independently and through events such as the Salvation Army's Two Weeks of Love.

"We also plan to have collection bins out during the holiday stroll and throughout the holidays," Leirness said, "but we want to direct attention to all of the great ways we can stretch dollars as a community."

Community asked to consider treatment options before heading to ER
  • Updated

MUSCATINE — With a rush in the emergency room at UnityPoint Health-Trinity Muscatine due to a spike in the number of COVID-19 cases in Iowa, as well as a shortage of hospital beds throughout the state, hospital employees are asking people to reserve a trip to the emergency room for only an emergency case.

UnityPoint Health-Trinity Muscatine emergency room lead nurse Tasha Tovar spoke of healthcare providers having to ensure any case of COVID-19 in the emergency room is not spread to another patient.

The hospital has stated no patient will be turned away.

However, because of the numbers of patients seeking treatment throughout the state, the public is asked to determine if they need emergency treatment or if urgent care would be sufficient before seeking medical attention.

“Anybody who is experiencing low oxygen levels or difficulty breathing is definitely an indication for an emergency department visit,” Tovar said. “Any type of immunocompromised or high risk patient, if they are experiencing COVID symptoms with shortness of breath or dehydration, they are much more appropriate for emergency care than urgent care or express care.”

Other symptoms that might warrant a trip to the emergency room may include persistent pain or pressure in the chest, confusion, or discoloration (blueness) in the lips or face.

Tovar said mild symptoms are expected with COVID-19 and some of the symptoms that can allow a patient to recover at home include aches, coughs without shortness of breath, fever, and loss of taste and smell. Tovar said many of these can be treated with over-the-counter medications. She said mild nausea or normal symptoms of a cold can be treated at home. She recommends people with mild symptoms stay at home and self-isolate.

Tovar also said people who have been exposed to COVID-19 but don’t have symptoms should not go to the emergency room for a COVID-19 test. She said there are many testing places available, but having to perform testing could further congest the emergency room.

Emergency medical responders are also very busy with the pandemic and Tovar said they should be called only in an emergency.

Tovar said the community has helped the staff tremendously simply with their recognition and support. They have noticed that support beginning to wane a bit as the state has reopened after being shut down due to the pandemic.

“We aren’t in isolation from COVID – our families are dealing with it also,” Tovar said. “We are human people outside of the hospital and this is affecting our lives and our children’s lives and our parent's lives as much as anyone else. Our nursing staff continues — not only our nursing staff, but our techs, our housekeepers, our security, our dietitians — they are all showing up to work every single day and kind of exposing themselves by risking exposure to COVID for the people who need our help. I think continued support from our community would be the biggest impact the community could make.”

Pfizer seeks emergency vaccine use
  • Updated

Pfizer formally asked U.S. regulators Friday to allow emergency use of its COVID-19 vaccine, starting the clock on a process that could bring limited first shots as early as next month and eventually an end to the pandemic — but not until after a long, hard winter.

The action comes days after Pfizer Inc. and its German partner BioNTech announced that its vaccine appears 95% effective at preventing mild to severe COVID-19 disease in a large, ongoing study.

The companies said that protection plus a good safety record means the vaccine should qualify for emergency use authorization, something the Food and Drug Administration can grant before the final testing is fully complete. In addition to the FDA submission, they have already started "rolling" applications in Europe and the U.K. and intend to submit similar information soon.

With the coronavirus surging around the U.S. and the world, the pressure is on for regulators to make a speedy decision.

"Help is on the way," Dr. Anthony Fauci, the top U.S. infectious disease expert said on the eve of Pfizer's announcement, adding that it's too early to abandon masks and other protective measures. "We need to actually double down on the public health measures as we're waiting for that help to come."

Meanwhile, the surging coronavirus is taking an increasingly dire toll across the U.S. just as a vaccine appears close at hand, with the country now averaging over 1,300 COVID-19 deaths per day — the highest level since the calamitous spring in and around New York City.

The overall U.S. death toll has reached about 254,000, by far the most in the world. Confirmed infections have eclipsed more than 11.8 million, after the biggest one-day gain on record Thursday — almost 188,000. And the number of people in the hospital with COVID-19 hit another all-time high at more than 80,000.

With health experts deeply afraid Thanksgiving travel and holiday gatherings next week will fuel the spread of the virus, many states and cities are imposing near-lockdowns or other restrictions. California ordered a 10 p.m.-to 5-a.m. curfew starting Saturday, covering 94% of the state’s 40 million residents.

The Texas border county of El Paso, where more than 300 people have died from COVID-19 since October, is advertising jobs for morgue workers capable of lifting bodies weighing 175 pounds more. Officials are offering more than $27 an hour for work described as not only physically arduous but “emotionally taxing as well.”

The county had already begun paying jail inmates $2 an hour to help move corpses and has ordered at least 10 refrigerated trucks as morgues run out of room.

COVID-19 deaths in the U.S. are at their highest level since late May, when the Northeast was emerging from the first wave of the crisis. They peaked at about 2,200 a day in late April, when New York City was the epicenter and bodies were being loaded onto refrigerated trucks by forklift.

In Texas, Republican Gov. Greg Abbott has ruled out another shutdown and singled out El Paso county leaders for not enforcing restrictions already in place. The state’s attorney general, Ken Paxton, likened the county's chief administrator to a “tyrant” after Paxton won an appeals court ruling blocking local leaders from shutting down gyms and other nonessential businesses.

Friday's emergency use filing sets off a chain of events as the FDA and its independent advisers debate if the shots are ready. If so, still another government group will have to decide how the initial limited supplies are rationed out to anxiously awaiting Americans.

How much vaccine is available and when is a moving target, but initial supplies will be scarce and rationed. Globally, Pfizer has estimated it could have 50 million doses available by year's end.

About 25 million may become available for U.S. use in December, 30 million in January and 35 million more in February and March, according to information presented to the National Academy of Medicine this week. Recipients will need two doses, three weeks apart. The U.S. government has a contract to buy millions of Pfizer-BioNTech doses, as well as other candidates than pan out, and has promised shots will be free.

Not far behind is competitor Moderna Inc.'s COVID-19 vaccine. Its early data suggests the shots are as strong as Pfizer's, and that company expects to also seek emergency authorization within weeks.

The public's first chance to see how strong the evidence really is will come Dec. 10 at a public meeting of the FDA's scientific advisers.

So far, what's known is based only on statements from Pfizer and BioNTech. Of 170 infections detected to date, only eight were among people who'd received the actual vaccine and the rest had gotten a dummy shot. On the safety side, the companies cite results from 38,000 study participants who've been tracked for two months after their second dose. That's a milestone FDA set because historically, vaccine side effects don't crop up later than that.

"We'll drill down on these data," said FDA adviser Dr. Paul Offit of the Children's Hospital of Philadelphia.