Outbreaks of infectious diseases are always a problem in hospitals.
You have drills.
Logs are available.
There is a plan.
But it’s hard to plan for a pandemic.
“I wouldn’t be honest if I said I imagined it,” said Dr. James Keller, chief medical officer at Advocate Lutheran General Hospital in Park Ridge. “We were all prepared for the outbreak of infectious diseases and they were there in terms of isolation and everything we’re doing for respiratory borne viruses, but in terms of frustration and uncertainty I don’t think many of us are prepared imagined that.”
In late 2019, doctors from the suburbs, like many others, watched as a wave of disease swept the world, beginning in China and then across continents and countries until it landed in the United States in January 2020 and has since claimed the lives of 36,494 people in Illinois alone . More than 6.8 million have died worldwide.
“I don’t think I personally understood how serious it was going to be until I saw what happened in Italy and how devastating it was and how it surprised her,” said Dr. Jonathan Pinsky, medical director for infection control and prevention at Edward Hospital in Naperville. “I knew then that it was going to be bad.”
As they watched the world’s rest of the world’s caregivers grapple with the disease, local doctors, nurses and hospital officials recognized the impact it would have on the country’s healthcare system when it arrived, but few could imagine how the Pandemic would change the medical treatment of Americans as well.
“We knew this was a marathon,” said Dr. Tom Oryszczak, executive vice president and chief medical officer at Northwest Community Healthcare in Arlington Heights. “It has been very disheartening to see the scale of the disease and the extent of the suffering and destruction of people and their families, but you are learning along the way how to provide better care and we have together as a group of medical professionals in the community learned all over the country and around the world.”
Bend the curve
To minimize the impact of COVID-19 on the state’s healthcare resources, Gov. JB Pritzker issued a “stay-at-home order” that went into effect Tuesday three years ago. The order was intended to slow the spread of the virus so hospitals would not be overwhelmed by infections.
But hospitals initially faced another risk as the number of sick grew and access to personal protective equipment such as gowns, masks and gloves dwindled.
“We were fortunate that we had enough PPE and never ran out, but there was also an outpouring of generosity from the community,” Pinsky recalled. “There was a seamstress in town who made hospital gowns for us.
The state would spend millions of dollars at inflated costs to ensure medical supplies to other hospitals and health facilities during the first few months of the pandemic.
The state also spent millions to recreate Chicago’s McCormick Center as a makeshift hospital for less seriously ill COVID-19 patients, but it became largely redundant and was dismantled a few months later.
Today, several suburban hospital officials are reporting that supplies of PPE are now greater than before the pandemic, for fear of being understaffed again.
“Equipment and supplies were used so quickly and intensively in the early days, and that was the reason for the shortages,” Keller recalls.
Store shelves and many homes are still stocked with test kits, masks and other items that were once essential for going out at the height of the pandemic.
“There’s less stigma attached to wearing a mask to protect others,” Keller said. “I think this is here to stay where someone with a scratchy throat masks up in public for the safety of others.”
At its peak during the initial spike, hospitals across Illinois were treating more than 5,000 COVID-19 patients daily through the end of April. Almost a quarter of them would be in intensive care beds needing one-on-one care, according to records from the Illinois Department of Public Health.
Illinois recorded its first COVID-19 death on March 17, 2020. In just a month, 1,133 more across the state would die from the disease. In mid-May, IDPH records showed the state was averaging nearly 120 deaths a day from COVID-19.
weather the storm
Initially, there was little that could be done for those requiring hospitalization due to COVID-19.
“A lot of the care we provided in those early months was supportive,” Keller said. “When therapeutics were identified, that changed course.”
Remdesivir was the first antiviral drug used to fight COVID-19 infection. The drug’s effectiveness is still somewhat controversial, but most frontline doctors believe it has benefited many patients.
“Remdesivir was a game changer,” Pinsky said.
Finally, monoclonal antibodies were developed to also combat the severity of the symptoms of an infection, while today a five-day regimen of the antiviral drug Paxlovid is widely used to keep the symptoms of COVID-19 in check.
A change in weather coupled with state-imposed mitigation efforts also helped reduce patient burdens at hospitals across the state in the spring of 2020. Children continued to be kept away from school, while many sports and other extracurricular activities were also suspended. Many workers who were able to work from home continued to do so well into the summer.
Doctors reported that patients who had postponed visits because of other medical issues, afraid of catching COVID-19, sought help. To address these concerns, most physicians turned to telemedicine. Virtual doctor visits by phone or computer exploded in use.
“If there was a silver lining in all of this, it was the advancement of telemedicine,” Keller said. “We had tried and somehow knew it could be important in how it could improve access to healthcare for specific populations and speed up interventions. I think that’s something that will stay with us for a long time.”
And more help was on the way.
In November, a partnership between drugmakers Pfizer and BioNTech had produced a COVID-19 vaccine that had shown 95% efficacy. By mid-December, the vaccine had been shipped to each state and distributed to those most at risk. Moderna and Johnson & Johnson also made vaccines.
That was less than a year after the virus was first detected in the United States.
“The speed at which these have been developed is unprecedented,” Oryszczak said. “That was really amazing.”
But it wasn’t early enough to stave off a second wave.
Cases skyrocketed again in November, with hospitals across the state treating more than 6,000 COVID-19 patients a day.
In December 2020 alone, Illinois recorded 4,237 COVID-19 deaths, the most of any month throughout the pandemic.
As measures eased and eventually ended, COVID-19 hospitalizations fluctuated for much of 2021.
People traveled hundreds of miles for vaccination appointments, but doctors reported seeing the effects of these vaccinations on patients.
“Vaccinations were day and night,” Pinsky said. “We saw a change there. Bam.”
Most severe cases, he said, were in unvaccinated or immunocompromised middle-aged people.
COVID long-distance drivers have been added to the lexicon.
A significant portion of the infected population reported symptoms long after they had stopped testing positive for the infection. Brain fog, loss of taste and smell, fatigue and persistent cough were among the most common symptoms. But not every patient is the same, the doctors explained. And many were never hospitalized for the infection.
Northwestern Medicine opened its comprehensive COVID-19 center to treat and evaluate long-distance drivers.
“I think what makes it a very, very difficult problem to solve is that your group isn’t uniform,” said Dr. Marc Sala, co-director of the center and assistant professor of pulmonology and critical care medicine. “What I see now is that while the number of people who come to our clinic on referral is about the same, the reason I see them has changed.”
A study conducted by the center showed that the majority of long-distance patients were women.
“There’s a lot of speculation as to why women and females are biased toward people who get COVID for a long time,” Sala said. “But if you look at most, but not all, autoimmune diseases, women are more likely to be affected than men.”
More transmissible variants of the original strain also became a problem, first with Delta and then with Omicron in 2022. Omicron also tended to sidestep the vaccine’s effectiveness, and last year a special booster dose was developed to combat the new strains.
However, what these new versions of COVID-19 weren’t was more dangerous.
“After the 2021-2022 winter, there was a sense of relief because we didn’t see infections that were as severe,” Pinsky reported.
In fact, IDPH figures show that while hospitalizations for COVID-19 infections hit an all-time high of more than 7,300 per day in January 2022, only about 15% of them required ICU beds at the peak of the spike.
Health experts will note that the pandemic is not over and COVID-19 remains a threat. But through vaccination or natural immunity, the virus isn’t wreaking the kind of havoc it’s been causing in previous years.
This winter, COVID-19 hospitalizations never rose above 2,000 patients. Currently, fewer than 900 people are hospitalized with COVID-19 nationwide and only 13% are in intensive care beds.
Most doctors agree that while the healthcare industry has taken a hit during the pandemic, there have also been significant triumphs.
“When you look at what healthcare workers and industry have accomplished during the peak of the pandemic, there’s a lot to be proud of for the work that’s been done,” Oryszczak said. “I understand I have biases on this, but I am very proud of the healthcare community and how we have adapted to the challenge of the pandemic.”