On Sunday, March 15, many New Orleanians were throwing crawfish boils, catering to Bourbon Street’s tourists, and grumbling over the cancellation of the St. Patrick’s Day parade. At the time, Louisiana had 91 confirmed cases of coronavirus. A week later, Louisiana health officials confirmed 837 cases and 20 deaths.
“That’s a 10-time increase in seven days,” Gov. John Bel Edwards said in a press conference on March 22.
Health experts and local doctors interviewed by VICE blame the severity of COVID-19 in New Orleans on Mardi Gras, which took place February 25. During the celebration, approximately 1.4 million local and international visitors descended on the city.
In Arkansas, Tennessee, and Texas, health officials said COVID-19 patients in their states had recently traveled to New Orleans. “I expect that Bourbon Street is an epicenter of spread of this virus for a lot of the country,” said Michael, a New Orleans emergency physician whose name, like other medical professionals' names throughout this story, has been changed to protect his anonymity for fear of professional repercussions.
Now that the tourists have gone home, COVID-19 has found a fertile breeding ground in Louisiana’s population, which includes the sickest and poorest people in the nation. Heart disease, respiratory conditions, physical disability, diabetes and obesity—all risk factors for death from COVID-19—are more prevalent in Louisiana than in other parts of the country. In New Orleans, many people live in close quarters, making social distancing almost impossible.
“People aren’t self-quarantining because they can’t,” said Jason, an emergency department nurse. “[You often see] a big group of people living in a small [space]—usually a grandmother with a child and grandkids… We may fail if we keep going on the current course and if the numbers keep climbing like they do.”
COVID-19 is spreading faster in Louisiana than anywhere else in the world. The Pelican State trails New York and Washington for the highest number of confirmed cases per capita. On March 22, Edwards issued a statewide “stay at home” order, citing fears that the Louisiana health care system could run out of capacity in as short a time as a week.
In New Orleans, where most Louisiana cases are concentrated, doctors and nurses think a breakdown might come sooner than that. “Systemic collapse is a true concern,” said Kenneth, a New Orleans emergency physician. “It's not Lord of the Flies today, but our supplies—face masks, personal protective equipment [PPE], gowns, beds and ventilators—are dwindling, and everyone’s getting nervous.”
Kenneth and other emergency department nurses and doctors said their hospitals are at or close to capacity. Because health care infrastructure is sized to meet the population—393,000 people live in Orleans Parish—New Orleans’ soaring caseload could easily overwhelm an already strained system. Right now, doctors are sending home patients who should be in the hospital.
"The hospitalist service has not wanted to admit 'stable' patients with [both COVID-19 and comorbidities like] diabetes," said Michael. "Normally, I'd be screaming that they should be admitted. But the people I admitted [with COVID-19] were sicker.”
“The patients we have intubated in the intensive care unit are not able to wean off the vents,” said Jennifer, a registered nurse in an emergency department. “Two hospitals in the region are already out of ventilators. There are no more rooms available. The patients in the emergency department who need to be admitted are just sitting there.”
In New Orleans—and across the country—hospitals are rationing PPE, which puts health care workers at risk of infection. Jennifer and Kenneth are buying industrial respirators and Tyvek suits from home improvement stores. They’re reusing gowns and wiping down their face shields and goggles with bleach wipes between patients instead of tossing the contaminated items and donning sterile new gear, which is in short supply.
“My N95 mask strap broke,” Jennifer said. “I had to staple it to continue to use my mask.”
“The CDC is irritating all of us… [with] this new asinine thing that says wear bandanas,” Kenneth said, referring to the CDC’s recently updated face mask guidelines, which advocate the “use of homemade masks... as a last resort” for health care workers running out of PPE. “That's like sending a soldier to war [wearing] flip flops and a T-shirt,” Kenneth said.
Kenneth’s main concern isn’t running out of PPE—he said that’s inevitable during a natural disaster like a pandemic, which overwhelms the system by its very nature. Kenneth is worried about what will happen when his colleagues get sick.
“If we run out of PPE, that sucks, but if we run out of people, that’s a bigger issue,” Kenneth said. “If the true frontline people with the critical care skills get knocked out, that's the collapse.”
The PPE shortage is especially bad when combined with what emergency department nurse Monica calls a “no-testing culture.”
“Health care workers are afraid to test [themselves] because they feel they’ll be a burden on the system,” Monica said. “What does [getting sick] mean for their jobs, their colleagues?”
Three of Monica’s colleagues at the hospital are out sick. One of Kenneth’s fellow doctors tested positive for COVID-19 and can’t work for two weeks. Jennifer knows four night shift nurses who are sick. Sources say that at multiple hospitals, cafeteria workers came to work sick and have since tested positive for COVID-19, exposing dozens of health care providers to the disease. Michael suspects that infectious disease experts would be “aghast at our ability to contain virus within the hospital.”
“Nurses and doctors in the [triage] tent will contract this disease,” said Jason. “We’re running out of nurses. Hopefully, the feds"—the Department of Defense with supplies, and the National Guard with personnel—"send emergency relief.”
Jason hopes to see more PPE released from the Department of Defense. Michael wants additional hospital staffing from other states and the military, several field hospitals, and a centralized triage system. He believes these initiatives are underway, but he fears it may be too little, too late.
Kenneth said there will always be some hardy doctors and nurses willing to “raw dog it” (work without gloves and PPE). But he can’t ask his colleagues to work under those conditions. He’s planning for a future without adequate staffing or beds, one where every available space in the hospital—the operating rooms; the hallways—is filled with patients. He anticipates treating the “walking wounded” (people with minor injuries such as broken arms) wherever he can.
“I can go in a closet; I can go in a parking lot—I will take care of [patients],” Kenneth said. “Shit’s getting real. This is about to blow up. I just hope I have enough bourbon.”
Follow Missy Wilkinson on Twitter.
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