COVID19 ‘We run towards problems, not away from them.’ As COVID-19 closes in, a rural doctor awaits the inevitable.

Dean Krakel/High Country News

IN EARLY MARCH, Dr. Jason Hogan realized what was about to happen: The new coronavirus had infiltrated his community, and it was going to be bad. Hogan, one of seven emergency medicine physicians at the only hospital in Gunnison County, Colorado, and his colleagues were seeing dozens of patients with textbook COVID-19 symptoms. Some had been sick for more than two weeks. During that time, they ate dinner with their families, picked up groceries and talked to friends.

Hogan, who has cropped dark hair and the calm demeanor of one who habitually reassures the worried, understood the virus’ potent transmission capacity. Given the sheer number of symptomatic patients, he had a hunch that the virus had already spread widely in the community. And this signaled trouble for his rural, resource-limited hospital, which serves a large valley in the mountains of Colorado’s Western Slope.

“If you wait until people are coming in, you’re already way behind.”

“If you wait until people are coming in,” he told me over the phone in mid-March, “you’re already way behind.”

And, indeed, they were. Since that weekend, Hogan has been on the front lines of one of the nation’s COVID-19 epicenters. Like several other ski-dependent areas in the Western U.S., Gunnison County— home to the ski town of Crested Butte — was hard-hit. It ranks among the nation’s top 10 counties for rate of infection per capita. The county response has been notably aggressive, with business closures, limits on gatherings and shelter-in-place policies that came much earlier than the state’s orders.

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FOR HOGAN and medical workers like him, the new coronavirus collapses the boundaries between the work of the day and life beyond it. At home, the virus distorts everything. His sleep schedule is erratic. At work, he fears for his wife, Sara, a physical therapist working in Crested Butte, who recently entered her third trimester of pregnancy with their first child. During the second week of March, as the number of patients rose, Hogan worked long shifts nearly every day. He came home exhausted and worried, prey to a constant background hum of anxiety and fear. “We’re all talking about it (at the hospital), potentially coming home and hurting family,” he said.

For Sara, who has blond hair and a love for cross-country skiing, mid-March was a painful, uncertain time. She had stopped seeing her own patients to avoid exposure. COVID-19’s impact on pregnant women remains unclear, but pregnancy lowers immune response, and the American College of Obstetricians and Gynecologists said that some COVID-19 symptoms in mothers, including high fevers, can impact infant health. At home, she found herself crying at random moments during the day. She worried about Jason’s health. She worried about her own. She worried about the baby. One night that week, the two sat down to discuss physical separation. Sara even bought a tarp to silo Jason’s side of the house. But for the time being, even though Jason has been exposed, they have decided against absolute isolation. “It was scary to think that if he got sick and didn’t handle it well, it would be really hard for me to be far away from him,” she said.

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Instead, they have developed new routines. During the day, Sara takes walks and tries to restrict her consumption of news. Jason sleeps in a separate room and uses a different bathroom. They wear masks in the house and limit contact as much as possible. They share only an exercise bike, which they “sanitize aggressively” before and after each use. “We haven’t kissed or hugged or had any of the normal day-to-day contact in a month,” Jason said. Still, Sara feels reassured when he is at home, even if they don’t interact. “If he’s home, he can be asleep,” she said. “He can be asleep the whole time, I don’t care.”

Both read the grim news coming out of hospitals in China, Italy and New York. What those doctors experienced, Jason would soon. A recent Washington Post article written by a physician dubbed this fear “pre-traumatic stress disorder,” the awareness that bad times are coming and there’s no preventing it. Sara worries about her husband’s mental health, but, she said, “I’ve been proud and also reassured by how mentally focused he is.”

Gunnison County’s first COVID-19 related death came on March 23. Later that day, I sent Hogan an email, asking what this meant for him. “A trauma surgeon I trained with as a medical student used to say that as emergency/trauma providers, ‘We run towards problems, not away from them,’ ” he wrote. “I like to remind myself of that in these situations.

“Working in health care in any capacity reminds you that life is finite and to try your best to take care of yourself, so you can help take care of others.”

“In regards to changing my personal or professional life, my perspective on death changed a long time ago,” he went on. “Working in health care in any capacity reminds you that life is finite and to try your best to take care of yourself, so you can help take care of others.”

Dean Krakel/High Country News

AS MARCH PROGRESSED, Hogan and his colleagues worked 12- and 16-hour shifts, many days in a row. Whenever a patient’s lungs filled with fluid, Hogan ran a tube through the mouth and down the windpipe. Ventilators carrying oxygen hummed at all hours. Gunnison Valley Health has 24 beds, a small staff, just a handful of ventilators, and no Intensive Care Unit. Without an ICU, the hospital cannot treat the sickest patients, those with viral pneumonia or extreme difficulty breathing. The staff must take these cases via ambulance to Grand Junction, more than two hours away over some dicey mountain roads. (The hospital has requested an ambulance team from the state.) It’s assumed that at least 10% of the medical workers will be sick with COVID-19 at any one time; several have already tested positive. Whenever the staff had a spare moment, they trained frantically on each other’s emergency room roles. When one worker falls ill, another has to step in.

Yet despite the strain, by the end of March the hospital had not been overwhelmed. Hogan and other local health officials credit the integrated effort of the county government, the Health and Human Services Department and a strong network of volunteers to “buffer” the hospital against a wave of patients. This is done, in part, by strict rationing of tests and by exporting care, often multiple patients a day. What keeps Hogan up at night, he said, is the scenario in which their partner hospitals reach patient capacity, even as cases increase in Gunnison. And this may be coming: Available data suggests that Gunnison’s hospital can expect a mid-April surge of patients. The staff is planning for the “worst-case scenario,” where the breathing-impaired cannot be transferred. The hospital is currently building an off-site emergency room at a local field house mainly used for livestock shows.

This anticipation can be hard, Hogan said, especially given the possibility that neither the virus’ spread nor the burden on the hospital will have eased by his wife’s early-June due date. “I just hope to be able to be in the delivery room and hold my son when he’s born,” he said, though he acknowledged that this may not be a good idea. Sara said her immediate priority is simple: Stay healthy. Each Thursday marks another week of the pregnancy – “a small thing to celebrate” in these uncertain times – and another day closer to giving birth to a baby boy.

“My mindset is to try and control what I can control,” Sara said. “The due date is all I can wrap my head around right now, and we’ll see what happens after that.”

Nick Bowlin is a contributing editor at High Country News. Email him at [email protected] or submit a letter to the editor.

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