COVID-19: Anecdotal Accounts to Consider

Bo Brusco | July 16, 2020

A Pandemic of Uncertainty

The onset of Covid-19 has caused an information crisis. The distribution of misinformation on social media sites has spiked, the data provided by our leading experts are being questioned, and our nation’s basic understanding of this pandemic is becoming increasingly convoluted by political agendas. For many Americans, the search for facts has been too disheartening to continue; and when we objectively consider the situation at hand, it is completely understandable to see why we don’t unanimously understand anything. 

Although anecdotal evidence is not typically ideal, we resort to it when we suspect that the available data has been politically hijacked. And as scientists struggle to keep up with this novel coronavirus, eye-witness accounts may be our best resource for at least comprehending the severity of the situation. 

Enter Nate Smithson. Nate is a Registered Nurse at Intermountain Medical Center (one of the only Level I trauma centers in Utah). He has been an RN for over two years now—just enough time to get his feet wet before the pandemic. I had the opportunity to interview Nate, and I believe his first-hand experience with the virus is invaluable, especially for those of us who find the conventional sources of information to be futile or otherwise compromised. His words needed no editorial tampering nor political spin; however, I did embolden particularly poignant parts of his responses that deserve our sincere contemplation.

Nate Smithson and his wife, Chloe Mayer Smithson.

What is some general information about the hospital you work at in regards to COVID-19?

Before the new virus broke out I worked in the respiratory ICU. When Covid came to the US, ours was converted to the COVID ICU. Most of our patients come from the Salt Lake area, but we have received patients from all around Utah and neighboring states that didn’t have hospitals with sufficient resources. 

Do you feel that your hospital was overall prepared for the pandemic?

Short answer is no. But I don’t think any hospital was prepared. After the Ebola outbreak a few years ago, my hospital set up a stand-alone building specifically designed for infectious diseases, and they had a trained team of nurses and caregivers set aside to staff it in case of an outbreak. The only problem is that it only had two beds. At the beginning of this pandemic, we had one of the first cases in America flown to our hospital by the CDC to test the readiness of that unit. It functioned exactly as it was supposed to, but the next week the case count started climbing in Washington and that is when we realized that our two bed unit would not be enough. That is what led to us creating our sequestered COVID ICU.

Do you remember when your hospital received its first COVID-19 patient?

I remember it very well, actually. We had prepared for the outbreak and we were in the process of converting our entire ICU into a negative airflow unit. The night before we officially opened it we got our first two COVID-19 patients. There was a lot of excitement around it. It was all still very new and none of us knew much about what the disease was at the time. About half of the staff, myself included, were still under the impression that this was a fancy flu and our safety measures were overkill. When one of the patients first arrived he was fine by normal ICU standards—not on much oxygen, able to get up and walk around by himself, a pretty easy patient. And then a few hours later he got up to use the bathroom and immediately started tanking. We couldn’t get enough oxygen in him and had to intubate. That’s when I started to realize that this was nothing like the flu. I had never seen someone deteriorate that quickly and it scared me. He was in a medically induced coma for over a week, and when we finally tried to wake him up he didn’t regain consciousness for another week. I spoke to his wife on the phone every night to give her updates and I remember telling her multiple times to prepare for the worst. I still don’t know how it happened, but he was able to recover after three weeks and left the ICU. Last I checked he finally made it home and was working with Home Health.

Do you remember roughly about what percentage of hospital patients had COVID-19 when your state began to reopen? 

I don’t know the percentages off the top of my head, but a few weeks before the state began to reopen we had 18 patients between the two COVID ICUs at my hospital. The week the state reopened we were down to one ICU and had seven patients. Since reopening, we are now back to two full COVID ICUs, and we have had to start overflowing to other units.

Detail, if you can, the demographics of the COVID-19 patients you have seen so far.

We have seen patients ranging in age from 24 to 92. Most people that I talk to seem to think that this is just a disease for the elderly but it affects people of all ages. Oftentimes they have no previous medical conditions. The majority of our patients are in their late 40’s to early 60’s. 

Describe the range of symptoms and severity of cases you have witnessed so far. 

One thing that we have seen a lot is that these patients can deteriorate pretty quickly. So we have been cautious and have had patients come up to the ICU earlier than we typically would with other diseases. Sometimes they don’t get worse and they leave the ICU in the next day or two. Other times they are doing just fine and the next time you look at the monitor they have tanked and need to be immediately intubated. The patients that need intubation and ventilation they are all very similar. They require high levels of sedation so they don’t fight against the ventilator. Many of them have very low blood pressure, blood clots, kidney failure, skin breakdown, and many other issues. A lot of problems are directly related to the disease, others happen as a side effect of the treatment, but we have to allow it in order to keep the patient alive. The other problem we have seen is that these patients take a very long time to recover. We have had many patients on the brink of death for over a month with no sign of improving and then suddenly one day things start getting better. Other times things don’t get better and the patient finally gives up the fight. Another interesting and somewhat devastating thing that we have seen across the nation is the prevalence of blood clots with this disease. Blood clots can cause a myriad of issues, one of the most severe being strokes. It appears that many patients are having strokes due to the clots but because they are so sedated they don’t show symptoms until much later when we start to wake them up. The extent of the damage varies between patients, but it is a big concern that needs a lot more research before we can understand what is causing it.

Do most of the COVID-19 patients know or suspect how they contracted the virus?

Honestly, I don’t know the answer to that question. There are very few patients that are still conscious and able to speak by the time they get to me. Most of them have tubes down their throats and are heavily sedated. We have found that many patients recently attended family gatherings where someone had it, or have a family member that brought it home from work or elsewhere. It seems to be that the people suffering from it the most are doing everything that they are supposed to, but someone close to them isn’t. People are going out thinking that they have nothing to worry about because they are healthy. They end up catching it and giving it to their family members who end up in the ICU as a result.

What was one of the most memorable or noteworthy experiences you have had so far in the ICU during the pandemic?

I don’t know how I could pick one moment. We spend weeks, sometimes months, doing everything for these patients. We feed them, we bathe them, we keep their hearts pumping when they stop; we practically live for these people and when they die, it hurts. A little piece of you dies with them. But what hurts even more is telling the families that their loved ones aren’t going to make it. We develop relationships with them while we care for their patient. They pray for us, they support us, and they plead with us to do everything that we can. It hurts when we have to come to them and say that we can’t do any more. Oftentimes they break down into tears. Other times they are hurt and angry, and they turn that anger towards us. That is probably what hurts the most. When you develop a relationship and get to know them and they are constantly encouraging and supporting you, and then in an instant they tell you that you gave up, that you are a horrible person because you weren’t able to save their loved one. But I can’t blame them. They are going through something horrible and they need somewhere to direct all of their emotions. It just hurts to see them suffering.

Do you and your coworkers have enough PPE? 

There is a shortage of a lot of things that we need, but we are adapting to the situation to make our resources last. Before all this started, N95 masks were only to be worn for four hours at a time, or in between patients and then thrown away. When Covid came, we were all given two, and we have to wear them multiple days at a time while the second one is being cleaned for reuse. Fortunately, since my unit is high risk we are using devices called PAPRs. It is a positive pressure system that continuously pumps filtered air into a hood. For now we are ok, but everyone is trying to find ways to make our supplies last as long as possible.

Nate Smithson (3rd from the left) and his colleagues at Intermountain Medical Center wearing their PAPR masks.

How many hospital employees have been diagnosed with COVID-19, if any?

In my unit we have been lucky so far and no one has been diagnosed with Covid. We are in a pretty unique situation, though. Since we know that all of our patients have Covid, we are able to prepare for it and take all the necessary precautions to avoid it. On other hospital floors where you have a mix of patients, it might be harder to effectively protect yourself. I don’t know the numbers for the whole hospital, but there were recently 11 employees diagnosed with Covid on the floor above mine. 

Are you worried about contracting the virus? 

I am terrified of the virus. Not so much because I am afraid of getting it, but because every patient I see reminds me of someone in my life. Most of our patients are in their mid to late 50’s and every time I go in to work I just see my mom and dad laying face down and dying. There was a 24 year old girl that’s the same age as my wife. We had a guy pass away a couple weeks ago and his family came in to say goodbye. He had five kids and each one of them was the same age as one of my younger siblings. The youngest was sixteen and it killed me to sit there and watch her say goodbye to her dad. Under different circumstances, each one of these people could have been someone I know, and they are all—every one of them—the sickest people I have ever seen.

What would you say to someone who insists that COVID-19 is like a common cold or the flu?

I would tell them that it most definitely isn’t. I have taken care of people with the flu, I have watched people die from the flu, but never have I seen the flu do anything even close to what Covid is doing to these people. It is true that not everyone will have life threatening symptoms, but the percentage of patients that do is alarming. I have been closer to this disease than most people ever will and it is terrifying. I wish I could show people just how bad it can get. If everyone spent just one day in a COVID ICU, there wouldn’t be anyone left that still thought this was just the flu.

What would you like to say to those who refuse to wear masks? 

We have been using masks in hospitals and other healthcare settings for decades. The efficacy of surgical masks has been studied, researched, and proven over and over again. The effects that masks have on both the person wearing them, and the person on the other side, have been studied for years. They are safe and they are effective. If surgeons can wear them for 16 hour surgeries without any negative side effects, then you will be just fine for your 30 minute trip to Walmart.

Is there anything else you think the average American should know or consider in regards to COVID-19?

Yes, this is real. If it isn’t real for you, it is real for the newly widowed mother of five. It is real for the family that just lost their father, mother, or daughter. Just because you may not be affected personally doesn’t mean there aren’t people out there that have been absolutely devastated by the effects of this disease. If you have any complaints or reservations to wearing a mask and social distancing, please reconsider. If you won’t do it for yourself do it for those that might not live through this disease. If wearing a mask saves just one person, then it is worth it. That one person is someone’s whole world.

Consider This 

Though the pandemic may seem like a distant crisis that some of us are being inconvenienced by, like Nate said: it is real. Nate Smithson is a real person who is witnessing this pandemic every day of his life. Nate and I went to college together. We played music together. He Isn't a politician, he hasn’t been paid off by some villainous billionaire, nor has he been recruited by a nefarious entity hell-bent on depopulating the world; but he is very aware of the severity of the situation, and is doing everything he can to save lives. And while his story might not accurately reflect what is happening in your town, it serves as a reminder that it could.

Nate (left) and me (3rd from the right) before a show in November 2016.

The next time a friend, colleague, or family member shares with you an article about how COVID-19 is no worse than the flu, or how some report was inaccurate or inflated, remember Nate Smithson. His experience should compel us to exercise more caution, for our own sake and for that of our loved ones. If you have become mentally exhausted from trying to keep up with the changing and competing information, consider what has been shared today and behave accordingly because while we can’t calculate the exact risk of COVID-19, we can be certain it is there.