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"Challenging" doesn't begin to describe the COVID-19 pandemic's impact on nurses and others at Meritus Medical Center.

"It's been so many more things than just challenging," said Heather Markell, a clinical nursing manager at the hospital near Hagerstown.

"It's rewarding. It's gratifying. It's heartbreaking. It's devastating. It feels hopeless. At times, you feel hopeful. It's felt endless," she said.

And now the workload is increasing.

Again.

Despite the availability of vaccines, guidance on masking and social distancing and medical advances, Markell and her coworkers are seeing a surge of COVID-19 patients that resembles what they went through last winter, during the height of the pandemic here.

But this time, she said, their COVID-19 patients are younger.

They're sicker.

And most — more than 80%, typically — are not vaccinated.

In July, the county recorded two COVID deaths, according to the county health department. In October, the number was 42.

Since the pandemic began, the county has reported at least 423 COVID-19 deaths.

'It's going to be a long winter'

"At this point, COVID-19 is largely a preventable disease, but it continues to create a significant burden for our community," Earl Stoner, Washington County health officer, wrote in an email Thursday. "The only way to get out of this is if we all work together for the greater good of the community, and that means protecting all of us."

Stoner wrote that he recognized that "everyone is exhausted with this pandemic." But, still, the case numbers, hospitalizations and deaths are rising again. 

"Simply put, people need to get vaccinated and boosted; wear a mask in indoor public settings; get tested if they have symptoms or have been exposed to an infected individual; and stay home if they are sick. Now it is more important than ever that we collectively focus on the things we know prevent the spread of COVID-19 and its variants," he wrote.

He and Danielle Stahl, spokeswoman for the health department, urged vaccinations for everyone age 5 and older.

Maulik Joshi, CEO and president of Meritus Health, said the public needs to take notice.

"I do think we need a health advisory right now," he said.

COVID-19 numbers dove a few months ago. Vaccines were being distributed and warmer weather kept people outdoors longer.

On July 17, Meritus did not have a single patient in the hospital with COVID-19.

But by the end of August, that number was 31. By the end of November, it reached 53.

On Wednesday, 60 patients were being treated for COVID.

Of those, 49 people — 82% — were not vaccinated. Thirteen of those 60 were in the intensive care unit, and 85% of them in intensive care were not vaccinated. And five were on ventilators — four of whom were not vaccinated.

According to figures kept by the county, 51.2% of Washington County residents were fully vaccinated as of Dec. 4.

The Centers for Disease Control and Prevention says you become “fully vaccinated” 14 days after receiving a second dose of the Pfizer or Moderna vaccines or a single dose of the Johnson & Johnson vaccine. The CDC also says people age 18 and older should receive booster shots..

The county's positivity rate, which was below 1% in the summer, was over 14% as of Dec. 3. Meritus Health was recording a positivity rate of more than 18% for the tests it administered.

Joshi is confident that  "we'll get out of this" pandemic and that the community can do it together.

He's still urging people to get vaccinated as quickly as they can.

"Most of the very sick people are unvaccinated," he said.

To Joshi, the most recent news about variants, such as omicron, is interesting. More important is what people can do every day.

"To me, it's smoke," he said of the variants. "The fire is still COVID. It's important for us all to get vaccinated as soon as possible."

Eventually, the pandemic will ease into an endemic, such as the annual flu season. In an endemic, a virus is present, but manageable.

"We're not there yet with COVID-19," he said.

The COVID pandemic is at a pace and impact "that is far from the end," he said. And being in an endemic "also means your hospitals are not stressed."

Right now, he said, hospitals are stressed.

To find enough nurses, Meritus has sought help from other sources, such as outside agencies that provide temporary staffing options.

"We have over 100 agency nurses, the highest number we've had since I've been here," Joshi said.

"It's going to be a long winter, and our staff is really tired."

'Fill those buckets'

Markell said that she and the other front line nurses and "every member of this health care facility wants the best for this community. They want the absolute best in health care for this community."

She also said some nurses have switched professions because of the pandemic's toll on them.

"I've seen nurses leave (a shift) on top of the world because we've had patients we've been able to successfully discharge home after watching them experience a week, two weeks, three weeks, 32 days length of stay in the hospital isolated from their families, their loved ones, their known way of life," Markell said.

But there are other moments.

"I have seen nurses leave with their bucket so empty, it's all they can do to sit in the car in the parking lot and talk themselves into their next shift," she said.

When they go on those shifts, nurses are seeing different types of patients than they did last winter.

"The first time around, we saw a lot of elderly patients with co-morbidities (who) really suffered, and we have a lot of loss and that generational gap," Markell said. "This time we're seeing much younger patients. … Patients in their 50s, patients in their 20s or 30s, otherwise healthy, independent people that'll leave dependent on oxygen. They'll leave dependent on therapy. They'll leave dependent on assistive devices like wheelchairs or walkers."

Even donning and doffing the gloves, masks and other personal protective gear can weigh on health professionals. The process can seem like a delay to patients who have pushed a bedside buzzer, Markell said. And the gear limits the human connections between nurses and their patients.

Then there is the rise and fall of case numbers.

"Just when we think we can get loved ones back together and gatherings back together, and we can start getting some what we would consider normalcy, (then) seven days later, we could see a spike," Markell said.

She said the staff was grateful for the summer days with no COVID patients. But to some, when the numbers started climbing again, it felt like a false victory.

"It's been challenging for us as leaders to continue to have them fill those buckets to say, 'It is a win. That is a win. And you have to know it's a win.' And even if it's a day where we have zero COVID-positive patients, that is a win. And even if, two weeks later, we have another 20 admissions, that hope and that glimpse in time is a win."

This article originally published in The Herald-Mail and online at HeraldMailMedia.com in December 2021.