'I wish they could see how bad things are getting': As Wisconsin hospitals fill up with COVID patients, front-line workers sound the alarm

One of Paige Schonfelder's recent COVID-19 patients told her she'd done everything right.

The woman had a compromised immune system, so she'd heeded experts' advice to stay home and avoid social gatherings. She must have picked it up at the grocery store, she told Schonfelder.

For weeks, the woman suffered alone at a Fox Valley hospital where Schonfelder works nights as a nurse. She only saw family again in her last few days, as she died.

Yet in Schonfelder's small hometown a few hours northwest of Appleton, restaurants flaunt signs saying they don't require masks. Some people think COVID-19 is overblown, or a hoax. She's a firsthand witness, she tells people there: The threat is real.

"I see it, I deal with it, I was at work overtime. I wish I was lying." 

Six hundred and eighty-three patients were in the hospital with COVID-19 on Wednesday, the state hospital association reported, nearly double what it was two weeks earlier.

In April, surging hospitalization numbers were a bellwether for Wisconsin's highest death totals since the pandemic began. Although death totals have been level for most of September, on Wednesday, officials reported a new single-day record with 27.

At ThedaCare in the Fox Valley, where hospitals have been among some of the state's hardest hit, vice president and chief medical officer for acute care Dr. Michael Hooker said the surge of coronavirus patients is happening much faster than they'd expected. If the trend isn't reversed, he said, it could overwhelm hospitals in as little as two weeks. 

"Back in March, we had predictions of six hundred or a thousand inpatients all at once ... We were (thinking), 'There’s no way that we can take care of that many people,'" Hooker said. "I’m having memories of that feeling."

ThedaCare began to send COVID-19 patients to its Neenah facility and critical access hospitals in Berlin, Shawano and Waupaca after it ran out of room at its COVID unit in Appleton. Bellin Hospital in Green Bay was at 94% of its capacity on Tuesday, Bellin Health leaders said. And Aspirus Healthcare in Wausau reported the same day that it has had to place some patients on a waiting list for entering the hospital. 

The state's top health officials said this week Wisconsin is nearer than ever to needing to open an emergency field hospital built in spring at the state fairgrounds.

But hospital workers continue to see callous social media comments and confront family, friends and acquaintances who don't believe the virus is anything to worry about.

As hospitals across the state brace for what the next few weeks could hold, these employees are buckling down for harder, longer work days, and pleading with their communities to take the dangers of the pandemic more seriously, before it's too late.

Hospital workers now report different worries than in spring, when the virus was new 

Jessie Schaumberg knows that 24 COVID-19 patients in an ICU doesn't sound like a lot. But everything you do in isolation takes twice as long. 

The personal protective equipment is uncomfortable, and goggles can fog up. Patients can't read your facial expressions and sometimes you have to yell through your mask just to be heard.

Sometimes, it's 4 a.m. when Schaumberg, a clinical nurse specialist at Bellin Health, starts her daily report to hospital leadership detailing the status of those infected patients: How many are there? How long have their stays been? How much oxygen are they on? What other conditions could make their illness worse?

Schaumberg has worked in the ICU for 19 years. Still, the onset of the pandemic and the fear it awakened in everyone at the hospital was unlike anything she'd ever experienced.  

In spring, as a coronavirus outbreak tore through Green Bay's meatpacking plants and hit the area's Latinx community hardest, Bellin employees cared for their first large wave of patients. That was heartbreaking for staff, Schaumberg said, knowing that many of the people were sickened — and some would die — just because they showed up to work. 

Now, the challenge is figuring out how to provide high-quality care for an even more massive influx of COVID patients. It upsets her to know that caring for many of these patients at once — patients who require more time, resources and labor than others — affects her staff's perception of whether they're able to do enough for the people they care for. 

"We take really good care of patients. (The nurses) thrive on how good of a job we do. But when you're overwhelmed with critically ill COVID patients, it completely takes away the ability to provide this high level of care," she said.

In Madison, UW Health's University Hospital saw its peak of coronavirus patients in April and May, said nurse Christina Brahos. Most of her memories of that time are of frustration.

Nurses were responsible for more than usual: Cleaning rooms, doing their own blood draws, coordinating dietary services and setting up telehealth appointments with specialists, in addition to their regular work. 

"It was very exhausting," Brahos recalled. "We weren’t able to give the best nursing care that we could have because we had to do so many other things ... I didn’t feel like I had a lot of time to form a connection with people."

Jennifer Bosetski, an ICU nurse at Ascension's St. Elizabeth campus in Appleton, caught a glimpse of an overwhelmed health care system when she worked temporarily at Ascension Columbia St. Mary's Hospital in Milwaukee as cases surged in the city in April. At one point, more than 40 people with COVID-19 were on ventilators at the Milwaukee hospital. 

She said her fear of the unknowns of the disease has subsided, but there are other fears to contend with now — like that the surge of patients now appearing in her hometown hospital will only grow if people remain indifferent to the risks. 

"I'm a different scared, a more educated scared," Bosetski said. 

In some ways, hospitals are better off now than they were when the pandemic began, said Dr. Brian Hoerneman, director of emergency care at Marshfield Medical Center.

At the beginning, they struggled for personal protective equipment and access to testing. Those issues are resolved for the most part. 

But like elsewhere in the state, the Marshfield hospital is seeing its highest patient numbers yet. In the last week, it's begun to move COVID patients from its designated unit into other areas of the hospital to deal with increased volumes. 

The challenges of taking care of patients with a highly infectious disease "make the long days even longer," Hoerneman said.

Front-line staff, already worn out, fear missing work more than the illness itself 

The performance of an overwhelmed hospital comes down to its staff.

As of Tuesday, at least 8,114 Wisconsin health care workers have tested positive for COVID-19, state health department data show. Brahos, the Madison nurse, is one of them. Then there are others who have had to quarantine after an exposure. 

You can add more beds, you can create additional wards, you can put up tents, Hooker of ThedaCare said — but none of that matters if there aren't enough employees to take care of people. 

That weighs heavy on the mind of Schonfelder, the Fox Valley nurse, as she takes necessary trips out into the community. 

"I'm not afraid of me getting sick. I'm afraid of getting sick and needing to be off work for so long. That's going to really hurt," she said.

Hospital leaders in Marshfield have tried to be "creative" with staffing, Hoerneman said, but at the end of the day, fewer staff in the building means they can take care of fewer patients.

Already stretched thin, nurses and doctors are making sacrifices to keep working. Schonfelder has picked up extra shifts, sometimes clocking 16-hour days. 

And the stress doesn't always end with the work day. After working with a COVID patient, Bosetski changes her clothes and leaves her shoes at the hospital to protect her family when she goes home. If she feels like it's too risky, she can stay in a family camper or a hotel that Ascension provides. 

The hard work comes at a price. High stress for months with an uncertain future, coupled with the experience of losing patients to COVID-19, has produced symptoms of post-traumatic stress disorder in ThedaCare employees, Hooker said. 

"We're really fighting a war in the hospital," he said. 

Brahos knows the feeling all too well. She feels visceral tension and fear at times, she said, and those anxieties don't go away even on her days off. Knowing that there's no end in sight has made her less optimistic about the future and doubt the inherent goodness of people.

"(I have) a lot of lingering thoughts at night. 'Who am I exposing? Am I going to get sick? What is the moral right thing for me to do? Who can I see? Who is it worth taking the risk for?'" she said. "You’re on a constant high alert."

UW Health provides resources to help its employees cope with the stress, but at the end of the day, she said, going to a counseling appointment or a mindfulness session just feels like yet another task on her plate. 

Those in health care struggle watching others ignore virus worries 

Before the pandemic had arrived in Wisconsin in earnest and before masks were required all over the hospital, Amy Mager brought a patient with pneumonia down to the radiology department at Froedtert Menomonee Falls Hospital. Nothing seemed amiss.

Mager, who assists with imaging, diagnostic tools like X-rays and ultrasounds, found out within an hour that the patient had tested positive for COVID-19. She was sent home to quarantine, riddled with guilt. 

"I just remember sitting in my car, crying," she said. "I brought this patient in the hallway, into the department. Who was also exposed?" 

Another time, a COVID patient's heart stopped while getting a CT scan. She described it as one of the scariest moments in her life as nurses rushed to provide CPR. The patient died. 

Despite these experiences, and despite three high-risk family members catching the virus just a few weeks ago, Mager said she still sees other family members and friends acting like the virus is no big deal. 

"I feel like it's a huge slap in the face," she said. "I try to educate and I also try to be respectful in what I'm saying, but it shouldn’t be a hard concept."

She's not alone in having to confront people who seek to minimize the pandemic. 

Hospital employees are trying to share what they're seeing at work to convince others that Wisconsin stands at a tipping point. 

If residents can put aside politics, apathy and the "COVID fatigue" that has begun to loosen our attention to the tools that work to stop spread, health officials agree that the pressure on hospitals could be relieved and we could begin to flatten the curve, again. 

If not, it's likely just a matter of weeks before hospitals can no longer provide the level of care they used to as more patients flood in.

Beyond the sliver of the population that believes the virus is a hoax, most others simply haven't been personally affected yet, health workers agree, making it difficult for them to empathize with those who have or fully commit to following the recommended precautions to slow the virus' spread. 

Just around 2% of Wisconsinites had received a positive test result as of Wednesday. But that shouldn't be a reason to play down the threat, Hooker said — it simply means there are many, many more people who will get infected. 

"Before we can get through this pandemic, either approximately 80% of the population gets infected, or we have a vaccine," Hooker said. "There's no other way to get through a pandemic. It's not like we're only going to get 20% of the population sick." 

Bosetski has resorted to blocking people on social media who dabble in conspiracies about the pandemic. Dr. John Steinlage, an Ascension urgent care doctor, said he's grown more "bossy" with friends who send skeptical texts about the evidence-backed tools to slow the spread. 

"I see this post on Facebook all the time. 'Well, if masks work, why are we having a surge?'" said Dr. Anthony Zeimet, an infectious diseases expert who also sees coronavirus patients at Ascension hospitals.

Despite Gov. Tony Evers' statewide mask mandate and the science-backed reasons to wear one, some people aren't — and others aren't wearing them correctly, Zeimet said. 

Schaumberg, at Bellin, has run into the same problems in her personal life. With children in elementary school, she said there's a tremendous amount of peer pressure from other families to resume life as normal. 

"I just wish (the community) could see how bad it's getting," Schonfelder said. "We need to make a change now. At this rate, I don't think we'll be able to keep up. Something needs to be done." 

UPDATE Oct. 1, 2020 at 9:41 a.m.: A prior version of this article incorrectly stated that Ascension provides a camper for staff to stay in if social distancing from family is needed. That camper is Bosetski's own; Ascension provides hotel rooms for such reasons.

MADELINE HEIM covers health and science for USA TODAY NETWORK-Wisconsin. A 2018 graduate of the University of Wisconsin-Madison, she previously covered education for the Winona Daily News and is happily back in her home state, where she can root unapologetically for the Packers and continue her quest for the finest cheese curds in all the land.

Contact her at 920-996-7266 or mheim@gannett.com; follow her on Twitter at @madeline_heim.