'It breaks your heart': Wisconsin's stressed health system braces for another COVID wave

Molly Beck Madeline Heim
Milwaukee Journal Sentinel

Ten months ago, Tina Schubert held her right hand to the sky in relief while a colleague plunged a needle into her left arm. After nearly a year of trying to rid helpless patients of an inscrutable disease — and escape it herself — a vaccine had arrived. And she was first.           

The moment was photographed for history books. Schubert, a respiratory therapist at University of Wisconsin Hospital in Madison, had received the first COVID-19 immunization in Wisconsin — a milestone she recalls as "emotional" and "hopeful." 

Respiratory therapist Tina Schubert became the first of UW Health’s healthcare heroes to receive the Pfizer COVID-19 vaccine at approximately 2:30 p.m. CT on Dec. 14, 2020.

But now, Schubert and her colleagues are experiencing a familiar yet unthinkable surge of infections fueled by mutations of the virus the vaccines were created to stamp out because not enough people followed Schubert's lead. 

COVID in Wisconsin: Track COVID-19 and the vaccine in Wisconsin

"It breaks your heart because one minute you're happy and you're excited, and now you're just ...," she said in a recent interview, pausing. "I'm sorry I'm becoming emotional because no one expected another variant to come and affect us the way it is right now."

Wisconsin is facing a replay of last winter and its hospital workers are bracing again for the physical and emotional exhaustion of caring for more patients than their workplaces are equipped to handle. 

Unlike the last time Wisconsin experienced this rate of COVID-19 spread, workplaces and classrooms have reopened. Sporting events and concerts are back. And unlike last year, Gov. Tony Evers and state health officials are not planning as of now to issue orders to require us to wear face masks or socially distance by limiting capacity, following a series of successful lawsuits from Republicans over past mandates. 

"We all know, whether there's a mask mandate or any other mandate from me or our public health people locally, that we have a solution — it's a shot. It's real simple," Evers said this week at a press conference in Milwaukee. "Get a shot and we'll be able to get out of this."

Wisconsin's hospitals, testing labs and contact tracing workforce are keeping up with demand, but the future is unclear as cases continue to tick upward and hospitalizations are matching levels before vaccines were widely available. 

As of Sept. 10, 1,047 patients infected with COVID-19 are in Wisconsin's hospitals. That's well below the peak of 2,277 hospitalizations Wisconsin experienced in the fall but more than double the number of COVID-19 patients in hospitals just a month ago.

The number of COVID-19 patients in intensive care units right now is as high as it was in mid-December when vaccines had just been approved for use and virtually no one had received a shot yet. About 93% of ICU beds were being used as of Friday, according to the Wisconsin Hospital Association. 

Schubert said she and her colleagues didn't imagine when they received shots that hospitals would see another surge of cases similar to those before vaccinations were available.

"At the beginning, it's hard to predict what the future would be like. On the one hand, once we were received the vaccination, the vaccines, we were happy and everyone was excited and we were hoping things would be different at this point. And then this new variant came," she said.

"I knew we were going in the right direction and it was going to be a long road just to get a lot of people vaccinated. I am still hopeful — I can't give up on that. I am still hopeful."

'If we don't do things differently'

Hospitals in the northern regions of Wisconsin are running out of intensive care beds, where many COVID-19 patients end up. In the Fox Valley and northeast regions, there are two ICU beds available in each area. In the northwest, there was one bed available on Friday. 

Compounding the unexpected increase in patients are other healthcare needs that had been delayed by the pandemic until recently. 

“There is a lot of pent-up demand for non-covid business," John Raymond, president and CEO of the Medical College of Wisconsin, said during an Aug. 19 event hosted by the Metropolitan Milwaukee Association of Commerce. "Our ICUs are pretty full right now with cancer patients and cardiovascular and neuroscience patients."

Raymond said if more Wisconsin residents don't get vaccinated or use mitigation tools like face masks and social distancing, the catastrophic surge of cases that hit some southern states in recent weeks could happen here. 

"What happened in Missouri and Arkansas — they're a month or two ahead of us and if we don't do things differently, we shouldn't expect a different outcome," he said. "If we don't change and we don't do things differently, we're going to have a pretty significant surge here in Wisconsin as well over the next few weeks."

Ben Weston, a Medical College of Wisconsin professor and medical director at the Milwaukee County Office of Emergency Management, said during the event that a key to combating the quick-spreading delta variant of COVID-19 is to encourage those who are unvaccinated to talk to doctors they trust with other prescriptions about the vaccine. 

“There is frustration that what we’re seeing now — the cases, the hospitalizations and the deaths — at this point are preventable,” Weston said. “That wasn’t the case necessarily a year ago. But at this point, we have one of the most effective, safest vaccines that’s frankly ever been developed in history, and so a lot of what we’re seeing here is preventable.” 

Department of Health Services spokeswoman Jennifer Miller said the department has distributed $6.2 million in grants to 100 organizations for vaccine promotion programs. 

Another $6 million will be spent on COVID-19-related campaigns, including those that encourage vaccines, Miller said. 

Evers also created two vaccine incentives in recent months, including offering free cream puff desserts at the Wisconsin State Fair in exchange for a vaccine shot. The puffs were donated, Miller said. Another program providing $100 Visa gift cards also is under way. 

Contact tracers in 'triage mode'

Contact tracing — the public health practice of notifying people who’ve tested positive for COVID-19 and notifying those who were exposed to them to prevent the virus from spreading unabated — was supposed to be the bedrock of tamping down the virus. 

But local health departments, some of whom only have a handful of employees to do the job, quickly became overwhelmed last fall when the state was recording thousands of new cases per day. State health officials say the system is showing signs of stress again. 

Though the current surge is producing an average of about 1,500 new cases per day, far from the more than 6,500 per day at the peak of last fall’s surge, contact tracers are already in triage mode, said Ryan Westergaard, chief medical officer at the state Department of Health Services, in a recent call with reporters.  

“When disease activity gets so high, we can’t reach every single person,” Westergaard said. 

Just less than 30% of Wisconsinites are using the state's cell phone app that notifies you when you've been potentially exposed to a person who tested positive for COVID-19, he said. 

Tracers are also relying on bolstered public knowledge about how to contain the disease that they’ve picked up over the last year and a half to pick up their slack. It’s likely that many people know now that they should stay home if they’re sick, get tested if they have symptoms and let others know if they’ve tested positive, Westergaard said. 

Locally, public health workers are calling back temporary tracing staff that they let go during early summer’s lull, hoping they’ll still be available to help as departments balance a new surge in cases along with trying to get people vaccinated. 

In Winnebago County, which is seeing an average of 43 new COVID-19 cases per day, according to DHS data, health officer Doug Gieryn said in late August that he had already expanded his temporary tracing workforce to deal with demand. 

He pushed staff to take vacations during the summer, knowing things could get worse in the fall — he just wasn’t sure how much worse. 

But now they’re weary and burnt out, repeating the work they started some 17 months ago again. 

“I don’t want anyone to think that public health can control the surge of this virus. It cannot. This virus is going to expand and infect at every opportunity,” Gieryn said. “The best we can do right now is help people get vaccinated.”

Each contact tracing investigation can take upward of an hour to complete, and more if the person who tested positive needs special accommodations, like an alternate housing situation. Last fall, when a health department might have recorded a hundred cases in a day, the math made it impossible to reach everyone in time to make a difference. 

Even the close to 300 tracers hired by the Department of Health Services by last November, meant to take the load off of local jurisdictions, couldn’t keep up. They turned to a triage model, where tracers would prioritize cases in high-risk locales like nursing homes and schools, and asked people who tested positive to notify their own contacts and ask them to quarantine. 

Testing labs keeping up with demand

As testing increases because of virus spread or through mandatory testing policies in workplaces and schools, labs set up to analyze COVID-19 tests are keeping up with demand.

Most labs in Wisconsin are prepared to keep up, said Alana Sterkel, associate director of the communicable disease division at the Wisconsin State Laboratory of Hygiene. 

That’s in contrast to last year, when sometimes even obtaining a test when you were sick was difficult. In the pandemic’s early days, supply shortages constrained tests to hospitalized patients and sick health care workers. 

Today, Sterkel said she’s not hearing about supply problems and that labs have been able to handle the uptick in tests. 

Pop-up testing sites may struggle slightly more with their testing capacity than fixed ones, she said, and those that need to send samples out of state might cause results to be delayed. Even so, she said she hasn’t heard of a turnaround time longer than three days. 

Larger labs were already looking to scale up their testing capacity heading into fall because of an increase in demand from schools, colleges and workplaces that will conduct routine COVID-19 testing, Sterkel said. For example, the University of Wisconsin-Madison is requiring unvaccinated students and employees to test weekly. 

Though Sterkel said increased testing needs from schools shouldn’t have too much of an impact on the general person’s turnaround time for a test, she added that “capacity is not limitless” and that a big increase in the volume of tests could strain labs again. 

Still, she said people with COVID-19 symptoms should still be seeking tests. Demand for tests dropped off in the spring and early summer as vaccines became more available, but vaccinated people can still test positive for the virus, though they are significantly less likely to require hospitalization or die from it. 

And though at-home coronavirus tests are now available, Sterkel said they can be less accurate and urged people to get tested in clinical settings, like at the doctor’s office.

Contact Molly Beck and Madeline Heim at molly.beck@jrn.com and mheim@gannett.com. Follow on Twitter at @MollyBeck and @madeline_heim.