BY ALEX HOEFT, WITH ADDITIONAL REPORTING BY JULIANA DEMAREST | Moonshine Ink

Editor’s note: This article was updated to reflect a correction in medical terminology.

It’s been over eight months since Tahoe Forest Hospital discharged Mary, its first patient housed overnight with COVID-19 symptoms.

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Mary isn’t her real name — she preferred to remain anonymous both back in April, when Moonshine first spoke with her about her experience (read Testing Triage for COVID-19 in Tahoe), and now. Overall, she’s doing well.

“I feel fine,” she said. “I haven’t been in to get a lung scan or anything like that, but I feel fine. It took quite a while — I would say a couple months to feel like I was fully recovered. It was definitely a steep climb back up … I was tired, it was hard to walk up the stairs. When I tried to resume the work that I did before, I could do a fraction of what I could do.”

Those who have been intubated because of the novel coronavirus seem to be having a harder time with recovery, is her thought process; Mary was never intubated, despite spending two nights at TFH.

Mark Redpath, however, was on a ventilator (read Dead Man Walking). Months after being discharged, he still has a long road to recovery — that is, if he can recover. With continued chest pain, shortness of breath, coughing, and dangerously elevated blood pressure, all indicators point to Redpath having permanent health issues following his bout with the disease.

Doctors are working diligently to bring him some answers. During his three-week stay in the intensive care unit at Tahoe Forest, radiograms were already showing the likelihood of permanent lung damage resulting from COVID-19. When he interviewed with Moonshine at the beginning of December, he was scheduled to have an echocardiogram and a pulmonary function test, with a CT scan likely to follow.

“Seven months later, I’m still having major issues,” Redpath said, explaining that unlike long haulers — those who have lingering symptoms — there’s concern he could have long-term injury. “Hopefully, it all comes out negative and I’m a long hauler, but I’m not that naive to think that way. It would be silly for me to do that. There’s no way there’s something not wrong.”

COVID-19 surges are worse than ever across the United States. Locally, TFH is also seeing a rise in inpatients with the disease; as of press deadline, there have been a max of 11 at one time since mid-March. Prior to cold weather, the high was eight inpatients.

Harry Weis, CEO of TFH, issued a message on Dec. 1, expressing concern. “The amount of care we can provide is limited based on the availability of staff, equipment, and space,” he wrote. “We’re beginning to reach our higher limits
on delivering this care.”

Yet he explained to Moonshine that while more positive cases are popping up (and leading to the state-labeled purple tier, which is based on testing positivity and case rates), 98% of COVID-positive locals are “recovering with physician guidance at home.” Still, he urges community members and visitors to adopt healthy daily lifestyles, don masks, physically distance, and regularly wash their hands to curb the spread as much as possible.

Healthcare workers on Tahoe’s frontline and its fringes express the same concern; others, one with experience in the medical field, see the COVID-induced mandates as more alarming than the disease itself.

Behind enemy lines

Dr. David Ritchie is part of the frontline troops. At TFH, Ritchie is a hospitalist in the intensive care units with the COVID-infected patients.

The day after a second TFH patient succumbed to the disease (Nov. 19), he spoke with Moonshine and described what he’s seen: “[These patients] are extremely ill. They are struggling to breathe, and they are alone. They have a nurse who is typically seeing at least one other positive patient with COVID, who is trying their darndest to be in that room helping them, but can’t be there 100% of the day, so these poor folks are hitting their call button and waiting for a nurse to put on all of their PPE, waiting for me to do the same, and having us come in and treat them and trying to make them feel better. But they’re ultimately at the mercy of a virus that we don’t have a treatment for that is adequate.”

Fans whir away in the ICU, circulating air to keep the rooms clean. Family and other visitors aren’t allowed inside, and many of the patients, Ritchie mentioned, are too short of breath to call their loved ones.

“In two words or less, it’s scary,” he said. “It’s really scary. It is much more of a severe disease than I think the general community perceives it as. People are dying at Tahoe Forest right now.”

FIGHTING THE GOOD FIGHT: Tahoe City resident Sarah Lowis has worked as a staff nurse at Renown Health in Reno for seven years. Nowadays, when a friend, acquaintance, or passerby learns she’s a healthcare worker, they thank her for her service, as people do with veterans. Courtesy photo

Based in Reno, Renown Health is the trauma center for the entire region, including the Tahoe Basin. Sarah Lowis is a Tahoe City resident working as a Renown staff nurse on the orthopedics and spine surgical floor, one level up from the COVID ward.

Since mid-March, when increased recognition was heaped on healthcare workers, Lowis has received praise for her line of work.

“I find that if I mention to somebody offhand or in a conversation that I’m a nurse or something, they’ll say, almost like they do to a veteran, ‘Thank you for your service.’ It’s kind of a new phenomenon.”

Lowis had a choice in the early days of COVID’s Reno presence to either move to the COVID floor or stay where she was, on the then-orthopedic/neuro unit. She stayed put, but the hospital has turned into a toss-up in terms of who’s staffed where, from what floor, which floors are now combined in focuses, and keeping everything running smoothly.

“The whole hospital is like a saltshaker, shaken up and down so many times,” she said. “We’re all just trying to wait for this to get back to some kind of normalcy, which is a long way away.”

The hospital turned its parking garage into an alternative care center to house a surge of COVID-19 patients. Lowis explained there are 700 beds in the care center, but her guess is that they won’t get much more than 200, if that.

“It would be a long time before that happens at Renown per se, and yet just because there’s 700 beds does not mean there’s staff to accommodate them,” she said.

TFH itself isn’t currently pursuing expansion beyond its current site. During the spring, there were discussions about possibly pushing into the extended care facility on hospital grounds, but even with the current rise in cases, Weis said “very few patients have escalated to needing a ventilator with the therapeutics we have (steroid treatments, convalescent plasma, Remdesivir).”

As a destination point, Tahoe remains one of the busiest rural areas during the pandemic, Weis continued, but the peak of inpatients at the hospital is nowhere near the tales of crowded emergency rooms that plague news channels. Currently, TFH has 25 acute inpatient beds; the hospital is prepared to house eight to 15 additional acute inpatients using various parts of the hospital if it comes to that.

“The peak [of inpatients with COVID-19] over the entire nine months, one day was seven in April and one day, I think it was June 30, the 4th of July weekend period, we had eight on one day,” Weis said. The end of November, however, ushered in higher numbers, hovering right around 10 inpatients as of press deadline.

Credit for the lack of drastic upswing in hospitalizations Weis attributes to the community for taking “seriously in majority the importance of face masking, the physical distancing, and the regular hand-washing.”

IT TAKES TWO: Tahoe locals head into nature to keep their distance from others not of their household. Photo by Wade Snider/Moonshine Ink

Body autonomy and self-reliance

As is well known, there are those who find discomfort with government mandates, and locally it’s no different. Some, like Placer County District 4 Supervisor Kirk Uhler, have a large stage to stand on. Uhler regularly shares his viewpoints on social media — in a June video he compared the effectiveness of masks to wearing AIDS awareness ribbons, and during a recent message he noted, “Reflexively locking down, thinking that somehow that works, is horse crap. It doesn’t work.”

Others utilize their own networks to express their frustrations.

On Nov. 24, Nikki Florio, founder and director of the nonprofit Bee Heroic, hosted Bee Mask Free — a public event at the Truckee restaurant El Toro Bravo, with an agenda to discuss medical freedom, business and human rights, and how to take action amid mandates and curfews.

The invitation stated, in part, “With looming lockdowns, mandatory/forced vaccinations, surveillance, internment camps, food and ecosystem implosion, and fascist law on the horizon, it can be difficult for some to take a stand. We must all join together, stop the pandemic lie, and stop fascist takeover of our government.”

Laura Minard was one of the speakers at the event, her focus specifically on body autonomy. Minard is a board-certified holistic nurse coach, as well as a registered nurse with experience in intensive care and surgical units.

“As someone who has a pretty good idea of conventional medicine and the thought there, and the holistic world and the thought there, it’s given me a unique view of what’s going on,” she told Moonshine.

Minard said her own doctor has been diagnosed with the coronavirus and recovered in two days; a current client had it and by day three was feeling fine; to name just two. “I’ve known a lot of people [who had it],” she said. “I haven’t known anyone who’s died or had a serious case … People who are more holistic-minded, they aren’t afraid at all. I have no fear for me, for my parents, for anybody, because I’m very confident in the way we can treat it early if we have anything.”

Minard closely follows the nonprofit group Physicians for Informed Consent, which has been referred to as an anti-vaccination organization but doesn’t publicize itself as such. PIC has compared COVID-19 to previous seasonal and pandemic flus, and has its own information regarding the pandemic at physiciansforinformedconsent.org/covid-19

She’s not under the impression the virus isn’t real. Rather, Minard believes people can combat the virus by trusting their bodies to handle it. Relying on immune systems, current therapeutics, and focusing on secluding those more likely to suffer from the disease could’ve left the remaining population going about their normal lives.

“A lot of [the response] was manmade errors, but for the everyday person running around, [not] up until this time did we ever worry about how many people we possibly could have killed with the flu, or we were scared to go to the grocery store when it was flu season,” she said. “That’s where I see the disconnect.”

On the requirement of wearing masks, Minard pushes for individual choice. Sure, private establishments can make their own rules, but a statewide effort is where it goes wayward for her. She’s disbelieving about the scientific evidence touting proof that masks work, mentioning that large pharmaceutical organizations more concerned with making money are behind the information.

“And then you start to demonize people who don’t subscribe to that,” Minard continued. “It’s a very dangerous social pressure model for when a vaccine comes out. I can see how people who are hesitant to take the new coronavirus vaccine will be painted as selfish and less-than.”

To beat a disease

Weis at TFH spelled out two ways for humans to beat the coronavirus: “We either have to get the disease and live through it so we have the antibodies and immunity from that … or the secondary option is to get the vaccine.”

Minard and others support the idea of natural herd immunity, a concept by which a significant portion of a community would contract the disease, and ultimately, as a whole become immune to it.

Florio, creator of the Bee Mask Free event, said, “We have trillions of these viruses in our body every single day and we have lived with them for thousands and thousands of years. And we need them there. We get sick, we get these viruses, we build up immunity, and we’re good to go.”

Florio pointed to such groups as World Doctors Alliance for her own research, where she’s put in time reading “thousands of hours from physicians and thousands of hours’ worth of published papers.”

The two women are not in favor of herd immunity through a vaccine, however. Both Florio and Minard are following national and international conversations around the creation, testing, and eventual release of a COVID-19 vaccine, and both are concerned about the potential requirement to become vaccinated, not to mention the use of vaccines in general. (As of press time, there has been no official word from President-Elect Joe Biden’s office that his administration will require a vaccine for all Americans.)

Dr. Robert Oldham, Placer County’s public health officer, pointed out the dangers in relying on simple community spread for eventual immunity. He and Weis agree that herd immunity is the solution for victory against COVID; but relying on humans to contract the virus organically would come with two main problems.

“Doing that would overrun our healthcare delivery system, which is already, even right now with restrictions in place, it’s challenged,” Oldham said. “The second reason is, hey, it actually isn’t going to work. All the science says that if we went gangbusters and said no more restrictions, it would take probably a couple years to get the herd immunity path without a vaccine.”

And look at past swells of diseases, like smallpox and polio, Weis echoed. “A way that we stopped it was from vaccines,” he said. “It wasn’t just letting the disease do whatever it wanted to do every year. The vaccine is what really stopped that and gave us the quality of life and helped us avoid either short-term or long-term crippling effects.”

Dr. Tim Lombard is a board-certified cardiologist who has been practicing at TFH for 40 years. He expressed his frustration with those who are opposed to mask mandates and the restrictions placed on people’s lives the past nine months, citing a quote by the philosopher Arthur Schopenhauer that’s been top of mind for him as of late: “All truth passes through three stages. First, it is ridiculed. Second, it is violently opposed. Third, it is accepted as being self-evident.”

“We’re somewhere between the first and second phases,” Lombard pointed out. “Somehow, we need to get to number three.”

Mary’s own views, which come with the wisdom of having had COVID-19, are about using the knowledge gained since springtime to not needlessly shut down the economy but be smart about interactions with others.

“I think people need to be able to work,” she said. “[But] if people could sacrifice … I drove through town and there were people at all the outside places, crammed together, all these little tables with nobody with masks on because they’re eating and drinking … I mostly think it’s important if we could just buckle down for a bit.”

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