One day in late March, Lethia Moore developed a little cough.
Allergies and asthma sometimes bothered the 78-year-old, though not recently, and she was healthy otherwise. She took her temperature. No fever.
She couldn't have the coronavirus, surely. Where would she have gotten infected? She and the son and niece she lived with had barely left their James Island home, heeding public officials’ warnings.
Just in case, Moore used her inhaler to ward off bronchitis. Yet, she still felt like she had something in her throat. Her doctor prescribed new medication.
But her cough felt worse, not better. Soon she labored to breathe between words. Her daughter, Sherryl Mitchell-Moore, became alarmed. She worked at Roper St. Francis Healthcare and pressed her mother go to the hospital, right away.
"Something is wrong," she insisted.
Early on April 3, Moore's son drove her to Roper Hospital where they met Mitchell-Moore and her husband outside the emergency room doors. A woman in a mask sat at a table, blocking the entrance. Another helped Moore into a wheelchair, then explained that the family couldn’t go any farther. No visitors allowed.
Moore, whose husband had died two years earlier, hugged her family. They spoke words of love and prayer. They promised to call often.
Then, the wheelchair moved. The ER doors opened with a whoosh. A stranger in scrubs and a mask pushed Moore inside toward a negative-pressure room.
This wasn't New York, not New Orleans nor Detroit. It was just one hospital in one mostly rural Southern state. Yet, Roper fought the same confounding new enemy. Six people inside the building already battled COVID-19, the illness caused by the coronavirus. Others lingered, awaiting test results that took days. So much about the hospital felt changed.
Moore's family watched her vanish inside. They would never see her again.
Nine days later, as dawn broke on Easter morning, a nurse arrived at Roper's intensive care unit for patients with COVID-19. She found the mood especially somber.
By then, Roper had treated more of the sickest people with COVID than any hospital in town. Charleston County's first victim, a retired nurse, had died in this unit a few weeks earlier.
Now, all six rooms were full. Overnight, another COVID patient had died, the county's second.
Even among ICU staff accustomed to working at the veil between life and death, the loss hurt. And it frustrated. Medical professionals traffic in science; the core group here often compared notes about studies coming out of Italy and China. Yet, each day, things changed. So much about this terrible virus felt unknown.
The nurse, Brandie Gelwicks, got to work. She changed into ocean gray-blue scrubs, slipped disposable booties over her shoes, wrapped a sky- blue plastic gown around herself, propped an N95 mask over her mouth and nose, yanked a bonnet over her hair, pulled a face shield over her eyes, and tugged purple gloves over her hands.
Then she stepped into her patient’s room. The door closed behind her, sealing her inside, the negative pressure system’s incessant hum filling her ears and drowning out the unit’s commotion.
Before her, a woman lay dying.
A ventilator breathed for Lethia Moore. Her medical team had tried everything they knew to do, but she kept getting sicker. They doubted she would live another day.
A little after 10 a.m., as parishioners across South Carolina tuned in to virtual Easter worship, Gelwicks spoke to Mitchell-Moore, the woman's daughter.
“She’s not alone. I’ve been in here with her all morning," Gelwicks assured. But the family needed to say final farewells, from afar, a necessity she realized only worsened their grief.
A few hours later, Moore's loved ones gathered in a Zoom meeting. Gelwicks joined in, then held up an iPad so the family could say goodbye to Moore, who could not speak back. After about 25 minutes of love and tears, the Zoom meeting ended.
The afternoon ticked on. Each minute Gelwicks spent in the room increased her own risk of exposure, yet she remained, sitting near Moore's ventilator. The room’s window looked out over Charleston Harbor and the empty city streets below. Patients' families sent Easter meals for the nurses, respiratory therapists and other staff. Some drew bunny whiskers onto surgical masks, trying to lighten the gloom.
Gelwicks, an athletic 26-year-old, played Moore some soft jazz and music from Motown great Brian McKnight, soothing sounds that she would want someone to play for her mother. On one wall of the room, glass looked out into the unit, toward the nurses' station. To avoid going in and out of COVID rooms, staff wrote notes to each other on the window, usually when the nurse inside needed supplies.
But now, Dr. Craig Mackaness wrote a note to Gelwicks on it: “She looks really comfortable. Thank you for being in there.”
Around 5 p.m., Gelwicks clasped Moore’s bare hand in her gloved one and spoke in reassuring tones as the great-great-grandmother's heart rate dropped, and she died, one of about 2,000 COVID-related deaths in America that day.
Moore wasn’t the first to die in the unit over the weekend. And she wasn't the last. By Easter’s end, another patient would succumb.
Three days later, just before 7:30 a.m., the massive transition of nursing shifts wrapped up inside Roper, a pale yellow structure with 382 beds in downtown Charleston’s congested medical complex, a 24-hour city within the city. For almost 170 years, Roper's employees had cared for victims of every plague that exacted its then-mysterious toll on Charleston's inhabitants — yellow fever, typhoid fever, smallpox, Spanish flu.
Now six of its modern-day incident command leaders, all in masks, gathered in a small conference room called The Bunker. A barrage of events, demands and new research whipsawed them daily. More death, less money, too few COVID tests and a serious scarcity of protective gear. To name a few.
Each day began with this teleconference call. Craig Self, vice president of strategy and business development, leaned toward his laptop.
“Welcome to day 30 of our COVID emergency response command staff call."
A woman’s voice piped in with the latest numbers.
“Today, we have tested 2,311 patients. We have 119 pending this morning. ...”
The four-hospital system had nine COVID-positive patients — seven at Roper, two at its Mount Pleasant hospital. No news on getting more personal protective equipment. And revenue was projected to run about half its normal amount for the rest of the month.
Dr. Chris McLain, interim chief physician officer, chimed in: “Anyone who has run a marathon knows that midway is when your teammates need encouragement.”
And they had good news.
In just hours, the hospital would go live with its first COVID-19 tests, performed here in this building, an important leap forward.
As they spoke, excitement buzzed through Roper's lab, a realm of vials, microscopes and biohazard signs.
Patients were waiting days for COVID-19 test results from a private lab and the state health agency. Every hour of that time meant wasting precious protective gear — masks, gowns, gloves — while caring for patients who weren't infected. But at 10 a.m., workers in this room would run their own first tests.
Vanessa Shamrock, lab services director, couldn't hide a grin. The coming moments were the big payoff after weeks of frenzied work trying to get testing here, especially after Roper's rival next door, the Medical University of South Carolina, became the first hospital in the state to do in-house testing. Like other sites across America, it didn't have enough to meet demand, so their waits stretched into days.
In late March, one of Roper's vendors had received emergency authorization from the U.S. Food and Drug Administration to offer a new test. It used one of the company's existing systems, GeneXpert, already in place at about 5,000 facilities around the country — including Roper Hospital.
That bumped Roper toward the front of the line. The company had sent it supplies, now at the ready.
When 10 a.m. arrived, a woman in a teal lab jacket scooted up to a counter with a protective shield, then set specimens from two patients in this hospital into a white machine about the size of a couple of microwaves stacked on top of each other.
About 45 minutes later, she removed the first. It was negative.
So was the second.
Then, a runner arrived with a specimen from a patient at their Mount Pleasant hospital. It, too, went into the machine. Another 45 minutes passed.
Kenna Shaffer, a lab assistant, removed it. Her co-workers shifted a little closer, ears perked.
The specimen came from a 46-year-old man waiting in the Mount Pleasant hospital's emergency room. He'd arrived complaining of pain in his right ribs; a scan showed what looked like ground glass in his lung, a telltale sign of COVID-19. The medical team needed confirmation to move forward.
“We got a positive,” Lisa Boyd, a medical technologist, hollered.
A few muted whoops rose up. Not because someone had the virus but because the test worked.
“Third time’s the charm,” she added.
Roper's sister hospital, Bon Secours St. Francis, also has the equipment and would start testing. Its other two hospitals would get the apparatus within days. Ultimately, they’ll be able to run 330 tests a day.
But they can’t do that many yet. For now, they'll only test inpatients and employees to keep turnaround time low. Like everyone else, their vendor is hustling to meet demand.
When the incident command team first met a month ago, they looked at each other: What did the coming weeks hold?
One man spoke up. James Berg, the newish interim president and CEO, assured: “You will be better after this.”
He'd been through it already, or the closest thing most Americans could imagine: the Ebola outbreak five years ago. Berg was president of Texas Health Presbyterian Hospital when a Liberian man arrived at the ER with stomach pains, fever and a searing headache. Medical staff misdiagnosed him and sent him home. He returned much sicker, exposed a range of people not wearing protective equipment, and then died in the hospital.
Two nurses who'd treated him contracted Ebola but survived. Although the hospital contained the virus after that, the missteps triggered a wave of criticism.
From it, Berg learned many things.
He learned the importance of calm at the top. And transparency. And the need to look forward, an eye toward emerging from this battle with new knowledge, new techniques, new plans.
From COVID-19, telemedicine almost certainly would emerge a victor. About 70 percent of the system's care now, from neurology to prenatal care, was provided over videoconferencing. This ensured access — and saved money. But Roper, like any hospital, wouldn’t have risked providing so much treatment this way if the coronavirus hadn't forced its hand. Yet, as a result, hospitals now will have a vast pool of patients across specialties to study.
The pandemic also forced hospitals to rethink infection control, like the days back when scientists gained new understanding of bacteria and infection that led medical workers to assume all patients have bacteria on their skin. Today, before even a finger prick, they clean it.
Should they now assume all patients harbor airborne viruses?
And what about future visitations in the hospital? Perhaps limits are needed.
And what about protective equipment? Could they make better use of N95s and other respirators?
Because it’s not just surviving COVID-19.
It's also about COVID-20.
The Tinfoil Room
When Brandie Gelwicks, the nurse, removed her protective equipment Easter Sunday, she set her N95 into a brown paper bag, the kind that children use to carry lunch to school, and wrote her name on it. Then, she removed the rest of her protective garb, showered and headed home.
Her N95 remained. It would become a guinea pig.
Normally, the masks got tossed into the trash each time a medical worker interacted with a different patient in isolation. But across the country, these white pieces of fabric had become worth their weight in protective gold.
N95s are so named because they filter at least 95 percent of the tiniest airborne particles. Given the world is battling a tiny airborne enemy, the masks have become critically important — and in critically short supply. They also present a challenge.
Other kinds of protective equipment — plastic gowns, rubber goggles, face shields — are smooth and can be wiped or sprayed with powerful disinfectants that kill the coronavirus. But masks are cloth. If you spray them with cleaner, the cloth absorbs it, and whoever wears it next will inhale the cleaning chemicals.
So, to conserve N95s, hospitals now made medical staff, even those who worked with COVID patients, reuse them. That included nurses at Roper who had to wear their N95s for multiple days, or until they got damaged or soiled. Understandably, many sounded alarms at reusing masks that could have the coronavirus on them.
Those alarms reached Susan Scheeler, environmental safety manager, better known as Safety Sue.
She came up with a plan. It involved tinfoil and sunlight.
On Monday, members of the hospital’s decontamination team pushed a three-tiered metal cart, the kind that normally carried patient meals, along Roper's eight stories, many of which sat in eerie silence similar to hurricane ramp-up. Like hospitals across America, Roper had suspended many procedures.
As the cart went, it filled with brown paper bags. Each contained a used, and potentially contaminated, N95. It emerged from the COVID ICU with more bags.
One bore Brandie Gelwicks’ name.
Workers pushed the cart back to the second floor where they met Safety Sue, who sat in front of a door near a sign blaring in red letters: DANGER.
Then, in yellow: ultraviolet light decontamination in progress.
Gelwicks’ mask arrived here on Monday, the first day Roper used this new decontamination procedure. On Wednesday, when Roper’s lab performed the first COVID-19 tests, marked the third day of N95 decontamination. Among the 30 masks in paper bags on the cart that day were 19 from staff in the COVID unit.
Safety Sue opened the door to the room behind her. It appeared resurrected from “Lost in Space.” The original version.
In the midst of a pandemic, this is how you build a decontamination room.
First, you go to the grocery store, bypass the empty toilet paper shelves, and buy every roll of aluminum foil. Back at the hospital, you find an unused space, say, the old House Calls recording studio. Cover every wall with sheets of tinfoil, dull side inward. Then, on two facing walls, hang five metal grow lights on each. But instead of regular plant bulbs, use UV-C light tubes. Run power to them using several yellow and white extension cords.
Then take some two-by-fours and stretch rows of blue rubber cord across the room like clotheslines. Hang a meter to measure the light dosage. Then take a ton of little black clips and hook them across the blue wire like clothespins.
Finally, use the clips to hook each "dirty" N95 to the blue wire.
“This process is not a normal process in a hospital,” Safety Sue said.
Of course, reusing N95 respirators isn’t normal either. Neither is COVID-19. There’s lots of learn-as-you-go.
Roper adapted this process from protocol created by the University of Nebraska using UV-C technology. UV-C is a kind of ultraviolet light from the sun, like the kind that gives people sunburns. Earth’s atmosphere blocks UV-C, a good thing for human skin and eyes, which it can seriously damage. However, UV-C also harms other things on Earth, too — namely microbes like coronaviruses whose DNA it alters, rending them unable to infect earthlings.
Inside the decontamination room, the day’s N95 masks soon hung along the blue cords like white doves on the power lines, each representing the health and safety of a medical worker. With the door safely closed, glowing blue light illuminated the room, bounced off the tinfoil, and probed every nook and cranny of the masks where a virus might hide. At least, that was what studies showed was happening.
The technology wasn’t new. This process just applied it in a new way. Roper and other hospitals already used UV-C light in mobile form, taking it into rooms that had housed patients with highly contagious germs, including coronavirus and hospitals' nemesis bacteria C. difficile, to disinfect them.
More than an hour later, the UV-C lights flipped off. Two sterile processing technicians entered the room with another cart, this one full of white paper goody bags, each with a name written in black Sharpie. They plucked each mask from its clip, examined it for damage, then matched the name on it with one written on the clean bags, ready to return to their users.
Safety Sue hoped that each N95 could endure being disinfected three to five times while supplies ran so short. Tally marks recorded each one's trip through the tinfoil room.
If Charleston got a surge, this system could decontaminate 500 masks per day. It wasn’t as good as giving front-line staff new N95s. But that wasn’t an option. Nobody knew when adequate supplies would make it to hospitals like this one.
Lethia Moore’s family struggled with the shock of losing her so suddenly. Sherryl Mitchell-Moore, her daughter, took more time off work from Roper St. Francis to plan the viewing and funeral in a time when public gatherings were banned. It terrified her to think of how many people out in the world carried the coronavirus around and didn’t know it.
Everywhere, she saw potential carriers.
One day, her husband stopped by Home Depot and Lowe's to get some lumber cut. He sat in his truck. Both stores were packed with people, many without masks. He drove away.
Mitchell-Moore planned a small graveside service. Her mother had four sons, one daughter and a multitude of grandchildren, great-grands and even a great-great grand, plus a large and close-knit family of Mazycks and Vanderhorsts in Mount Pleasant. Yet, there would be no big funeral, no hugging through shared tears of loss.
Moore's children lived in town, except for her oldest son who’d made a home in Delaware with his family. Last weekend, he prepared to head back to Charleston to bury his mother.
As they packed, his wife felt sick. Her throat hurt.
A doctor suggested she get a COVID-19 test. She took it on Tuesday, but results would take several days. Lethia Moore's family suspended her burial indefinitely.