Nurse Jessica Mistic was among the first to get the COVID-19 vaccine last winter, after nearly a year battling on the front lines of the pandemic at Sanford Bemidji Medical Center where she works.
“Finally we had another weapon in our arsenal. We could do something about it. I was so hopeful and so excited,” she said, recalling the day she got her first shot.
Nine months later she says that feeling of hope has dimmed.
With the vast majority of COVID-19 patients in the Bemidji hospital unvaccinated, Mistic says many have told her they regret not getting the shot — and by the time they're hospitalized, it's too late to get vaccinated.
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Some continue to believe disinformation they've read online about the vaccine. Others don't believe COVID is the reason they or their loved one is being hospitalized.
“It's heartbreaking. And it's frustrating,” she said. “It's so sad."
While not as large as last fall's surge of cases, hospitalizations and deaths, this wave of the pandemic, which boasts the highest levels of ICU admissions for 2021, comes with fresh heartache: If more people had been vaccinated, it would have prevented unnecessary deaths, and another wave of exhausting work for an already burned-out health care workforce.
‘Kick in the gut’
From his perch at M Health Fairview as chief well-being officer and a pulmonary and critical care physician, Dr. Bryan Williams thinks about how the accumulated grief of the pandemic is contributing to labor shortages in the health care system.
Williams, who also treats people with severe COVID-19, said this latest wave has been hard to fathom for many in the field.
"When it started to come back, it was a real kick in the gut,” said Williams. "For some of those [health workers] that were most hard hit by the last wave, I think that enough was enough for them."
Williams says his health system is down nurses, respiratory therapists and nursing aides, making it even harder to handle the crush of patients during this wave.
The staff left behind are taking on additional work as a result, he said, and he worries that will only exacerbate the labor shortage as those workers become fatigued.
In northwest Minnesota's Clearwater County, which has the lowest vaccination rate in the state with about 43 percent of those who are eligible having gotten one shot, Essentia Health physician assistant Nicole Kiesow regularly talks to patients about the COVID-19 vaccine.
She says a lot of her unvaccinated patients are elderly — which means they are at the highest risk of getting severe cases of COVID-19.
She says they have a false sense of security — they consider themselves healthy, and, in this rural county, already isolated.
“Some of them are like, ‘Well, I just thought I'd wait and let the people that really needed [it] get it first,’” she said. Kiesow tells them, “You don't have to worry about the others as much. But you need to do what you have to do to keep yourself healthy."
Not enough space, double the work
Some of Kiesow’s patients may end up being admitted to the hospital with COVID-19, but finding a bed right now may not be easy, with ICU capacity for COVID patients the highest it’s been all year.
Dr. Christina Bastin de Jong is also with Essentia Health in Duluth, where she treats COVID-19 patients in the intensive care unit.
She said the crunch is caused by a mix of staffing shortages and high demand for care — made even more complicated by the fact that COVID-19 patients stay in the hospital longer, with only experimental medicines available to help them recover.
"There aren’t great treatments for COVID in the ICU, once you have it,” she said. “The hard part this time is that, could they have gotten their vaccination earlier, it may have prevented some of this.”
“That's really hard,” she said.
‘They don’t have faith in you’
Dr. Andrea Patten is an emergency room physician at Sanford Health's facility in Bemidji where she regularly sees patients with COVID-like symptoms, many unvaccinated.
Patten said she sometimes finds herself in what she describes as a "mind-boggling scenario" with patients when she suggests COVID testing.
“From that minute it is like this battleground of beliefs,” she said. “Then [when] I tell them, ‘You have COVID,’ it's just like I’ve shot daggers out of my eyes."
Patten said her job is much harder when patients don't trust her.
“It's hard to show up. You read the [research] articles, and you try to be the expert. But people don't want to hear it. They don't believe you. They don't have any faith in you,” she said.
Patten said distrust of the vaccine — and of medicine in general — is a battle she's had to fight in her personal life, too, which she says can feel isolating in the community where she was born and raised.
She said family and close friends have chosen not to mask or get vaccinated, straining relationships.
"You're left with a scenario of 'How do I balance still trying to maintain relationships and friends who don't think the vaccine is wise?’ You love people because they're your friends and family. And you'll support them. But it's definitely changed the things that we talk about,” she said.
In Buffalo, Allina Health anesthesiologist Jeremy Macheel says skepticism about the pandemic, mask-wearing and now vaccination has been prevalent all along. In Wright County where he lives, about 60 percent of those who are eligible have gotten at least one shot.
And while many of his coworkers are vaccinated — and employer and federal mandates will soon require it — he's been surprised that some of his colleagues still won't get a shot.
"I just assumed that most people [in the health field] would be on board with receiving vaccines," he said.
While he respects the idea of patients having autonomy over their health, he says a pandemic presents a different challenge.
"If I let my blood pressure run sky high, OK. That's most likely only going to affect me,” he said. “But my decision to not wear a mask, not get vaccinated will inevitably affect somebody else."
Back in Bemidji, nurse Jessica Mistic says she’s balancing her stress at work by riding and taking care of her horses. And yet disagreements over the pandemic seep into her personal life, too.
Most recently at a funeral, a family member asked her how she could be wearing a mask.
It's easier, Mistic told her family member, than being on a ventilator.