As COVID cases continue their post-Thanksgiving surge, some Philadelphia-area nurses say they are overwhelmed and exhausted, struggling to help patients in even greater numbers than they saw in the initial wave of the virus.

At St. Mary’s Medical Center in Langhorne, nurses who treated two to three COVID-19 patients at a time last spring now find themselves responsible for up to seven very ill patients, and fear there soon will be more.

The facility was treating more than 100 each day this week, well past the peak hit during the first wave, which was about 76 patients, the nurses said. Hospital officials would not confirm the patient census.

“We were down to less than 10 during the summer when things kind of let up, and then maybe a month ago we started to see COVID numbers slowly creep from under 10, to the teens, to the 20s, then drop back down,” said Bill Engle, a registered nurse at St. Mary’s. “We have seen an exponential rise in the last two and a half weeks. It’s just exploded.”

Health care workers throughout the region are facing similar burdens, health officials and county leaders said.

In Philadelphia, Temple University Hospital and Einstein Medical Center each have about 100 COVID-19 inpatient cases each, still below the peaks reached in the spring, according to the Pennsylvania Association of Staff Nurses and Allied Professionals. Einstein officials confirmed the count and said they have begun implementing their own “surge plan” to add more beds.

Some hospitals are having to divert ambulances away from their overstretched emergency rooms. In some cases, workers themselves are getting infected. Beds, especially in the intensive care units that treat the most critically ill patients, are growing scarcer, especially in rural parts of the state.

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“We are significantly concerned about what we are seeing in a number of counties,” said Nate Wardle, a spokesperson for the state health department.

Every intensive care bed in Pennsylvania could be filled by mid-December according to one state planning model, said Val Arkoosh, a physician and chairperson of Montgomery County’s board of commissioners, saying she was concerned about what Thanksgiving travel would mean in the next two weeks for hospitals that are at or near capacity now.

Statewide, 4,982 people are hospitalized with COVID-19 and more than 80% of ICU and medical/surgical beds are occupied. Nationally, 98,691 people are in the hospital with the virus, according to the Atlantic’s COVID-19 Tracking Project, about twice as many as there were a month ago.

‘High nurse burnout’

Two weeks ago, staff at St. Mary’s held a strike calling for increased staffing at Bucks County’s largest hospital. Now, they say the explosion in cases — about a third of the hospital’s beds now hold COVID patients — is proving their point.

» READ MORE: As coronavirus cases rise, 800 Bucks County nurses go on strike over ‘dangerous’ staffing levels

“The strike directly relates to COVID,” said Beth Redwine, a nurse in the hospital’s Mother/Baby Unit. “This is proving why we were out there — because we were short-staffed. And now, everything we said when we were out there is being proven true. You’re going to have high nurse burnout, and it’s not safe for the patients.”

A spokesperson for Trinity Health, which owns St. Mary’s and four other hospitals in the region, said officials there are “committed to bargaining in good faith” as they continue contract negotiations with nurses next week, and are “closely monitoring the situation” regarding the COVID-19 surge. The hospital has a “surge plan” in place to support its staff if more COVID-19 patients are admitted to the hospital over the next few weeks.

The health care system did not address a discrepancy between the nurses’ count of COVID-19 patients at St. Mary’s and data on a state dashboard that reported all of Bucks County has just 87 people hospitalized. The system deferred questions to the state; state officials say they get data straight from the hospitals.

Health care workers on the front lines say the situation is clear to them.

“In the spring it was exhausting, sad, draining, emotional, but we did have more hands to help. This time, we don’t have those extra hands,” said a nurse working on a COVID floor who requested anonymity out of fear of reprisals. “I know I wouldn’t want to be one of seven patients [assigned to one nurse] — not because I don’t trust the nurses, but because you can only do so much.”

Some St. Mary’s nurses have both COVID-positive and COVID-negative patients, and must take lengthy precautions to protect them all.

“Once you go in, you’re spending a minimum of 20 minutes to half an hour in [a patient’s room], getting in and getting out,” said Robert Bozek, a registered nurse in the cardiac intensive care unit. “If you have seven patients, how fast can you turn around and get back to see that someone’s [condition has] changed? Nurses are trying to keep an eye on patients who can turn on a dime, and do.”

» READ MORE: Nine months into the pandemic, Philly’s Black residents still suffer the most: ‘It’s very hard to understand.’

No outside aid available

Temple University Hospital nurses are in the same position as their peers at St. Mary’s, said Beverly Minch, an ICU nurse there. PASNAP represents about 8,500 nurses and health care workers statewide; most area hospitals do not have unions.

“We surged again just in the past few weeks and right out of the gate we saw the staffing issues, we saw the supply issues,” she said.

Both hospitals are among those that have not shut down elective procedures, as they were required to do in the spring. Then, shuttering those units freed up staff to help in ERs and ICUs, though the move has led to significant financial distress at hospitals.

Supplies like ventilators and protective masks are well stocked this time, Minch said, but because the rest of the hospital’s units are still operating there are other shortages. Temple ran out of body bags recently, she said, and there have been shortages of IV equipment, and of critical drugs, like the sedatives for patients on ventilators, who must be kept unconscious.

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“This patient’s going to wake up,” Minch has had to say to the hospital’s pharmacists, “I can’t have that.”

On Tuesday, she said, she cared for two COVID-19 patients, both on ventilators. One, she said, was so ill they really required all of her attention. In the medical and surgical units, nurses are taking on six to seven patients when they should have no more than five, Minch said.

A Temple spokesperson declined to answer questions about staffing and workloads, saying “our clinicians and staff continue to do superb work.”

During the Philadelphia region’s spring COVID-19 surge, local hospitals were able to tap health care workers from unaffected parts of the country. This time, few regions have been spared.

Bucks County health officials offered little information about the conditions at the county’s major hospitals. County health commissioner David Damsker said, “In general, the hospitals are always trying to discharge patients who meet the clinical requirements for discharge.”

But in Montgomery County, Arkoosh said some patients are receiving long-term treatment in ER’s, a sign that there are no rooms elsewhere in the hospital. And one hospital in the county has dozens of workers in quarantine due to exposure to the virus, likely due to community spread, she said.

County health officials reached out to the National Guard for relief but were told the guard could offer no aid.

“There is no spare hospital personnel to come this time,” Arkoosh said.