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Full ICUs, daily death watch: A look at COVID-19, unvaccinated patients in Southwest Florida hospitals

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Aaron Renfroe lies semi-reclined in his hospital bed as he struggles to speak between labored breaths and bouts of tears.

The 44-year-old Fort Myers man has been at Gulf Coast Medical Center for four days because of COVID-19 complications and can't properly breathe without plastic tubing, known as a nasal cannula, sending extra oxygen into his lungs.

His wife is also sick from the novel coronavirus — much worse than him, he worries — on another floor of the hospital. His son and daughter have it too but are well enough to recover at home.

Matthew Josephson, a registered nurse at Gulf Coast Medical Center, treats Aaron Renfroe for symptoms associated with COVID-19 on Friday, Aug. 13, 2021. Renfroe, who is unvaccinated, tested positive for COVID-19 along with his family. He said his wife is also in the hospital with COVID-19.
Matthew Josephson, a registered nurse at Gulf Coast Medical Center, treats Aaron Renfroe for symptoms associated with COVID-19 on Friday, Aug. 13, 2021. Renfroe, who... Matthew Josephson, a registered nurse at Gulf Coast Medical Center, treats Aaron Renfroe for symptoms associated with COVID-19 on Friday, Aug. 13, 2021. Renfroe, who is unvaccinated, tested positive for COVID-19 along with his family. He said his wife is also in the hospital with COVID-19.
Andrew West/The News-Press

None thought much about catching the virus during the previous 17 months, Renfroe said. And, like the vast majority of the record 900 or so now-hospitalized COVID-19 patients in Lee and Collier counties, none of his family have been vaccinated. 

Renfroe chokes up as he speaks of being separated from his wife and kids. They've never been apart for this long, he said.

"I mean, it is a very serious illness. But the way I dealt with it was, 'If I get it, I get it. If I don't, I don't,'" Renfroe said from his hospital bed. "Well, guess what? I got it, and I wish I never did."

The News-Press/Naples Daily News spent a day inside Gulf Coast Medical Center in south Fort Myers and another day at NCH Baker Hospital in Naples last week to chronicle how patients and staff are coping with this latest, and what has become the highest, surge in COVID-19 hospitalizations.

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Staffers say they're exhausted and had hoped not to face yet another surge in cases. They believe it has largely been driven by residents' continued refusal to get vaccinated as the highly contagious delta variant spreads through the state. And, despite improved treatment options, too many are still dying, they say.

Renfroe is receiving four liters of oxygen per minute — on the lower end for COVID-19 patients — as well as remdesivir anti-viral treatment and steroids. He's doing fine, but he could turn for the worse, nurses say.

Given that, does he regret not being vaccinated? Here, things get complicated and speak to the challenge public health agencies face in changing the minds of vaccine holdouts.

"Some days I say yes; some days I say no," he said. "Does the vaccine work? Yeah, it probably works for a lot of people, and probably (speeds up) time being in the hospital. But that's a choice that everyone needs to make on their own."

It's a choice with consequences.

While vaccination doesn't prevent all hospitalizations, it can dramatically shorten lengths of stay and prevent most deaths, according to the Centers for Disease Control and Prevention. As of this week, 58.1% of Floridians over 12 have been vaccinated. That puts Florida behind 23 states, the District of Columbia, Guam and Puerto Rico. 

Florida is now leading the nation in the rate of new COVID-19 infections and has lately been beating its own daily all-time highs for hospitalizations. As of Friday afternoon, the number was 16,849. 

Nearly half of the state's health centers are not accepting patient transfers from other facilities, according to the Florida Hospital Association. Another 29% are so full they expect to expand patient care into hospital areas typically used for non-medical purposes.

More than two-thirds of the state's hospitals also reported they expect to face shortages of critical care staff in the next week. 

"This particular disease requires an incredible amount of effort around infection control — it's very labor intensive, very tense and very draining," said Justin Senior, CEO of Safety Net Hospital Alliance of Florida. "People are naturally going to be worn down by incredibly labor intensive practices that are done under tense circumstances."

Related coverage: Lee Health reports number of COVID-19 patients up to 571, fewer need intensive care

More: COVID, delta variant & burnout fueling crisis. 68% of Florida hospitals expect to hit critical staff shortage

Nichole Arevalo, a registered nurse at the downtown campus of NCH in Naples, treats a COVID-19 patient in the Intensive Care Unit on Monday, Aug. 9, 2021. COVID-19 cases in Southwest Florida are spiking.
Nichole Arevalo, a registered nurse at the downtown campus of NCH in Naples, treats a COVID-19 patient in the Intensive Care Unit on Monday, Aug. 9, 2021. COVID-19 cases in Southwest Florida are spiking.
Andrew West/The News-Press

Yet another Southwest Florida pandemic peak

Southwest Florida's hospitals have seen their own patient volumes rise sharply since June. That's when Lee Health, the region's largest, saw this year's COVID-19 patient volume low of 30 people. On Friday, it had 593. NCH was treating 218. Physicians Regional Healthcare System was treating 124 at its two Naples hospitals on Friday.

COVID-19 patients now occupy nearly a third of Lee Health's 1,812 licensed patient beds. It's the primary reason that the four-hospital public health care system, the largest between Tampa and Miami, is at 90% staffed capacity.

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Andrew West, Fort Myers News-Press

Gulf Coast, its flagship hospital, already ran out of so-called "negative pressure" rooms designed to keep in the air of contagious patients. Staff now rig plastic, some PVC piping and filtered fans over patient beds to approximate the same effect over overflow patient beds, including Renfroe's. It's called a "hood."

Nichole Arevalo
We’re used to seeing patients dying but not so many. So, it’s really rough. And, you know, it takes a toll on you.

Hiring is also at a fever pitch, which is a big reason staffed capacity is not closer to 100%. Lee Health hired about 160 nurses during June and July and still has openings for about 1,400 other medical and support positions.

Medical staff said they're exhausted and are, frankly, losing patience with people who still refuse to take COVID-19 seriously and avoid vaccinations.

Nichole Arevalo, a nurse at NCH Baker Hospital, said burnout has become a real problem among medical staff. 

"Seeing patients dying, that's really rough," Arevalo said. "We're used to seeing patients dying but not so many. So, it's really rough. And, you know, it takes a toll on you."

Lee Health has counted more than 800 patient deaths from COVID-19 since the start of the pandemic. Of those, about 150 were in the last 90 days. NCH has not yet reported similar fatality counts.

Nichole Arevalo, a nurse on the COVID-19 front lines at NCH describes the year last and a half
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For some nurses, like Matthew Josephson, pandemic care is the only experience they have known professionally. Josephson, 23, was hired by Lee Health last summer during the first COVID-19 peak. Today, he speaks with the weariness of a grizzled veteran.

"Whenever patients come in, and they're still not vaccinated, I still have to care for them and (show them) empathy. I do because they're human," said Josephson, who, on this day, is caring for Renfroe. "But it's hard, you know, when I know that all of this could have been prevented."

This unit, on the third floor of Gulf Coast has four 12-room stretches of hallway. At the end of June, this particular wing was down to four or five COVID-19 patients. Now, it's at capacity, Josephson said. For now, there's no end in sight.

Josephson works three 12-hour shifts a week.

"I might have a day off in between (shifts) but it takes that whole next day to kind of recuperate yourself and get back into the mindset of, 'OK, let's suit up and do it again,'" he said.

In the busy ICUs, a daily death watch

It's now 9 a.m. and medical rounds are starting on the third floor of Gulf Coast, which houses its intensive care unit and the most serious of COVID-19 patients. 

A team of eight doctors, nurses, respiratory therapists and other support staff go over each patient's condition and the care plan for each day. Each is equipped with computers on rolling desks they take from room-to-room. The discussion is barely louder than a whisper.

Nearly every room along this stretch of hallway houses a COVID-19 patient on a ventilator. All have been rendered heavily sedated and/or unconscious to prevent them from the experiencing the extreme discomfort of breathing through a tube. 

Matthew Josephson, a registered nurse at Gulf Coast Medical Center, and Alejandra Loayz, a registered nurse, prepare to treat patients for symptoms associated with COVID-19 on Friday, Aug. 13, 2021.
Matthew Josephson, a registered nurse at Gulf Coast Medical Center, and Alejandra Loayz, a registered nurse, prepare to treat patients for symptoms associated with COVID-19 on Friday, Aug. 13, 2021.
Andrew West/The News-Press

Their only movement are occasional involuntary twitches. Most are on their stomachs, a "prone" position that helps them breathe easier. The rooms are dark and the only visitors allowed inside are doctors and nurses checking their status and occasionally repositioning them on their beds.

Family members may only be in the ICU for a few minutes at a time and may not enter the rooms unless patients are about to die — and just that one time because they have to quarantine afterward.

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Nurses say that most of these patients, once they're put on a ventilator, will likely never wake up.

"We had one patient earlier this week who came off the ventilator and did really well, so that was encouraging," said nurse Betsy Groendyk, the ICU's clinical supervisor. "But most patients who end up on the ventilator don't come off of it. I've heard many say, 'Give me one more day; don't put me on the vent,' because they know that when they have to go on the vent it's pretty much done."

Lee Health has imposed even more visitation restrictions now, limiting family visits to one per patient during rounding. None are here today. The entire floor is as quiet as a library.

NCH has similar restrictions. Visits are restricted to one person at a time and none are allowed for critical-care patients, unless the patient is nearing the end of his or her life.

The rising number of serious cases has forced NCH to use other parts of the hospital for critical-care patients, said David Lindner, the physician overseeing that hospital system's COVID-19 response.

"Not only are our ICUs full but, like many other institutions, we have spilled over into other units," Lindner said. "There's not enough beds here to handle all the COVID we're having to deal with."

COVID-19 medical director at NCH, Dr. David Lindner describes changes in the disease as delta surges
Andrew West, Naples Daily News

He added that the increase in cases, and the increases in patient deaths, has been too much for some staffers to handle.

"We have a couple of our newer staff (members) that have backed off because they weren't prepared for the emotion and the hurt," he said. "It's hard to go home a realize that people your age are dying. That's difficult."

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'Forever changed' by hospitalization

Treatment of COVID-19 has improved greatly since the start of the pandemic. So, many more hospitalized with COVID-19 do recover. Renfroe, for instance, was discharged Monday after a week in the hospital. His wife's condition was not immediately available.

Across town at Cape Coral Hospital, Shannon Ruvelas, 43, was discharged after spending six days there. Ruvelas, a local business owner, said she was otherwise healthy before she tested positive for the novel coronavirus on Aug. 1.

Left: Medical personnel including doctors, nurses, respiratory therapists and more make the rounds in the intensive care unit at Gulf Coast Medical Center on Friday, Aug. 13, 2021. Right: NCH personnel work in the Intensive Care Unit at the downtown Naples campus of NCH on Monday, Aug. 9, 2021. Left: Medical personnel including doctors, nurses, respiratory therapists and more make the rounds in the intensive care unit at Gulf Coast Medical Center on Friday, Aug. 13, 2021. Right: NCH personnel work in the Intensive Care Unit at the downtown Naples campus of NCH on Monday, Aug. 9, 2021. Left: Medical personnel including doctors, nurses, respiratory therapists and more make the rounds in the intensive care unit at Gulf Coast Medical Center on Friday, Aug. 13, 2021. Right: NCH personnel work in the Intensive Care Unit at the downtown Naples campus of NCH on Monday, Aug. 9, 2021. Andrew West/The News-Press

The mother of one said she initially suffered cold-like symptoms. Five days later she was in the hospital's emergency department with a fever more than 102 degrees and dangerously low blood-oxygen levels. 

She said hospital staff put her on oxygen immediately and gave her an X-ray and blood tests within an hour. But, because the hospital was full, she remained with roughly 20 other COVID-19 patients in a sectioned-off part of the ER for many hours before finally getting a hospital bed.

Her stay is a blur, she said. But Ruveles knows this: She regrets not getting vaccinated and believing the negative comments about doing so on social media and certain cable news shows.

Shannon Ruvelas
I am forever changed by the experience. I was anti-vaccine prior to (hospitalizations) because I was scared of it and I didn't know what side effects it would cause.

"I am forever changed by the experience," she said. "I was anti-vaccine prior to (hospitalizations) because I was scared of it and I didn't know what side effects it would cause."

Ruvelas, who has scheduled an appointment for a vaccination, still suffers the effects of COVID-19, including inflamed lungs and elevated blood sugar (a side effect of steroid treatment).

"So, long term, it's just going to be a lot of monitoring with my doctor and making sure that I'm getting myself as healthy as possible," she said. "I am concerned about the long-term side effects. But, at this point, there's not a lot I can do other than just allow myself to heal and get healthier."

Diane Corrie, left, a registered nurse at Gulf Coast Medical Center, vaccinates Johnna Michaelkiewicz for COVID-19 at a vaccination site on the campus on Friday, Aug. 13, 2021. Vaccinations are starting to tick up as the delta variant of COVID-19 is surging.
Diane Corrie, left, a registered nurse at Gulf Coast Medical Center, vaccinates Johnna Michaelkiewicz for COVID-19 at a vaccination site on the campus on Friday,... Diane Corrie, left, a registered nurse at Gulf Coast Medical Center, vaccinates Johnna Michaelkiewicz for COVID-19 at a vaccination site on the campus on Friday, Aug. 13, 2021. Vaccinations are starting to tick up as the delta variant of COVID-19 is surging.
Andrew West/The News-Press

COVID-19 vaccine demand increasing again

On the ground floor at Gulf Coast, a vaccination clinic stands ready to take all comers. But on this day last week, inoculators served a seeming trickle of people. And, staff said, this is actually an improvement over previous weeks.

All three federally approved vaccines are available, allowing people to decide if they want a one-dose Johnson & Johnson vaccination or the two-dose varieties made by Moderna and Pfizer.

Ann Lee, a pharmacist for Lee Health, prepares a COVID-19 vaccine at a vaccination site at Gulf Coast Medical Center. Vaccinations have picked up as the delta variant has started to spread.
Ann Lee, a pharmacist for Lee Health, prepares a COVID-19 vaccine at a vaccination site at Gulf Coast Medical Center. Vaccinations have picked up as the delta variant has started to spread.
Andrew West/The News-Press

Claude Houle, who oversees the vaccination clinic, said demand for vaccinations here surged between December and February when they first became available. But dropped considerably in the spring and summer.

More: Demand for COVID-19 testing increases in Southwest Florida; expect to wait for appointment

More: Delta variant of COVID-19 expected to take over in Florida as dominant strain

Now, as the delta variant is spreading and hospitalizations are increasing dramatically, traffic has increased 75% in the last three weeks, he said.

"A lot of people have been holding off because they did not trust the vaccine, they did not trust the information that was being provided nationally," he said. 

According to the CDC, 54.5% of Lee County residents over the age of 12, the minimum age for vaccinations, had been fully inoculated as of Tuesday. In Collier County, it was 62.9%.

Ivette Torres, a registered nurse in the intensive care unit at Gulf Coast Medical Center, prepares to treat a COVID-19 patient on Friday, Aug. 13, 2021. The unit along with all the hospitals in Southwest Florida are seeing an influx of COVID-19 patients. Most of them unvaccinated.
Ivette Torres, a registered nurse in the intensive care unit at Gulf Coast Medical Center, prepares to treat a COVID-19 patient on Friday, Aug. 13,... Ivette Torres, a registered nurse in the intensive care unit at Gulf Coast Medical Center, prepares to treat a COVID-19 patient on Friday, Aug. 13, 2021. The unit along with all the hospitals in Southwest Florida are seeing an influx of COVID-19 patients. Most of them unvaccinated.
Andrew West/The News-Press

One of the holdouts was Johnna Michaelkiewicz, of Fort Myers, who received a Johnson & Johnson one-dose vaccination last week. Michaelkiewicz, a surgical technician at a dental clinic, said she initially thought she didn't need one.

"And then more and more patients of ours were coming in, and they had either recovered from COVID or had a partner that was in the hospital with COVID," she said. "And I thought, 'OK, I should get it."

Frank Gluck is a watchdog reporter with The News-Press and the Naples Daily News. Connect with him at fgluck@news-press.com or on Twitter: @FrankGluck

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