CHESTERFIELD — Dr. Steven M. Brown, who manages care for critically ill patients in several states from his living room, watches with frustration as the list of those with red boxes by their names, signifying they have COVID-19, grows longer.
It wasn’t supposed to be this way — not now.
Only a few months ago, Brown and his colleagues at the Mercy Virtual Care Center had reason to believe things were returning to normal. People were getting vaccinated. COVID-19 cases were declining.
Then everything went into reverse.
Vaccination rates inexplicably slowed, people took fewer precautions and cases began to surge again as a highly infectious variant of the coronavirus was allowed to take hold.
After experiencing so many lives lost and seeing signs the pandemic was nearing its end, Brown said the latest setback is “inconceivable.”
Back in early 2020, at the start of the pandemic, Brown stopped working at the virtual care center, a 125,000-square-foot Chesterfield building where roughly 300 clinicians provide around-the-clock telemedicine to more than 600,000 patients in seven states.
He was 64 and overweight, placing him at higher risk for contracting COVID-19. He had Mercy set up the equipment he needed to do his 12-hour night shifts from the safety of his Chesterfield home.
“I just didn’t expect I would still be here a year-and-a-half later,” said Brown, now a month away from his 66th birthday.
“Hopes have been somewhat crushed again because of the delta variant, which is an entirely new virus practically in the way it’s behaving, how sick people are getting,” said Brown, an internist who specializes in lung disease and critical care.
Research from other countries that dealt with the delta variant before the U.S. suggests it is two to three times more likely to put an unvaccinated person in the hospital than the earlier strains of the coronavirus.
Brown, like other medical professionals and public health experts, is frustrated.
“We really, really, really had an opportunity to crush this,” he said. “And knowing infections like I do, I knew that was a rare opportunity, and we squandered it.”
In a corner next to Brown’s wraparound sofa is a large folding table where he faces four 24-inch computer screens. He can watch heart monitors, check X-rays or scans, message nurses and doctors, access patient records, check lab results and order tests and medications.
The doctor can use a camera in a patient’s room to zoom in so close that he can look down a patient’s throat as a nurse holds a flashlight.
He constantly fields calls from nurses, who consult with him on everything from delirium to stubbornly high blood pressure.
He has two laptop computers open on each end so he can quickly access the latest research articles as scientists learn more and more about treating COVID-19.
When the pandemic first hit hospitals, it reminded Brown of the AIDS epidemic in the 1980s, when doctors knew little of the disease and many were dying. He watched the oxygen levels of COVID-19 patients drop as he desperately tried to get them through the night.
“There was a great sense of futility because we didn’t have anything to fix them,” Brown said. “I could comfort them and support them, but they had unrelenting illness, and they were dying. It was very scary.”
He remembers losing four patients in one hour. He cared for married couples on ventilators in the same unit. He treated four siblings in Oklahoma who all died within a few weeks of each other.
Brown had to talk young new nurses through the unimaginable, as they held cellphones next to patients on ventilators so loved ones could say goodbye.
“They were faced with things they couldn’t have possibly been trained for,” he said.
But his decades of experience taught him to have hope. He knew scientists would learn new ways to prevent, treat and care for COVID-19 patients — and that promise got him and his co-workers through the darkest days of the pandemic during winter as holiday gatherings and doubts in mask-wearing pushed daily death totals in the U.S. above 3,000.
More hope arrived when vaccines became widely available by April. More than 1,000 people at a time were getting shots at mass vaccination events. Cases and positivity rates dropped. Patient beds opened up. Brown got a haircut and visited an out-of-town grandson.
At the start of one shift, a 36-bed intensive care unit in Oklahoma City had just 24 patients.
“How wonderful,” Brown thought at the time.
Then practically overnight, the intensive care unit he supported in Springfield filled with COVID-19 patients. Hospitals in Arkansas and Oklahoma were not far behind. It happened so quickly in Springfield, they had to scramble for ventilators, cooling blankets, oxygen masks as well as contract nurses and respiratory therapists.
Brown gets calls from half a dozen nurses in one minute. Despite being just 15 feet from his kitchen, he can't get up for meals. His wife, Jean Millner, a former chef, takes his favorite enchiladas or frittatas to his spot in front of his busy screens. He has Alexa play classical music or Broadway tunes to stay calm.
“People are sicker. They were coming in and crashing faster,” Brown said. “From the time they enter the door and the time they wind up on ventilators with serious consequences is much shorter.”
They include younger and otherwise healthy adults, pregnant women miscarrying or delivering babies too early. They are nearly all unvaccinated. “It’s horribly tragic,” he said.
Some deny they have COVID-19, he said. Family members of patients he talks with still refute the need to get vaccinated. Others are just misinformed. “So many people say I didn’t know it was this bad,” he said.
While it’s stressful, the face-to-face doctors are once again bearing the brunt, he said. “I’m not at the bedside. I’m not masked the entire time and having to change gloves and wash hands 40 times a shift or more.”
Brown tries hard to lighten the mood. When a nurse asks him to order a pint of blood, he asks if she wants fries with that. If she brings up a complicated medical problem, he’ll say, “Well, we really need to call the doctor. Oh wait, I’m the doctor.”
The rewards of caring for people remotely are great, he says. He can help busy doctors and nurses better focus on their patients, helping to improve care and prevent staff burnout. His expertise helps patients stay near those who give them comfort, such as relatives and clergy, instead of transferring to a more heavily staffed hospital farther away.
With surging cases, protests over wearing masks and lagging vaccination rates, Brown said he’s not sure when he’ll return to the virtual care center.
“I’m happy to just stay at home. The food is a lot better,” he said. “I just assume I'll stay here until everything dies down.”
He’s not sure when that will be. He’s worried that uncontrolled spread could lead to another, even more dangerous variant.
The average number of new cases in Missouri topped 3,000 on Thursday for the first time since the middle of January. At the start of June, it was just 400. In the past three days, 131 deaths have been reported.
“Not only for yourself, but for the community, people need to get vaccinated,” Brown said. “If you get vaccinated, I’m not going to be taking care of you. I’m not going to be managing you on a ventilator.”