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Gordon Narayan is overcome with emotion after visiting with a patient during his cleaning shift at Harborview Medical Center on Aug. 20, in Seattle. Until the late fall, the Seattle area had mostly kept the coronavirus in check. But now cases are rising faster than ever. (David Ryder/Getty Images)

As hospitals across the country weather a surge of COVID-19 patients, in Seattle 鈥� an early epicenter of the outbreak 鈥� nurses, respiratory therapists and physicians are staring down a startling resurgence of the coronavirus that鈥檚 expected to test even one of the best-prepared hospitals on the pandemic鈥檚 front lines.

After nine months, the staff at Harborview Medical Center, the large public hospital run by the University of Washington, has the benefit of experience.

In March, the Harborview staff was already encountering the realities of COVID-19 that are now familiar to so many communities: patients dying alone, fears of getting infected at work and upheaval inside the hospital.

This forced the hospital to adapt quickly to the pressures of the coronavirus and how to manage a surge, but all these months later it has left staff members exhausted.

鈥淭his is a crisis that鈥檚 been going on for almost a year 鈥� that鈥檚 not the way humans are built to work,鈥� said Dr. John Lynch, an associate medical director at Harborview and associate professor of medicine at the University of Washington.

鈥淥ur health workers are definitely feeling that strain in a way that we鈥檝e never experienced before,鈥� he said.

Until the late fall, the Seattle area had mostly kept the virus in check. But now cases are rising faster than ever, and Washington Gov. Jay Inslee has a 鈥渃atastrophic loss of medical care鈥� could be on the horizon.

鈥淭his is the very beginning, to be honest, so thinking about what that looks like in December and January has got me very concerned,鈥� Lynch said.

Lessons Learned From Spring Surge

When the outbreak first swept through western Washington, hospitals were in the dark on many fronts. It was unclear how contagious the virus was, how widely it had spread and how many intensive care beds would be needed.

Intensive care unit nurse Whisty Taylor remembers the moment she learned one of her colleagues 鈥� a young, active nurse 鈥� was hospitalized on their floor and intubated.

鈥淭hat鈥檚 really when it hit 鈥� that could be any of us,鈥� Taylor said.

Concerns over infection control and conserving personal protective equipment meant nurses were delegated all sorts of unusual tasks.

鈥淭he nurses were the phlebotomists and physical therapists,鈥� said nurse Stacy Van Essen. 鈥淲e mopped the floors and we took the laundry out and made the beds, plus taking care of people who are extremely, extremely sick.鈥�

A lot has changed since those early days.

Dr. John Lynch and Vanessa Makarewicz of Harborview Medical Center in Seattle have spent months preparing their hospital for a major increase in patients during the colder months. Some issues cannot be avoided, though, like a shortage of personal protective equipment and an exhausted staff.(Will Stone)

Staff members besides just nurses are now trained to go into COVID rooms and be near patients, and the hospital has ironed out the thorny logistics of caring for these highly contagious patients, said Vanessa Makarewicz, Harborview鈥檚 manager of infection control and prevention.

How to clean the rooms? Who鈥檚 going to draw the blood? What鈥檚 the safest way to move people around?

鈥淲e鈥檝e grown our entire operation around it,鈥� Makarewicz said.

The physical layout of the hospital has changed to accommodate COVID patients, too.

鈥淚t鈥檚 still busy and chaotic, but it鈥檚 a lot more controlled,鈥� said Roseate Scott, a respiratory therapist in the ICU.

Harborview has also learned how to stretch its supplies of PPE safely. And as cases started to rise significantly last month, the hospital quickly reimposed visitor restrictions.

鈥淚n the past, we鈥檝e had visitors who then call us two days later and say, 鈥極h, my gosh, I just came up positive,鈥欌�� said nurse Mindy Boyle.

Boyle said months of caring for COVID patients 鈥� and all the steps the hospital has taken, including having health care workers observed as they don and doff their PPE 鈥� has tamped down the fears of catching the virus at work.

鈥淚t still scares me somewhat, but I do feel safe, and I would rather be here than out in the community, where we don鈥檛 know what鈥檚 going on,鈥� said Boyle.

Roseate Scott, a respiratory therapist at Harborview Medical Center, says that now, nine months into the pandemic, she feels much more comfortable working in the COVID ICU. But she still worries that the current surge in hospitalizations will overwhelm her hospital.(Will Stone)

鈥榃e鈥檙e All Tired of This鈥�

Preparation can go only so far, though. The hospital still runs the risk of running low on PPE and staff, just like so much of the country.

During the spring, the hospital cleared out beds and recruited nurses from all over the nation, but that is unlikely to happen this time, with so many hospitals under pressure at once.

鈥淎ll things point to what could be an onslaught of patients on top of a very tired workforce and less staff to go around,鈥� said Nate Rozeboom, a nurse manager on one of the COVID units. 鈥淲e鈥檙e all tired of this, tired of taking care of COVID patients, tired of the uncertainty.鈥�

Already, COVID鈥檚 footprint at Harborview is expanding and bringing the hospital close to where it was at its previous peak.

鈥淭he fear I have personally is overwhelming the resources, using up all the staff 鈥� and the numbers are still going to go up,鈥� said Scott.

And she said the realities of caring for these desperately ill patients have not changed.

鈥淲hen they鈥檙e on their belly, laying down with all the tubes and drains and all these extra lines hanging off of them, it takes about four to five people to manually flip them over,鈥� Scott said. 鈥淚t feels intense every time. It doesn鈥檛 matter how many times you鈥檝e done it.鈥�

Hospitalized patients are faring better than in the spring, but there are still no major breakthroughs, said Dr. Randall Curtis, an attending physician in the COVID ICU and a professor of medicine at the University of Washington.

鈥淭he biggest difference is that we have a better sense of what to expect,鈥� Curtis said.

The few treatments that have shown promise, including the steroid dexamethasone and the antiviral remdesivir, have 鈥渋mportant but marginal effects,鈥� he said.

鈥淭hey鈥檙e not magic bullets. 鈥� People are not jumping out of bed and saying, 鈥業 feel great. I鈥檇 like to go home now,鈥欌�� Curtis said.

Dr. Randall Curtis, an attending physician at Harborview Medical Center, says the biggest change since spring is that they know what to expect when patients end up in the ICU. Some treatments help, but there have not been any major breakthroughs, he says.(Will Stone)

Taylor said nursing has never quite felt the same since she started in the COVID ICU.

鈥淭hese people are in the rooms for months. Their families can only see them through Zoom. The only interaction they have is with us through our mask, eyewear, plastic,鈥� Taylor said. 鈥淲e鈥檙e just giving their body a runaround trying to keep them alive.鈥�

This story is from a reporting partnership that includes and .听