Andrea Kanerva sat on the edge of the bed with her hair pulled up, exposing the ties of her blue hospital gown. Fuzzy green socks with white treads covered her feet.
She spoke deliberately, breathing deeply as the lines on the monitor behind her danced up and down, graphing fluctuations in Kanerva's pulse, blood-oxygen level and respiratory rate.
Kanerva, who lives in Hamburg Township and works as a service adviser for Briarwood Ford in Saline, is part of Michigan's third wave of novel coronavirus patients — hospitalized at the height of a surge that for weeks has led the nation.
"There were days when I thought I was turning around a little bit and then I went right back down. It's been a long struggle," said Kanerva, who tested positive for the virus on April 7 and was hospitalized nine days later.
The day she went to the emergency room — April 16 — Michigan's third COVID-19 surge peaked, hitting the highest number of new cases in a single day this year — 8,955. Coronavirus hospitalizations topped 4,000 that day, too — a more than 460% rise from four weeks earlier.
She was admitted to St. Joseph Mercy Ann Arbor Hospital and needed supplemental oxygen to breathe.
By Tuesday morning, doctors weaned Kanerva off the oxygen to assess whether she could remain stable without it and potentially go home.
"I'm really looking forward to it," she said. "It'll be nice to be in my own home, hopefully, sit on my couch and rest. I don't really foresee doing a whole lot. But that's all right. I'll take one step at a time and do what I can."
There are some stark differences in the state's third surge compared with previous spikes, said Dr. David Vandenberg, vice president and chief medical officer of St. Joseph Mercy Ann Arbor.
"What we're seeing is a definite shift of toward the younger patients," he said. "No question about that. I would say that our average age ... is about 58 in this surge."
Kanerva, a mother and grandmother of three, is 59.
The downward shift in the age of patients this time, Vandenberg said, is likely due to how vaccines were prioritized in the state, with more doses initially aimed at older, more vulnerable people.
Statewide, about 65% of residents ages 65 and older are fully vaccinated — about 1.1 million people, according to the Michigan COVID-19 vaccine dashboard. That compares with about 40% of Michiganders ages 50-64; 24% of those ages 40-49, and 21% of those ages 30-39.
The vast majority of people contracting the virus now and getting sick enough to be hospitalized haven't yet gotten a COVID-19 vaccine, Vandenberg said.
"We have definitely seen several very sick 20-somethings and 30-somethings, 40-somethings," he said.
Kanerva is among the unvaccinated.
"I was trying to get the vaccine, and I got sick before there was a place available for me to get it," she said. "I will definitely be doing that. I'll tell you that. I would recommend to anybody to definitely get it because this is not a fun thing."
Of the 15 coronavirus patients on ventilators at St. Joseph Mercy last week, seven were in their 30s or 40s, Vandenberg said.
"Most of those patients have some comorbidities," which are underlying diseases that put them at higher risk for severe illness or death from COVID-19, and can include such conditions as obesity, diabetes and high blood pressure, he said. "We're definitely seeing a younger age group who's pretty sick."
"Thank God," Kanerva said, she never needed a ventilator. "I sure didn't want that.
"I was on 3 liters (of oxygen) for quite a while ... between 3 and 4," she said. "Yesterday, they took me down a little bit, and then today, I haven't had any. I've been doing good."
COVID-19 deniers get hospitalized, too
After the first two waves of COVID-19 patients who poured into the hospital in March-April of 2020 and again in November and December, registered nurse Karla Kanitz thought she'd seen it all.
She's the charge nurse for the 32-bed 10th floor east unit at St. Joseph Mercy Ann Arbor, where every room can convert into a negative-pressure room, ideal for containing infectious diseases like novel coronavirus; each room can serve in an intensive-care capacity, too.
Last week, the unit was filled with coronavirus patients. Two other floors of the hospital also were functioning as COVID-19 units.
In the early days of the pandemic, Kanitz recalled, "we didn't have a lot of PPE. We didn't have a lot of staff. We didn't have a lot of anything. We didn't know what we were dealing with.
"I got COVID myself ... and that was a scary time, you know?"
But this third round — with high case rates driven by a more contagious and potentially more deadly strain, known as the B.1.1.7 or United Kingdom variant — has delivered plenty of new surprises for the 19-year veteran.
Among the biggest of those surprises is that 14 months into the pandemic — after more than 800,000 Michiganders have been infected and more than 17,000 have died — some patients are still skeptical that the virus is real.
"Some of them still don't believe that they have it," Kanitz said. "We had one wife who told us we were all well-paid actors," after her husband died of COVID-19. "So people are still very much in disbelief."
Vandenberg recalled a patient who refused to have a coronavirus test "because they didn't believe in it," even though the person was clearly infected with the virus, he said. "There was no doubt about it. They lost their sense of smell, and they were sick, and wouldn't get the test because they didn't believe that it was a real thing.
"I treated them just like it was the real thing because it was diagnostic. The symptoms were classic and everything, and it was obvious. But you, know, they didn't want to be counted as one of the 'fake statistics.' "
It was, he said, "just astonishing. ... I've never seen anything like it. It's just, it's politicized."
That the pandemic struck in a contentious presidential election year brought politics into medicine, fed conspiracy theories and made it hard for polarized Americans to understand the science, Vandenberg said.
"Now, you've got both sides kind of push-pulling away," he said. "Both sides are resisting vaccines. ... It's a shame, but that's what happened."
It's a resistance that could prove deadly.
"Get the shot," Vandenberg said. "You're going to get COVID or you're going to get a vaccine. ... I mean, honestly ... I can just tell you that COVID is way worse than the vaccine — not by two times, or five times, but by 1,000 times, maybe by 10,000 times, in orders of magnitude."
Many patients also don't seem to grasp how not making correct everyday choices — such as wearing a mask, social distancing, hand washing and avoiding gatherings — can land them in the hospital or kill them, Kanitz said.
"They'll say something like, 'Well, there was a party. We had a family party of 35 last weekend. Do you think I got it from there?' " Kanitz said. "And I'm like, 'Yeah. You probably got it from there.'
"I would just really like people to know that it's still here. And it's still serious. ... It can just so rapidly progress. ... Just because you maybe had a positive test five days ago, and you've done fine up until now, today might be the day that you don't do fine anymore.
"So don't ignore it. Don't wait. ... The ER is available to you."
Depression, fear creep in
Registered nurse Brandy Jones has found it hard to remain upbeat and cheerful through it all.
Tears well in her eyes as she talks about how depression crept in during the state's second surge in November-December, and she struggled to get through each workday.
"Watching people deteriorate like that and not being able to help, it's like heartbreaking ... and then you have to leave that room and go to the next room and you have to just put it in the back of your head and move on," said Jones, an intensive care nurse. "And that's really, really hard to do.
"I ... had to tell my husband, like, 'I'm sad all the time. I felt like I had done everything to help these people, and now it's like I'm not making a difference, you know?' "
Jones got professional help for her depression, and found support through the hospital.
"By talking to people; it helped a lot, and I got out of it," she said.
"And here we are now in the third surge, and I feel like I'm still going. ... I'm going to do the best I can for these patients. And I might not be able to save them all, but I can give them ... the best possible care that I can in their end of .... life, if that is the way it's going to go."
It's jarring, Jones said, to see so many younger patients in need critical care this time. Many are the same age as she is.
"Before, I feel like it was grandma, grandpa, you know, 70-, 80-, 90-," year-old people who needed intensive care, said Jones, who is 43. "Once in a while, occasionally, we would have like someone in their 50s or 60s."
Lately, the people she cares for remind her of her best friend, her husband, "somebody that is, you know, 43 years old that has kids in high school, or maybe doesn't even have kids yet ... like young," she said. "That's like a big eye opener."
Jones said she wishes people would stop suggesting COVID-19 is no big deal, or no worse than the flu or a bad cold.
They'll say, "It's only like 1% or 2% that end up sick,' " Jones said. "That really bothers me when people say that. I'm just like, 'but if it was your mom or your dad or your grandma, trust me that 1% is gonna be 100% to you.' "
Patients with COVID-19 can deteriorate fast, Kanitz said.
"You might call that family member at 10 or 11 a.m. as the nurse and say, 'They're doing great,' or 'They've turned a corner,' ... and then by 1 o'clock, you're calling the doctor saying, 'Things aren't looking as good,' " Kanitz said.
"And by 2 o'clock, the doctor is calling ... the family, saying, 'I know three hours ago everything was fine, but now they're intubated or on high-level bi-pap (ventilator).' It changes so quickly. It's a lot for these people to take in."
In more severely ill patients, she said, high-flow oxygen through a bi-pap machine still can't deliver enough oxygen. That's when doctors often must resort to a ventilator.
"The ventilator itself is pushing air literally down into the lungs to force air to get oxygen into the bloodstream," said Dr. Eugene Liu, a hospitalist at St. Joseph Mercy Hospital. "And that's the hardest part about COVID is it makes the lungs ... very stiff. And it's hard to get oxygen to the bloodstream so that the rest of the body can work."
If a COVID-19 patient is put on a ventilator, the odds of survival grow slimmer.
"Once you're sick enough to be on the ventilator ... our survival rate is about 50%, and that's been consistent throughout the whole" pandemic, Vandenberg said. "It's not good. ... So making the decision to intubate is very traumatic. ... It can sometimes feel pretty hopeless."
For some patients, even with the help of a ventilator, their hearts and lungs grow too weak to keep them going. On Monday, Liu said, a 34-year-old patient went on a heart-lung bypass machine known as ECMO (extracorporeal membrane oxygenation) to give the body time to rest, and was transferred to a nearby hospital that specializes in that treatment.
Other young people also have required a level of care they haven't needed in previous surges, Liu said. It's taking many of them weeks and weeks to recover, if they do at all.
"I tell patients and families, be prepared for the long haul. ... They literally can be on bi-pap for two or three weeks," he said. "We try ... to take off the mask, you know, and let them eat. But we're finding many of them, they can only take off the mask for literally 30 seconds, a minute, and their oxygen saturation tanks. So that's the struggle."
Because family and friends can't visit patients, depression is common among those hospitalized with COVID-19, too.
"It's very difficult because they're very appreciative of the nursing and our nursing is wonderful. ... But it's not family. It's not the same," Liu said.
"Most of them ... they're scared.
"Now, I think everyone's sort of known someone who didn't do well and probably died, or at least got really sick. And so at least they experienced that or got a story from that. ... After a few days, they're just shocked how they're not better yet.
"And so I think that's the mentality I see in most of the patients now is that they come in extremely frightened and scared ... and maybe they've progressed to where they're here a couple weeks, and then that's ... sometimes when some anxiety and just even depression can kick into that."
'It changes your thought process, this COVID'
John Collins wore a surgical mask over his face, covering the high-flow oxygen tube delivering lifesaving air to his nose as he lay in a hospital bed Tuesday on the 10th floor of St. Joseph Mercy Hospital's east tower.
Collins, who is 84, suspects he caught coronavirus from his daughter, who lives with him and his wife and son in Milan.
His first symptoms were gastrointestinal.
"I came into St. Joe's with uncontrolled bowel, diarrhea and a urinary tract infection and went to the emergency room, and they quickly ran a COVID test. And within 10 minutes, they said, you've got it," Collins said.
He survived polio as a child, and has had several operations on his legs. He now uses a walker or a power chair to get around.
Even though Collins has been eligible to get a COVID-19 vaccine for months, the process seemed too arduous.
"I put off to doing that because of my mobility," he said. "It would be hard for me to go somewhere and get out of the vehicle and go into a building and wait and get a shot. If there was a drive-up, where you could drive up and get a shot, then I think I could have and would have got it done."
Access to vaccines — not just being eligible for them — is a problem that has yet to be fully addressed for Michiganders like Collins, said Dr. Anurag Malani, director of infection prevention for the St. Joseph Mercy Health System.
"It is a shame that we have an 84-year-old that hasn't had the vaccine yet," Malani said. "When COVID is surging, that requires staff, that requires infrastructure," and it means there may not be enough trained workers to host drive-through vaccine clinics or deliver shots directly into the arms of homebound or disabled people.
"I think there are some programs ... trying to get to people's homes and give it to people in the home," he said. But that option still isn't widely available in many parts of the state.
"I would say the large majority of the people that are in the hospital are not vaccinated. I don't think it means they didn't want to get vaccine. I think it means a few things: Maybe they didn't want to. I think that's probably the minority, but I also think it's vaccine access that plays a major role."
Collins, who worked for 28 years at Ford's now-shuttered Milan plant, said he's been in and out of the hospital in recent weeks — recovering just enough from COVID-19 to go home, only to relapse, and need to be readmitted.
"Things got worse and worse," he said, as the virus began to attack his lungs and pneumonia set in. "Hopefully, we can get through it this time.
"I'm coughing quite a bit, which is good to get up some of the phlegm and stuff. It's kind of hard to catch a breath after a while, but that's part of the sickness," said Collins, who also owns a store called Collins Center in Milan.
"We own our own business there in town," he said. "We've been there for 52 years ... right on the corner of Main Street, No. 1 W. Main St.
"My wife runs the front end of it. She's running it all right now, but we're drop point for a dry cleaner in Saline, and we have crafts and that sort of thing. I repair TVs, radios and electronic equipment."
He said he misses her, and wishes she could be at his bedside to advocate for him because the virus has made it difficult to think clearly and communicate.
"It changes your thought process, this COVID," he said. "I don't know how to explain that but you have to think more about what you're saying and how you have to say it and that sort of thing and whether it's going to come out right," said Collins, who is a father of five and grandfather of five.
Though the hospital has smart tablets patients can use to video chat with their loved ones, it's not a technology his wife has embraced.
"I just talked to my wife and son today," he said, pointing to a landline phone on his beside table. "They just got their first shot" of a COVID-19 vaccine. "I think they went to some place in Saline. I'm not for sure because it just happened. We haven't really been in communication with each other."
The pandemic, he said, has been devastating for him on several levels. Not only has it made him sick, but it also "shut down my businesses for a while," he said.
Information about the virus was twisted and woven into politics, which infiltrated the news and pop culture, Collins said, making an already bad situation worse.
"It seemed like everything was to throw (former President Donald) Trump out of office," he said. "I never have seen such disrespect for the president. Period. In all my lifetime."
But no matter where a person's political allegiances lie, one thing he has learned is true: The virus is real. And it's brutal.
"I say, get the shots," Collins said. "Get the shots. That's the main thing. And be careful of what you're doing. We still don't know what or how many variants there will be to this whole system yet, so all we can do is hope and pray it gets over with."
Doctors: Vaccine is the best medicine
Patients who come to the hospital with COVID-19 often scour the internet on their smartphones, looking for treatments or some promising study that might help them recover from the virus more quickly.
"They're like, 'what else can you do? What else can you do? Well, how about this? How about that?' " Liu said.
"But when you're this sick, there really is no effective thing." Though there is a known benefit to giving hospitalized patients the antiviral drug remdesivr and the steroid dexamethasone, really, he said, "you're just buying time for the body to heal."
And some people don't get enough time.
"There is no good cure for this, period. And so what can you do? You try to stop from getting it in the first place, and that's the vaccine," he said
There have been a small number of vaccine breakthrough cases where a few fully vaccinated people get so sick they need hospitalization and even fewer die.
Malani said some people might draw comfort from looking at the state's COVID-19 vaccine dashboard to see that as of Friday, 33.7% of Michiganders ages 16 and older were fully vaccinated.
But he sees it differently. Malani flips the statistic, and considers 66.3% haven't yet had the shots.
Vaccines, he said, are the only way out of the pandemic.
"That's how we get back to normal," he said. "If you want to go to the bar, if you want to go to the theater, or you want to resume kind of what we remember as normal, the only way to get there is through ... herd immunity."
And the only way to get to herd immunity is to get vaccinated, he said.
Health care workers don't want pity or parades, Vandenberg said.
"Don't feel sorry for us. We get we went into this to take care of people," he said. "We're going to tell our grandkids about how we ... managed through this."
But they need a break.
"If we don't get enough people vaccinated, we're going to have another (surge), and another one, and another one after that. You can bet on it," Vandenberg said.
He hopes that those who are vaccine-hesitant will be persuaded when they see that friends and family had no lasting side effects.
"They're going to see that we didn't grow tails," Vanendberg said. "Our arms didn't fall off ... and we didn't go to the hospital for COVID, right? And they're gonna go, 'You know what? Maybe I'll get it, too.'
"I think a lot of hesitancy is just trust and just kind of being a little afraid. That's OK. It's human nature. I don't shame anybody. ... You can't convince people who are conspiracy theorists, but the people that are on the fence ... God bless them. They'll come along.
"And then, I think you'll see, a moment where things just get better."
Contact Kristen Jordan Shamus: email@example.com. Follow her on Twitter @kristenshamus.