The coronavirus pandemic is hitting the Midwest and mountain states hard right now, including Montana, where some hospitals are overwhelmed with COVID-19 patients.

After largely stable numbers in the double digits for most of the summer, daily new cases in Montana started an upward spike in late September. The state averaged 866 cases per day this week. Nearly 500 people in Montana have died.

Dr. Jamie Riha, a critical care specialist at the Billings Clinic in Billings, tells NPR's Morning Edition the facility has "a critical level of patients in our ICU."

In response, she says the hospital has multiple or double occupancy, which means more than one patient can be in one room of the ICU. They're also holding ICU patients outside of the normal area.

"Our hospital is strapped thin," she says. "We've come up with great out-of-the-box solutions and we're continuing to be able to care for patients at a very high level. But if the pandemic continues accelerating at the rate it's at, things are going to be getting very, very limited and tough decisions will have to be made."

Riha implores everyone to wear masks to "help get this pandemic under better control."

NPR's Noel King spoke to Riha about how her patients are doing, how the staff is coping and what Americans can do to help.

Interview Highlights

On how the patients are doing

The patients are unfortunately very, very sick and they are very frightened. The United States has been living with this pandemic for a long time. People know what the virus can do. And they, unfortunately, once they reach the intensive care level, they know that there's a very good chance they may unfortunately not survive, and so patients are very scared.

And it's one of the biggest challenges — emotional challenges, I should say — for physicians and nurses ... caring for these patients is that we are so strapped right now. And so tight and trying to cover all of the ICU patients that we are not able to spend lengthy amounts of time with these patients, comforting them or providing the emotional support that they need.

And so it is very challenging for the patients. They are able to connect with their families via cellphones. And we also do have iPads so that patients can connect with them via FaceTime or Zoom as well. But it still is a very lonely, isolating disease for the patients in the hospital.

On one particular experience she can't get out of her mind

There's multiple patients that have impacted me deeply. But the one that has impacted me the most was a woman. She was just around 50 years old, otherwise healthy, and was admitted to the hospital earlier this fall with low levels of oxygen due to COVID. She'd been in the hospital for only about two days and the condition of her lungs declined significantly enough to the point of requiring ICU level care. She was transferred to the ICU when I was working a night shift. And unfortunately, despite arriving to the ICU talking, approximately three or four hours later, she died very quickly due to complications from COVID. And I had to go out and tell her husband and her two teenage children who we had called in, that his wife and their mother had died.

And it was one of the most traumatic experiences for me, as well as multiple members of the team, because those two kids lost their mom. And it really impacted me, not just because I had to look at the grief and loss that her family and her children were experiencing, but because she was truly an otherwise healthy female. And I think so many people believe that this disease only threatens the lives of the elderly or those with really sick chronic medical conditions. And it's not true. It can take the life of anyone.

On how she is coping

I will be honest. It's a challenge. I'm emotionally, mentally and physically exhausted. I try when I'm off work to separate as much as possible. I exercise. I spend time with my husband and my two young children, but it's a challenge.

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