Editor’s note: This is the fifth in a series of stories on COVID-19’s current impact in Southwest Virginia. The delta variant has produced case rates double those in the state as a whole, with even more disproportionate death rates. News Channel 11 spent a day in Wise County and spoke to half a dozen people — from an ICU nurse to a small business owner, an elected attorney to a respiratory therapist.

NORTON, Va. (WJHL) – Far too often over the past six weeks, Heather Long has stuck tubes down the throats of people from her own community — just like she did for week upon week during last winter’s COVID-19 surge.

“A lot of times with the COVID patients, what we see is their oxygen levels are just so bad that they get to a point where it’s just not safe anymore for them not to be intubated,” said Long, a Ballad Health respiratory therapist and manager of the cardiopulmonary department at three small Southwest Virginia hospitals.

Long, who has done this kind of work for 13 years, said the hours and moments leading up to intubation can be terrifying for patients. Bipap and other “high-flow oxygen” methods haven’t been enough to keep their oxygen saturation sufficiently high, and the patients themselves feel as though they’re being smothered.

Respiratory therapist Heather Long

“The equipment’s dinging in the background because their oxygen level is low, and it’s sheer panic on their face,” Long said during a short break outside Norton Community Hospital.

That’s when Long and her colleagues have to put on their game faces, no matter how they’re feeling inside.

“You just have to kind of get your emotions in check and just try to say, ‘you know, this is the patient, I need to help take care of them right now,’ and I hate to say it, but try not to think of them on a personal level,” Long said.

“After we get everything taken care of and the patient stabilized, then, you know, it’ll kind of hit you and you have kind of go and ‘have a moment.'”

Those moments are rooted in the grim statistics that accompany intubation or being placed on a ventilator. The objective, Long said, is for patients to get some time to rest and recover while the machine completely takes over the breathing their bodies have been struggling so mightily to do.

“Usually with the COVID patients, unfortunately when you get to that point, we don’t see a lot that are extubated and come off,” Long said. “When they get to that point, it’s usually not good.”

When she’s not treating COVID patients, Long runs one of the nation’s busiest black lung clinics in the heart of Southwest Virginia’s coalfields.

“If you’ve worked in the field as long as I have, or any amount of time really, you deal with a lot of death,” Long said.

She’s certainly seen her share before the pandemic hit. That said, Long’s previous experience pales in comparison with the havoc COVID has wrought.

“Never this amount of death and this many patients at one time.”

Current surge not Long’s first COVID rodeo

Unlike her colleague Lori Looney, a registered nurse who oversees Norton’s ICU, Long isn’t getting her first experience of the COVID nightmare. She was also on the front lines during last winter’s surge when Ballad centered its Wise County COVID treatment at Lonesome Pine Hospital in nearby Big Stone Gap.

“We didn’t know what we were dealing with, we didn’t know how to really attack it, how to treat it,” Long said of the first wave that peaked in December and January.

She said that left clinicians questioning, “what did I learn in school, because everything I learned that’s supposed to help is not.”

Staff members had to improvise ways to try and help patients, but Looney said the winter surge was a real test with vaccines unavailable.

“It was a lot of elderly people, and that was extremely difficult and I don’t know that I’ll ever get over that,” she said.

“I just try to keep my emotions in check. I have my moments that I go and have a breakdown or two. But being a manager, I try to do my best to be there for my staff and be supportive of them as well. Just because I know how much they’re going through because this is round two for me.”

Long has shared what she learned during the winter with staff at Norton, as have some other people who worked at Lonesome Pine during that time.

She said that’s helped the “newbies” at Norton who hadn’t dealt with COVID up close and personal — like Long did many times, including with one elderly patient who will stick with her.

“He had somewhat been doing just a little bit better,” Long said. “And we were a little bit hopeful.”

Southwest Virginia’s population-adjusted COVID-19 death rate has been nearly quadruple Virginia’s over the past week — and triple the rate since Sept. 1.

But then the man took a turn for the worse — something that happens often in COVID cases — and his respiratory aid graduated from a nasal cannula to a BiPAP machine.

“Maxed out on the BiPAP, it was, you know, ‘we’re gonna have to do something.’ He really didn’t want to be intubated, he didn’t want to talk to his family before he was intubated because he didn’t want them to see him like that.

“I have a really hard time getting that out of my mind, I think about him all the time,” said Long, who stayed with the man during the intubation.

“Afterwards, the therapist that was with me and myself, we both cried, because we knew that if it progressed to that point that it was probably not a good prognosis for him. And it ultimately (wasn’t), and he’ll just always stick in my mind.”

Long said she worries about picking up a breakthrough case and taking it home to her 5-year-old son, who can’t be vaccinated. She even worries about having enough equipment to serve the people who just keep showing up with serious cases of a virus that puts very, very few vaccinated people in the hospital.

“I have to keep a count of our equipment because we’re afraid of running out or running low.”

Long said having to closely track inventory was “very daunting” and a first in her career. And the native of Coeburn, Va. has a plea for her neighbors, who she wishes would all get vaccinated.

“My biggest thing is if you don’t want to get the vaccine, then that’s fine, but social distance, wear a mask, and wash your hands, and try to help us out, because it’s really hard.

“That would be a lot of support for us, along with prayers.”