It’s been half a year since COVID-19 upended people’s lives in Illinois.

Since businesses sent employees to work from home, and many shut down. Schools closed and shifted classes online. Parents scrambled to juggle both work and their kids’ learning. Isolation — and loneliness — set in as people tried to slow the spread of the coronavirus.

Buzz words like social distancing became the norm, as well as masks covering most of peoples’ faces (and littering streets and empty playgrounds).

Illinois public health officials say COVID-19 has so far killed more than 8,500 people in Illinois and infected more than 280,000. That’s just cases that have been confirmed through testing.

WBEZ is revisiting several COVID-19-related health care issues we explored in the past six months to see what’s changed — or hasn’t.

The Challenge of Transferring Patients

During the height of the pandemic this spring, when hospitals in Chicago were overwhelmed with COVID-19 patients, some small hospitals, with the least amount of resources and mainly treating low-income people of color, were stuck. They couldn’t get many other hospitals to take their patients.

In Illinois, there’s no agency coordinating how patients flow from one hospital to another. And there’s no agency that has the power to force hospitals to take patient transfers.

The major gap has created a patchwork transfer system that has led hospitals to rely on old friends and connections to help move patients when they’re overwhelmed.

This remains the status quo. But hospitals are no longer brimming with patients sick with the coronavirus.

Still, with a potential uptick in cases in the coming months, it’s time to fix the issue now, said Illinois State Rep. La Shawn Ford, who represents some West Side communities hit especially hard during the pandemic. He said he plans to propose legislation when lawmakers meet in November to address hospital transfers for COVID-19 patients.

“The pressure is not where it was,” Ford said. “But that’s when we have to make sure that we fix it. We’ve learned from the times when it was a crisis.”

He said the balancing act will be to get more hospitals to take transfers, without overwhelming them.

“It could have unintended consequences,” Ford said, like patients lingering in emergency departments, waiting longer to get treated.

A spokeswoman from the Illinois Department of Public Health, which regulates hospitals, did not comment.

Norwegian American Hospital in Humboldt Park on the West Side had to work the phones this spring to get patients transferred. One day, Norwegian contacted 21 hospitals, some in suburbs nearly an hour’s drive from the West Side, and were able to transfer just two patients.

Heather Khan, Norwegian’s vice president of patient care services, said the hospital is in a better place now, with just two or three COVID-19 patients a day compared to nearly 40 a day for most of April and May.

“I think it would take a lot to get to where we were before, because the beds have emptied out,” Khan said.

But if and when Norwegian does get slammed again, the hospital would likely work the phones again, leaning on friends at other hospitals, Khan said.

Rush University Medical Center, a teaching hospital on the Near West Side, fielded hundreds of transfers from other hospitals in the spring, including from Norwegian.

Short of new rules that would help hospitals transfer patients, Rush has been partnering with Chicago public health officials to create a dashboard that would show where in real time there are available critical care beds for the sickest patients. The idea is to steer patients to those beds, even though public health officials can’t force transfers.

But some hospitals are still reluctant to share that information, said Rush’s chief medical officer, Dr. Paul Casey. Many hospitals are in bad financial shape after they had to cancel money-making elective surgeries during the beginning of the pandemic. The idea of having to share where you have a bed available, instead of using it for your own patient who could generate money for a hospital, could be tough for many hospitals.

“The threat or the thought for hospitals that just went through a pandemic that independently was an incredibly challenging time, but on top of that taking away the financial driver of being able to do procedures, really leaves a lot of hospitals in a bit of a tailspin from a financial and operational perspective,” Casey said.

People Dying At Home

In May, a WBEZ investigation found a dramatic drop in the number of people seeking medical care since the pandemic took off in March, potentially contributing to the climbing death toll during the pandemic.

Then earlier this month, a national poll by NPR, the Robert Wood Johnson Foundation and Harvard University revealed even more. Of nearly 530 people surveyed in Chicago, more than one in five people said they weren’t able to get medical care for a serious problem when they needed it during COVID-19. A majority of those respondents said they got sicker because of it.

In the early days of the coronavirus, hospitals told people to stay away. They needed all the available beds for patients with COVID-19. Doctor’s offices largely moved online, visiting with patients over video or on the phone.

NorthShore University HealthSystem in the northern suburbs was among hospitals where patients stopped showing up. At the time, cardiologist Dr. Mark Ricciardi told WBEZ he believed that some people could be ignoring their symptoms, like chest pain, and dying at home.

Now, Ricciardi said he’s busy again and that people are likely more comfortable coming back, especially with constant messaging from hospitals and doctors that they are saf, that they won’t get COVID-19 at the hospital or in a doctor’s office.

“In April and May, I think the acuity of patients was worse,” Ricciardi said. “In other words, they were a little sicker. Now I think that acuity has returned to the level of acuity that we became accustomed to pre-COVID.”

The emergency departments at NorthShore’s four hospitals are busier, too. People are coming back for the “usual stuff,” such as chest pain, heart attacks and strokes, said Dr. Ernest Wang, chief of emergency medicine.

And while the number of patients with coronavirus NorthShore treats has dwindled, like it has at other hospitals, Wang still worries the deadly disease could come back with a vengeance as people get used to living with it in their communities.

“One of my colleagues walked into the ED yesterday and said, ‘COVID is back,’” Wang said during an interview on Wednesday. “I think we haven’t seen the real sick, dramatic presentations as much, so when we see it …”

He trailed off.

Another sign more patients are returning to the doctor’s office? At Esperanza Health Centers, a group of clinics on the Southwest and West sides, the number of deaths for their typically low-income and uninsured patients jumped early on in the pandemic, to 15 deaths in May. By July, the number was back to normal, with around three deaths, said Esperanza’s chief medical officer Dr. Andrew Van Wieren.

“I see a lot of people who previously were scared to come into the health center now want to come in,” Van Wieren said, to get a flu shot or lab work done. “I feel like I still do see a pretty significant divide. Some patients still don’t want to come in at all. Some patients are willing to come into our health center but not willing to go to the hospital, because they determine that’s higher risk in their mind, and then other patients are willing to go anywhere at this point.”

Hospital staffing

When COVID-19 took off in Illinois in March, state public health officials and hospitals advertised top dollar to staff up quickly to treat an expected surge in patients.

Dr. Eileen Murphy, a local obstetrician and gynecologist, was among physicians who were paid some $200 an hour to work at a field hospital set up inside the McCormick Place Convention Center just south of downtown Chicago.

“I did meet a fair number of people from out of state,” Murphy said, describing her two tours of the field hospital. “They literally flew in for the day. One woman was from the Midwest. Another was an ER type doc from Florida. I met a lot of nurses from out of state.”

She never ended up working a shift. The field hospital, meant to relieve hospitals by taking their less sick COVID-19 patients, wound down after treating just 38 people. The venture cost about $65 million.

The state ended up hiring at least 400 health care workers to help treat patients in the spring and recruited more than 36,000 volunteers, a spokeswoman said. Some of those contracts have since ended.

Loretto Hospital, a small facility in Austin on the West Side that mainly treats low-income and elderly Black patients, feared that its nurses would get lured by McCormick’s high salaries. CEO George Miller said that didn’t end up happening, though the hospital did lose a group of physicians to the field hospital that were meant to staff Loretto’s emergency department.

Now he’s in hiring mode for more nurses.

“We thought when flu came, there’s going to be a second wave,” Miller said. “We’re preparing for that.”

University of Chicago Medical Center, a teaching hospital in Hyde Park on the South Side, has hired more than 200 nurses since June to fill vacancies and beef up staffing in the coming months. And the University of Illinois Hospital on the Near West Side plans to add at least 160 nurses as part of a tentative deal with its unionized nurses after they went on strike for a week.

But as some hospitals hustle to recruit more employees, other facilities are cutting staff or pay, even as COVID-19 could flare in the coming months.

“Nobody wants to talk about this because they’re frankly afraid of losing their jobs,” said Dr. Jay Chauhan, a head and neck surgeon in the suburbs and past president of the Chicago Medical Society. “And really, where are you going to go?”

To cut $187 million from its budget, the Cook County Health system is closing two clinics, suspending inpatient pediatric care at one of its hospitals and converting the emergency department at its other hospital into a 24-hour standby department. The health system is the largest provider of medical care by far than any other hospital in the area for people who can’t afford to pay for it.

Mercy Hospital in Bronzeville on the Near South Side plans to close entirely next year.

Ironically, Mercy’s planned closure has been a boon for another financially-stretch hospital: Roseland Community on the Far South Side. CEO Tim Egan said he’s fielding calls and resumes from Mercy employees as he looks to staff up. He recently hired a Mercy physician to be the medical director of Roseland’s emergency department.

What to watch for in the coming months

Jaline Gerardin, an assistant professor at Northwestern University who models COVID-19 data for Illinois public health officials, is keeping a close eye on whether Illinois could have another bump in COVID-19 cases.

“Intervention fatigue is a real thing,” Gerardin said. “If there is an increase in transmission, are we going to detect it quickly, or are we going to only notice it once there’s already kind of substantial transmission and more hospitalizations and deaths happening?”

And then there’s the flu colliding with COVID-19 this fall and winter. Doctors are pushing flu shots, hoping to control the spread of one disease while scientists work to create a coronavirus vaccine. Then figure out a way to get the public vaccinated.

Another thing doctors are focusing on while waiting for a vaccine? Testing more people for COVID-19 to contain the spread.

Kristen Schorsch covers public health on WBEZ’s government and politics desk. Follow her @kschorsch.

This story is a part of the Solving for Chicago collaborative effort by newsrooms to cover the workers deemed “essential” during COVID-19 and how the pandemic is reshaping work and employment.

It is a project of the Local Media Foundation with support from the Google News Initiative and the Solutions Journalism Network. The 19 partners span print, digital and broadcasting and include WBEZ, WTTW, the Chicago Reader, the Chicago Defender, La Raza, Shaw Media, Block Club Chicago, Borderless Magazine, the South Side Weekly, Injustice Watch, Austin Weekly News,Wednesday Journal, Forest Park Review, Riverside Brookfield Landmark, WindyCity Times, the Hyde Park Herald, Inside Publications, Loop North News and Chicago Music Guide.