(CNN)Dr. Shannon Tapia, a geriatrician in Denver, cries as she talks about her work with the elderly during the Covid-19 crisis in Colorado, where hospitalizations and case rates are soaring.
"I guess with all of the death happening, the fact that I'm so exhausted, it's like, I don't even have time to process it," Tapia said. "But then, when I sit down with someone and they ask me questions, I just break down, because it's the first time I've had to think about it, and it's hard."
So many of her patients in long-term care facilities have died from the disease, "I got to a point where I stopped counting," Tapia said.
Colorado was among the 34 states and one US territory that reported at least one record high day of Covid-19 hospitalizations during November, according to The COVID Tracking Project.
Gov. Jared Polis, who recently tested positive for the coronavirus, said last week that more Coloradans are now infected with the virus than at any time since the start of the pandemic, with about 1 in 41 residents in the state testing positive.
And residents and staff of long-term care facilities, such as those where Tapia works, have been especially vulnerable. They accounted for more than 100,000 deaths, or 40% of all Covid-19 deaths in the country by November 24, according to the Kaiser Family Foundation.
"The rates in our long-term care facilities all over have skyrocketed, the deaths have skyrocketed. It's a different volume now and sadly much, much worse," than earlier in the pandemic, Tapia said.
Allison Boerner, an ER nurse in the Denver area, has had nightmares since the pandemic started.
Before the pandemic, Allison Boerner, a charge nurse in a hospital emergency room in Parker, in the Denver metro area, said her work had never caused her to lose sleep. Now she regularly has nightmares or flashbacks, she said.
"When I close my eyes at night, I see my patients either dying or the family members that I've had to tell, be involved in telling, that their loved one is no longer here," Boerner said. "That's what I see the most."
"I don't have any explanation other than it's like living a nightmare," she said of having to tell relatives that their loved ones had died, and she cannot physically comfort them.
Boerner said she also hadn't cried a lot on the job -- before the pandemic.
"You hold that back in. You want to stay tough for the family, and stoic," Boerner said. "And there's been a lot of tears shed in ER rooms during Covid."
"Because we are treating that person dying like our loved one dying, because they don't have anyone else, and they need that grace, and they need that human touch, and they need someone to be there when they're taking their last breath," she said.
The experiences will always be with her, Boerner said.
"Death is something that no one wants to have to deal with, but we all have to deal with it. It's something that's inevitable. And to not let family be with a loved one that's dying is something that you will never forget," she said.
At the beginning of the pandemic, people were afraid to come to the emergency room because of the virus. Now, the number of patients her ER is seeing is "overwhelming," Boerner said, and nurses are working overtime.
"Now the fear is gone, and everyone has Covid, and everyone's coming to the emergency room on top of all the other patients we're seeing, and it's inundating the system," she said.
A doctor who treats the elderly and works as a hospice physician, Tapia said death isn't new to her, and she sees her job as ensuring "people have the best quality of life, consistent with their values and goals, that they can have towards that end transition."
But Covid-19 has made that almost impossible, because what's most important, at the end of life, is to be with loved ones, she said.
"Their families can't visit, or they can do it through a screen, or they might get one compassionate visit covered in PP," or personal protection equipment, Tapia said. "It's just devastating, the loneliness."
And that's after patients had endured long stretches of not seeing family and friends because of limited visitation.
"We had to shut down and make it so people couldn't visit to protect them, but I don't know if it protected them, because of the loneliness and the isolation that it caused," she said.
"And then because of mismanagement of this entire pandemic, they're still getting it, you know? So, it's like, all right, so you're still dying of Covid, and you haven't been able to see your loved ones. What was the point to any of that?"
It's clear that the crisis is taking a heavy toll on both health care workers and their coworkers.
Dr. Tapia's new puppy helps her cope.
Boerner tears up when talking about the toll the pandemic is taking on the people she works with.
"You know, we lean on each other," Boerner said. "The holidays have been rough for a lot of us. We're not seeing our families; we're doing everything we can to keep the public safe. And so, it was extremely frustrating for us when people are not doing that."
Tapia said she absolutely sees depression on the rise among her colleagues.
"Depression, anxiety, you know, hopelessness, fatigue, burnout," she said.
Tapia said she is coping by having more therapy sessions, which have gone up "astronomically because of Covid," medication and a new puppy.
"Covid is very much why I am on antidepressants, and they have really, really helped," she said.
A number of frontline workers have quit, according to Tapia.
"The emotional toll is huge for all of the frontline workers," she said.
"So, I think we're going to hit a point where especially nurses, this country's not going to have them, you know, staffing the care we need is going to be a huge problem."
For those who stay, the problems won't be over when the crisis ends, she said.
"I think a lot are really just trying to take one step after the other, do the next right thing," she said. "And I think there's going to be a huge reckoning when things calm down and people get to really process what's happened to them."
