COVID-19 breaking point: Northern California hospitals, ICUs filling up with virus patients
The coronavirus has found a weak spot in the California healthcare system. It’s the intensive care unit.
With the COVID-19 surge causing record hospitalizations, and with fears that Thanksgiving get-togethers are about to result in even more extremely ill patients, Gov. Gavin Newsom warned this week he may order another stay-at-home rule at any moment to stop a Christmas crisis in hospitals, particularly in acute care units where capacity is extremely limited.
Already this week, one Sacramento-area hospital in Marysville reported just two ICU beds left. In Placer County, health officials say COVID-19 patients are taking up more than 15% of beds, a worry heading into winter when hospitals are typically most busy. In Sacramento County, health officials on Tuesday said they already are seeing the first reports of Thanksgiving week infections leading to early hospitalizations.
While a hospital may have 100 beds for patients, only a small percentage of those are available for extreme care, with the type of equipment and specially trained doctors and nurses to handle patients that require, for instance, a ventilator to keep them breathing because their lungs have failed.
“Bottom line, we are looking at ICU capacity as the primary trigger for deeper (restrictions) actions,” Newsom’s health chief, Dr. Mark Ghaly, said on Monday.
Ghaly said the state estimates that 12% of people infected by COVID-19 end up in the hospital. Of those, up to 30% end up in ICU. That means only a small slice of infected people will in fact end up in an ICU, but it is still enough, given current transmission levels, to overwhelm the north state’s healthcare system within the next few weeks.
If the virus does not abate, ICUs in the Sacramento region will hit 103% of capacity by Christmas Eve. Currently, those units are 76% full. Northern California hospitals, north of Sacramento, have less capacity and could fly past 100% full by early December, the governor said. San Joaquin Valley hospitals may hit the capacity needle by mid-December.
“When that capacity goes away, we know the quality of care, not because of anyone’s fault, sometimes takes a dip and we see outcomes we don’t want to see,” Ghaly said. “The second half of December could be pushing the limits in some areas. We want to act sooner than that.”
Sacramento-area hospitals plan for COVID
Sacramento-area hospital officials say it is not time to sound the alarm just yet. Almost all still have space and staffing available.
But they acknowledge that the trend lines over the past month suggest they may be weeks away from being required to take dramatic steps, such as setting up field hospitals in county fairgrounds or calling on the state to open its Sleep Train Arena overflow treatment facility in the city of Sacramento.
Can they avoid that? There is a chance.
“My crystal ball is broken,” said Siri Nelson, president of Marshall Hospital in Placerville, where El Dorado County COVID-19 cases are soaring. “The next couple of months are going to be a roller coaster though for everyone. We need to be cautious.”
She is one of many local hospital and health officials who say they are looking to the general public to agree to avoid mixing and mingling indoors without masks.
That did not happen over Thanksgiving week when national transportation officials reported millions of fliers, many presumably heading to family gatherings, staying overnight at relatives’ homes and likely not wearing masks the entire time, if at all.
Sacramento saw 1,115 new cases reported on Tuesday, 10 times more than just a few weeks ago. County health officer Dr. Olivia Kasirye said that is an ominous sign for hospitals as Christmas, another family gathering moment, approaches. “Entire families are coming up positive,” she said.
In the Sacramento region this week, hospitals report varying levels of urgency.
Marshall Hospital is in decent shape at the moment, Nelson said. As of Tuesday morning, 11 of its 20 ICU beds were taken, leaving nine available. If those get filled, the hospital could turn some surgery department beds into ICU beds because doctors and nurses there have the experience to deal with critical patients.
The hospital could look to transfer some patients to other hospitals, if needed. But, already, one such hospital, Renown Regional Medical Center in Reno, has said it cannot accept as many patients as usual due to its own patient load issues.
At Adventist-Rideout hospital in Marysville, just north of Sacramento, there were nine COVID-19 patients in ICU as of Tuesday, leaving just two ICU beds available, according to state data.
Meanwhile, the virus was spreading through the Yuba and Sutter County area more rapidly than ever. Sutter County had the highest test positivity rate this week among all 58 counties at 19.8%. Yuba ranked third-worst at 15.3%.
The Marysville hospital is among many in the region who send patients to other Sacramento hospitals at times. That is not an unusual move, but is typically done to send patients to hospitals that have particular treatment facilities and skills, not because a hospital doesn’t have space.
“We remain in close contact with the California Department of Public Health as we monitor ICU bed capacity minute-by-minute,” Rideout officials said in a statement. “Our surge plan includes double-occupancy rooms, if needed.”
“The issue isn’t only that of facilities – we could set up several – it’s one of staffing,” Yuba County spokeswoman Rachel Rosenbaum said in an email. “Hospitals cannot expand more ICU or regular beds unless they have the nursing staff to take care of those patients and right now, the hospital is dealing with severe staffing shortages as many have also tested positive or are quarantined due to being close contacts of positive cases.”
Hospital staffing an issue
Employees inside hospitals are typically fully protected by safety equipment, hospital officials say. But they are running into more infected people in the general community, forcing the quarantines.
“This staffing shortage is further impacted by community transmission of COVID-19 resulting in staff members in quarantine as they are exposed to COVID-19 in the community,” said Mindi Befu, spokeswoman for Barton Memorial Hospital in South Lake Tahoe, one of the region’s COVID-19 hot spots.
Carmela Coyle of the California Hospital Association said hospitals can’t simply transfer employees in from other units.
“The nurses and clinicians trained to deal with those cases are not the same as those trained to care in the intensive care unit,” she said. “Is there some cross-staffing that can go on? There is some, but at the end of the day, we are in need of critical care nurses, those ICU nurses, and it is difficult and, in some cases, against union contracts to substitute other nurses into those areas.”
At UC Davis, staff are again becoming fatigued. It’s not all bad, though, Dr. Stuart Cohen, infectious diseases chief at UC Davis Health, said. “I think the patient care side is improving,” Cohen said. “I think people know how to manage the patients. I don’t think there’s any reluctance to manage the patients.
“Just like the general population, though, I think we all wish this was over with already.”
Brian Jensen, a regional vice president at the Hospital Council of Northern & Central California, agreed that hospitals are working from a stronger knowledge base today than they were in the spring and summer.
“Hospitals and other health care facilities have really learned a lot in this process,” he said. “They’ve prepared. They have protocols in place to keep people safe when they come into the care facilities. So the first thing I would say is people should continue to seek out healthcare when they need it and not postpone care out of fear that they will go to a place where they’ll be exposed to someone else. We’re not seeing spread of COVID in hospital facilities.”
Within a few weeks, as well, California’s hospital employees are expected to be the first in the state to be offered the first doses of coronavirus vaccines.
The problem California and its hospital face now, Ghaly said, is that the virus is everywhere. There is no singular source to blame, such as family gatherings or bars. That means activities and places – notably indoors – that were considered relatively safe a month ago are no longer safe.
“When you have this level of community spread ... the minute you walk in the door of any entity indoors, the chance of encountering someone with COVID who can transmit it is higher than it’s ever been,” Ghaly said. “All of those things we’ve been talking about for months are only amplified today because of the level of transmission.”
It’s prompting hospital officials this week, such as Dr. Clint Purvance, president and CEO of Barton Health, to join Ghaly in imploring healthy residents to help.
“As regional hospitals begin to reach capacity,” Purvance said in a statement to the Bee, “it is imperative that we slow the spread of COVID-19 to avoid additional challenges that may affect patient care.”
This story was originally published December 1, 2020 at 3:34 PM with the headline "COVID-19 breaking point: Northern California hospitals, ICUs filling up with virus patients."
