The coronavirus surge is back. California hospitals face familiar worries about PPEs and beds
Look at nearly any point on the map in California and you can see an area that has a hospital with a battle on its hands.
Coronavirus cases are surging in the rural borderlands of Imperial County and in Los Angeles. The southern San Joaquin Valley along Highway 99 – Fresno, Kings, Merced counties – is now emerging as another hot spot. Farther north, Lodi Memorial Hospital and Stockton’s St. Joseph’s Medical Center scramble to handle the numbers of cases inundating San Joaquin County.
California now leads the nation with more than 450,000 confirmed cases of coronavirus. More Californians – roughly 7,000 – are now in hospital beds with COVID-19 than during March and April’s spring surge, according to the California Hospital Association. More than 2,000 of those patients are in intensive care.
Even as California’s hospitals come under unprecedented siege from a resurgent pandemic, hospital industry leaders this week warned that the state’s health care framework could still crack under threats to capacity that have been omnipresent since March:
- Personal protective equipment and testing supplies remain in short supply as multiple states report surges in cases.
- Patients need specially trained critical care personnel, but they may not find enough in areas experiencing the worst flare-ups of COVID-19.
- The worst-hit counties will need beds at alternate care sites outside hospitals.
“Many people, when they think about capacity, they think about beds – literally, mattresses and pillows – and, of course, it is much more complex than that,” said Carmela Coyle, president and CEO of the California Hospital Association. “Capacity is made up of not just space and beds. In fact, those are the easiest things to resolve. It is all about staff and personal protective equipment and testing, and unfortunately, all three of those things are in short supply.”
Coyle said she hopes California will rethink how it manages its response system. Managing the strain on staffing and supply chain for 40 million people gripped by a pandemic surge will mean greater regional and statewide coordination – and a new way of thinking.
California thinks of disasters as earthquakes and wildfires. A pandemic is different.
“Our current system relies on mutual aid being brought in from other places, other counties, and of course, that does not work well in a pandemic.” Coyle said. “That is, everyone needs to be prepared for a surge. There are no additional or excess resources. This is not a short-term, episodic kind of event. It is continuous.”
California’s COVID-positive cases were increasing by between 1,500 and 2,000 a day before June 15. They had exploded to as many as 9,000 a day as of Wednesday, Coyle said.
In Northern California, some of the highest COVID admission rates are in the Central Valley – as high as 40% in Fresno and Kings counties, Coyle said, while in nearby Placer and Sacramento counties, about 8-10% of the patients in the hospitals were confirmed or suspected of having COVID-19.
“It is a disease and a series of outbreaks that is dynamic. It is popping up and moving across the state, but it’s very difficult to predict,” Coyle said. “We really need to be able to coordinate across counties and look at things more regionally and statewide to be able to plan for what may be an extraordinary surge.”
Surge strains supply chains, people
The soaring infection and hospitalization rates and the increasing demand for masks, gowns, shields and testing supplies not only have placed greater strain on supply chains but also on medical workers.
At St. Joseph’s in Stockton, staffers are on edge, said Faye Robinson, a behavioral health case manager and a representative for health care workers in the Service Employees International Union-United Healthcare Workers West.
“People are calling out sick,” she said. “I don’t think it’s that they’re always physically sick. They’re mentally sick. We don’t have mental health days. They’re taking time off because they’re mentally exhausted.”
Robinson said union members have been trying to support one another.
“I’ve had people come into my office, who have just said, ‘I can’t do this,’ and I’ve let them come into my office and cry,” she said. “It’s been, ‘OK, let’s go for a walk. Go with me. Take 15 minutes, and let’s go for a walk outside.’ I just listen to them.”
Brian Jensen, regional vice president of the Hospital Council of Northern & Central California, said health care workers are in high-pressure situations.
“When it comes to the front line workers, they are putting themselves in the breach,” Jensen said. “They’re putting themselves in a place to help others, and hospitals have always been a place where there are a lot of high stakes, there is a lot of human emotion, as well as the physical aspects of injury or illness at play.”
One worst-case scenario shows that California’s hospital workers need to be prepared to treat as many as 25,000 COVID-positive patients.
“That’s about four times the level we are today and that is really the hard work that is now under way,” Coyle said.
Conference rooms with hospital beds?
Hospitals’ emergency operations plans and command centers are in place. Hospital officials also talk to state planners “so they understand what hospitals need and what the broader health care delivery system needs in order to manage this surge,” Coyle said.
About 45,000 people now occupy the state’s 50,000 available beds, she said. That leaves an additional 5,000, Coyle said, and hospitals are making room to “stretch and surge” an additional 20,000 beds.
“That means beds in office buildings and conference rooms and all the rest within the hospital footprint,” she said.
If given a couple of days, Coyle said, hospitals can expand their ICU capacity.
“Many hospitals now have already and are continuing to source staffing options from out of state,” she said. “But again we’ve got 50 states and the District of Columbia all pulling on that same, finite resource, but hospitals are looking to line up additional staffing, should it be needed.”
Doctors, nurses and health experts who have been battling the virus since February – the first community spread cases of the novel coronavirus were in Northern California – are also gaining ground, Coyle said.
Patients are spending less time in ICU beds and on ventilators. Antiviral treatments such as remdesivir, steroids such as dexamethasone, high-flow oxygen treatments and convalescent plasma therapies are helping to shorten hospital stays.
“We know that physicians and nurses have learned a lot in the last four to five months around treating individuals with COVID-19,” Coyle said.
Populous states compete at once
While medical knowledge and treatments have improved since March, Coyle said, capacity issues have returned as three of the nation’s most populous states — Texas, Florida and California — are seeing coronavirus cases surge.
“All hospitals in California and quite frankly nationally are drawing on the same supply of these key ingredients to capacity. There is only so much staff available to be tapped into, whether that’s in California or across the nation,” she said.
Coyle said hospitals welcome the assistance of the Department of Defense, which deployed military medical teams in hot spots around California. She said she also hopes the state will allow hospitals to exceed mandated nurse-patient ratios.
However, Stephanie Roberson, the government relations director for the California Nurses Association, noted that some hospitals have cut full-time nurses from their payrolls. Relaxing nurse-patient ratios will only leave the remaining nurses to shoulder more stress and workload.
“They already have a process by which they can ask for a waiver of staffing requirements from the California Department of Public Health,” Roberson said. “Those requests last for 90 days, and once those 90 days are up, they can re-apply. We’re seeing the running list of the hospitals that have applied and they’re getting approved.”
Coyle said hospitals have a huge need for nurses with critical care skills, and the state workforce doesn’t have enough. Hospitals are cross-training workers to serve that higher level of care, she said, but they also have to look outside the state.
In some cases, she said, hospitals also have numbers of COVID-19 patients who no longer need an acute-care setting but are still too ill to return home. That’s where alternate care sites come in, including plans for Sleep Train Arena and other large-scale sites to be opened as needed.
Coronavirus threatens hospital workers, too
Not all counties have that option, though, Coyle said, and that is particularly troubling for communities with COVID hot spots. Community spread also strikes the very health care workers needed during this crisis.
Robinson said union members at St. Joseph’s have told her that they are just as worried about getting the new coronavirus at work as they are about getting it in the community. They are buying their own cloth masks to wear at work, she said, and they don’t know how effective they are.
“Our members are scared to death. They’re scared because they don’t have the proper PPE,” Robinson said.
However, Natalie Pettis, a Dignity Health spokeswoman, said all Dignity workers are given the appropriate level of PPE for the work they do, but certainly everyone is “concerned about contracting COVID and should be taking the appropriate steps to protect themselves.”
Robinson said health care workers are doing everything they can to keep their families safe. A co-worker “told me her husband goes out and wipes down the car after she gets out of it every day,” she said.
Robinson, too. Her newborn grandchild was born on Palm Sunday in a hospital she couldn’t enter because of COVID-19 restrictions. When her daughter and grandson visit her, she showers, tosses her work clothes directly in the laundry and leaves her shoes at the door.
“I will not touch him until I am clean and I wipe everything down,” Robinson said. “Then I say, ‘OK, I can hold him now.’”
This story was originally published July 27, 2020 at 5:00 AM.
