California Hospitals Applying Early Lessons As They Brace For A COVID-19 Surge

Nov 20, 2020

The UC Davis Medical Center.
Credit Andrew Nixon / CapRadio

Shortly after announcing a statewide 10 p.m. curfew this week, California health officials drew attention to a looming problem: strained hospital capacity.

Health and human services secretary Dr. Mark Ghaly says 12% of all new COVID-19 cases statewide will result in hospitalizations. With hospitals across the country facing staffing shortages, experts say it’s crucial that Californians obey public health orders to mitigate virus spread.

“It could mean a serious challenge on our entire health care delivery system,” Ghaly said. “Your neighbors who are nurses … they are also at risk because of individual choices we’re talking about today.”

Early in the pandemic, officials urged Californians to stay home and “flatten the curve” to prevent a flood of COVID-19 patients in emergency rooms. Meanwhile hospitals stocked up on personal protective equipment, trained additional staff, expanded intensive care unit capacity and found ways to isolate infected patients from the rest of the facility.

Hospitals say they’ve learned a lot since the first wave of the virus. They expect people contracting the virus now will become sick later this month, and they’re also anticipating spikes related to the Thanksgiving holiday.

CapRadio asked an industry leader, a hospital administrator and a physician how prepared they feel for the flood of patients expected to hit in two to three weeks.

They said staffing will be the biggest challenge. But if you have a surgery or a cancer screening coming up, assume your appointment is going to stand.

‘Normal Operations’

In the spring, hospitals across California postponed and canceled thousands of procedures in an effort to preserve beds, personal protective equipment and staff capacity.

At the time, they were following guidelines from Gov. Gavin Newsom and from the American College of Surgeons.

But Carmela Coyle, president of the California Hospital Association, says facilities are going to great lengths to avoid that strategy.

“It’s our hope that we never do that again,” she said. “What happened is for non-COVID patients, whether that was cancer care, or heart care, they were simply unable to get those services. We should never find ourselves again in a position where we are having to choose between care for COVID-19 patients and care for other patients.”

Sacramento County’s hospitalizations doubled between Nov. 5 and Nov. 12, from 90 to 177 cases. As of Tuesday, the most recent data available, 208 people in the county were hospitalized.

Despite that, health systems in the Sacramento region say they’re continuing to provide the full array of surgeries and other services, and that it’s safe to come in for medical care.

Hospital administrators say they’re making daily decisions about what procedures they can perform based on how many COVID-19 patients are coming in, how many ICU beds they have open and how many providers are available to staff them.

“At present time we’re able to manage all of the COVID patients that are presenting to our hospital or to our ambulatory clinics without any deleterious effect on our normal operations for our non COVID patients,” said Dr. Douglas Kirk, Chief Medical Officer for the UC Davis Medical Center. “So at this point it’s really been no impact even though numbers have gone up.”

Physicians are encouraging people to go to their regular doctors’ appointments. There’s been a decline in new cancer diagnoses during the pandemic, indicating that people have not been getting regular screenings.

Dr. Parimal Bharucha, a pulmonary and critical care physician with Dignity Health, said people have begun to return for medical services.

“Everybody was in a lock down and people did not seek care, even though they needed care,” he said about the beginning of the pandemic. “We closed everything and there were instances where the nurses had to go home because there were not enough patients. That has changed now.”

Staffing Shortages

Earlier this month, nurses at University of California medical centers across the state held rallies about what they describe as unsafe work conditions related to the pandemic. These nurses say there isn’t enough staff to adequately meet patient needs.

“We are exhausted. Our families need us now more than ever,” said registered nurse Jenny Managhebi in a statement about the Nov. 10 rally. “We can only give the best care to our patients when we can care for ourselves.”

A spokesperson for UC Davis Health said in a statement that most of its nurses have scheduling flexibility and special COVID-19 sick leave. The hospital also says its nurses’ overtime hours are down this year over last.

But Kirk, the chief medical officer, says the staffing shortages happening at hospitals across the U.S are worrying.

“We have not had that effect here yet, but we do have employees that do get infected typically in the community because community prevalence is so much higher now than it was a month ago,” he said.

As of Thursday, more than 48,000 California health care workers have tested positive for the virus, and 211 have died according to the California Office of Emergency Services.

Hospitals typically rely on traveling nursing agencies that can assign workers to fill the gaps when employees get sick, but the hospital association says those registries have become strained due to the national surge.

As the pandemic wears on, health care workers across the nation have expressed feelings of fatigue and burnout from treating COVID-19 patients.

Bharucha, of Dignity Health, said it’s not just the long hours — it’s the emotional toll of treating patients who are isolated from their loved ones.

“We become the family member at that time and we become their eyes and we become their ears and we become their voice,” he said. “It hurts in the heart, what has happened.”

Earlier this year, Gov. Newsom created a California Health Corps to ensure adequate staffing for health care sites across the state. The goal was to recruit a pool of volunteer health workers, including retired physicians and medical school students.

An Associated Press analysis found sign-ups reached 93,000 in May, but only 5% of those who volunteered were cleared to participate.

The California Department of Public Health says there are approximately 900 people in the corps.

Coyle, with the California Hospital Association, said many of those volunteers don’t have the specialized training needed to work with coronavirus patients in the ICU.

And she said it’s not “easy or wise to try to pull personnel from other units of a hospital.”

“The specialized technology and treatments and medications and techniques used in an intensive care unit, it’s extremely critical that the people caring for COVID-19 patients have that expertise and background,” she said.

The association would like to see more flexibility around staffing ratios, which would allow nurses to more easily treat multiple patients at the same time. Currently hospitals have to request a waiver to be allowed to be out of compliance with those ratios. The association would like to see a blanket exemption during the pandemic.

Crisis Levels

Hospitals say they’ve spent much of 2020 creating surge protocols, and they’re ready to rely on them if the current surge gets worse.

Earlier this year, the state set up field sites in arenas and fairgrounds to treat overflow patients in the event that health systems became overwhelmed. They largely went unused. Those sites are now in a “warm state” and ready to be brought back online if it proves necessary.

“There’s a whole set of crisis care guidelines that have been developed,” Coyle said. “It’s not until you get to a level of crisis care that [alternative sites] may make sense, it’s all hands on deck.”

Bharucha at Dignity Health says there were 42 different versions of their surge plans.

“We’ve had nine months to get up on our game and I think we’ve done it very well,” he said. “We are very confident in terms of knowing what to expect when the patient shows up in an ER, knowing how to treat them, knowing we have adequate supplies.”

But he acknowledges that protective equipment is a finite source.

“If you don’t keep up with it or if we hit a big surge at one time and we get overwhelmed, probably we might see some shortages,” he said. “Next week is thanksgiving, and we are all in the health care industry worried about the family exposure, the community spread this is going to cause.”

Californians are urged to refrain from gatherings this holiday season, to avoid travel, and to wear a face covering when in public.