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Health and Medicine

Hospitals Juggle Resources, Continue Surgeries As California’s COVID-19 Cases Rise

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University of California, Davis Medical Center

With COVID-19 spreading rapidly in California and some hotspot hospitals becoming overwhelmed, facilities are performing a balancing act to continue business as usual while maintaining surge capacity.

Hospitals throughout California were stockpiling gowns and masks, pulling hospital beds out of storage and cross-training nurses this spring in case droves of COVID-19 patients appeared at their doors.

At the time, Gov. Gavin Newsom called on hospitals to cancel any procedures that weren’t absolutely necessary to prepare for a surge that didn’t materialize in most places. In late April, hospitals began welcoming some patients back.

Now, with COVID-19 spreading rapidly in California and some hotspot hospitals becoming overwhelmed, facilities are performing a careful balancing act to continue business as usual while maintaining surge capacity.

Hospitals have to monitor how many beds are open, who is on hand to staff them and what protective gear is available for those workers.

And in most cases, they are not canceling or postponing non-essential procedures.

“What we’re finding now is that hospitals are not delaying because they know they can still give care,” said Dr. Clifford Ko, director of quality improvement for the American College of Surgeons and a professor of surgery at UC Los Angeles. “They found out that they can take care of their COVID patients, and they can take care of patients that are non-COVID, and do it safely.”

The California Department of Public Health said in a statement that it’s “up to each facility or provider to decide whether or not elective procedures would compromise their ability to meet their community’s needs during this pandemic.”

In some parts of California, maxed-out hospitals are already turning non-COVID-19 patients away. Whether or not that becomes the case across the board depends heavily on the rate of spread, and how well hospitals can manage their resources.

Tracking Beds
There are 6,632 confirmed positive COVID-19 patients in California hospitals as of July 31, according to state health data. Roughly 2,000 of them are in intensive care units.

The rise in hospitalizations began in mid-June, around the time the state began reopening higher risk businesses such as bars and movie theatres. Before that, the numbers never surpassed 4,000 patients. Meanwhile, the number of available ICU beds statewide has dropped to 2,487, nearly half of the capacity from late April.

The state is considering ICU bed capacity as a factor in whether counties can reopen their economies. Counties must have at least one-fifth of those beds available to pass the metric. While Sacramento County has only 13.6% of ICU beds currently available, some Central Valley counties are more overwhelmed.

In Fresno County, 7% of ICU beds are available; Kings County has just 6.2%.

Dignity Health closed two facilities in Bakersfield amid a rise in cases.

San Joaquin County officials said earlier this month that their ICUs were operating at 124% capacity, and a federal medical assistance team was deployed to help them treat more patients.

But in Sacramento, hospital representatives say they’ve been able to make adjustments to function somewhat normally.

Steve Telliano, a spokesperson for the UC Davis Medical Center, said COVID-19 patients are being treated “all over the hospital” in isolated wards.

“More of the beds are assigned to COVID patients than they would normally be,” he said. “We’ll take half a floor, we’ll close it and make sure it’s converted to COVID-19 care … as we have more patients, we do that on more floors of the hospital, or if less space is needed than we unconvert those spaces and use them for other things.”

That kind of decision-making can prove more difficult for small, rural hospitals who may have fewer beds, smaller budgets and less staff to manage spikes in cases.

But by and large, Dr. Clifford Ko from UCLA says the emergency preparation that hospitals did earlier this spring puts them in a much better position to handle surges than they were in in March.

“If places are increasing in their COVID rates, now they can dial things up, dial things down because of the inventory that they took earlier,” he said.

Large hospital systems such as Kaiser Permanente or Sutter Health also have the advantage of borrowing supplies from other facilities or sending patients to another hospital if their nearest one is over-run.

A Strain On Staff, Supplies
Hospitals are also keeping a close eye on personal protective equipment for workers, which industry leaders say has been frequently hard to come by since the start of the pandemic.

At a California Hospital Association press conference earlier this month, president Carmela Coyle raised the alarm about the supply shortage.

“We’re all watching, and worried, about the supply chain,” she said. “Hospitals just can't obtain what isn't available … there are significant challenges for hospitals to manage inventories with a supply chain whose pace of production has not yet caught up to that international increase in demand.”

She says hospitals are contracting with new manufacturers and avoiding the distribution middleman in hopes of avoiding supply interruptions. They’re borrowing from neighbors, and they’re extending and reusing N95 masks as authorized by the U.S. Centers for Disease Control and Prevention.

California continues to build its stockpile of hundreds of millions of masks for all front-line workers, including farm and factory workers.

But nurses in California’s hospitals say the limited supply of gear is a constant worry.

A survey of 2,426 California nurses, conducted by labor group National Nurses United, found 52% are afraid of catching COVID-19 and 57% are afraid of infecting a family member.

Rachel Spray, a registered nurse at Kaiser Permanente Fresno Medical Center, said the reuse of masks and gowns, as well as the strain on staffing, have made her uneasy.

She’s been home in quarantine since Monday, when she called in sick after developing a headache and a cough.

“It’s not safe, I don’t feel safe,” she said. “It changes how I feel about my employer, it’s really destroyed any morale we had.”

Kaiser Permanente said in a statement that the system is extending the lifetimes of N95 masks using the CDC’s decontamination procedures, and that masks are not shared among staff.

“We prudently manage PPE supplies to ensure this equipment is available for our health care workforce for the duration of this pandemic,” the statement reads.

Spray says if hospitals pulled back on other procedures, they could better conserve masks and move nurses from the operating room into the COVID-19 units

“They should definitely stop doing elective procedures, to save PPE, to use the nurses,” she said. “We could definitely use that help. We just don’t have enough staff.”

But surgeries are a main source of income for hospitals and canceling them could limit health systems’ ability to keep people employed, experts warn. When elective procedures were postponed back in the spring, many hospitals had to lay off and furlough workers.

The California Hospital Association estimates California hospitals will see a net loss of $14.6 billion through the end of December 2020, or $11.2 billion after accounting for federal assistance.

“If a hospital goes out of business because they delayed all the surgeries, and then subsequently can’t help anybody, then that’s not what we want,” Ko said.

For now, most hospitals are still encouraging people to come in for surgeries and to make medical appointments as recommended by their physician.

Editor’s Note: Sutter Health is a major donor to CapRadio.

Copyright 2020 CapRadio