Some California hospitals are close to reaching their breaking point, prompting Gov. Gavin Newsom to bring in hundreds of hospital staff from outside the state and to prepare to re-start emergency hospitals that were created but barely used when the coronavirus surged last spring. California officials paint a dire picture of overwhelmed hospitals and exhausted health workers as the state records an average of 22,000 new cases a day. After nine months of the pandemic, they recognize about 12% of people who test positive will end up in the hospital two to three weeks later.
At the current rate, that means 2,640 hospitalizations from each day’s new case total. “We know that we can expect in the upcoming weeks alarming increases in hospitalizations and deaths,” said Barbara Ferrer, health director for Los Angeles County, the state’s largest with 10 million residents. For some, “the respiratory infection becomes unbearable — they have difficulty breathing and it’s very frightening,” said California Hospital Association president and CEO Carmela Coyle.
What starts with a spike in emergency room visits can cascade into jammed hospital beds and ultimately intensive care units. California’s hospitalizations already are at record levels, and the state has seen a roughly 70% increase in ICU admissions in just two weeks, leaving just 1,700 of the state’s 7,800 ICU beds available. “That fragile but important system may be overwhelmed,” Dr. Mark Ghaly, the state’s top public health officer, said Tuesday. “And the goal of saving lives becomes threatened when that system isn’t as robust and as strong as it can be.” Several hospitals in Los Angeles County and others in San Diego, Imperial and Fresno counties are among those close to running out of intensive care beds that are needed for the sickest patients.
In response, California has requested nearly 600 health care workers to help in ICUs through a contracting agency and the federal government. It’s starting a two-day program to train registered nurses to care for ICU patients and setting up links for doctors to consult remotely on ICU patients. Some hospitals are postponing elective surgeries to free up staff and beds. “Without some major change in our overall behavior … we will see hospitals continue to feel that pressure and get overwhelmed,” Ghaly warned. With that tragic scene in mind, Gov. Gavin Newsom recently imposed an overnight curfew, a ban on nonessential travel, and issued stay-home orders in regions where open ICU beds have dipped below 15%. Similar concerns about patient overload and staffing shortages faded during the initial months of the pandemic, leaving most of the state’s auxiliary surge hospitals barely used.
But now capacity is dwindling even before the impact of infections spread by those who ignored entreaties to stay home for Thanksgiving. County health officials point to a spike in health care workers themselves becoming infected and a dearth of traveling nurses who are busy in other states dealing with their own unprecedented spikes. When specially trained critical care nurses become overwhelmed, hospitals will likely first draft post-surgery nurses to fill the void. And if they too are swamped, hospitals will shift to a team approach, where a critical care nurse oversees others with less training who can still perform many duties.
That would require waiving strict nurse-to-patient ratios that are uniquely written into law in California, something the California Nurses Association argues would inevitably endanger patients’ care. Riverside University Health System Medical Center, for instance, has opened an ICU in a former storage room, chief executive Jennifer Cruikshank told Riverside County supervisors on Tuesday. An ICU nurse who typically cares for two patients is now taking care of three, she said, and doctors and housekeepers are taking extra shifts. In another attempt to help, the state is activating the first two of 11 alternative care sites that have a total capacity of 1,862 beds. A site in hard-hit Imperial County, on the border with Mexico, already has 19 of its 25 available beds in use, though it can expand to handle 115 patients. The second site is at the former home of the Sacramento Kings professional basketball team.
The goal is to have the first 20 beds ready by Wednesday in a practice gymnasium, then prepare another 224 beds in the main arena — some in luxury suites where well-heeled fans once watched games. It’s still unclear what patients will be placed there, Office of Emergency Services spokesman Brian Ferguson said. Last spring the state spent $12 million initially setting up the arena and hiring roughly 250 medical workers who were told to expect 30 to 60 patients within days. But only nine arrived over the next 10 weeks, leaving doctors frustrated before the site was put back into mothballs. It will be staffed this time with California Medical Assistance Teams, which usually respond to disasters like wildfires, and members of Newsom’s California Health Corps — paid volunteers who are often recently retired medical professionals.
The state also is seeking workers from contract medical providers and the federal government. Newsom wants more volunteers after his corps dwindled to fewer than 900 members, less than 1% of the 93,000 who originally signed up. Only 10 corps members were recently assisting at hospitals and nursing homes. But program spokesman Rodger Butler said some have previously assisted in intensive care units and Newsom on Monday said the program “has been incredibly effective, particularly in our skilled nursing facilities,” with members helping at more than 100 facilities statewide. Coyle said the corps isn’t a major help for hospitals “because the patients we are caring for are among the most acutely ill and very few of the Health Corps volunteers were trained at that highest level.”
Fresno County has been pleading for state help to staff three area hospitals for several weeks, but was sent just one or two workers for each amid the nationwide shortage, county Emergency Medical Services Director Daniel Lynch said. “We’re fulfilling what we can, but it is getting harder,” Ghaly said. Fresno officials urged the state to open 123 alternative care beds ready for use at Porterville Development Center in Tulare County, but Lynch said they were told the state’s priority is the Sacramento arena. Now county officials are considering putting overflow beds in the Fresno Convention Center.
Ferguson defended the state’s approach of having “flexible” alternative care sites that could serve residents displaced from nursing homes or skilled nursing facilities, or absorb some of hospitals’ less serious patients. “This is kind of what the next stage of this looks like, if things go back to really bad,” Ferguson said.
Associated Press writers Brian Melley contributed from Los Angeles, Amy Taxin from Orange County and Daisy Nguyen from Oakland.
-DON THOMPSON Associated Press
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