Your questions about hospital ICU capacity, answered

As the number of coronavirus cases soars in California, state officials have turned to hospitals’ ICU bed capacity to decide when different regions of the state must go into a tighter lockdown. When 15% or less of ICU beds in any one of the five regions of the state are available, residents in that region must largely stay home starting the next night.

Here’s a look at what that actually means, how hospitals can boost the number of ICU beds and more.

Q: What is ICU capacity and how is it measured?

A: Put simply, ICU capacity is the number of ICU beds at hospitals in a region. Hospitals have to submit their total number of available ICU beds to the state each day, including both staffed ICU beds and staffed ICU surge beds. Surge beds are beds that aren’t currently being used as ICU beds, but could be converted into ICU beds if necessary. While hospitals typically have a specific ward for patients who need intensive care, beds in operating rooms and units where patients normally go after being anesthetized can be converted into ICU beds.

An ICU bed is different than a regular hospital bed in that it can support someone who is critically ill. These beds allow for more monitoring of a patient, there is just a patient or two per nurse, and there is access to critical care equipment like ventilators. For coronavirus patients, hospitals also use what are called negative pressure rooms, or isolation rooms, where contaminated air in the room is sucked out and filtered so that it doesn’t waft into the rest of the hospital and infect other patients or health care workers.

The upshot? The number of ICU beds is not firm, but fluctuates depending on a number of factors.

QWhat are the different regions in California and what is the current ICU availability?

ACalifornia posts this information daily at covid19.ca.gov. As of Tuesday:

• Southern California — 10.1% ICU availability

• San Joaquin Valley — 5.6% ICU availability

• Bay Area — 24.5% ICU availability

• Greater Sacramento — 18.8% ICU availability

• Northern California — 25% ICU availability

This means that residents in Southern California and much of the Central Valley are now subject to a stay-home order that shutters outdoor dining and hair salons, limits retail shopping and more. Much of the Bay Area is also subject to these restrictions despite having more than 15% of ICU beds available, because local public health officers decided to move forward with the lockdown to try and reduce the anticipated surge in cases.

QCan hospitals do anything to increase ICU capacity?

AYes. Hospitals can cancel elective surgeries to free up beds. They can convert operating and other rooms into ICU space. Some hospitals are also sending home people who aren’t critically ill anymore and monitoring them remotely. Hospitals can also bring on more staff to help and, if necessary, even transfer patients to other hospitals.

QWhat’s the biggest challenge to boosting ICU capacity?

ARight now, staffing. At the start of the pandemic, a big issue was getting enough personal protective equipment (PPE) like masks and gowns, but hospitals have been stocking up on supplies. With COVID-19 spreading out of control across much of the country, hospitals are struggling to bring on enough nurses. Many rely on traveling nurses who go from hospital to hospital as needed. Right now, they’re needed everywhere and California is competing with places like North Dakota and other hard hit states, with some places paying as much as $8,000 a week.

QAre hospitals transferring patients and doesn’t that hurt the ICU capacity in the receiving region?

AYes and yes. Hospitals transfer patients for a couple of reasons: Either a patient needs more advanced or specialty care than a hospital can provide or they’re out of space. Even before the pandemic hit, small, rural hospitals regularly transferred patients with complicated needs to elite medical centers like UCSF and Stanford. During the pandemic, some counties with limited hospital space, such as Imperial County, have struggled with capacity issues. According to the California Emergency Medical Services Authority, which helps coordinate hospital transfers, Imperial hospitals transferred 34 patients out in November, including to the Bay Area. One patient went to UCSF, one to Stanford, and one to Kaiser in San Leandro.

State officials have said they will try to coordinate transfers within a region to resolve capacity issues, but they may also do longer distance transfers if necessary. And while transfers may affect regional capacity slightly, the ultimate goal is to care for patients and not overwhelm any one region.

QHow does California compare to the rest of the country?

AAs dire as the pandemic situation is in the Golden State, other states have it much worse. Places like Rhode Island and Indiana are reporting more than 100 cases per 100,000 residents. California is reporting fewer — just shy of 59 cases per 100,000 residents.

But, as The New York Times reported recently, California has just 1.8 hospital beds per 1,000 people — lower than all states but Washington and Oregon.

QDoes California have enough beds to handle the surge?

AFor now, yes. Some individual hospitals have struggled, but large hospital systems in the Bay Area, such as Stanford, Sutter, UCSF and John Muir, have said they are able to care for patients. Many have not yet had to scale back elective surgeries.

But that could change quickly. COVID-19 hospitalizations have increased 70.8% in the last two weeks to more than 10,500 patients, and coronavirus ICU hospitalizations have increased 68.7% during that time to more than 2,400 people.

The state is preparing what it calls alternative care facilities, or surge hospitals, in hardhit regions. In total, the state has 11 of these sites — 1,862 beds — that could be up and running within one to four days, including the San Mateo County Event Center. One, in Imperial County, is already up and running.

The state could also set up 22 additional 50bed field hospitals, if necessary. The state has also limited who can stay in hotels in hard-hit areas to free up hotel space for essential workers, like traveling nurses, or to quarantine patients.