ICU bed capacity reaches a crisis

Area hospitals take emergency measures, but no letup in sight

As California’s coronavirus cases and deaths surge to new highs, the Bay Area’s supply of ICU beds continued to plummet Thursday, and Southern California joined the San Joaquin region in reaching capacity.

With less than 15% of intensive care unit beds now available in multiple Bay Area counties and just 3% statewide, hospitals are being forced to take emergency measures to meet the needs of patients.

With Christmas and New Year’s Eve right around the corner, raising the potential for super-spreader parties and gatherings, medical professionals worry demand won’t taper off any time soon.

“The hospital is very full. The services are very full. People are doing extra shifts,” said Dr. Julie Parsonnet, a professor of medicine and epidemiology at Stanford University, who also practices at Stanford Hospital. “It’s scary for us, and it should be scary for the population.”

Marin County ran out of ICU beds this week. San Mateo County was close behind, with just four staffed ICU beds available Thursday afternoon. That number has ranged from three to 12 over the past week, according to Travis Kusman, the county’s director of emergency medical services. Santa Clara County had 41 ICU beds available as of Thursday morning, or 12% of its total capacity. Contra Costa County had 10% of its ICU beds available Thursday morning. In San Francisco, which still has nearly a third of its ICU beds available, officials on Thursday ordered newcomers and visitors to quarantine for 10 days upon arriving in the city.

“An increase over this next holiday period could put us over the edge into a truly catastrophic situation,” said Dr. Grant Colfax, the city’s health director. “We cannot afford a further increase in cases, especially an increase like we saw during Thanksgiving.”

The situation is worse in Southern California, where the region’s ICU bed capacity fell to 0% Thursday.

The pressure on hospitals came as California reported its deadliest day of the pandemic yet Wednesday, with 428 deaths and a record spike of 51,773 new cases. By Thursday evening, counties had reported another day in which California’s cases exceeded 51,000, according to data compiled by this news organization. Throughout the state, about 650 new COVID patients were admitted to hospitals both Tuesday and Wednesday — the most since the start of the pandemic. The state reported it had 1,260 ICU beds available, a decrease of 71 as the number of people hospitalized with COVID-19 in California on Wednesday rose to 15,431.

But it’s not just ICU beds that are affected: Emergency room visits are spiking. Bay Area emergency rooms are seeing nearly twice as many COVID19-related visits each week as they were in mid- October, according to new data released by the U.S. Department of Health and Human Services. The result, doctors and health officials say, is a disruption in care for everyone from COVID-19 patients, to people suffering heart attacks, to car crash victims.

Three weeks after Thanksgiving, we now are likely in the tail end of that surge in hospitalizations, said Dr. John Swartzberg, a clinical professor emeritus of infectious diseases and vaccinology at the UC Berkeley-UCSF Joint Medical Program. There’s an average lag of about two weeks between infection and hospitalization — a standard that can vary widely. But hospital demand may remain strong because we’re still in the midst of the holiday party season, just a week away from Christmas, and not far from New Year’s Eve, Swartzberg said.

“We may not see much of a drop, if any, because we’ve got more holidays coming up,” he said. “And that’s what’s so catastrophic.”

About 12% of infections result in hospitalization within two to three weeks, and about 12% of those eventually end up in an intensive care unit, according to state health officials.

At the UCSF Medical Center in San Francisco, capacity is “OK” for now — both the hospital’s ICU and acute care beds are about three- quarters full, said Dr. Jeanne Noble, UCSF’s COVID response director. But coronavirus cases are mounting, and staff members are dusting off emergency surge protocols written early in the pandemic.

Back in March, UCSF set up tents outside its hospital to quarantine patients with respiratory symptoms that might be corona virusrelated. As the number of COVID-19 patients at the hospital dropped, the tents were converted for other patient uses. On Wednesday, they became COVID-19 wings once again.

The hospital has several more steps it can take if room becomes scarce. As a last resort, staff would turn a gymnasium across the street into an overflow hospital — but no one wants to do that, Noble said.

The biggest problem at the hospital right now is a shortage of nurses to staff its beds. Exposure to COVID-19 has sidelined some, forcing them to stay home and quarantine, Noble said. Others are home with wintertime flu and colds.

Noble expects COVID-19 case numbers and hospital demand to continue to grow, but she’s hopeful UCSF won’t hit capacity.

“We’re concerned that if that is going to happen, that will happen in the next couple of weeks,” she said. “Probably the next 14 days or so will be the most critical.”

Hospitalizations won’t hit their peak until seven to 10 days after cases begin to decline, Colfax said.

There are 150 patients currently hospitalized with COVID-19 in the city — the most since the start of the pandemic — and that number is expected to exceed 200 “in the next couple weeks.” It could go even higher if the new restrictions don’t curb transmission.

“Given the continued rise in cases,” Colfax said, “we expect our ICU and acute care beds will continue to fill rapidly with sick patients.”