Virus monitors still unraveling state ICU order

More than two weeks after the state ordered counties to accept coronavirus patients from overwhelmed regions, Marin’s public health officer said he still lacks a clear understanding of how the process is supposed to work.

“Luckily we never got to the point where the system stressed enough to test that,” Dr. Matt Willis said.

On Jan. 5, the California Department of Public Health instructed counties with adequate intensive care capacity to accept patients from overwhelmed regions.

At that time, both the San Joaquin Valley and Southern California regions were reporting 0% bed availability in intensive care units. The Bay Area’s capacity was 3%. The Sacramento region’s was 6.4%, and the Northern California region was 27.5%.

Willis said that despite the order, “We haven’t had that hard call where the state is specifically requiring that we accept a patient that we don’t feel prepared to accept. That has never occurred.”

Willis said Kaiser Permanente’s San Rafael Medical Center and Novato Community Hospital, which is operated by Sutter Health, sometimes admit non-local patients from other hospitals in their networks.

“They rebalance patient loads across their systems,” Willis said. “It really hasn’t been a significant burden on our ICU capacity. Since the beginning of the pandemic, Kaiser has accepted less than 10 COVID patients from outside the Bay Area.”

When the order was issued, Willis sought clarification on what gave the state the authority to mandate the transfers. He also wanted to know how it would be determined whether Marin hospitals had adequate intensive care unit availability to accept new patients.

At the time, Marin was reporting ICU bed availability of 5%. Twenty of the county’s 21 ICU beds that were deemed to be functionally staffed were occupied.

Willis said his questions remain unanswered.

In an email to the Independent Journal, the state health department wrote, “These transfers will be directed by the Director of the Emergency Services Medical Authority (EMSA) or designee when transfers require coordination outside the affected patient’s region.”

Marin County stopped issuing daily reports on ICU bed availability at its three hospitals on Dec. 20 after 0% availability was reported at the hospitals from Dec. 15 to 18.

At that time, the county stopped basing its calculation of ICU bed availability on the assumption that Marin’s three hospitals had adequate staffing to provide a total of 29 intensive care unit beds, about 75% of the ICU beds the