Stanford Health returning to normal
With few infections of staff, routine care restarts
Stanford Health Care is resuming elective surgeries and other nonemergency procedures this week — and is encouraging patients to seek out that care — after finding that less than 1% of its health care staff tested positive for the coronavirus and very few had markers of previous infection.
More than 11,000 workers, out of about 14,000 total, have undergone testing for active infection and antibodies, Stanford Health officials said. Only a few dozen, or about 0.33%, tested positive and none had symptoms of illness. Fewer than 3% tested positive for antibodies, which indicate they had been infected at some point.
Those were startlingly low rates, Stanford Health administrators said. And the revelation should help reassure patients that it’s safe to seek out health care services that they have put off for the past couple of months.
“The first step was making sure our staff was safe,” said David Entwistle, president and CEO of Stanford Health Care. “We’re testing all the patients. We’ve now tested the staff. We’re creating that trust so that patients are safe coming in.”
Hospitals and other health care facilities postponed nonemergency procedures across the state in midMarch under California and local shelterinplace orders. The purpose was twofold: to prevent spread of infection in health care settings and to free up beds and other resources in case of an anticipated surge in COVID19 patients.
But that surge never arrived; as of last week, Stanford only had nine patients hospitalized with
the coronavirus, and across the Bay Area hospitalization numbers have been falling.
In the meantime, many medical centers have been losing money from canceled or postponed procedures while patients suffered with nonurgent conditions that left them in pain or discomfort. Even emergency room visits dropped off — in many places by more than half — and doctors worried that patients were delaying care for serious issues such as heart attacks and strokes.
Two weeks ago. Gov. Gavin Newsom announced that hospitals could begin to provide nonemergency care again as long as they had procedures in place to protect patients and their staffs. Among the criteria for reopening are the ability to do largescale testing of patients and employees, having enough personal protective equipment such as masks and gowns for health care providers, and being able to keep patients with COVID19 — or those suspected of being infected — separate from others.
UCSF began offering that care last month, and slowly some other providers have reopened too. Sutter Health started phasing in nonemergency care this week, said Dr. Bill Isenberg, the health system’s vice president for patient safety. Kaiser Permanente is resuming “high priority” elective procedures, including surgeries that had been delayed but can’t be put off any longer without risking patient health, said Dr. Smita Rouillard, associate executive director.
Stanford Health, which operates seven hospitals and outpatient clinics across the Bay Area, began calling patients last week to reschedule elective surgeries, such as joint replacements, back procedures and even cancer operations that weren’t urgent.
In a typical week, Stanford Health does about 1,200 to 1,400 procedures a week. During the past seven weeks, surgeons had been doing about 200 elective procedures a week that they had decided needed to be addressed immediately. Roughly 700 procedures were scheduled for this week.
“It’s been a big pivot one way and then very cautiously pivoting back to more routine care,” said Dr. Mary Hawn, chairwoman of the surgery department at Stanford. “We are very excited. As physicians and nurses, it’s been hard to sit on the sidelines waiting for the surge, and then gratefully and fortunately that did not happen.
“There have been so many patients whose care we had delayed, and now we can reach back out to them and ensure them that the health care environment is safe for patients,” she said.
Stanford administrators said that about 85% of patients they contacted were eager to reschedule procedures. The rest were hesitant, often because they did not yet feel comfortable visiting the hospital due to the outbreak. Some patients said that because of shelterinplace restrictions that are keeping them apart from family and friends, they don’t have anyone to care for them after surgery.
John Swartzberg, a UC Berkeley infectious disease expert, said that the very low rates of infection and antibody-positive tests among health care workers at Stanford suggest that hospital procedures to control the virus are working and that patients should feel reassured by those results.
“That’s telling us that our infection control procedures are working and that they’re being robustly used,” Swartzberg said. “People talk about being so frightened to go to the hospital right now, but I think it’s probably a pretty good time to go. It may not be a bad time at all, because the hospital census is quite low.”
Indeed, as hospitals prepared to be overrun with COVID19 patients they kept many beds empty, and many facilities in the Bay Area are now well below their usual occupancy levels. As a result, some health care systems have announced pay cuts or staffing reductions. Last week, Stanford Health said in an internal letter that workers would need to take pay cuts or use paid time off, or else accept unpaid leave.
Even emergency departments that weren’t closed or forced to scale back services reported significant drops in patient visits. And those patients who did show up were sicker than usual, suggesting many people were delaying care, physicians said. At Stanford Health, emergency doctors said they saw more people with advanced appendicitis, for example, and a higherthanusual percentage of their patients needing to be hospitalized.
“Maybe people let their disease process go further than they should have,” said Dr. Andra Blomkalns, chairwoman of the emergency department at Stanford. “What we’re trying to figure out is how to convince people that it’s safe to come back. I’m hoping people will stop trying to avoid coming to the emergency department when they need it.”