Hospitals on alert as spread increases
There are beds for now, but wary officials watch capacity
As coronavirus cases fill hospital beds in record numbers across the Bay Area, health care and government leaders warn that a continued surge could edge facilities close to capacity.
For now, regional hospitals say they remain in a stable place and are able to manage the influx of patients. But that could change, in a dramatic way.
San Francisco’s top health official warned Wednesday that the city could see major hospital capacity problems in late summer and into the fall, if cases continue to rise at a rate that saw California surpass 10,000 per day for the first time Tuesday.
“We have flattened the curve and we will do it again. If we
don’t, the consequences will be dire,” said Dr. Grant Colfax, director of the city’s Public Health Department, at a news conference Wednesday. “While it is hard to slow down the reopening that we all want so badly, the price we pay for moving too quickly is very high.”
Colfax’s warning comes at a time when the Bay Area, along with the entire state of California, is wrestling with a troubling surge in coronavirus cases, causing spikes in hospitalizations. The worsening situation has health officials on high alert and helped persuade the governor to rescind policies aimed at reopening a battered economy.
In San Francisco, average models predict 900 coronavirus patients in San Francisco hospitals by early October, nearly 10 times the current number of 92, if trends continue, Colfax said.
Indicators of “grave concern” that put the city on high alert are the reproductive rate of the virus, case rates and hospitalizations, Colfax said. The reproductive rate of the virus is now 1.3, meaning that for each person infected, the virus spreads to more than one, on average. Case rates rose to 7.7 infections per 100,000 residents, raising the total cases to date reported in the city to 4,696 Wednesday. Hospitalizations increased 33%.
By Wednesday evening, health departments across the state reported 8,513 new cases for a total of 354,862. The death toll rose by 124 to 7,364.
In the Bay Area, counties reported 696 new cases Wednesday evening, for a total of 38,412, and seven more deaths for a total of 674. The number of hospitalizations spiked 38% over the past two weeks, reaching a record high of 650 hospitalized patients.
Across the Bay Area, hospitals are at least half full, some more than 80%, but mostly with non COVID19 patients. After months of planning and vigilant daily monitoring, hospital leaders said they’re cautiously optimistic that they can handle the spike in patients for now.
“We are not close to a scary number,” said Dr. Kathleen Clanon, medical director for Alameda County’s Health Care Services Agency. “I never want to say that we’re confident of anything with COVID19 — the whole experience has been very humbling — but at this moment ... we have plenty of capacity in our hospitals, and we haven’t even come close to normal capacity, never mind surge capacity.”
A Chronicle survey of seven Bay Area county public health departments found at least 9,000 acute care beds and more than 1,750 intensive care unit beds, numbers that can change depending on staffing. Counties can adjust to a surge with at least 4,450 more beds in standing hospitals and emergency facilities that have not yet been activated or set up.
Capacity is a fluid concept, officials said, with hospitals able to staff more beds, open up unused units, or double up patients in rooms to stretch space. Since hospitals usually operate near capacity, some said they’re not concerned until they’re more than 90% full. Others cautioned that ICU bed capacity falling below 20% is a warning sign.
Dr. Ori Tzvieli, Contra Costa County deputy health officer, said that even if hospitals are OK, for now, he’s concerned what will happen if the rate of increase continues. Hospitalizations in his county quadrupled over the past month.
“Clearly if it keeps going that way, I’m worried,” he said. “I’m particularly worried if it stays like this through the fall and other regular flu and pneumonia start hitting in October and November.”
Bay Area hospital officials said they plan for an expected flu surge every year that can fill hospitals to capacity. Clanon, in Alameda County, said she usually asks hospitals to flex capacity up to 15% during flu season. That could clash this year with the coronavirus, as past diseases did. During the 2009 H1N1 outbreak, visits for flulike symptoms spiked in the fall.
San Mateo County has some of the lowest capacity in the Bay Area currently, with just 12% of acute care beds and 20% of ICU beds available, as of Wednesday.
San Mateo County Health’s Deputy Chief Srija Srinivasan said the health care needs of the community are being met and hospitals have shown they can surge upward, as needed. For instance, the state can set up a 125bed surge site at the San Mateo County Event Center.
“The thing that keeps me up at night is the unpredictability of this all,” San Mateo County Supervisor David Canepa said.
Sonoma County had the lowest ICU capacity in the Bay Area on Wednesday, with just 6 out of 67 staffed ICU beds available. Hospitals said they staff to patient volumes.
“We have capacity, we have (personal protective equipment), we have appropriate staffing, we have medications, but that’s today,” said Dr. Chad Krilich, chief medical officer for St. Joseph Health in Sonoma County, which runs Santa Rosa Memorial Hospital and Petaluma Valley Hospital. “Tomorrow will be a new day, and we’ll evaluate where we stand from a volume standpoint.”
Healdsburg District Hospital is a rural facility with 17 acute care and four ICU beds. If beds filled up, the hospital could convert rooms to treat coronavirus patients within 24 hours. The hospital would then start moving COVIDnegative patients to the unit usually used for patients before and after surgery.
“We are absolutely concerned that at some point we’re going to start utilizing (the surge) plan and implementing it to some degree. It’s just a matter of how full and for how long,” said Brian Seekins, director of plant operations.
Contra Costa pulled back on economic reopening plans this past weekend, warning in a press release that patients could “quickly exceed capacity.” Tzvieli said the main trigger wasn’t hospitalizations. The county still has 30% of acute care and about half of ICU beds available. It was the positivity rate hitting 8% that could result in more hospitalizations in a week and ICU admissions in two weeks, he said.
Dr. Nick Mickas, medical director of clinical operations of John Muir Health, said the system’s two hospitals in Concord and Walnut Creek have adequate capacity for at least two weeks. Those calculations didn’t take into account the county hitting the brakes on reopening or the hospitals’ not activating surge plans.
“I’m feeling very comfortable with where we are now, even with the numbers coming up in the future in the near term,” Mickas said.
The county can open two alternate care sites at Craneway Pavilion in Richmond and the Contra Costa County Fairground in Antioch.
Other counties were less worried. Clanon, of Alameda County, said that even with the increased numbers of cases, projections show hospitals won’t reach capacity for six to eight weeks. Facilities can surge up to 35% above capacity. If they fill, the county already mapped out a site at the fairgrounds with around 100 beds, but hasn’t needed to activate it.
San Francisco is preparing to open its first alternate care site in the Presidio that will treat COVIDnegative patients who have been discharged from the hospital but still need medical supervision. It will accommodate 20 initial patients, with a capacity of 93.
Kristen Bailey Silloway, a nurse at San Francisco General Hospital, is among those deployed to set up the site.
“It’s all in preparation for a possible surge,” she said. “What we’re going through right now is unprecedented during our time. None of us have ever worked during a pandemic. We’re just making it up as we go along.” San Francisco Chronicle staff writers Erin Allday, Mike Massa and Anna Bauman contributed to this report.