Hospitals prepare for onslaught of COVID-19 patients.
From Kaiser to Stanford, facilities are gearing up to treat large numbers of ill residents
Bay Area hospitals are prepping for surging demand for beds, supplies and staffing amid a highly contagious coronavirus that comes with unknowns — how quickly it will spread and how many of those afflicted will require in-patient care.
If the virus continues to spread at its current rate, said Jennifer Tong, the associate chief medical officer at the Santa Clara Valley Medical Center, the three-hospital system “could exceed currently available critical care beds in our community” within three or four weeks.
Across the region and California as a whole, medical experts and elected officials now are bracing for a shortage of beds and equipment — like ventilators — and a lack of nurses and other medical professionals. But hospitals are emphasizing their flexibility in responding to the shifting landscape.
At Stanford, Andra Blomkalns, chair of the Department of Emergency
Medicine, said different units are being asked to plan for the worst and design contingency plans outlining staffing and other needs.
“Right now, we’re worried but comfortable,” Blomkalns said.
On Tuesday, Gov. Gavin Newsom said the state has about 74,000 hospital beds, with a “surge capacity” of about 88,000 beds. According to state projections, California could need anywhere from around 4,000 to 20,000 additional beds. According to the Kaiser Family Foundation, the state is 47th in the U.S. for the number of beds per residents, with just 18 beds per 10,000 residents.
“We’re running every conceivable option,” Newsom said.
There’s also expected to be a shortage of beds in licensed intensive care units, specifically. Although most people who contract the virus don’t need to be hospitalized, some do and tend to require intensive care.
According to a Bay Area News Group analysis of state data on licensed ICU beds, California has around 7,442 beds total, with about 1.8 beds per 10,000 residents, under normal circumstances. The five-county Bay Area has about 1,320 beds in total. Some Bay Area counties, like San Francisco at 3.6 and Santa Clara at 2.2, have more beds per capita. But others, including Alameda at 1.7, Contra Costa at 1.4 and San Mateo at 1.2, have fewer.
Data released recently by the Harvard Global Health Institute suggests that in a moderate scenario where around 40% of the population is infected over the course of a year, both the Oakland and San Jose metro areas would need more than five times the number of available ICU beds than they currently have.
By late Tuesday, California had nearly 600 confirmed cases, with more than 150 in Santa Clara County alone. No one knows exactly what will happen or how effective the Bay Area’s shelter-in
place directive will be in limiting spread of the virus, but those figures stand to rise dramatically in the coming days and weeks.
“Hopefully, the shelterin-place order will change things,” Blomkalns said. “But I think it’s going to get a bit worse before it gets better.”
Still, Blomkalns insisted regular hospital beds can be converted into beds suitable for critically ill patients and doctors can adapt to meet other needs, too.
“There’s nothing magical about the word ICU bed,” Blomkalns said.
A spokeswoman for the California Hospital Association, Jan Emerson Shea, has been in contact with hospitals across the state as the pandemic has grown about other concerns, from supplies to staff.
“It’s so difficult to predict what’s going to happen,” Emerson Shea said. “Everybody is working to try to preserve as much of the resources as possible, from the actual supplies and equipment to the workforce, and trying to think through all of the potential ramifications of this virus.”
Emerson Shea has heard about several issues repeatedly, she said, from a lack of protective equipment for medical workers to having enough health care workers to meet demand. Hospitals, she said, are canceling nonemergency surgeries and urging people to call before coming in. Some, like Kaiser, have created hotlines people can call where nurses can perform initial phone screenings.
“Hospitals not only have to be there to care for patients with this virus but for everybody else,” she said. “People are still going to have babies. People are still going to get in car accidents. We need to make sure we preserve the strength of the health care system so it can continue to function for everybody who needs care.”
Hospitals also are concerned about a lack of ventilators for patients who need help breathing. It’s unclear how many ventilators local hospitals have, but some, like Stanford, have been scrambling to add to their stockpile in recent weeks.
The Valley Medical system — which includes Valley Medical, St. Louise and O’Connor hospitals — says it has about 100 ICU beds and around 200 devices capable of ventilating patients.
One of the main challenges for the system and other hospitals in the area is having enough healthy doctors, nurses and other medical professionals on hand to care for sick patients.
In a disaster setting, Tong said, they could pull in different types of clinical providers to help treat coronavirus patients. For instance, she said, anesthesiologists have the type of training to care for patients who need ventilators.
Where ICU nurses usually care for a patient or two at a time, some nurses aren’t coming in because they are showing symptoms themselves. The hospital system also is trying to offer flexible shifts for nurses who still can work but have children who need care at home because of school closures related to the virus. If there is a surge of patients, the ratio of nurses to patients could shift.
“It would be kind of a last resort in order to maintain services,” Paul Lorenz, CEO of Valley Medical, said, adding that the county also could request help from other parts of the state or country.
And as a system of several hospitals, Tong said, there’s a command center that can move supplies from one site to another and help physicians collaborate.
At Stanford, Blomkalns’ team is also exploring ways it could shift work. Specialists could become generalists, for instance, or cardiologists might be tasked with internal medicine. And they’re working on scaling up express care, she said, to get people out the door quickly.
Unlike some community hospitals with limited resources, Stanford has a vast network it can tap as need grows.
“We bring in other people who are otherwise doing research,” Blomkalns said. “We ask people to work more. Everybody’s been stepping up to the plate and providing additional coverage.”
Health care providers also are trying to slow the spread of the virus in an attempt to limit the need for hospitalization. At Kaiser, which has opened at least one drive-thru testing site for members, that means limiting the number of people coming to the hospital in an attempt to limit the threat of exposure to infected people.
In an emailed statement, Kaiser said its “physicians are reviewing all elective procedures scheduled this month to determine those that can be safely postponed. We are currently contacting patients affected by this to discuss options for rescheduling and to answer questions they may have.”
At the state level, officials also have said they are working to get at least two new hospitals up and running. More details are expected Friday, but it’s not yet clear how quickly the hospitals would be functional or how many people they could serve.
“We’re trying to look ahead,” Tong said. “But the hardest part is not knowing what’s ahead.”
“Hospitals not only have to be there to care for patients with this virus but for everybody else.”
— Jan Emerson Shea, spokeswomen for the California Hospital Association