‘Surge plan’ in place locally

Health care workers call on community to pull together, play it safe

CHICO » The strain of the coronavirus pandemic is tipping medical staff to the breaking point, and Butte County’s already thin resources are concerned about meeting the community’s needs as cases surge.

Between Dec. 3 to Thursday, the county’s available ICU beds dropped from 21 to eight, according to current statewide hospital dashboard data.

The region’s service demands are unique. Butte County has a slightly older population with

slightly higher numbers of some conditions like respiratory illnesses, according to the 2019 Community Health Assessment from Butte County Public Health. This means when hospital capacity and staffing get tight or overwhelmed, more vulnerable people are at risk for going without the care they need.

Enloe Medical Center’s chief medical officer Dr. Marcia Nelson said partnerships with the whole region’s medical providers — even more limited since the Camp Fire — will be crucial.

On Thursday (as the county prepared to go into a three week Regional Stay at Home Order at midnight) Nelson said the hospital is less worried about available beds and more about having enough staff.

But as of the same day, data from the state monitoring dashboard showed there was just one open ICU bed at Enloe with five open at Oroville Hospital.

The hospital has not commented on that number or the current open ICU beds and total admitted COVID-19 patients it has as of Friday.

“We are currently operating under normal high census conditions, with limited beds at all levels of care,” Marketing Manager Joe Page said. “In addition, we have a multilayered surge plan in place which will allow us to increase bed capacity when specific triggers are met.”

Allocating resources

Like everywhere in the country, the region is now dealing with the full effects of Thanksgiving Day exposures, 14 days later.

When the expected Christmas surge hits towards the beginning of January, resources will continue to be stretched thin, Nelson added. This is in part because of the uncertain nature and severity of COVID-19 symptoms and their timeline for presentation

after exposure.

“The difficult part with COVID-19 that makes it so different from the flu is people can have symptoms that feel rather mild for the first 5-7 days, than precipitously decline or get worse,” Nelson said.

To prepare for these expected surges, Enloe staff created an internal monitoring system in June to analyze cases happening within the hospital, creating biweekly projections for how many COVID-19 patients to expect within different age groups and what age groups end up being admitted. A surge plan has been revised many times for how to allocate resources, including expanding rooms and beds where possible, for more capacity.

People need to know that recommendations and guidance have changed as much more is known about the virus, Nelson added.

“We had a lot of learning to do,” she said, and added she is optimistic with more treatment options now available and vaccines which may be up for use in the coming weeks.

Staff stretched thin

Front line medical staff aren’t just needed more as more cases need to be treated, they’re also getting sick more often. Nelson said the same increase in COVID-19 cases that was expected is also being seen among health care workers — “It’s right on time.”

The impacts of losing Feather River Hospital in the Camp Fire are still being felt, she said, although there was also a reduction in population to service after the fire.

Butte Glenn Medical Society’s Immediate Past President Sean Liston (also the founding president of Healthy Rural California and secretary/treasurerelect of Enloe Medical Center staff) works at the Chico Eye Center in private practice. He’s watched the effects on staff who tested positive and said he’s grateful that the center was quick to prevent any surge by making any exposed

staff member stay home until they tested negative.

But from a wider perspective looking at both Butte and Glenn counties’ medical providers, even with time to prepare and allocate resources, Liston is very concerned for the ability to meet the needs of the whole community — “the numbers (of cases) can swing very quickly.”

“I am worried about stretching them (staff) too thin,” he said. It means elective surgeries which are actually necessary for some patients, like corneal transplants, get canceled or postponed. Or more patients could need to isolate before surgeries due to the virus, further pushing their appointments out.

While telehealth can fill some gaps, some procedures needing to be done in person will inevitably be affected. Liston said not all elective surgeries can wait.

And Dannielle Harwood, a private physician in Chico, said she has watched the toll on people stressed about whether to seek medical aid and even the ability to get any aid.

“For me, the concern is when my patients get sick with COVID-19, is there going to be a spot for them at the hospital, and how (can we) safely manage them on an outpatient level?” she said. “When people are in crisis you have to make it work.”

Saving lives

The three medical professionals agreed people need to understand following prevention guidelines won’t just prevent deaths due to COVID-19, it will prevent deaths of those who cannot get medical aid if hospitals become overwhelmed.

When ICUs are overwhelmed with COVID-19 cases, all over the country hospitals are seeing other deaths as people in need of emergency care cannot be helped in time, Liston said.

“When we don’t have enough resources, it is always the most vulnerable like children, the low income (individuals) and the elderly who are always the

ones who suffer the most,” Harwood added.

“It hasn’t happened yet here, but one of the hard things is when the hospital is full and patients get sent home early or don’t get admitted,” she said. “We’re then trying to manage patients at home who under ideal circumstances might be in the hospital.”

Liston worries daily about his vulnerable patients who are elderly, have diabetes or are immunocompromised.

“While the overall morality rate is relatively low, it is higher than the flu, but in that particular sub group, which is a significant population of who I take care of, the mortality rate is extremely high,” he said.

Liston, who’s lived with mild asthma, added “I have been essentially living in a bubble since March.”

“I’m not so much afraid for myself getting sick because I believe I’ll probably recover. I am more concerned about getting that infection and possibly giving it to a patient. I don’t know if I could live with being that person. I guarantee as soon as (the vaccine) is considered appropriate for me to get it, I will be at the front of that line.”

In addition, more evidence has arrived that the virus can cause ongoing comorbidities — new health conditions which previously healthy people didn’t have before.

“They’re (COVID-19 survivors) having problems with their heart, inflammation, strokes, and needing limbs amputated,” Liston said. “They’re surviving but those people are going to live the rest of their lives possibly permanently affected by COVID-19. Even though you recover, there can be some significant morbidities associated with this even for those without risk factors, and we just can’t predict who it’s going to affect like this.”

Nelson added for this reason, expanded telehealth services are available 24/7 at Enloe Medical Center for patients to talk to physicians without having to

come in person.

Battling misinformation

When people believe misinformation about the virus, it can cause other issues for health care providers.

“We’re really blessed in the U. S. to have some of the best scientists and physicians in the world. And when we listen to the best guidance from our scientists and medical leaders, then that’s when were going to get it right,” Nelson said.

“It’s been really unfortunate there have been so many other voices that aren’t based in science that have gotten a lot of traction,” she added. “But when you get back to what science and people in medicine are saying, it’s all been very consistent. Yes, it has changed since the springtime, because as we learn more about the illness, recommendations change.

“That’s what science looks like. You start, you learn, you change and you make things better. And you grow.”

Liston said in his office, there have only been a few people taking issue with wearing a mask.

“After 11 years of practice here in Chico and interacting with other physicians in our entire region, I can assure you the vast majority are taking this seriously.”

“It’s an opportunity to educate the patients,” he said. “But I’ve had to have patients leave and say ‘ we’ll see you next year when the pandemic is no longer here.’ It’s just to protect the other patients as well.”

Harwood said misinformation can spread easily

“when people get under a lot of stress and fear sets in — that’s when it gets easy to forget about being a community.”

“This has been going (for) months and months and months. I think people are just tired,” she said.

“It’s really important to view this situation the same way we view the fires and the possible Oroville (spillway) breakage — as a community,” she said. “And a community takes care of each other — we take care of our vulnerable members.”

“Our vulnerable right now include the health care providers. They are on the front line right now being exposed, worrying about taking it home to their parents, their spouses, people with cancer.”

All three implored the community to work together to stay home at this time. After hearing too many stories about family gatherings that led to COVID-19 exposures, Nelson said. “The best way to show people we love them is not come from out of town right now, do a Zoom call or Facebook call.”

“We’re asking everyone to be kind to each other, be understanding,” Harwood said. “And that’s how we’re going to get through this. We’ve been through tons of tough stuff before.”

“The system is stressed. The biggest way to prevent this is stay home, for people to not go out unless they have to — though we know a lot of people have to.”

“This is not a game. These are people’s lives we’re dealing with,” Liston added.