Bay hospitals prepare for increase in patients
Kaiser Permanente in Northern California has pitched tents to fill with COVID19 patients. San Francisco General Hospital has rented more ventilators and fixed others. Seton Medical Center in Daly City has received enough masks and goggles to protect workers for a month — a day before they would have run out.
Bay Area hospitals are trying to increase capacity ahead of an expected case surge that Gov. Gavin Newsom says could peak in May. But almost all were running low on some supplies. Seton Medical Center has only three ventilators — a potential disaster if any of their 15 COVID19 patients, two in intensive care, take a turn for the worse.
“We’re trying to get ahead of
this,” hospital president Anthony Armada said. “You can’t create this when the surge is here.”
California still needs tens of thousands of hospital beds, thousands of ventilators and millions of N95 respirator masks, Newsom said in daily briefings this week.
Officials at seven hospital systems in Northern California contacted by The Chronicle said they have enough supplies for now, but are feverishly planning to get more. Cases of COVID19, the disease caused by the coronavirus, ticked up to more than 3,000 in the Bay Area Friday since the pandemic began just over a month ago.
“We are prepared for the most dire projections,” said Sutter Health Chief Medical Officer Stephen Lockhart, who oversees 22 hospitals, half in the Bay Area. “We’re definitely not complacent. We’re not arrogant.”
Lockhart said concern about lack of personal protective equipment, called PPE, is real.
Yet, he said, “We never have and are never intending to have a situation where staff are ever in danger.”
Hospitals say they’re following guidelines of the Centers for Disease Control and Prevention, which recently loosened them to allow doctors and nurses to use the same masks for an entire shift instead of throwing them out each time they leave a patient’s room.
Frontline medical workers don’t always agree protections are enough. Some told The Chronicle they’re being exposed to the coronavirus as personal protective equipment is rationed — and fear things will get worse. The number of infected health workers statewide more than tripled from March 27 to April 3 — from 48 to 156 — the state public health department reported. Local nurses have protested the lack of PPE: Some said they’re buying or making their own masks in case their hospitals run out.
Becky CherryMay, a nurse at Kaiser’s Vacaville Medical Center, said that because the virus clings to surfaces, like the outside of a mask, when reusing one “it’s so easy to contaminate yourself,” despite careful practices. She said guidance about how to use personal protective equipment changes “hour to hour,” and she is constantly retraining other nurses. Part of the problem is she doesn’t know how much PPE her hospital has.
“Of course we are anxious and worried about our PPE,” she said. “It’s in the back of my mind that we may not have anything at all down the road.”
California has a statewide shortage of testing supplies, and the results of nearly twothirds of tests are still pending. Because of the lag, hospital officials say they are forced to assume that everyone — even those with no symptoms — has COVID19. As a result, they’re using valuable protective equipment that could be distributed if they knew who actually was infected, Lockhart said. Faster tests will help ration gear: Seton Medical Center is one of the first hospitals in the country to use Sunnyvale biotech company Cepheid’s 45minute test.
Hospital officials said infections are rising slower than projected, but they still have to prepare for a surge. Lockhart said he’s “cautiously optimistic” that shelterinplace orders will slow infections to the point that the number of new patients remains manageable.
Here is how local hospitals are preparing:
Kaiser Permanente (21 medical centers in Northern California):
Kaiser has run a coronavirus command center since February that it says never closes. And it has pitched surge tents in Northern California, spokesman Karl Sonkin said. Senior Vice President Irene Chavez said this week the hospital system “has the appropriate PPE to protect teams.” In accordance with CDC guidelines, staff are asked to reuse unsoiled masks.
Kaiser regularly assesses available beds, staffing, material and equipment and is “taking aggressive and proactive action” to get surgeready, Sonkin said.
The hospital system has declined to say how many COVID19 patients it is treating. Last week, nearly half of all patients at Kaiser Permanente Medical Center in San Jose were positive, an executive said.
Sutter Health (11 Bay Area hospitals):
California is taking over Sutter’s inactive California Pacific Medical Center Pacific Heights campus in San Francisco for COVID19 patients. The hospital system is prepared to increase capacity by three times and set up surge tents, and it projects to have enough ventilators, Lockhart said Thursday.
Sutter is distributing 2 million N95 masks found by the Service Employees International Union Healthcare Workers West. Beds in intensive care units (ICU) can be manipulated remotely when possible so nurses can avoid entering the room and being exposed. Sutter is also retraining employees and making it easier to move them between hospitals where needed.
The hospital system declined to disclose the number of COVID19 patients.
Santa Clara County (Santa Clara Valley Medical Center, O’Connor Hospital, St. Louise Regional Hospital):
The three hospitals were treating 245 COVID19 patients as of Friday. Roughly a third of ICU beds are being used by positive patients and another third are available, the county reported Friday. A majority — 67% — of ventilators are not in use.
The county added 250 beds at Santa Clara Convention Center for COVID19 patients discharged from the hospital, Dr. Jennifer Tong, director of the county emergency operations center’s surge prep team said Thursday. Supply of ventilators is dynamic as hospitals receive and repair some supplies. Because of worldwide shortages, the focus is on local suppliers to fill gaps.
County Supervisor Cindy Chavez said Thursday the Santa Clara Valley Medical Foundation received almost $5 million in donations to purchase more equipment.
Zuckerberg San Francisco General Hospital:
The hospital had 21 COVID19 patients, 11 in ICU, on Friday.
The hospital began reducing the number of nonCOVID19 patients several weeks ago and reconditioning unused units for the surge, spokesman Brent Andrew said, as well as renting additional ventilators and fixing others.
“Like every hospital in this country, we are facing a challenging situation with respect to supplies. It is a matter of significant concern,” Andrew said.
He said 500 reusable respirators were being prepared Thursday. Wipes are in short supply. UCSF: The San Francisco hospital system had 17 COVID19 patients, 10 in ICU, on Friday. The hospital has plenty of bed space and ventilators, spokeswoman Kristen Bole said, because they eliminated up to 80% of nonurgent surgeries.
The hospitals have five weeks’ worth of masks, primarily due to donations, she said. Face shield supplies are very low. Care providers wear one mask per day unless it gets soiled or wet and are using washable fabric gowns instead of disposable ones.
Seton Medical Center, Daly City:
The hospital, which had five floors taken over by the state for COVID19 patients but is still accepting other patients, had 15 positive patients, including two in ICU, Thursday.
Its COVID19 units have 177 beds, including 14 for intensive care. The hospital is still short 11 ventilators. Hospital president Anthony Armada said he reached out to the state and county — and even Tesla’s Elon Musk — for help. As a backup plan, they’re converting 16 anesthesia machines.
The hospital received 15,550 N95 masks and 1,200 goggles Thursday, Armada said. Only nurses treating COVID19 patients get N95s, but others can wear surgical masks. The supply should last 35 days at moderate surge levels and 26 days at high surge.
Alameda County Health Systems (Highland Hospital, San Leandro Hospital and Alameda Hospital):
The three hospitals had four COVID19 patients Friday. It’s a low percentage of current beds, but that number can change quickly in the anticipated surge, spokesman Terry Lightfoot said.
Jim Morrissey, EMS Medical Health Operational Area Coordinator for Alameda County, said the county recently obtained 1.5 million N95 masks from state and federal agencies. It sent 48,000 N95 masks, 3,000 surgical masks and nearly 500 gowns to Highland last week.
Respiratory masks are provided to staff caring for COVID19 patients and those in the Emergency Department, Psychiatric Emergency Services, Labor and Delivery, Urgent Care and working with immunocompromised patients, Lightfoot said.
“We, along with hospitals across the country, are deeply concerned about our ability to sustain a significant surge in patients as a result of the coronavirus,” he said.