Rural hospitals buckle under mounting surge
Patients must wait as ICUs exceed capacity
Mendocino County emergency room nurse Kristen Marin says the surge in COVID-19 cases is the worst she’s ever seen.
In Humboldt County, Dr. James Goldberg worries his exhausted emergency department staff is worn out from working relentless shifts since the pandemic began 18 months ago.
Farther north, in Del Norte County, emergency room doctor Aaron Stutz has never seen his hospital so understaffed, and worries about what’s to come.
Rural California counties are reeling under the latest COVID-19 surge as the delta variant rips across the state and strains already-limited resources in mostly vaccine-hesitant communities. Patients have to wait for beds. Burnedout nurses want to quit. In
“Health care workers are tired and angry. Some are depressed; we’re all just so burned out.” Dr. Beth Abels, internal medicine physician in Eureka
county after county, intensive care units, which care for the sickest patients, are full.
“Right now, there’s a huge need for nursing and other allied health staff,” said Stutz, who works at Sutter Coast Hospital in Crescent City. The hospital — the only acute care hospital in Del Norte County, which borders Oregon — has always faced staffing challenges, relying on traveling physicians to support medical staff. Now, slammed by the surge that’s arrived with the delta variant of the coronavirus, its situation is dire.
“Because we’ve just not had enough staffed beds ... a lot of patients who are coming into the emergency department are waiting to be placed,” Stutz said. “Just waiting.”
In August, at least seven rural Northern California counties — Amador, Del Norte, Humboldt, Lake, Mendocino, Shasta and Tuolumne — saw their all-time high rates of hospitalized COVID patients, according to state health data.
“We are full. Our ICU is full. Our step-down unit is full,” Dr. Alexander Heard, medical officer at Adventist Health Sonora, told the Tuolumne County Board of Supervisors last week. Adventist Health is the sole hospital serving the county’s 54,000 residents. As of Wednesday, the county had two ICU beds available.
The stress comes at the same time when these rural areas are contending with fast-moving wildfires, which severely degrade air quality and can cause health complications for residents with respiratory illnesses or other underlying conditions.
Over a seven-day period ending Tuesday, Del Norte County recorded 188 new cases per 100,000, Mendocino County recorded 65 cases per 100,000, Shasta County 61 cases per 100,000 and Humboldt County recorded 41 cases per 100,000, according to The Chronicle’s COVID-19 tracker. California’s average over the same period was approximately 37 new cases per 100,000 people. Cases are leveling out or dipping elsewhere in some other parts of the state, particularly the Bay Area — which has far higher vaccination rates than its rural counterparts, and also for the most part requires rather than recommends the use of masks indoors.
Del Norte County ranks 25th among counties in the country in terms of cases per capita over the past seven days, according to the New York Times national tracker.
Del Norte County has canceled nonemergency surgeries, restricted visitors and requested more staff from the state’s Emergency Management Services Agency per the hospital’s surge plan. On Tuesday, the county had 23 hospitalized COVID-19 patients, up from six on Aug. 1. It had no ICU beds available. The numbers may sound modest from a big-city perspective, but they are
overwhelming for a small rural hospital.
Vaccine hesitancy seems to be a big factor in the surge. Eight doctors across Del Norte, Humboldt and Mendocino counties told The Chronicle that more than 95% of their COVID-19 patients were unvaccinated. Around 41% of Del Norte County’s population of nearly 28,000, for example, is vaccinated — far below California’s statewide average vaccination rate of 55%.
According to state data released Monday, unvaccinated people in California are more than six times as likely to contract the coronavirus than those who are vaccinated.
Doctors in Del Norte and surrounding counties became so frustrated last week that more than 100 of them released a stark public letter, begging people to get vaccinated. “We must admit we are tired,” they wrote. “We will keep working, of course. But we are tired. We are tired of the suffering, pain and death that can be avoided by getting vaccinated.”
Dr. Beth Abels, an internal medicine
physician in Eureka who signed the letter, said she was “shocked and disappointed that it’s come to this.”
“I’m horrified about the low vaccination rate in our community,” she said. “This is so unnecessary. We shouldn’t be in this position. Vaccines are free, easily available, safe and effective, and there’s really no reason for us to have our health care system so severely impacted.”
Abels said one of her own patients, a nurse, recently told her she was thinking about quitting the field for good.
“Health care workers are tired and angry. Some are depressed; we’re all just so burned out,” she said.
Goldberg, the ER director at Providence St. Joseph’s in Eureka, said the weight of the pandemic is getting heavier, compounded by the need to address other non-COVID illnesses at the same time.
“Our staff has done the best under the most trying of circumstance,” he said.
The hospital is prepared to expand its intensive care capacity from 12 to 19 beds but then will need more staff for the expansion, Christian Hill, a Providence St. Joseph’s spokesman said.
“We have been in contact with public health officials in Humboldt County, and CDPH, to try to get additional staff,” he said. As of Monday, the hospital had 27 COVID patients — seven in the ICU, with five of those on ventilators.
Dr. Bessant Parker, chief medical officer at Adventist Health, which runs three hospitals in Mendocino County, said the situation is ripe for more burnout among medical staff everywhere, with death and sadness a recurring reality.
“The personal toll and impact this has on a person, 18 months into this pandemic, is a lot,” he said. “We’re starting to see the exhaustion throughout our staff.”
ER nurse Marin, who works at Adventist Health Ukiah Valley, said her colleagues were tired but many were doing their best.
“We all signed up for this line of work for a reason, but none of us thought this (pandemic) would ever get this bad,” she said.
With rural hospitals filling up, neighboring counties are starting to accept their overflow COVID patients while also handling their own surges. Dr. Andy Coren, Mendocino County’s public health officer, told a Board of Supervisors meeting last week that three of the county’s 27 COVID patients were hospitalized “out of county.”
Dr. Stephanie Dittmer, a family medicine physician who works at Providence Redwood Memorial Hospital in Fortuna (Humboldt County), said the overflow of COVID patients affects all patients in need of medical care.
“We can’t take care of the heart attacks or the pneumonia or the heart failures. It has snowballed in a scary way,” she said.
The rural doctors had one message for the public: Get vaccinated. The Aug. 16 letter signed by Del Norte County physicians underscored the point:
“You’ve trusted us with every aspect of your health. Please trust us with this. We are not asking you to do anything that we have not already done. Please, for the sake of the community, the young, the old, and all the in-between, get vaccinated.”