Hospitals brace for onslaught
Staffing shortages complicate efforts to handle influx of patients
hospitals are bracing for a rising tide of coronavirus patients in the coming weeks that health officials say is likely to surpass last winter’s surge and overwhelm health care systems that are already struggling to keep up with demand.
The intense pressure on the state’s health care system comes amid a national omnounced icron-fueled surge that has led to record-level hospitalizations nationwide and is further challenged by industry-wide staffing shortages. On Thursday, President Biden said he is sending 120 military personnel to six states to help overburdened health systems. California, which still has lower hospitalization rates than hard-hit states like New York, was not one of them.
The president also anCalifornia plans to send 500 million more test kits to American households, doubling the amount promised earlier, though it’s not clear when those kits will be available.
In California, health officials said they were eager for federal reprieves in staffing and testing, both of which are under enormous strain that’s expected to worsen in the near future.
“We thought last year was as bad as it could be,” Carmela Coyle, president of the California Hospital Association, said in a news briefing Thursday. She said this surge, stoked by a variant that causes milder illness in general but is astonishingly infectious, could be worse for hospitals than last winter’s wave.
“We are looking at a very, very difficult next four to six weeks, with the demands on California’s health care system
greater than anything we’ve seen before,” Coyle said.
As of Wednesday, nearly 13,000 people were hospitalized with the coronavirus in California, including 1,630 in the Bay Area. Both of those numbers are rapidly approaching the peaks of last winter’s surge, when 22,000 people statewide — and 2,200 in the region — were hospitalized with the virus in early January.
Though there are hints that this surge may be leveling off in parts of the country, including early signs of waning in the South Bay, coronavirus cases are not expected to crest for another week at least, assuming California follows the omicron trajectory recorded in a few other countries.
Hospitalizations typically lag a week or two behind cases. That means coronavirus hospitalizations could peak at the end of January — potentially with more than 30,000 patients across California, according to state forecasts.
The upside is that because people usually don’t get as sick from omicron as with previous variants, there probably will be less pressure on intensive care units, less need to put people on ventilators, and ultimately fewer deaths in this surge, even with the very high case counts, health experts say.
So far, intensive care patients are making up a smaller proportion of overall hospitalizations than they have during previous surges. In the Bay Area, hospitalizations currently are 50% higher than the peak of the summer surge caused by the delta variant, but there are fewer patients in intensive care: 221 ICU patients as of Wednesday, compared with 311 on the worst day in August. At the height of last winter’s surge, 539 people were in intensive care in the Bay Area.
Doctors said they’re seeing that mild illness play out both in terms of treating less severely ill patients, but also reporting a spike in people who aren’t very sick seeking care in emergency rooms. Health officials across the state have begun pleading with people to not go to emergency rooms for mild symptoms or to get tested for the coronavirus.
“Our ER and on the ambulatory side, the doctors are really busy,” said Dr. Gary Green, an infectious disease doctor at Sutter Santa Rosa Regional Hospital. “Our ER is swamped and our ambulatory docs are swamped with not only phone calls but also with patients who have mild symptoms who are really worried about COVID.”
A large proportion of those currently hospitalized with the coronavirus are not actually sick with COVID: At some facilities, a third to half of patients with the coronavirus don’t have symptoms and are being treated for other medical conditions, but tested positive upon being admitted. That could also mean a lighter burden on intensive care services in the coming weeks, compared with earlier COVID surges.
But with coronavirus cases so high — more than 100,000 new cases being reported every day in the state, and more than 15,000 daily in the Bay Area — that inevitably will lead to many more people requiring hospital care for COVID, health officials say.
“We have this warped view about how mild, or milder, omicron is, when it clearly can kill and put a lot of people in the hospital,” Dr. Eric Topol, executive vice president of Scripps Research in La Jolla (San Diego County), said in a virtual update on the surge Thursday with Dr. Robert Wachter, chief of medicine at UCSF.
Patient loads overall will almost certainly be much higher this winter than last, health officials say. At the peak of last winter’s surge about 53,000 people were hospitalized for all medical conditions, not just COVID; the current hospital census for the state is about 52,000.
And hospitals statewide were coming into this surge with about 20% less staff than last year, Coyle said. Plus, many hospitals are now dealing with massive numbers of staff — including nurses and doctors — who are unable to work due to having COVID, having been exposed to the virus and needing to quarantine, or taking care of family members who are ill.
Last week, the California Department of Public Health introduced an order allowing health care workers who test positive for the coronavirus but do not have symptoms to immediately return to work if necessary. Coyle said she expects few hospitals to use that option.
“But we are down to crunch time and there are really very few options that are left,” she said. “We are heading into a third year of a pandemic that we just can’t wish away. We find ourselves at this moment on the precipice of the most challenging time to date for California’s health care system.”