Large hospital systems in Southern California are preparing to create more space for coronavirus patients as cases continue to surge in the region and across the state.
One ER physician said hospital CEOs “are getting anxious” about the capacity of their facilities to handle the influx, and some are developing staged plans to ensure they can.
From Riverside and San Bernardino counties to Los Angeles and Orange counties, the numbers of patients infected with COVID-19 have been climbing dramatically in the past few weeks.
In Orange County, health officials reported Friday that COVID-related hospitalizations climbed 17.6% over the previous three days, well over the state threshold of 10%. The spread has been so pronounced that the county soon could find itself on the state’s watch list for possible renewed lockdown orders.
In L.A. County, the seven-day average of daily new coronavirus cases was 1,979 on Friday, an increase from the 1,379 average two weeks ago, officials said.
And in San Bernardino County, the number of new cases per week is growing rapidly, particularly among patients 18 to 49 years old, officials said. The county averaged about 160 new cases a week earlier in the month, in the mid 200s during the middle of the month and has averaged more than 300 over the past seven days.
San Bernardino County
Health officials in San Bernardino are getting ready with plans to use extra beds and temporary hospital sites in the county if the surge of coronavirus cases continues.
“This is the first time that, when we have discussions with hospital CEOs regarding hospital capacity, that our CEOs are getting anxious,” Dr. Troy Pennington, an emergency medical physician at Arrowhead Regional Medical Center, said during a news conference on Friday, June 26.
Hospitals are close to having to use their “surge capacity” beds, which are set up in addition to traditional licensed beds to care for an influx of coronavirus patients, he said. If hospitals fill up, the county could use alternate sites such as the National Orange Show in San Bernardino and the county fairgrounds in Victorville.
“We could be moving toward alternate care sites within a matter of weeks,” Pennington said. “That’s the very real reality of where we could be heading if we continue with the same slope of the curve that we’ve been looking at recently.”
Surgical beds are still available and there is still capacity in intensive care, he said, adding that the usage of fewer ventilators in treatment these days is a silver lining.
In preparation for a possible influx of COVID-19 patients, Loma Linda University Medical Center and Children’s Hospital have designated isolation units to mitigate the spread of infection for adult and pediatric patients who have tested positive for COVID-19, spokeswoman Briana Pastorino said.
In addition, the hospital has three medical surge tents outside the emergency department, which could serve as an isolation space suitable for screening patients who are showing symptoms, she said.
Los Angeles County
UCLA Health is carefully monitoring COVID-19 testing and hospitalization data, maintaining regular contact with Los Angeles County public health officials and hospitals throughout the region, and is well-prepared for the possibility of additional patients, said spokesman Phil Hampton.
As of Thursday, the system’s hospitals had 31 patients who were COVID-19 positive and has treated 304 coronavirus patients since March 12. Ronald Reagan UCLA Medical Center in Westwood has 446 beds and UCLA Medical Center in Santa Monica has 281 beds. That includes 133 intensive care unit beds in Westwood and 22 in Santa Monica.
Hampton said UCLA has a “comprehensive, multistage” surge plan in place and could gradually increase the number of beds to 1,100 by adding beds to single in-patient rooms and converting other rooms to provide ICU-level care.
Hospital systems in Riverside County say they are gearing up for a surge by ensuring they have the capacity to expand the number of beds both in their hospitals and intensive care units.
Riverside County’s 17 hospitals have 3,560 licensed hospital beds, of which 2,500 are currently in use, county spokeswoman Brooke Federico said. But only 311 of those beds are occupied by COVID-19 patients, she said. However, the intensive care units are almost entirely occupied by COVID-19 patients. Of the 385 ICU beds, 90% are in use and 95% of those are occupied by COVID-19 patients, Federico said. Also, countywide, 680 ventilators are available, of which 166 are in use, she said.
Under a five-phase surge plan drafted last week, county hospitals are in phase three, where patient volumes are continuing to rise but they have not had to expand into areas of the hospital that are not licensed for a specific use, such as intensive care, said Dr. Michael Mesisca, medical director for the Emergency Medicine Department and Disaster Medicine Team at the Riverside University Health System.
“We are moving toward phase four, when we will begin to use other spaces within the hospital,” he said. “Phase five is when we grow out of treatment areas into spaces such as conference centers.”
The health system also has hired travel nurses, more nurses on staff, worked to maximize telehealth options and invested in supplies — from ventilators and IV pumps to monitors and cots.
It is not quite the time to panic, Mesisca said, but county residents should show vigilance by using face coverings and practicing physical distancing to help ensure that the local hospital systems don’t get overwhelmed.
Over the past week, UCI Medical Center in Orange has averaged approximately 50 hospitalized coronavirus-positive patients a day and nearly 880 patients with the virus have been admitted and treated since the middle of March, spokesman John Murray said.
“These patients are admitted to dedicated (coronavirus) units, including ICUs. We will expand the number of beds available as needed,” he said. Murray said that while supply lines for some personal protective equipment continue to be stretched, UC medical centers across the system are busy securing supplies necessary to manage an additional surge of patients.
At Hoag Hospital Presbyterian in Orange County, only 5% of hospital beds are in use for coronavirus patients because most coronavirus patients are not hospitalized, said Dr. Philip Robinson, director of infection prevention. Fewer than 2% of their ventilators are currently in use, he said.
“Many of our coronavirus patients are seen at Hoag Urgent Care and/or Hoag Medical Group offices,” he said. “We triage and treat them in an outpatient setting, and patients convalesce at home in isolation. Telehealth options support this as well.”
Robinson said one of the challenges health-care professionals continue to face is having to remind the community not to delay care when experiencing potentially life-threatening medical conditions such as strokes and heart attacks.
“We have seen patients so wary of engaging the health care system that they let these symptoms go unchecked during the height of the crisis, resulting in permanent damage, and in some cases, death,” he said, adding that people should not delay essential surgeries and important medical screenings simply out of fear.
Robinson said also reminded the community that it has a responsibility to slow the spread of the virus so health systems are not overwhelmed.
“It is incumbent upon the community to continue to practice hand hygiene, social distancing and wearing face coverings in public to help slow the spread and allow hospitals to care for those in need.”
Kaiser Permanente system
Kaiser Permanente, which has medical centers throughout Southern California, does not disclose its bed or ICU capacity, or numbers of COVID-19 patients undergoing treatment at its facilities.
However, Nancy E. Gin, regional medical director of quality and clinical analysis, said the system has sufficient beds and ventilators to treat any surge in coronavirus patients.
The health system has the ability to “leverage expanded treatment capabilities, including the ability to increase treatment space, staff, and supplies to manage surges, even as we reopen the health care system with new, social distancing measures in place,” Gin said.
“Given the emphasis on testing, monitoring and contact tracing, we expect to be better able than at the start of the pandemic to identify and predict potential hotspots and surges of patients seeking high-level care for the coronavirus. This will allow us to tailor surge planning to meet local needs rather than planning for a surge in coronavirus patients systemwide.”
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