Health care facilities in the region are trying to conserve masks and other equipment that are already in short supply as the new coronavirus spreads. They’ve canceled elective procedures and routine medical appointments.
They’re using drive-through clinics to treat people with mild respiratory symptoms and keep them out of urgent-care centers and emergency rooms, so that if they do have the virus they don’t infect others.
Bay Area hospitals are not yet seeing a surge in patients with fevers and coughs who could be infected with coronavirus, but they’re taking actions now to prepare for what many anticipate is an inevitable swell. Even with a regional “shelter-in-place” order designed to slow spread of the disease, doctors, nurses and other frontline workers are fearful that they’ll soon be overwhelmed with people seriously ill and in need of critical care.
“The attempts at flattening the curve are very laudable. It’s correct to try to do that, otherwise we get this massive peak and overwhelm the hospital system,” said Dr. Hallam Gugelmann, an emergency physician at the CPMC Mission Bernal campus in San Francisco. “But I don’t know how well it will work. I think it’s probably too late. I think there are probably a ton of cases out in the community. That’s what I’m worried about.”
Gugelmann and other providers noted that if coronavirus is indeed already circulating widely, then it’s even more important that people comply with shelter-in-place orders — which took effect in six Bay Area counties on Tuesday — and stay home as much as they can. There could be a fine line between a bearable burden on the Bay Area health care system and a swell in cases that is overwhelming.
The fear is that if hospitals get too many patients with COVID-19 — the illness caused by coronavirus — all at once, then there won’t be enough ventilators and critical care beds for everyone who needs them. If the cases can be spread out over a longer period — a phenomenon known as “flattening the curve” — then hospitals have a better chance of keeping up.
“Ideally, this is all within very painful capacities, but we have to plan for the step when it’s beyond our usual capacity,” said Dr. David Witt, national infectious disease leader for Kaiser Permanente. “How do we get more ventilators than we normally stock? How do we expand the rooms that we can use ventilators?
“We’ve been running as fast as we can for several weeks. All are working extraordinarily hard, everyone in the hospital. And we will work as hard as we have to, for as long as we have to,” Witt added.
The Bay Area had more than 325 cases of COVID-19 as of Tuesday afternoon, and six people had died — with five of those deaths in Santa Clara County. Nearly half of the cases are in Santa Clara County, where 56 of 155 patients have been hospitalized, according to the Public Health Department. That doesn’t mean that a third of people with coronavirus are seriously ill enough to need hospital care. Testing shortages nationwide mean that most people with symptoms are never tested, and there are certainly many hundreds of patients in the community with mild illness who have not been diagnosed with COVID-19, authorities say.
It’s impossible to know exactly how many people may be sick with COVID-19 now, but one marker is the national surveillance of individuals with flu-like symptoms — which are very similar to coronavirus symptoms. Typically in the first weeks of March, the number of people reporting symptoms would be starting to fall as the flu season receded. But those reports have been picking up this year, according to the U.S. Centers for Disease Control and Prevention.
At San Francisco General Hospital, spokesman Brent Andrew said the patient load seemed about normal for the time of year.
“We are checking several times a day to see if a surge is coming,” he said.
The hospital currently has two coronavirus patients and is using 10 ventilators, with more than five times that many in reserve. Andrew did not know if the coronavirus patients were on ventilators.
It’s not just equipment that could be an issue at San Francisco General. The hospital was already understaffed and overwhelmed before the pandemic was declared, and now the problems have only compounded, staff members say.
In January, San Francisco General was actively trying to fill 75 vacancies in its staff of about 900 full-time registered nurses, according to the hospital. About 14 of those full-time positions were in the emergency room alone, but several nurses previously interviewed by The Chronicle worried that wouldn’t be enough to handle the demand at the time.
Now, the hospital needs even more nurses to handle the looming uptick from COVID-19, said Christa Duran, an emergency room nurse.
“We’re more overwhelmed because, although we have the same amount of patients coming in, the patients are getting sicker,” she said. “So they are requiring more nurses and more resources to help them.”
In an attempt to alleviate the staffing shortages, Mayor London Breed announced an emergency declaration Tuesday to expedite the city’s ability to hire nurses and other frontline health care workers. The Department of Public Health typically takes six months or more to hire a nurse.
The change, effective immediately, will allow the city to hire qualified and licensed nurses “on the spot,” which means they will likely be able to start work a week after being hired, pending necessary clearances. The Department of Public Health has started contacting candidates who have already applied in the past, and officials will host an invitation-only nurse “hiring fair” at San Francisco General this weekend.
While Duran said she is thankful City Hall is taking dramatic steps to increase hiring, she is skeptical that officials will be able to get enough employees to meet demand given the shortages around the country. She is also worried that a surge in new nurses who need training could strain the more experienced nurses who will need to assist them.
Another possible problem with staffing is the potential for doctors and nurses to become infected themselves, which would harm both the individuals and the hospitals that rely on them, if they are forced out of work for days or even weeks. Several nurses who treated a COVID-19 patient in a Vacaville hospital later tested positive for the virus, and about 100 people in total were placed in quarantine after the exposure. Two UCSF health care providers have tested positive. A San Francisco emergency physician published an essay online this week about being diagnosed with coronavirus; he does not believe he was infected while at work.
In Daly City, Seton Hospital has seen a steady uptick in the number of patients with respiratory symptoms over the last three weeks — from one at any given time a month ago, to 10 or 11 now, said Dr. Robert Perez, who oversees the physicians. He said the numbers likely will start growing exponentially next week. The hospital is scrambling to open up a second intensive care unit that will expand its capacity from 14 ICU beds, each with a ventilator, to 40 in the next week, Perez said. It is also adding 30 to 40 additional rooms for patients who may need to be quarantined and treated with IVs or oxygen.
Nurses and doctors at hospitals around the Bay Area said staff already are running low on N95 masks, face shields, gowns and other protective gear, and in several places they’re being told to clean and re-use equipment that ordinarily would be tossed after one use. At some hospitals, nurses have to check out masks from a supervisor.
Seton has canceled or postponed elective surgeries, in part to preserve medical supplies that may be needed for a surge in patients, Perez said.
“We don’t know if the supply we get from China is going to start replenishing in two weeks, four weeks or two months, so we want to conserve what we have now,” Perez said.
Seton has treated one confirmed COVID-19 patient, but like many hospitals, it did not initially know the person had the virus, Perez said. One nurse there who asked to remain anonymous said there was concern among staff who treated the person that they had been exposed, and in turn may have exposed others.
The hospital subsequently set up a triage tent for suspected coronavirus patients outside, where staff are dressed in protective gear, so that people who may have the virus are less likely to transmit the virus to nurses, doctors and other patients.
Several hospitals have set up similar outdoor clinics. Sutter Health has drive-through respiratory clinics around the Bay Area, where patients — on orders from a doctor — can get checked out while sitting in their cars. That prevents potentially contagious people from entering the a hospital or office and exposing others, but it also helps nurses preserve their equipment, since they don’t have to change masks or other items in between patients.
Dr. Robert Nordgren, area CEO for Sutter Bay Medical Foundation in the Peninsula and San Francisco region, said 170 people were seen at one drive-through clinic on Sunday.
“We’re making contingency plans so we could see many more patients” at the clinics, Nordgren said. “So if there is a volume surge we are able to meet that. I can confidently say, we do have the capacity to ramp up if we see that demand.”
Erin Allday, Trisha Thadani, Catherine Ho and Peter Fimrite are San Francisco Chronicle staff writers. Email: [email protected], [email protected], [email protected], [email protected] Twitter: @erinallday, @TrishaThadani, @Cat_Ho, @pfimrite
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