Sonoma County hospitals prepare for coronavirus patient surge; no plans to halt elective surgeries

If Santa Rosa Memorial Hospital starts moving patients from the emergency department to inside the vast white tent outside the hospital, that will indicate the dreaded coronavirus surge has begun.

It’s what county public health officials and health care workers have long feared since the pandemic arrived in Sonoma County in March. So far, Memorial Hospital — the county’s highest-level trauma center — has been able to manage its volume of COVID-19 patients, as have other local hospitals.

“When you see us panic, you’ll know,” said Scott Rocco, manager of Memorial’s emergency department, as he stood Friday outside the white tent covering six medical bays where doctors and nurses would take care of a rush of sick people. Later that day, the county would report 89 new cases of COVID-19, the highest single-day total.

Late Saturday, the county reported two more people have died of COVID-19, bringing the total to 16 since the pandemic emerged in early March. Details on the two new deaths were not available Saturday.

Rocco explained a surge occurs when the number of people showing up at a hospital exceeds its ability to treat them. It happened with recent wildfires, but it hasn’t occurred in the ongoing pandemic — at least not yet.

If it does, Rocco and other leaders at Sonoma County hospitals say they’re ready, or as ready as they can be.

In the spring, no surge of hospital patients materialized, although area medical centers had urgently prepared. Now, the county is losing a grip it had on the virus, resulting in soaring numbers of new infections, 11 deaths since late June and more residents suffering from the infectious disease needing hospital care.

To be sure, the spike in virus-related hospitalizations statewide over the past two weeks is alarming and a reminder the pathogen has not taken a summer break. California’s 416 hospitals have had a 49% increase in patient admissions with COVID-19, and a 38% boost in patients needing intensive care.

Challenges mount

This time around, Sonoma County hospital leaders say nurses and doctors know much more about treating the highly contagious disease and have many more therapeutics like Remdesivir available.

Dr. Chad Krilich, chief medical officer for St. Joseph Health Sonoma County, operator of Santa Rosa Memorial and Petaluma Valley hospitals, said a hospital’s readiness for an inundation of virus-afflicted people depends on a number of factors, including whether there are enough health care workers and protective gear for them to take care of the influx of patients.

“Given our current volumes today and given the projections that I’m seeing today, are we ready for a surge? Yes,” Krilich said Friday. “Tomorrow will be a different day and we'll need to reevaluate everything all over again.”

The COVID-19 hospitalization rate was the one local statistic that had remained relatively stable, even as infections steadily increased. That changed a few weeks ago.

In late May, the largest number of coronavirus patients hospitalized in the county was eight. Through most of June, the average number of virus patients in a local hospital was five, and there were never more than seven.

Since June 26, though, the number of COVID-19 cases in local hospitals has jumped to 28 patients on Friday, according to the county’s hospital capacity dashboard.

As of Saturday, the average number of people hospitalized over a three-day period had increased 30%, far exceeding the 10% benchmark established by the state, signaling trouble with suppressing the virus outbreak. Therefore, Sonoma County on Friday landed on the state’s coronavirus watchlist, joining 29 other counties and triggering eventual restrictions expected Monday to halt indoor dining and drinking at restaurants, wine tasting rooms and breweries, among other pullbacks.

Expansion of beds, ICU care

As local hospitals admit more coronavirus patients, they are revamping plans to potentially add more beds as they need them, including staffing additional ICU beds as patients fill them.

In the event of an actual surge, the county’s six acute-care hospitals and its one long-term acute care hospital could add at least an additional 184 regular hospital beds, along with at least 58 beds for ICU patients to its 707 staffed beds, 67 of which are ICU beds, according to a Press Democrat survey of the seven medical centers. Sutter Santa Rosa Regional Hospital was the only one that declined a request for information about the number of extra beds it planned.

At Memorial and Petaluma Valley sister hospitals, negative pressure rooms for virus patients could be increased from 11 to 25 and 26 to 32, respectively. Memorial could add six more ICU beds to its 26 and Petaluma Valley similarly could add another five ICU beds to its nine.

Kaiser Permanente officials say they can add 11 regular hospital beds and 29 more ICU beds in the event of a surge, while Sonoma Valley Hospital in Sonoma and Sonoma Specialty Hospital in Sebastopol both said they could add 35 more hospital beds.

Up north at smaller suburban Healdsburg District Hospital, 11 regular hospital beds could be added and any one of the 13 medical/surgical beds could be converted into ICU beds.

So confident in their preparation to manage a surge, hospital officials don’t plan to stop surgeries or elective procedures should a wave of virus patients flood local medical centers.

“We currently have plenty of capacity and do not have plans to postpone or cut back on any procedures at this time,” said Dr. Sabrina Kidd, Sonoma Valley Hospital’s chief medical officer.

Kidd said the hospital, which is largely an outpatient center for procedures and surgeries, would continue outpatient services even if inpatient beds fill up. But she’s closely monitoring staffing and supplies of personal protective equipment.

“If any of these become limited, we may be forced to make other plans or restrict some services depending on the shortages and needs at that time,” she said.

Michelle Gaskill-Hames, senior vice president of hospital and health plan operations at Kaiser Permanente Northern California, said Kaiser has remained in a “state of readiness“ since initial surge planning in spring.

“As a result, Kaiser Permanente facilities and staff can manage the current growth in hospitalized cases, expertly treating patients with the virus, while safely caring for patients with other conditions as well,” Gaskill-Hames said in a statement.

She said if necessary, Kaiser’s integrated health care system could accommodate patients moving from one Kaiser medical center to another, as they did during the 2017 North Bay fires.

Carmela Coyle, president of the California Hospital Association, said hospitals know how to address the rising tide of patients, with many more tools that are “actually shortening the stay of those patients,’’ making the challenge different than at the onset of the pandemic.

“The surge is about finding a balance between caring for COVID-positive patients, and continuing to care for everyone in the state of California,” Coyle said.

Virus numbers unpacked

On Friday, Memorial Hospital in Santa Rosa was treating 12 patients who had tested positive for COVID-19. Krilich said that while there has been an increase in virus-stricken patients, the majority of them are being treated on the medical/surgical floor and not in intensive care.

What’s more, he said, while there are more coronavirus patients receiving care, a significant number were admitted to the hospital for another illness before getting diagnosed with the infectious disease.

“By virtue of our practice to test all patients who have been admitted to the hospital, we also find out that they’re COVID positive,” Krilich said. “They may be someone who's an asymptomatic shedder and who isn't actively having the disease.”

Krilich also said not everyone in the hospital who has tested positive for the coronavirus is actively battling the disease or has symptoms such as fever, elevated heart rate or difficulty breathing.

For example, Dr. Omar Ferrari, medical director of Memorial’s emergency department, said there have been cases in which patients come into the hospital as a result of an opiate overdose and then test positive for COVID-19.

“There are those hospital admissions that would have been admitted, regardless of their COVID,” Ferrari said. “But they wind up in the COVID pool, simply because we're testing for it.”

Nevertheless, Krilich said he didn’t want to minimize the severity of illness suffered by some patients battling the contagion. And he said asymptomatic people can lead to more virus spread and endanger those who are more vulnerable or susceptible to severe symptoms.

Hospitalization concerns

Of all the coronavirus tracking metrics the public has come to know or at least get familiar with — including case rates per 100,000 residents and positive testing rates — increasing hospitalizations has been among the most worrisome for county public health officials.

“Hospitalizations are important because they tell you who's getting really sick, and they tell you something about vulnerable populations, and how much vulnerable populations have been impacted by COVID,” said Dr. Sundari Mase, the county’s health officer who has orchestrated the community pandemic response.

Mase said the recent spikes in hospitalizations and related deaths of COVID-19 patients — the local death toll stands at 16 with 11 of them since June 28 — is tied to recent outbreaks in skilled nursing and residential care facilities. In recent weeks, the county has seen at least seven COVID-19-related deaths of senior care home residents, including five who lived in a skilled nursing home.

“There is no mistake that we've had a significant increase in hospitalizations due to our skilled nursing facility outbreak,” she said.

Better positioned for the worst

Local hospital officials, doctors, nurses and medical staff have learned a lot since March when they were planning for the unknown, a hypothetical surge based on computer models that predicted 600 to 1,500 virus patients at once needing hospital care.

Deborah Burger, a longtime local Kaiser nurse and a president of National Nurses United, said a major difference between today’s surge planning and that of a few months ago is the ability to quickly test patients for COVID-19.

That allows hospital staff to better plan patient care, which is crucial since hospitals now expect to manage both COVID-19 patients and regular patients, Burger said. Anticipating a surge early in the pandemic, hospitals canceled all elective procedures, which greatly reduced patient volumes.

Although confident area hospitals should be able to handle a steadily increasing flow of virus patients, Burger warned that nurses and other health care workers continue to endure inadequate supplies of personal protective equipment, especially N-95 masks.

Hospitals are stockpiling the masks and in some cases asking nurses to wear the same mask for a week, Burger said, noting the inherent risks. Hospitals can’t afford to let nurses and other health care workers become ill with the virus, she said.

Equally important, the veteran Kaiser nurse said, at the beginning of the pandemic, Sonoma County residents took the public health emergency seriously. That could easily change, she said, if people "decide that they’re fed up with social distancing and limiting encounters with groups.“

This public resistance to mask wearing, and staying a proper distance apart from anyone but family, has greatly contributed to the virus roaring back with a vengeance in other parts of California and in Florida, Texas and a few other states.

Krilich, the St. Joseph Health chief medical officer, agreed. He said the benefits of responsible behavior by Sonoma County residents in the spring, and that continues, enabled the community to gain an edge reducing the worst of the virus threat. Although the county now is struggling mightily to keep the virus in check, an infamous surge that could overrun local hospitals with patients so far has been avoided.

If people let their guard down, though, and ignore public health recommendations, such as wearing facial coverings, social distancing, practicing good hygiene and avoiding large groups, Krilich said any gains against the virus would vanish and it would have the upper hand.

“If people choose not to wear a mask, we won’t have the benefit that we’ve had thus far,” he said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.