Inland hospitals are preparing to treat more COVID-19 patients in the coming weeks than they ever have before — and they’re worried it could get worse after that.
Numbers from just before Thanksgiving show Riverside, San Bernardino and Los Angeles counties on track to break records for the number of coronavirus patients — set this summer, shortly before record numbers of deaths were recorded — within the next few days. And holiday gatherings could push the number higher soon afterward.
Some hospital administrators say they’re not sure how they’ll handle the influx.
“I called a number of hospitals this morning in the western region of San Bernardino County,” John Chapman, president and chief executive officer of San Antonio Regional Hospital in Upland, said Wednesday, Nov. 25. “And to a hospital, they are like us — they are bursting at the seams.”
The hospital is close to 99% capacity, and had over 35 patients in the Emergency Department — including eight critical patients — waiting for beds as of 8 a.m. Wednesday, he said. Most of that overflow group was sent to other hospitals.
“I think I’m good another week or two, but it can’t keep growing like this week after week,” Chapman said. “That’s why I’m praying that there are more restrictions put in place for our county.”
Emergency officials for Riverside and San Bernardino counties say that the system overall still has room to treat more patients, especially if they cut back on elective surgeries and other services.
In Riverside County, for instance, the number of COVID-19 patients still hasn’t gotten close to the number of people hospitalized in the worst recent flu year — December 2017 to January 2018 — said Bruce Barton, director of the county’s Emergency Management Department.
“The issue with COVID is the workload that comes with COVID patients,” Barton said, noting that severe cases result in longer hospital stays than severe flu cases. “Even though the surge is lower, it’s not actually an apples-to-apples comparison. People are tired. Hospital administrators are concerned about their staff. And they’ve been doing it since the pandemic began.”
After peaking this summer, hospitalizations are rising across California.
San Bernardino County had 606 people hospitalized Tuesday, Nov. 24, just 32 people below the peak of 638 people hospitalized July 25, according to state figures. With an average of 27 more people being hospitalized with COVID-19 each day for the past week, the state database is likely to soon show new records.
Riverside County reported 455 coronavirus patients hospitalized, which is 95 people below the peak of 550 on July 14. It’s been adding an average of 15 hospitalizations per day over the past week, so it could top 550 within a week if the pace stays the same.
Los Angeles County had 1,809 people hospitalized with COVID-19, which is 423 people less than the July 18 peak. Over the past week, the number has increased by an average of 82 per day — but that’s increasing each day, and shortages in hospital beds and intensive-care beds are projected over the next two to four weeks, the county’s predictive modeling team said Wednesday.
Hospitalization numbers always reflect the situation from at least one day earlier and are set to be updated Friday, Nov. 27, because of the holiday.
In the Inland Empire, officials say the number of beds isn’t the problem. And unlike earlier in the pandemic, neither is ventilators or personal protective equipment. The issue is the number of medical professionals.
Field hospitals prepared early in the pandemic — in response to overflowing hospitals in other countries that saw coronavirus hit earlier — are ready to go in Riverside and San Bernardino counties.
“We have demobilized the equipment but we have not moved it off-site, so in a severe surge we could operate those,” Barton said. “The challenge there is going to be staffing. If we did operate those, we would need state and federal help with staffing.”
And that could be challenging, as the rest of the state also faces surges, and in many other parts of the country, it’s worse.
“In July, you could bring in (assistance) from the northwest or the Midwest to supplement your staff,” Chapman said. “But right now, with every state having this, the cavalry isn’t out there.”
The number of beds available can also paint an incomplete statistic, said Justine Rodriguez, a spokeswoman for Arrowhead Regional Medical Center in Colton, which tracks capacity issues for San Bernardino County.
“For example, a neonatal unit bassinet and the staff needed to care for that neonate are not appropriate for an adult with COVID-19,” Rodriguez wrote in an email. “COVID-19 patients in need of hospital care tend to be adults and about 25% of them need intensive care beds that are in finite supply. Additionally, infection prevention protocols can reduce bed availability below normal bed capacity.”
While Riverside County doctors and nurses are prepared for more hospitalizations, that’s also exactly what they expect, said Bob Blair, CEO of Southern California Permanente Medical Group for the Riverside area.
“We’re very concerned things are going to go up after Thanksgiving,” Blair said.
In the past, Kaiser Permanente officials have predicted how many hospitalizations they will soon have by tracking how many people are being tested for coronavirus and what percentage of them are testing positive. Those figures predict — close to one out of every 10 people being tested in Riverside County is positive — suggest an increase in several weeks even if Thanksgiving doesn’t cause a further spike, he said.
If and when that spike comes, Kaiser Permanente plans to move staff and resources from from its non-hospital operations to cover hospitalized patients.
New procedures put in place during the pandemic will also help, he said, such as increased use of telemedicine. Last year, about 15% of Kaiser Permanente’s care was virtual, compared to about 55% now, Blair said.
That even includes some serious coronavirus patients who have mild or moderate symptoms and don’t require hospitalization — and so aren’t included in the hospitalization figures.
“We basically admit them to their home,” Blair said. “Staff monitor them, a doctor or nurse practitioner checks at least once a day, and if they get worse, we bring them back. We have about 60 people active on the remote program who have pretty significant symptoms but they don’t need to be in the hospital.”
San Bernardino County also plans to delay procedures that aren’t urgent and use space such as conference rooms for beds.
And, across the Inland Empire, doctors and nurses pleaded with people to wear masks, wash their hands regularly and stay 6 feet from other people.
“The light at the end of the tunnel is that we’ll have a vaccine soon, but we need people to do their part until then,” Blair said. “If you’re not worried about yourself, worry about your family members, and remember that even healthy people die of this disease sometimes … We’re prepared, and this isn’t doomsday. But we need people to do their part.”
