‘It’s intimidating.’ Sacramento hospitals battling a coronavirus patient surge

An alarming surge in coronavirus cases since June in Sacramento is sending a record number of patients to local hospitals and hastening questions many feared: Are hospitals ready? How much can they handle?

“It’s intimidating,” Dr. David Witt, national infectious disease leader for Kaiser Permanente, acknowledged last week. Kaiser runs three hospitals in the Sacramento area and is seeing a sudden rise in patients. “How high the (surge) ceiling is, we don’t know yet.”

As of Monday, COVID-19 patient numbers in Sacramento County hospitals had jumped to 142, the most ever, and far above the low of just seven hospitalized virus cases six weeks ago. Of those, 42 are in intensive care, up from a low of two in late May.

Leaders of key local hospital chains say they are concerned about those increases, but say the current caseloads are under control and are no longer disrupting other hospital activities as they did during the early days of the crisis when less was known about how to handle COVID-19 patients.

Heads of UC Davis Medical Center, Kaiser Permanente, Dignity Health and Sutter Health said California’s early “stay-at-home” order, issued in mid-March, gave them the chance to learn and prepare for potential surges and could hopefully keep them from being overwhelmed in the way that healthcare facilities in China, Italy, and New York were.

For the moment, local hospitals report they have more than enough beds to handle what could be hundreds more patients this summer and fall. But intensive care unit beds are limited, and could fill if the state and county can’t tamp down the currently fast-growing number of infections.

“I am optimistic that we will handle it,” Kaiser’s Witt said. “I’m not looking forward to it. But we will handle it.”

Gov. Gavin Newsom, who says hospital patient numbers are the first data points he looks at each morning, mandated a new set of business closures last week and ordered mandatory face-masking in public to stem the rising caseloads. His administration has teamed up with federal officials to prepare a possible temporary overflow hospital inside the Sleep Train Arena in Natomas.

Sacramento County health officer Dr. Oliva Kasirye on Monday said she is concerned by the rising patient numbers, but is hoping the new infection rates will drop in the next few weeks as more people wear masks and as a result of the county shutting down bars and indoor dining at restaurants last week.

As they begin to deal with daily arrivals of patients, Sacramento health care providers say they have created a mutual support effort via teleconferences to share updates several times a week.

“We don’t want one hospital to be overwhelmed,” said Dr. David Lubarsky, UC Davis Health CEO. “We’re committed to helping each other.”

A state website on Monday suggests Kaiser Permanente in south Sacramento had 40 COVID-19 patients, followed by Sutter General with 27 and UC Davis Medical Center with 19.

COVID-19 deaths are down

A notable and positive aspect of the current surge of infections is that fewer patients are dying. Healthcare officials continue to point out that increases in deaths typically happen several weeks to a month after an increase in infections hits, which may mean a mortality surge is about to hit in California

However, hospital officials in Sacramento report another reason for guarded optimism: The new wave of patients in hospitals in June is younger than what officials saw in April and May.

“We don’t see the patients coming in now as sick as they were earlier,” said Laurie Harting, chief executive officer of Dignity Health’s Greater Sacramento Division. “They’re able to fight the disease more aggressively, versus the elderly who have more health problems and can’t fight it off as hard.”

But, she said, the virus has severely attacked some younger patients as well. “That’s a little scary how it attacks some people so differently from how it attacks others.”

The virus has been found to be more dangerous for people with existing, underlying health issues. Unfortunately, that’s a lot of people, Lubarsky of UC Davis said. “Most of America has co-morbidities. I don’t think people think of themselves as ill if they have high blood pressure or obesity or diabetes, (but) those are co-morbidities.”

UC Davis has treated 100 virus patients

Four months ago, when the first COVID-19 hospital patient in Northern California arrived from Solano County in an ambulance at the UC Davis Medical Center in Sacramento, it stoked alarm in the broader community and among medical center staff.

UCD Medical Center was used to dealing with viruses, but this one was new. It was a mystery.

Since then, the state-run teaching and research hospital has become one of dozens of cutting-edge facilities in the country that has used the interval to understand the virus better and figure out treatments.

Of the 100 patients UC has since treated, 10 have died. Among those who died, though, were eight people either on hospice or who had given orders not to be resuscitated.

Lubarsky, UC Davis Health CEO, said hospital staff have set up COVID wards, have learned more about drug treatments and have gotten a better idea of when and – more importantly – when not to use ventilators.

The UCD hospital has 84 adult beds in its intensive care units but has the ability to expand to 200 in an emergency. Both the COVID ward and the COVID ICU spaces are separated from the rest of the hospital and have their own air supply.

“We’re ready again if, God forbid, there is a resurgence of COVID-19 either this summer or in the fall,” Lubarsky said. “We stockpiled (personal protective equipment), stockpiled ventilators, stockpiled the extra beds.

“We never know when we’re going to get hit with a surge of patients immediately requiring intensive care.”

UC Davis and several other UC medical centers run their own COVID-19 tests and can deliver results in three hours, allowing medical teams to quickly determine who to admit to the hospital.

The same-day testing goes for employees as well, Lubarsky said.

“If they have COVID-19, they are not allowed to come back to work until they have negative tests,” Lubarsky said. “So we’ve really secured the workplace in terms of not being a spreader of the disease and in preventing people who might bring in the disease from the outside from spreading it among their coworkers.”

Dignity Health contemplates ‘new normal’

Dignity Health, the largest non-profit hospital association in California, runs facilities in Sacramento, Carmichael, Folsom, Grass Valley, Woodland and Stockton.

Realizing that each of its hospitals should not be left on its own, the system set up a regional “command center” to coordinate COVID response across the Greater Sacramento Division, said Laurie Harting, chief executive officer of Dignity Health’s Greater Sacramento Division. Dignity’s parent company, CommonSpirit Health, subsequently did the same across its national network.

“We’d go over the data every day. We’d look at our supplies. We’d find out if there were gaps,” Harting said. “If one hospital was short of something, we’d identify that right away and trade, so our other hospitals could make sure that each hospital had enough supplies. We are helping each other.

“We also wanted consistency, standardizing things and using best practices.”

Dignity appears to have enough available hospital beds for a serious surge, Harting said. “Right now, we’re running about 65 to 70 percent occupied, so the beds are there. We’re monitoring very carefully and every day.”

Harting said, in the aftermath of the pandemic response, there almost certainly will be long-term changes in how hospitals will function, but she doesn’t know yet what those changes will be.

“We’re always evaluating what the new normal will be,” she said, “what our new hospital volumes will be, and we flex (staffing) to that, so as positions are coming vacant, we’re not filling them right away until we better understand what that future is going to look like.”

Sutter Health: Shuttling patients between hospitals

Sutter has positioned itself to increase its “critical care capacity two to three times” if necessary in the coming months, said Dr. William Isenberg, Sutter Health’s chief quality and safety officer, in an email to The Bee.

The health care giant operates in 22 counties, and has plans to shift patients and resources from one facility to the next, depending on COVID-19 caseloads.

For the moment, the recent surge in cases has not altered daily activities at Sutter, Isenberg said. “While we are experiencing case increases in some counties, the hospitals in those areas have not experienced impacts that would affect their usual operations.”

“Sutter Health worked closely with state officials and other healthcare partner organizations to comprehensively prepare for a surge in patients and maintain that readiness,” Isenberg wrote. “Because our community-based hospitals, surgery centers and ambulatory clinics are interconnected, we can move people and resources — whether that’s personal protective equipment, ventilators or beds — to where they are needed most.”

The system initially cut back on many non-essential treatments, Isenberg said, but in recent weeks they have been “gradually broadening clinical services and caring for those patients with medically necessary, time-sensitive procedures and preventive care needs like cancer screenings, immunizations and other necessary clinical services. We continue to take a careful, phased approach that prioritizes the safety of our patients, employees and clinicians.”

Kaiser pushes preventive care

The time interval between the initial pandemic cases in March and the June surge gave Kaiser a chance to come up with new protocols and plans.

“We are fairly well prepared for this,” Witt, the Kaiser infectious disease leader, said. That said, “every battle plan is great until the battle starts.”

Part of his concern is the sheer number of potential cases.

“Ten percent of the population (has been infected) in the first wave. That means 90 percent are still vulnerable,” he said. “Until there’s effective vaccine, this will be the new normal. There appeared to be some immunity, but it wanes.”

While preparing for more COVID-19 patients, Kaiser officials also have been asking how they can increase the level of preventive care among their clients so that fewer of them might get serious cases of COVID.

The healthier the general population is to begin with, the better equipped it will be to fight the disease.

“How do we make sure we deliver as much preventative care as this becomes the new normal?” he said. “It is going to need a lot of creativity, and we will need to re-examine mandates to health care.”

In other words, some of what is called elective surgery or care is in fact preventive care.

“We need to examine this misnomer of elective procedures that are shut down” so that there will be hospital space available for COVID patients. “Screenings for colon cancer, mammography, diabetes control. This is all necessary, not elective.”

Ventilators and treatment changes

Hospital officials in Sacramento said one of the key discoveries during early treatment of COVID patients is that ventilators are not the best option in many cases. Studies nationally and experiences locally have shown that many severely sick patients do better if offered other treatment protocols.

“In the beginning of this, especially in New York, everybody had a breathing tube and a mechanical ventilator, and that apparently made worse the lung inflammation, and now we know that’s not the way to go about it,” Lubarsky said. “We really changed our treatments. What we’ve learned is we don’t want to intervene too early and too dramatically.”

Dignity Health officials echoed that: “The doctors have learned a lot about how to treat COVID, and more aggressively without intubating every patient,” Harting said. “Before, we were putting patients on ventilators and we found that using different therapies, different medications combined can get patients off the ventilators, and they end up going home faster.”

Dignity is treating patients with “convalescent plasma (therapy),” administering plasma donated from recovered COVID patients.

The anti-viral drug remdesivir has been “helpful,” Dignity officials said, but is in short supply at the moment.

UCD Medical Center is doing clinical trials, including with the corticosteroid dexamethasone.

Fear factor among employees

Hospitals report they have taken steps to not only protect their employees – focused on mask wearing – but to also calm their fears about their work environment and about bringing COVID back to loved ones at home.

That’s led to better treatment for patients, Lubarsky said. “Show (employees) how they are protected, and that alleviates some of the personal health fears they have and helps them do a better, more thorough job of helping patients. Fear ... makes you develop different patterns of work that interfere with the processes that are tried and true, if you will.”

UC Davis Med Center has had some employee infections, and some of that has been spread from other employees, Lubarsky said. People “were aggregating around the water cooler in the break rooms and chatting and sharing stories, and that turned out to be a risk, too.

“We instituted a wide range of policies to encourage people to stop doing that. We changed the way we did rounds on the floors, so that we didn’t have physician and nursing teams trading their germs among themselves. That’s made a big difference.”

Patients afraid to show up

Hospitals are seeing fewer heart attack patients since the virus showed up, but Witt, of Kaiser, says, “I don’t think heart attacks have gone away.” Instead, patients are staying away out of fear of catching COVID.

That has begun to change lately. Dignity has been scheduling more elective surgeries and is back to pre-COVID levels, Harting said. Still, she said, “we’ve noticed a negative trend. People are afraid to come to hospitals when they have symptoms of something serious. I just encourage community members: If you feel ill, the hospital is the safest it’s ever been for you to come in and get checked out.”

“We always screen all patients before they come into the hospital to be sure they don’t have signs or symptoms. So, if you’re having chest pains or you’re feeling dizzy or you have signs of a stroke, please get medical care right away. “

UC Davis Med Center’s Lubarsky reports his facility is now seeing people show up in worse shape because they put off visits to the medical center during the early months of COVID.

“We’re going to see more disability. For people who had a stroke, maybe they didn’t die, but they had more disability because they didn’t receive care right away.

“We think it’s really, really important that we are open for patient care that has been put off too long. What we’ve seen (nationally) is a lot of people dying from other diseases, probably because they didn’t get care early enough.

“We’ve got to get people back to coming in and trusting us. That’s actually more important than the little risk of being exposed to COVID-19. There’s really zero risk.”