L.A. is overwhelmed. How Sacramento hospitals are trying to avoid their own COVID crisis

Southern California hospitals are in crisis mode, overwhelmed with COVID-19 cases and, in some cases, rationing care. Are Sacramento County hospitals next?

Intensive care unit space at Sacramento hospitals has dropped to 10%, and officials say they are now girding for a potential “surge upon a surge” stemming from infections likely spread during Christmas and New Year’s gatherings.

In the last week, the November/December surge of new hospital cases has plateaued. But, “resources are stressed,” said Edmundo Castañeda, president of Mercy General and Woodland Memorial hospitals for Dignity Health, which has six local hospitals. “We are concerned about what is going to happen in the next week or two.”

Here is an overview of issues facing Sacramento hospitals based on interviews with three of the region’s largest entities: Kaiser Permanente, Dignity Health and Sutter Health. UC Davis Medical Center declined to make an official available to answer questions for this article, telling The Sacramento Bee in an email, “our team feels it is prepared to care for increased numbers of patients.”

Sacramento hospitals not in COVID crisis yet

Hospital leaders say they have not yet hit the crisis level seen in Southern California. And they hope not to. But they are in surge mode, which means they have expanded ICU beds, added and reassigned staff, and stocked up on equipment and drug therapies.

“If the surge is bigger than projected, it could outstrip our resources,” said Dr. Rob Azevedo, Kaiser’s chief physician in Sacramento. “That is when you make difficult choices. That is what we want to avoid.”

Lack of oxygen supplies for respiratory patients

In Southern California, hospitals have been running low on oxygen, which is typically provided to most COVID-19 patients from oxygen tanks and ventilators. The state is attempting to send oxygen supplies to the south state.

In Sacramento, Kaiser Permanente officials say they already have begun “managing” their oxygen supplies, but not withholding them from patients who need help breathing. Instead, they are taking better care to give patients the correct amount, they say, and not more.

Dignity Health officials say they are not in that position, but are sending oxygen and other COVID-19 resources back and forth among six facilities in the Sacramento region, depending on which ones need more supplies.

Ambulances backed up outside overcrowded ERs

In Los Angeles, ambulances are waiting in line for hours at times to be allowed to transfer patients into overcrowded hospitals. There was one report of an ambulance waiting eight hours. In some cases, first responders are told not to bring patients to the hospital if that person has lost vital signs and cannot be resuscitated by EMTs.

In Sacramento, ambulance officials report “wall time” is increasing. “Ambulances are tied up (waiting to drop patients off) at hospitals,” said Roberto Padilla, spokesman for the firefighters union. That means ambulances may have to come from longer distances when called to someone’s house or an injury scene.

Lack of refrigerated space to store the deceased

Some hospitals in California have run out of refrigerated space to hold the bodies of patients who have died from COVID-19. The governor last week announced that the state has obtained 88 refrigerated corpse storage trailers and has already sent some to Southern California medical centers.

In Sacramento, the county coroner told The Bee its facility already has two extra refrigerated units ready to help hospitals. Dignity Health officials acknowledged they could see themselves calling on the state for one of the refrigerated trailers.

“That is something that is on our mind as the surge continues,” said Dignity’s Castañeda, who oversees Mercy General and Woodland Memorial hospitals.

Lack of beds and hospital staff

Most Sacramento-area hospitals have expanded their ICU units, moving some patients into the post-operation rooms or turning other areas of the hospital into an ICU.

California Hospital Association CEO Carmela Coyle said that COVID-19 patients require a specific type of acute care.

“When people show up at the hospital, they need two things — either high-flow oxygenation which requires them to be put in a medical surgical unit with special equipment or ventilator care or ECMO (extracorporeal membrane oxygenation) which requires intensive care unit capacity,” Coyle said, “and so while hospitals are often big places, the kind of care needed by COVID-19 patients is very specific, very acute.”

Sending patients home early

Sutter Health a few weeks ago changed protocols to allow less ill patients to remain at home, with oxygen support, who previously would have been admitted to the hospital. Adventist Health has been taking this approach for some months now, using home monitoring technology. Similarly, some people who in other times might be admitted to the ICU are being treated in other areas of hospitals.

“The only people making it to ICU are the slam-dunk ICUs,” said Dr. Vanessa Walker of Sutter Roseville Medical Center.

The biggest problem, as the expected peak surge approaches, is staffing. Hospitals uniformly report staffers are overworked and stressed. Kaiser officials say they are looking to hire nurses and respiratory therapists, but are competing with hospitals nationally for those employees.

Coyle said hospitals need to expand cross-training of nursing staff.

“If we don’t have enough nurses for the intensive care unit, as an example, how can we take one of those critical care nurses and partner him or her with other nurses throughout the hospital?” she asked. “They’re all practicing at their level but working as a team, and will allow us to care for more Californians.”

Some counties block patient transfers to skilled care

Hospital leaders say a breakdown in the normal patient flow to skilled-care facilities means they have no room for patients coming to them for treatment for illnesses other than COVID-19.

“We have challenges discharging patients to other parts of the health care system when they are no longer in need of that acute care,” said California Hospital Association CEO Coyle. “It is creating a bottleneck within our hospital setting.”

Coyle said many of these policies are holdovers from when medical professionals knew far less about the COVID-19 disease, how to separate patients who have it from those who don’t and how to safely manage the care for both populations.

Months ago, there was concern about whether transfers added to a spread of the disease, Coyle said, but that has been addressed by the state with a much more thoughtful review of patients and increased testing capabilities.

Good news: Seasonal flu numbers low

Hospital officials report that flu season appears to be mild, so far. The COVID-19 pandemic may, in fact, have helped reduce flu infections because many people have been wearing masks, social distancing, washing hands and often avoiding contact with others.

“We still have a little to go to see what the flu season is like,” Kaiser doctor Azevedo said. “We are all wearing masks, social distancing. Those are the same measures that reduce the flu.”

Bottom line: Hospitals may see relief soon

Vaccinations are well underway in hospitals throughout the region. When those are done, more hospital workers will be available for shifts, because fewer will be quarantined for exposure to the virus or because they have tested positive.

“It was a very emotional day when I got mine,” Kaiser’s Azevedo said. “I now feel like I have been given an incredible opportunity to stay healthy to keep our community healthy. We see this as the way out of this pandemic.”

That alone has cheered up hospital workers as they head into the second year of dealing with the pandemic.

“There is hope. There is light at the end of the tunnel,” said Castañeda of Dignity Health.