As COVID-19 cases surge, how are hospitals coping with the strain?

With staffing shortages and less than 2% of beds available in Intensive Care Units (ICU), hospitals in California are struggling to come up with strategies to combat the COVID-19 surge.

California saw over 32,000 new cases reported today and over 18,000 people currently hospitalized, the state is currently at more than double its previous peak, which was in July. There is no end in sight with current CDC projections seeing this surge continue into January. 

 

 

While hospital staff and at-risk communities are receiving the first round of the vaccine roll-out, the vaccine will not be available to the general public for months. Hospitals in Southern California and the state in general are grappling with how to handle the surge.

The most contentious strategy so far: the Newsom Administration allowed hospitals to relax the patient-to-nurse ratios in acute care settings. California’s nurse-to-patient ratio law is unique to the state and has been in place for 15 years.

A single nurse in the ICU can now be asked to care for three patients instead of two. Nurses in units where patients are under electronic monitoring patient numbers can be increased from four to six, and in surgical wards five to seven. 

This move was contentious with nursing unions because of the amount of strain this puts on a single ICU nurse, who often has three very critical and complicated cases that need their full attention and care.

“This organization is vehemently opposed to any changes in the landmark nurse-to-patient ratio law,” said Stephanie Roberson, government relations director for the California Nurses Association. “Any change is going to result in patient harm and death at a time of the pandemic that we don’t need that. We would never negotiate or collaborate on this proposal that would almost certainly bring harm to our patients.”

Governor Gavin Newsom also put out a renewed call to recently retired healthcare workers and newly graduated doctors and nurses to help combat the most recent surge of the virus. This program, called the California Health Corps, was established in late March and was intended to deploy workers to surge points. But with a statewide surge currently happening, workers are needed everywhere.

Travel nurses were also a key strategy to coping with surges in coastal states in the spring. These nurses moved to these states for often short contracts and will continue to move to different states and hospitals as the need arises.

“We’ve had nursing shortages for years, particularly in high-end positions like ICU nurses, emergency room nurses,” Dr. Timothy Brewer, epidemiologist and professor of medicine at UCLA’s Fielding School of Public Health told AirTalk. “That’s always been a challenge, and it’s exacerbated by the fact that we’re seeing a national rise in COVID cases.”

In the spring it was easy to send nurses from other states to where there was a surge, but now with the nationwide surge in cases there is no extra capacity in the system, Brewer added.

State officials have also considered requesting the USNS Mercy Hospital ship back to the Port of Los Angeles. They have also requested 10 teams of 20 health care workers from the Department of Defense.

Hospitals have also considered quick-training nurses to work in ICU positions, which are often highly specialized positions that need extra training. But this does not address the core problems: occupancy levels in the ICU are at an all time high and there are a lack of beds available both in the ICU and the emergency department (ED).

ICU availability to treat the sickest COVID-19 patients was at 0% last week in the 11 counties that make up Southern California.

While that doesn’t mean there are no open beds, officials say they have to keep space open for non-COVID patients, too. L.A. County, home to more than 10 million residents, reported fewer than 100 ICU beds available on Dec. 17th. That number went down again the next day.

Hospitals have started moving patients that can be cared for in the ED to that department. But this has also caused a shortage of space and personnel needed for emergencies that still happen regardless of the pandemic.

Last week hospitals in Orange County were diverting ambulances to the point that when people called 9-1-1, dispatchers had to tell callers to find a different way to the ER because there were no ambulances available for emergencies. The Orange County EMS Director Dr. Carl Shultz had to order hospitals to stop diverting ambulances.

To continue to fight this surge hospitals are cancelling elective surgeries like hip replacements to free-up beds. Health care workers are also pleading with residents to stay home, and to not gather for the holidays.