In summary
California hospital officials talk to CalMatters’ Ana Ibarra about preparations the projected surge of COVID-19 patients — and life after the pandemic.
California hospitals are bracing for an incoming “storm” of COVID-19 patients in the next few weeks, racing against the clock to obtain more beds, ventilators, staff and protective gear.
This coronavirus pandemic is unlike anything they had prepared for, hospital leaders said Thursday.
Carmela Coyle, CEO of the California Hospital Association, and Dr. Stephen Lockhart, chief medical officer for Sutter Health, a medical and hospital system in Northern California, said hospitals will likely be stretched thin for resources, if they aren’t already. In a conversation with CalMatters health reporter Ana Ibarra, Coyle and Lockhart discussed the response to the pandemic — which in hospitals has been all hands on deck.
“The state’s model shows we will really begin to see the ramp-up of the surge literally in the next few days,” Coyle said. Hospitalizations are expected to peak in mid-May.
“We’re hopeful that the stay-at-home policy that the governor put in place is going to be the factor that changes and flattens the shape of the curve,” she said.
To be ready for the influx, California needs about 50,000 more hospital beds. Especially important are beds in intensive care units (ICUs).
“Critical care beds are the ones where the shortages are going to be the most devastating as far as our ability to care for patients,” Lockhart said. At the start of the pandemic California’s 416 hospitals together had about 11,400 ICU beds.
“When I say we’re increasing up to three-fold our capacity, those are the beds we’re increasing,” Lockhart said.
Critical care beds must be equipped with life-saving hospital equipment and staffed by appropriately trained nurses, doctors and respiratory therapists. Ventilators, which help patients breathe, are particularly crucial in the treatment of COVID-19.
“There is not a state in the United States that has the number of ventilators they would like,” Coyle said. That shortage has prompted a worldwide scramble to find or repair existing ventilators, swiftly manufacture new ones, and retrofit other hospital equipment to act as an alternative.
“Anesthesia machines which we typically use for anesthetizing patients for medical procedures have ventilators on them. Those ventilators can and will be put into use,” Lockhart said, who is also an anesthesiologist.
Certain types of CPAP machines also have a ventilation mode, Lockhart said. “We’re looking at all options for every piece of equipment that we have,” he said.
Also complicating California’s response is the breadth of this crisis, Coyle said.
“Unlike some of the disasters we deal with in the state of California — a fire, an earthquake, a mudslide — they tend to be isolated in one particular area and we as a state are then able to muster lots of resources and send it into that particular area,” she said.
COVID-19, she noted, affects the whole state at once: “We’re in a circumstance — which is why this is a pandemic — that we’ve never been in in most of our life times. This will be statewide, it will take every resource.”
The financial toll of the pandemic is also expected to be deep and long-lasting, particularly for medical centers. Elective surgeries are the lifeblood of every hospital, Lockhart said, and those are being cancelled to free up beds for COVID-19 patients.
Some hospitals, Coyle said, are losing between 20% and 30% of their revenue, and smaller hospitals up to 60%.
“I don’t mean to be alarmist,” Coyle added, but “I believe the entire health care delivery system, every hospital, will be in very serious financial trouble.”
The pandemic could also prompt fundamental change in the way the state and counties deliver health care, however, she said.
“Things will be different,” Coyle said. “We all wonder about what the frequency of another pandemic like this might look like. They are rare, but perhaps the way viruses are evolving we might need to consider rethinking the capacity of the health care system in the United States and how we make that happen.”