SACRAMENTO, California (AP) – The California government, Gavin Newsom and the Association of State Hospitals disagree on the best way to create space for critically ill coronavirus patients in medical facilities that are already under pressure and soon to be overwhelmed could be due to the anticipated wave of new instances of holiday gatherings.
A wave after Halloween and Thanksgiving created record hospital admissions and now the most seriously ill patients are dying in unprecedented numbers. California health authorities reported 583 new deaths and a record two-day total of 1,042 on Thursday.
The state has deployed 88 refrigerated trailers, up from 60 a few weeks ago, for use as makeshift morgues, mostly in hard-hit Southern California.
Hospital admissions are approaching 22,000 and according to state models, the number could reach 30,000 on February 1. Already, many hospitals in Los Angeles and other hard-hit areas are struggling to keep up and are warning that they may need care as beds in the intensive care unit are shrinking.
Earlier this week, state health officials bombarded and left hospitals with new orders restricting non-essential surgeries and requiring hospitals with scarce ICU space to take in patients from those who have run out, a warrant that may require transporting hundreds of miles.
The California Hospital Association said the orders don’t go far enough to address a crisis that “cannot be overemphasized.” It wants changes, including reducing the paperwork that it says takes hours every day from nurses who would otherwise be treating patients.
Carmela Coyle, the association’s chairman and general manager, said the group is negotiating with state officials, but they are not moving quickly enough.
“We need to act really fast to coordinate and see if we can take the burden off the health care system – focus on nothing but saving lives for weeks to come,” she said.
State epidemiologist Dr. Erica Pan replied on Thursday that the government “is committed to continuing to work closely with hospitals and local leaders.” She said state officials “appreciate any suggestions from those on the ground who are fighting this pandemic every day.”
In the meantime, in an effort to keep people closer to home, the Newsom administration issued a tougher travel advisory that says out-of-state residents are ‘strongly discouraged’ from entering California, and Californians would travel more than 120 miles from home.
The state’s advice in November encouraged people to stay at home or in their area without giving up a set number of miles. It outlined quarantine guidelines for out-of-state travelers, but didn’t explicitly discourage travel.
Dr. Rajiv Bhatia, an associate assistant professor of medicine at Stanford University and a former director of the San Francisco Department of Public Health, questioned the effectiveness of a distance requirement, noting that it will be difficult to force and that people may be tuning in yet another piece of state guidance. He said that by and large California has not provided enough data to back up restrictions.
“They just don’t want to give anyone a chance to communicate,” he said.
People who travel more than 120 miles are more likely to access commercial services such as hotels, a California Department of Public Health spokesperson said, noting that the distance is fair for rural and city residents.
Coyle said the hospital orders issued Tuesday do not provide the assistance hospitals desperately need.
Most hospitals affected by the nonessential surgery order have canceled all the kinds of procedures that have been blocked by the state, such as non-urgent surgery to release the spine or carpal tunnel, she said. It only applies to hospitals in 14 of the 58 counties, all in Southern California and the agricultural San Joaquin Valley, two regions with the most pronounced shortage of ICU beds.
Coyle said it’s also unclear how often the wire transfer command will be used. While it could mean sending patients hundreds of miles to Northern California by ambulance, rescue helicopters or other aircraft, transfers between nearby counties are more likely to be facilitated, she said.
In an earlier wave, patients in Imperial County were sent to hospitals along the border with Mexico as far as the San Francisco Bay Area. But the current outbreak is so widespread that only 11 mostly rural counties north of Sacramento and San Francisco are above the state threshold to have at least 15% capacity for coronavirus patients on ICU beds. More stringent restrictions apply to companies below that level.
UC Davis Health, which has the main trauma center in the Sacramento area, said it has not received any transfer requests. A spokesperson there and from the Sutter Health system both referred questions to the hospital association, while Kaiser Permanente did not immediately comment.
“If we can get patients in the right setting to start with, it will minimize the need to transfer patients afterwards, and that is frankly just better for patient care,” said Coyle.
That means California must begin coordinating patient care at the state level, where officials can see the big picture of the best-equipped hospitals at any time, rather than allowing local coordinators to follow common practice to send ambulances to the nearest facility, she said.
“Yes, transferring patients is important, but we have some big issues that need to be resolved,” she said. That includes temporarily suspending prescriptions that she said can tie nurses to paperwork for hours and make it difficult to use a team approach when delivering intensive care when hospitals don’t have enough intensive care nurses.
Stephanie Roberson, director of the California Nurses Association, said team nursing is a cost-cutting move that would undermine patient care after hospitals failed to properly prepare for the wave.
“It’s a slap in the face of safe patient care to call charts and documentation ‘bureaucracy,'” she said.
Pan said the state’s measures will “save lives,” as officials strive to get staff and resources from hospitals.
State health officials did not respond to questions about how they expect health regulations to be applied or how many patients or hospitals could be affected.
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Associated Press writer Kathleen Ronayne in Sacramento, John Antczak and Christopher Weber in Los Angeles, and Janie Har in San Francisco contributed to this story.