COVID cases may have peaked, but hospitals still face a torrent of patients

The pace of hospitalizations has slowed somewhat in the past week, but the numbers are still rising daily and aren't expected to level off for another week or two, according to state forecasts.

Nationwide, over the past week, 150,000 people a day were in the hospital with COVID, more than at any other point in the pandemic. Several Bay Area counties, including San Francisco, have already surpassed their previous peak for hospitalizations.

“Omicron has been really tough. It came very quickly and hit hard,” said Dr. Susan Ehrlich, executive director of San Francisco General Hospital. A month ago, the hospital only had one COVID patient, but as of Wednesday it had 64, he said.

“Just the pacing made it really challenging, and then the massive impact it had on staffing, much more so than previous surges,” Ehrlich said. "And it's at a point where we're two years in and we're very, very tired of all of this."

The upside is that most COVID patients are doing much better this winter than last because many of them are vaccinated and omicron causes milder illness for many people. One-third to one-half of hospitalized patients who have tested positive for coronavirus do not have any symptoms of COVID and are being treated for some other medical condition.

Milder illness overall means intensive care units are not as limited now as they were in previous surges. Last winter, nearly a third of COVID patients in Bay Area hospitals were being treated in intensive care and nearly every county in the state was concerned about running out of ICU beds.

This winter, only about 15% of coronavirus patients end up in the ICU, and even fewer need ventilators to help them breathe. ICU capacity has remained fairly stable across the state, with only one region, the Central Valley, coming alarmingly close to the limit.

“In general, hospitals feel capable of handling the patients they have,” said Dr. Matt Willis, Marin County health officer. “There is less oxygen demand, fewer patients in the ICU, more patients stabilized and discharged in just a couple of days. There are fewer deaths."

But Bay Area hospitals are feeling the pressure on other departments that were spared a bit last year. Emergency rooms, in particular, have been overwhelmed in recent weeks, leading to longer wait times in some places. Across the state, so many people with mild respiratory symptoms were presenting to emergency rooms seeking treatment or testing for COVID that health officials began pleading with them to stay home.

ERs are also seeing more regular patients, such as car accident victims and people with non-COVID respiratory illnesses, than they did last winter, when everyone largely stayed home due to shelter-in-place orders. the place and had no accidents. or catch the flu.

The current patient load, including COVID and non-COVID patients, is similar to or even slightly lower than what most hospitals see in a typical winter. Cases would be manageable, health officials say, if hospitals weren't also dealing with significant staffing shortages.

Staffing problems are happening in every industry, from schools and airlines to police agencies, firefighters, and public transportation. In hospitals, they have affected all areas of care: there are fewer pharmacists to fill prescriptions, lab technicians to complete tests, and janitors to clean rooms between patients.

“It's so busy, there are so many patients and so many rooms to clean,” said Juana Martinez, a housekeeper at Napa's Queen of the Valley, who also recently picketed the hospital, calling for improvements in staffing and pay. She said that with so many staff unable to work, she and her colleagues have to cover larger areas of the medical center and feel pressure to move faster cleaning rooms between patients.

At some Bay Area hospitals, 10% of staff have been unable to work on any given day because people have COVID, were recently exposed to the virus and need to quarantine at home, or were caring for sick family members.

That has meant some hospitals can't operate at full capacity because they don't have doctors, nurses and other providers to staff the beds. While most hospitals have not uniformly canceled elective surgeries — a tool commonly used in previous virus surges to reduce patient load and preserve ICU space — some are deciding day by day whether they have enough. staff to perform these procedures.

“We have daily if not multiple calls about staffing. Do we have adequate coverage and do we need to complete it? And how are we going to do that?” said Dr. Stephen Parodi, executive vice president of Kaiser Permanente. At Kaiser's Northern California region hospitals, twice as many staff have been calling in sick every day than in a typical January, he said.

“It makes a magnitude of difference juggling those staff and keeping hospitals running,” Parodi said.

Meanwhile, staffing problems at nursing homes and assisted living facilities have restricted their ability to take on more clients, meaning hospitals are often unable to discharge patients who no longer need hospital care but who are not ready to be home alone. Some counties have rented hotel rooms for these patients to receive some level of nursing care.

"We're just trying to keep the hospitals running and not keep new patients coming in," said San Mateo County Health Chief Louise Rogers. The county has rented rooms in three hotels for up to 79 recently discharged patients. "It's a bit like a safety valve."

In some counties, health care staffing issues are easing as community cases level off or decline. Additionally, staff who were infected earlier in the omicron surge are now returning to work. The state adjusted its quarantine and isolation guidelines last month, allowing most people to return after five days instead of 10. That has been a big help, hospital administrators said.

The state also allows health care workers who are infected but do not have symptoms to return to work immediately if there is a critical shortage. Bay Area officials said they are not aware of any hospital in the region that has had to use that protocol.

Regardless of the declining number of cases, county health officials don't expect the hospital situation to be resolved quickly.

“It will continue to be a difficult few weeks. That's not going to go away overnight,” said Dr. Nicholas Moss, Alameda County health officer. “Hospitalizations will take a little longer than cases. But I am hopeful that we are at or near our peak. And then we're going to go through what we knew was going to be a tough winter, one way or another."

Rogers said he's also hopeful that the worst of the surge is almost over. "But right now we're just focused, with our heads on getting through this," he said.