Shared from the 1/23/2022 San Francisco Chronicle eEdition

Hospitals swamped even as surge eases

Brittany Hosea-Small / Special to The Chronicle

Rebecca Cleopas (center) and Martha Mcnelis (right) of Queen of the Valley Medical Center in Napa demonstrate Wednesday.

This winter’s omicron surge — the most explosive wave yet of the 2-year-old coronavirus pandemic — may be cresting in the Bay Area, but hospitals expect more challenging weeks ahead as the astonishingly high case counts continue to translate into a torrent of patients.

Though the highly infectious omicron variant is causing less severe illness than earlier strains of the coronavirus, this winter has in some ways been just as difficult for hospitals, health care staff and administrators say. They may have fewer very sick patients, but most hospitals are about as busy this year as last as they deal with staffing shortages caused by COVID on top of profound physical and emotional fatigue among workers.

“It’s pretty brutal. Every day COVID just keeps coming and coming and coming,” said Paula Reimers, a respiratory therapist at Queen of the Valley Medical Center in Napa, where workers recently picketed to draw attention to staffing problems. “Everybody is feeling the burnout, and probably more this year than last year.”

COVID hospitalizations in the Bay Area and throughout the state are rapidly approaching levels similar to last winter’s peaks. In many hospitals, the inundation of COVID patients was so sudden that staff has struggled to keep up. At Queen of the Valley, the number nearly doubled overnight last week — from 12 one day to 22 the next.

The pace of hospitalizations has slowed somewhat this past week, but the figures are still climbing daily and not 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 time in the pandemic. Several Bay Area counties, including San Francisco, have already passed their previous peak hospitalizations.

“Omicron has been really tough. It came really fast and hit hard,” said Dr. Susan Ehrlich, chief executive of San Francisco General Hospital. A month ago, the hospital was down to just one patient with COVID, but as of Wednesday, it had 64, she said.

“Just the pace made it really challenging, and then the massive impact it’s had on staffing, way more than previous surges,” Ehrlich said. “And it’s at a time when we are two years in, and very, very tired of all of this.”

The upside is that COVID patients for the most part are faring much better this winter than last because many of them are vaccinated and omicron causes milder illness for many people. Anywhere from a third to half of hospitalized patients who have tested positive for the coronavirus don’t have any COVID symptoms and are being treated for some other medical condition.

Milder disease overall means intensive care units are not nearly as pinched 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 almost every county in the state was concerned about running out of ICU beds.

This winter, only about 15% of coronavirus patients are ending up in the ICU, and even fewer are needing ventilators to help them breathe. ICU capacity has been fairly stable across the state, with only one region — the Central Valley — coming alarmingly close to maxing out.

“Hospitals are by and large feeling able to manage the patients they have,” said Dr. Matt Willis, the Marin County health officer. “There’s less demand for oxygen, fewer patients in the ICU, more patients being stabilized and discharged in just a couple of days. There are fewer deaths.”

But Bay Area hospitals are feeling the strain across other departments that were somewhat spared last year. Emergency rooms in particular have been crunched in recent weeks, leading in some places to longer wait times. Statewide, so many people with mild respiratory symptoms were showing up in emergency rooms seeking treatment or testing for COVID that health officials began pleading with them to stay home.

Emergency rooms also are seeing more of their usual patients — for instance, car crash victims and people with non-COVID respiratory illnesses — than last winter, when everyone was largely staying at home because of shelter-in-place orders and not getting into accidents or catching the flu.

Current patient loads — including COVID and non-COVID patients — are similar to or even somewhat lower than what most hospitals see in a typical winter. The cases would be manageable, health officials say, if hospitals weren’t also dealing with significant staffing shortages.

The staffing issues are occurring across all industries — from schools and airlines to police, fire and public transit agencies. In hospitals, they have affected every area 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, 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 at the hospital, asking for improved staffing and pay. She said that with so many staff not able 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.

In some Bay Area hospitals, 10% of the staff has 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 ill family members.

That has translated into some hospitals not being able to operate at full capacity because they don’t have the 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 lower the patient load and preserve ICU space — some are deciding day to day whether they have enough staff to perform those procedures.

“We have daily if not multiple daily calls about staffing. Do we have the right coverage, and do we need to fill in? And how are we going to do that?” said Dr. Stephen Parodi, an executive vice president with Kaiser Permanente. In hospitals across Kaiser’s Northern California region, twice as many staff have been calling in sick every day than in a typical January, he said.

“It’s a magnitude of difference to juggle that staff and keep hospitals going,” Parodi said.

Meanwhile, staffing problems at nursing homes and assisted living facilities have restricted their ability to accept more clients, meaning hospitals often can’t release patients who no longer need inpatient care but aren’t ready to be on their own at home. Some counties have rented hotel rooms for these patients to get some level of nursing care.

“We’re just trying to keep the hospitals flowing and not impede new patients,” said Louise Rogers, chief of San Mateo County Health. The county has rented rooms in three hotels for up to79 recently discharged patients. “It’s a little bit like a safety valve.”

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

The state also allows health care workers who are infected but don’t have symptoms to return to work right away if there is a critical shortage. Bay Area officials said they don’t know of any hospitals in the region that have had to use that protocol.

Regardless of slowing caseloads, county health officials don’t expect the hospital situation to resolve itself quickly.

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

Rogers said she’s also hopeful that the worst of the surge may almost be over. “But right now we’re just focused — heads down on getting through this,” she said.

Erin Allday is a San Francisco Chronicle staff writer. Email: Twitter: @erinallday

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