Across the state, more than 4,000 people with either suspected or confirmed cases of the coronavirus are hospitalized. And while that's roughly half the number who were hospitalized during a summer spike in July, it's still a dramatic jump from last month when hospitalizations hovered around 3,000.
"Generally speaking right now, we have capacity," said Jan Emerson-Shea with the California Hospital Association. "But it's certainly fluid."
In the Bay Area, more than 400 people were in hospitals as of late last week with COVID-19. And while local hospitals say they're prepared, numbers are rising. Regional Medical Center in San Jose had 30 patients, up from 18 the previous week. Across town, Good Samaritan had 10 patients up from just two the week before. Santa Clara County's system — Santa Clara Valley Medical Center, O'Connor Hospital and St. Louise Regional Hospital — reached 35 patients, up from just 15 in late October.
"Overall our system is feeling prepared," said spokesperson Joy Alexiou, "but there are concerns about facing a significant and extraordinary surge that would result in exceeding the planned surge capacity for all hospitals within Santa Clara County and the Bay Area."
Stanford Health Care, which had 15 coronavirus patients, is "seeing an increase in COVID-19 testing samples and positivity," said spokesperson Julie Greicius.
In the East Bay, John Muir Health is "seeing a gradual rise in the number of cases and hospitalizations," said spokesperson Ben Drew, but "it has not been a sharp spike so far."
Still, with flu season and holiday gatherings looming, hospitals are gearing up. But where hospitals slapped up tents in the spring and summer to triage COVID-19 patients, wintry weather makes that process more difficult now.
At their Concord and Walnut Creek facilities, John Muir is setting up generator-powered mobile trailers equipped with heating and air conditioning.
"This will ensure we can maintain proper social distancing and keep patients protected from the elements this winter," Drew said.
The Walnut Creek trailer will serve as an auxiliary Emergency Room waiting room. The Concord unit will have a nurse station, exam areas, gurneys, chairs and other equipment to care for "low-acuity patients during a surge," Drew said. "This allows for more room to treat sicker patients in the ER."
Some other parts of the state are faring worse. In Imperial County along the southern border, the state's coronavirus hospital dashboard said Friday that it had zero ICU beds available. It's not the first time the region has hit capacity. Over the summer, Bay Area hospitals like UCSF and Stanford accepted transfer patients from the county, something that could happen again.
Space isn't the only issue. Staffing is also a hurdle. Like anyone else, nurses come down with the flu, so hospitals across the state regularly rely on traveling nurses to help out when those on staff get ill and can't come to work. And while the Bay Area has traditionally been a desirable location because of its relatively balmy winter weather, with the coronavirus spreading out of control across the country, there's growing demand for traveling nurses all over.
"Now other states are drawing upon the same pool," Emerson-Shea said. "'I think staffing issues are going to be a real challenge going forward."
Sophia Morris, vice president of account management at San Diego-based Aya Healthcare, said the company is seeing more demand for traveling nurses than she's ever seen in her 15 years in the industry.
In California, the company is fielding requests to fill around 2,200 positions, including in the Bay Area, compared to 1,000-1,500 in a regular winter.
"That's been slowly increasing every week," Morris said, adding that there is an urgent need in El Centro in Imperial County.
And pay has been increasing here to compete with hot spots across the country in places like Michigan and Illinois, where nurses can earn up to $6,000 a week.
"Is the supply equaling the demand?" Morris said. "No."
Toward the start of the pandemic, the state's public health department waived nurse-to-patient ratio regulations, so a single nurse could care for more patients than in the past (the actual numbers vary depending on the type of ward). That waiver expired over the summer, but now the hospital association is urging the state to reinstate it.
And while hospital systems from UCSF — which has actually bucked the statewide increase and seen a decline to around 10 hospitalized patients from more than 30 in September — to Kaiser insist that they've stockpiled adequate personal protective equipment like masks and gloves, the association is still concerned about the supply chain for that and testing equipment, like pipettes.
"There are still serious issues," Emerson-Shea said. "This is an ongoing problem nationwide and globally."
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