‘We can see this train wreck coming’: Local hospitals bracing for COVID-19 surge

The coronavirus pandemic, barreling along in its 21st month now, has created or heightened multiple needs in health care settings, from staffing of intensive care units to more elaborate personal protective equipment to mental health counseling.

Some of the gaps are more personal in nature.

“I would like to be able to see my patients’ faces again,” said Tammie Campbell, a radiologic technologist at Santa Rosa Memorial Hospital — she administers X-rays in multiple departments there.

The curve of the mouth can tell Campbell how much pain a subject is experiencing. A flaring of the nostrils can betray fear. Masks hinder that nonverbal communication. And let’s face it, they’re a pain to wear through an eight-hour shift.

“You get a little less of a lift when you can’t see their whole face,” Campbell said. “And when they can’t see your whole face — and just the physical irritation of constantly wearing a mask. There must be a guy in China who adds tickle fibers to every mask. And he never misses.”

Constant N95-ing is a relatively small price to pay for community health, but it’s indicative of the challenges, one stacked on top of the next for almost two years running, that have beset doctors, nurses, technicians and support staff during this health crisis.

And with the omicron variant spreading at breakneck speed, especially among the unvaccinated, they’re all coming to terms with the prospect of another manic, dangerous winter.

“Not ‘prospect,’” Deborah Burger corrected. “It’s gonna happen.”

Burger, who lives in Sebastopol and is both an active Kaiser Permanente RN and president of the labor organization National Nurses United, said her colleagues in the profession are bracing for the inevitable.

“It’s frustration and anger, because they already know what’s coming,” she said. “You don’t have to be clairvoyant. Nurses understand scientific information and infection control. They understand how to prevent disease. And people aren’t getting vaccinated. They’re not wearing masks as much as they once were. We can see this train wreck coming.”

Campbell put it a little differently. “I’d say we’re all tired,” she said. “That’s the word that comes to my mind.”

Who wouldn’t be, as the medical profession confronts yet another spike in virus transmission — by most estimations, the fifth of the pandemic.

Each of those surges has taken a huge toll on hospital staff as ICU wards have reached capacity and health workers, themselves, have at times been forced to quarantine. Even the ebbs have proven to be busy, with a rush of elective procedures that people had delayed during more dangerous periods.

The circumstances have called for more staffing all around. Instead, most facilities are getting by with less.

According to the federal Bureau of Labor Statistics, hospitals currently employ about 2% fewer people than they did in March 2020 at the start of the pandemic.

In some areas, it’s more dire than that. In upstate New York, the New York Times recently reported, hospital capacity has shrunk by 10%.

Kaiser Permanente wasn’t able to provide information on its employment trends before deadline Wednesday.

Sutter Health said through a spokesperson that staffing at its Santa Rosa medical center actually increased during the pandemic to meet high patient volumes. Providence, which runs Santa Rosa Memorial, Petaluma Valley and Healdsburg hospitals, said, “We are hiring more people than 2020.”

Sources here say they haven’t witnessed a noticeable increase in nurses and technicians quitting or taking early retirement. But many workers are finding ways to ramp down.

“There’s nurses who could be working full-time that have gone per diem on call,” Burger said. “There’s nurses who used to work for two different employers and have quit one of them.

“It’s like a marathon runner, and we’re expecting that runner to run three straight marathons. We have already reached our capacity.”

Liz Snyder, a Kaiser nurse who works in ambulatory surgery after 23 years in the emergency department, said she has become highly selective about taking overtime shifts.

“I chose not to overdo it,” she said, emphasizing that she felt it was important to reset if she hoped to give her patients the attention they deserve.

“Some nurses want to earn money. Sonoma County is expensive. But many of us said, ‘This might not be a good thing.’”

Some hospitals also lost staff members when California implemented a vaccine mandate for health care workers.

But it would be a mistake, these caregivers insisted, to view the staffing shortages as a choice made by employees. When the crisis hit in spring 2020, hospitals saw a loss of revenue due to cancellation of nonessential procedures.

Many responded by laying off staff. Rather than a wave of hiring during subsequent surges, most turned to quick fixes like overtime pay or nonsalaried travel nurses.

“Overtime as a business model is not great, during a pandemic,” Campbell said wryly. “I will say that.”

Front-line health care workers argue that while COVID exposed staffing shortages in their industry, it’s really nothing new.

“Hospital systems tend to chronically under-staff departments,” Snyder said. “So they tend to over-utilize that staff when things are busy. That’s a hospital system problem, not a nursing problem. If you’re already working in a chronically understaffed environment, and then you add a specific thing we’ve never experienced in our lifetimes, like a pandemic — yeah, it’s gonna stretch the staff very, very thin.”

Now those stretched-taut employees must prepare for another difficult winter.

Early studies suggest that while omicron is the most transmissible of the known coronavirus variants, it isn’t particularly virulent — meaning it’s less likely to put you in intensive care or result in death.

As of Wednesday, 29.5% of Sonoma County’s ICU beds (18 of 61) and 76% of its ventilators (57 of 75) were available, according to the county’s data dashboard.

Providence said a team meets daily “to evaluate planned, necessary surgeries.” It weighs factors that include “the impact of surgeries on all our hospital resources including our bed capacity.”

“We continue to adjust operations as needed. In some instances this has meant safely postponing a small number of non-urgent surgeries,” Sutter Health said.

Tarek Salaway, senior vice president and area manager of the Kaiser Permanente Marin-Sonoma service area, said, “We are not postponing elective surgeries at this time at Kaiser Permanente Santa Rosa, though there may be a wait time for certain elective or nonurgent procedures.”

All three providers say they have been able to meet their target nurse-patient ratios.

But the new mutations are still hard on the unimmunized.

In Sonoma County, 16% of the eligible population has received no shots, and another 8% is only partially vaccinated. That projects to additional work for hospital staff.

Many of them are already referring to the pandemic as a marathon. Snyder is one of them, but she sees a silver lining.

“Actually, in a way, a marathon, once you get used to something, it’s better than constantly sprinting,” she said. “Over the long haul you say, ‘Ugh, I don’t want to. But I know I can do this.’”

They almost certainly can. But the strain health workers have been shouldering for 21 months has a cumulative effect. Many are not only physically fatigued by the extra work, but mentally worn out by a crisis that has impacted the mental health of patients — and of caregivers.

A few weeks ago, Campbell said, she was taking images of patients in the COVID ward, and two of them asked her to stop and pray with them. Both were weeping. That sort of emotion takes its toll.

“To a certain degree, I have stripped myself of expectations,” Campbell said. “When it all started, most of us thought it’d be a couple months. I don’t think anyone believed it would be two, three years, or whatever this turns out to be. We’ve kind of gone, ‘All right, what will it be today?’

“You just deal with whatever the day has to offer. Then you go home and take a nap.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.