Sonoma County doctors guardedly optimistic about turning a corner on virus hospitalizations

Hospital emergency departments across Sonoma County remain busy combating a wave of viral illness that has slammed local households and resulted in a grim milestone recently with a new virus-related pediatric death.

Even so, local doctors are sounding a hopeful note about the wider trend of respiratory illness in the community.

Most agree the virulent “tripledemic” of COVID, influenza and respiratory syncytial virus (or RSV) appears to have plateaued in the North Bay.

“There’s a little bit of reason to be optimistic,” said Dr. Omar Ferrari, medical director of the Department of Emergency Medicine at Providence’s Santa Rosa Memorial Hospital. “Things are starting to move in the right direction.”

It’s a welcome signal for local health providers, but it comes with serious caveats. As families prepare to gather for holidays, and a prolonged snap of cold weather drives people indoors, experts worry that case rates could again soar.

“People are shopping, going to holiday parties,” noted Dr. Gary Green, an infectious disease specialist at Sutter Santa Rosa Regional Hospital. “And no one is wearing a mask.”

That latter assessment, about masking, may change after Bay Area health officials, including Sonoma County Health Officer Dr. Sundari Mase, this week reemphasized their recommendation that people mask up in public indoor settings.

The three viruses that have combined to strain the American medical system over the past month are not necessarily trending the same way.

It’s influenza that has health professionals most worried right now. The risk was made crystal clear recently when a local child died after contracting the H3N2 flu and RSV viruses simultaneously, according to county public health officials.

“That’s a good barometer that the H3N2 currently circulating can be really dangerous,” Green said. “It was a young, healthy person.”

The child was under the age of 5, according to a county representative.

“To lose someone so young in our community is truly tragic. Our thoughts go out to the family of this child,” said Dr. Mase. “This underscores the serious threat that RSV and influenza poses in our community. We urge everyone to get vaccinated against the flu as well as COVID-19, and to have their children vaccinated as well.”

While anecdotal reports paint a picture of overburdened Sonoma County emergency departments, hospital capacity is generally stable, and far short of crises conditions, local doctors said in interviews this week.

Santa Rosa Memorial administrators came pretty close to putting a surge plan into action two weeks ago, Ferrari said, “but we were able to hold steady and stay the course.” Providence Health, which owns that facility along with Petaluma Valley and Healdsburg hospitals, continues discussions related to surge measures — the addition of temporary beds when a hospital reaches capacity.

Sutter Santa Rosa has not been strained in that way, Green said, thanks to a recent expansion that effectively doubled the number of beds at the facility as well as the size of its emergency department. That project was finished in May.

“It couldn’t have come at a better time,” Green said. “If we hadn’t had that capacity, we could have been in surge right now.”

Kaiser Permanente did not provide an interview opportunity, but said in a statement that, “We are experiencing higher volumes than usual of pediatric respiratory illnesses for this time of year, driven by RSV and the flu. We are also seeing an uptick in flu and COVID hospitalizations. We are increasing staffing and expanding alternate space when needed.”

Sonoma County’s hospital capacity dashboard showed no surge beds are occupied here, indicating Kaiser Permanente Santa Rosa Medical Center also has not been forced to resort to surge protocols.

According to the county dashboard, 27.6% of the county’s ICU beds were available Thursday. That’s generally a lower cushion than local hospitals enjoyed before flu and RSV began to spike locally in mid-November, but above the 15% threshold of ICU bed availability established by the U.S. Department of Health and Human Services.

The county’s data generally supports the doctors’ guardedly optimistic view. On Dec. 1, a total of 114 people were hospitalized for COVID and/or flu in Sonoma County. (The county does not track RSV numbers.) On Dec. 2, there were 105. By Dec. 10-11, the total roster of COVID and flu patients had dipped to 72. On Tuesday, the most recent day with available numbers, the total had ticked back up to 83.

A difficult winter like this presents a double challenge for hospitals. As the patient count climbs, staff availability often wanes.

“Our staff is great about masking on the job,” Green said. “That doesn’t mean they’re careful about wearing masks at Costco or in church. So we have seen an increase in staff sickness.”

The most encouraging pattern locally is a declining rate of RSV.

“It’s on the downslope,” Ferrari said. “We’re just starting to turn the corner. We’re still seeing lots of sick kids. But there’s a decrease.”

Green reported a similar RSV decline at Sutter Santa Rosa. That virus, like influenza, tends to have a season that lasts four or five months, he said. Green believes that will hold in 2022-23, but is hopeful there will now be a long RSV tail after an early spike.

It’s a relief. Because RSV primarily affects children, it has taken a huge emotional toll on families, and has significantly impacted the local school system. In October/November 2021, Santa Rosa City Schools logged 573 certificated absences, a district spokesperson said. In October/November 2022, with students returning to full-time in-person class for the first time since the start of the pandemic, there were 1,237 absences, an increase of 116%.

Santa Rosa’s school system increased its substitute pool by more than 100 fill-in teachers this year, and still has not been able to fully staff its needs, the representative said.

The COVID-19 case rate, as it has periodically over the past three years, looks pretty stable at the moment. Green is hoping the coronavirus is at its winter peak and will soon being to decline. Ferrari, meanwhile, described an uptick in positive cases — many of them “incidental positives” caught when a sick patient is treated for flu or RSV — but no rise in hospitalizations.

“We have not seen a seriously ill COVID patient in quite a while,” Ferrari said.

Doctors and public health officials alike have never stopped preaching the benefits of vaccinations, but those shots are especially important for influenza.

Green said the particular flu strain of H3N2 going around now is “a terrific match for the vaccine (formulated for this winter season). Vaccinated people are so much more protected.”

RSV currently has no vaccine. COVID has several options, of course, but there are other tools in the coronavirus kit.

“If you look at flu vs. COVID, for both, vaccine is a survival benefit,” Green said, meaning it can help prevent fatalities. “But for COVID, Paxlovid also is a survival benefit. With flu, the treatment doesn’t help in that way. So the only real survival benefit for flu is vaccination.”

Flu and COVID vaccinations remain readily available at Sonoma County hospitals and clinics. It’s just one of the core recommendations, along with masking and hand washing, as residents head into another fraught holiday season.

But perhaps the most effective preventive measure — limiting indoor gatherings — is painful to accomplish during a time of year when family and communal celebration take precedence. On a Thursday-morning Zoom conference to discuss the tripledemic, doctors in Sutter’s regional network urged common sense when deciding whether to get together over the next 2-3 weeks.

“I call it tough love,” said Dr. Vincent Tamariz, the pediatric department medical director at Sutter’s California Pacific Medical Center in San Francisco. “I say, ‘Look, if your kid is sick, if your kid has a runny nose, you owe it to your family and you owe it to yourself not to be exposing your family.’ … When you’re infected, and you’re having symptoms — fever, cough and runny nose — these are people who really should not be seeking large family gatherings.”

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