Sonoma County hospitals avoid autumn surge of coronavirus patients

As coronavirus infections keep climbing around the state, Sonoma County hospitals are taking steps to ensure they have sufficient drug treatments, staffing and medical supplies to deal with a potential surge of patients sick with the infectious disease over the winter.

With the arrival of colder weather and peak flu season, medical professionals are hoping to somehow blunt the highly contagious virus from causing what some fear could be a perfect storm that could overrun local hospitals.

Sonoma County has averted an autumn spike in new COVID-19 cases that has medical centers in Southern California, midwestern, southwestern and southeastern states running out of hospital beds. However, local public health officials and physicians warned that throughout the pandemic, the county’s coronavirus trends have lagged the rest of the state and country by more than a month.

“We’re really preparing for four weeks out to see what happens around Christmastime,” said Dr. Chad Krilich, chief medical officer at Providence St. Joseph Health, which runs the county’s largest medical center Santa Rosa Memorial and Petaluma Valley Hospital. By the end of December, St. Joseph Health will add Healdsburg District Hospital, after an affiliate buys it.

County hospitals are now familiar with the drill of preparing for a surge of COVID-19 patients, because they went through it last spring. A big focus then among medical teams and supportive county public health officials was ensuring there were enough beds to treat sick patients.

But Krilich said bed availability is not the key issue in preparation this time around. A bigger priority now, he said, is making sure there are adequate supplies of personal protective equipment, enough staffing, lab testing capacity and coronavirus treatments such as remdesivir, convalescent plasma and monoclonal antibody therapies.

“It’s making sure we have a good supply chain for those things, making sure we have good staffing in place,” the doctor said, noting there are enough beds.

Senior care home indicator

Hospitalizations in Sonoma County related to the virus have remained relatively steady since mid-October, hovering between 20 and 35 patients a day, according to California Department of Public Health data. During that time, local hospitals have treated fewer than 10 COVID-19 patients a day in intensive-care units.

During the past two weeks, hospital admissions of infected area residents have increased from 17 on Nov. 16 to 30 on Nov. 26. That’s still half of the number in the summer, when the local hospitalizations connected with the contagion reached 60 on July 28.

On Friday, at St. Joseph Health’s hospitals there were eight COVID-19 patients being treated at Memorial and three at Petaluma Valley, Krilich said. None of those patients were in intensive care. The county’s other two major hospitals, Sutter Santa Rosa Regional and Kaiser Permanente Santa Rosa Medical Center, declined to provide specific tallies of coronavirus patients admitted.

Dr. Sundari Mase, the county’s health officer, confirmed local hospitalization rates of virus patients have increased slightly, but not nearly as much as they have in other parts of California the past few weeks. What’s more, Mase said new local COVID-19 cases recently have remained stable, even as infections have sharply increased in other Bay Area counties.

The local spike in hospitalizations over the summer was largely driven by coronavirus outbreaks in senior care homes, including skilled nursing centers and residential care sites for the elderly. Fortunately, such outbreaks, especially at skilled nursing homes, have significantly declined in recent months.

“Hospitalizations would really be driven up, if we saw more cases in our vulnerable populations, skilled nursing facilities and residential care facilities for the elderly,” said Mase, noting that virus transmission levels at nursing homes has been a better indicator of the hospitalization trend than new daily infections. “It was at the time when we were having outbreaks in those congregate care settings that we had the biggest increases in hospitalizations and ICU admissions.”

Modifying hospital treatment

Meanwhile, at Sutter regional hospital, the number of people hospitalized with COVID-19 has been “fairly consistent” the past few months, said Dr. Bill Carroll, the hospital’s chief medical executive. The numbers are much less than they were in the summer, Carroll said.

What has increased, he said, is the volume of people testing positive for the virus when visiting the hospital’s emergency room and other departments.

Since the disease emerged in March, Carroll said Sutter’s medical team has learned how to balance the safe care of patients afflicted by the virus and those being treated for other ailments.

At Kaiser Permanente, hospital officials say they are ready to increase bed and patient capacity by 35%, in the event of a surge of coronavirus patients. The hospital has seen a slight uptick in COVID-19 patients, but is managing their care while simultaneously treating other patients, said Dr. Michael Vollmer, infectious disease specialist and Kaiser’s regional epidemiologist in Northern California.

“As the science regarding COVID-19 care has evolved, we have modified our practices to improve outcomes, which can translate into reduced length of (hospital) stay,” Vollmer said.

Vollmer said these interventions include using high-flow oxygen, giving dexamethasone for patients requiring higher oxygen levels, prescribing remdesivir based on current national guidance and positioning patients face-down when they require mechanical ventilation.

“We also have a COVID-19 monitoring program where patients receive follow-up at home based on their risk level without necessarily requiring hospitalization,” the physician said.

Spread blunted by reopening block

Mase said one of the main reasons for the stable coronavirus situation — in contrast with much of the Bay Area and Southern California — is that Sonoma County never had a chance to reopen riskier parts of the economy like indoor restaurant dining and fitness studios — because since late August it has been stuck in the most restrictive “purple tier” of the state’s four-part community reopening plan.

The state’s reopening regimen for the 58 counties allows further reopening and expansion of commercial and public activities based on success controlling spread of the virus. Each of the four steps is defined by a colored tier describing the degree of transmission: purple for widespread, red for substantial, orange for moderate and yellow for minimal.

To advance from one tier to the next, counties are required to reach set benchmarks for three COVID-19 metrics: the average number of daily cases per 100,000 people; the overall share of tests that detect the virus, known as test positivity; and the test positivity percentage in a low-income neighborhoods.

According to the state’s most recent assessment of coronavirus metrics, Sonoma County had an unadjusted transmission rate of 13.1 daily cases per 100,000 residents. By comparison, neighboring Napa County has an unadjusted case rate of 22.4 daily cases per 100,000 people. (A rate of 7 cases or fewer per 100,000 residents is needed to advance reopening.)

Just a month ago before backsliding, Napa County had advanced two steps to the orange tier, allowing it to expand capacity for indoor dining, religious services, movie theaters and other businesses.

At that time, Sonoma County was the only Bay Area locale left in the bottom, or purple, reopening stage, indicating transmission of the virus is widespread. Many counties had advanced several stages and San Francisco had reached all the way to the least restrictive yellow tier, indicating minimal transmission.

San Francisco and San Mateo counties are set to reenter the purple tier on Sunday, which will leave Marin, in the red tier indicating substantial transmission, as the only Bay Area county not in the purple tier.

“We’re doing pretty good here. There has been a slight increase in cases, but not nearly the kinds of increases that other counties have seen,” Mase said. “Things haven’t really been open like they have in some other Bay Area counties.”

From last Sunday through Friday, the county reported 621 new daily infections, pushing the total COVID-19 cases to 12,049 since March. There were 2,267 active cases as of Friday, while 9,625 people recovered from the virus. Local public health officials reported Wednesday that two more residents died from complications of the coronavirus, boosting the pandemic death toll to 157 — at least 80% of them people 65 or older.

Across California, the seven-day average of daily virus cases has soared since mid-October, from less than 3,000 a day to nearly 14,000 a day. In just two weeks, average daily virus-related deaths statewide have doubled to 74.

Overall, there are more than 1.1 million California residents who contracted the coronavirus and about 19,000 have lost their lives to the viral infection.

An eye on vaccine arrival

At Santa Rosa Memorial, medical staff have an eye on coronavirus vaccines coming down the pike in planning for a winter surge of COVID-19 patients.

In the basement of one of the hospital’s parking garages, in a rather bland storage room, is an ultracold freezer that looks like a large refrigerator. The freezer, which can drop to minus 80 degrees Celsius (minus 112 degree Fahrenheit), is ready to store thousands of vaccine doses.

One type of vaccine made by Pfizer, which must be kept at minus 70 degrees Celsius (minus 94 degrees Fahrenheit), is expected to arrive at the hospital later in December. The hospital should have its vaccine distribution plan set by Dec. 7, Krilich said.

Who gets vaccinated will be prioritized according to federal public health guidelines, with health care workers being the first to receive it, especially medical staff in the hospital’s COVID-19 patient unit.

For the time being, Krilich agreed the pandemic is manageable in Sonoma County. He and other local medical experts say they’ll be ready if things take a turn for the worse.

“You just wake up the next morning and see what’s in front of you,” Krilich said.

You can reach Staff Writer Martin Espinoza at 707-521-5213 or martin.espinoza@pressdemocrat.com. On Twitter @pressreno.