Sonoma County hospitals in good shape for now to keep up with COVID-19

Early during the local coronavirus pandemic, maybe 1% of the patients occupying a hospital bed at Santa Rosa Memorial and Petaluma Valley hospitals had a diagnosis of COVID-19. But that share has grown steadily, particularly in the past month, just as it has across the state.

By the Fourth of July, some 5% of patients at both hospitals, which are run by Providence St. Joseph Health Sonoma County, had the virus, said Dr. Chad Krilich, the hospitals’ chief medical officer. Now, he said, 10% of patients have the virus, though most of them are not being treated in intensive care units.

Coronavirus hospitalizations across the state have surpassed levels reached during the first wave of the virus and hospitals in some regions, particularly in Southern California and the Central Valley have been forced to transport patients to other counties, according to the California Hospital Association.

But local physicians, health care providers and public health officials say the level of hospitalizations in Sonoma County is still manageable, though that could change if cases continue to increase.

“Each of the facilities in Sonoma County have been managing this incident appropriately,” Krilich said. “Given where we are today, we're managing to what we're seeing really well and the future will be predicated on how the community responds to the recommendations of our health officer.”

In the past week, more than 150 medical experts, scientists and nurses in the United States signed on to a letter urging political leaders to shut down the country again to once again suppress the spread of the virus.

Dr. Sundari Mase, the local health officer, said Friday before issuing any new restrictions she first wants to gauge the impact of state-ordered restrictions that resulted when the county was placed on the state’s COVID-19 monitoring list. Mase agreed with Krilich that at least for now, the county’s hospitals are effectively managing current patient volumes of patients with and without COVID-19.

State surge

Statewide, the number of people hospitalized with COVID-19 has grown dramatically and now exceeds previous peak levels several months ago, according to state hospital experts.

During a press briefing Wednesday, Carmela Coyle, the president and CEO of the California Hospital Association, warned that hospitalization rates are greater now than they were during the first wave of the pandemic in March and April. Coyle said before June 15, the number of new cases statewide was growing by between 1,500 and 2,000 a day.

“After June 15, we saw things skyrocket precipitously,” she said. “We're now looking at 4,000 to 9,000 new COVID positive cases a day.”

Then, almost exactly two weeks later, the number of California residents hospitalized with COVID-19 began to rise significantly, she said. The incubation period for COVID-19 — from exposure to symptoms — is thought to extend to 14 days, according to the federal Centers for Disease Control and Prevention.

Local increase

In Sonoma County, the number of people hospitalized with COVID-19 has grown dramatically since late June when the number of hospitalizations went from single to double digits. The number hit 44 in less than a month and now sits at about 42 confirmed COVID-19 positive patients, according to the county’s hospital capacity dashboard.

The rapid increase in hospitalizations had been one of the pandemic trends that landed Sonoma County on the state’s coronavirus watchlist on July 10. After three days on the list, the state manadated Sonoma County to issue restrictions to halt indoor dining and drinking at restaurants, wine tasting rooms and breweries, among other pullbacks.

At that time, the average number of people hospitalized over a three-day period was increasing by 30%, far exceeding the 10% benchmark established by the state for suppressing the virus. But as of Saturday, hospitalizations are currently stable, with a 1% decline in the past three days.

On Thursday, Mase provided the Board of Supervisors with on update on the local spread of the virus. She reported that 70% of 120 COVID-19 patients who have ever been hospitalized were over 50 years old. Of these, 47, or 39%, have received treatment intensive care units.

Only one person under the age of 18 and 35 residents between 18 and 49 have ever been hospitalized.

Mase, who frequently receives updates on hospital capacity and the number of COVID-19 patients, said local hospitals have been operating at about 90% capacity since they’ve been conducting elective surgeries. For the most part, they are non-emergency surgeries that should not be delayed.

But if the rate of hospitalizations continues to increases, she said, it may be necessary for hospitals to curb the number of elective surgeries to increase capacity.

“Once they’ve stopped that, they would free up the hospital, and have a lot more beds,” she said, adding that local hospitals could easily come up with more intensive care beds.

The county’s COVID-19 dashboard for hospitalizations lists five available of 67 staffed ICU beds as of Friday. Mase said hospitals could quickly implement their surge plans to come up with 30% more ICU beds.

Under normal conditions, hospitals try to reduce the number of empty intensive care beds because of the high cost associated with staffing them.

The skilled nursing bottleneck

But one area of concern for both Mase and local hospital officials is broad impact of coronavirus outbreaks at skilled nursing facilities. Mase said many skilled nursing centers in the county are no longer admitting new residents because of these outbreaks. That leaves hospitals with nowhere to transfer patients who no longer need to be in a hospital but may need post-acute care in a skilled nursing home.

Currently, 16 of the county’s 20 skilled nursing facilities have either staff or residents who have been infected with the virus. As of July 21, 143 residents and 89 staff in skilled nursing and residential care facilities for the elderly have come down with the virus. Roughly 70% of those infections have been in skilled nursing homes.

Krilich said 10% of patients who had a COVID-19 diagnosis at Memorial and Petaluma Valley hospitals could actually go back to a skilled nursing home. However, he said that about 75% of the skilled nursing facilities the hospital usually partners with are not accepting admissions in Sonoma County.

“The impact of that is the hospitals become the de facto skilled nursing facility thereby taking up our capacity,” Krilich said.

As a result, regular hospital beds are now being occupied longer by patients who are ready to go to a skilled nursing center, as well as patients without a COVID-19 diagnosis who also require skilled nursing care.

“We're seeing, you know, our length of stay go up ... just recently, it's trending the wrong direction,” he said.

But beyond that, Krilich said the two hospitals are “well positioned” to care for patients with COVID-19. The hospital has a “great supply chain” of personal protective equipment, therapy medications, and lab testing capacity, he said.

“Right now, it's a capacity management issue primarily and trying to find a way forward to get patients discharged to skilled nursing facilities,” he said.

Manageable for now

Sutter Santa Rosa Regional Hospital has also seen an “uptick” in coronvirus patients in the past month, though that increase is manageable, said Dan Peterson, the hospital’s CEO. Peterson credits the hospital’s doctors, nurses and other medical staff with providing excellent care of all patients during the pandemic.

Peterson said that as with the rest of the community, Sutter hospital staff are waiting to see what happens, as there could be scenarios where COVID-19 cases and hospitalizations could rise dramatically.

“We’re dealing well with the patients that we have right now, but we’d like to keep our community out of a scenario that could be troublesome and out of a serious outbreak,” Peterson said.

It’s a scenario that could come to pass if local residents don’t embrace social distancing, masking and other public health recommendations as they have in the past.

Michelle Gaskill-Hames, a senior vice president at Kaiser Permanente Northern California, in a statement called for similar public vigilance.

“While we wait for a vaccine, we need to embrace the public health actions that focus on social distancing measures including maintaining six feet of distance and using masks to protect each other,” she said. “ Following these measures is crucial now to stop the rising tide of these infections.”

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