The number of people hospitalized with coronavirus in Orange County has plateaued at around 700 current patients – after rising sharply for several weeks starting in mid-June.
Doctors and hospital officials say they’re cautiously encouraged that hospitalizations are not rising, while also urging the public to wear masks and physically distance.
According to experts, the local hospital system can manage the current volume of patients, with several local hospitals converting regular patient rooms into intensive care rooms as part of their separation of COVID and non-COVID patients into separate wings of a hospital.
Yet at the same time, the pandemic is taking a toll on nurses and other staff, whom hospitals say are stretched thin, and some hospitals have paused non-emergency surgeries to help conserve protective gear.
“We’re at a sort of tipping point right now, where if things get worse, we are going to be in a situation where the hospitals are going to need help to deal with increased COVID hospitalizations,” including bringing in outside staff, said Dr. Saahir Khan, an infectious disease specialist who works at the intensive care unit at UC Irvine Medical Center, speaking about the overall hospital system in Orange County.
“So this is really a critical time for people to be responsible and maintain adherence to all the guidelines to prevent the spread of COVID-19,” he added.
“We’ve been able to handle what we’ve got. If we disregard social distancing, wearing a mask, if we start opening up in an irresponsible fashion, we’ll flood the system…you can see that in the states that did that” like Florida and Arizona, said Dr. Todd Newton, the Orange County medical director for Kaiser Permanente, which has two hospitals in Orange County.
“We’re plateauing at a higher number…it doesn’t mean we go back to zero [patients]. We still have a lot of people admitted, because they’re sick and they stay sick for a long time,” he added.
There “certainly is a weariness and fatigue” among nurses and staff, Newton said.
In its daily status update on OC hospitals, the county Health Care Agency reported Wednesday that 12 hospitals had activated surge plans, four hospitals had canceled some procedures or services, six hospitals had supply issues, 12 hospitals had increased their morgue capacity and 12 hospitals had requested state permission to relax regulations on nurse-to-patient ratios.
Safe treatment of coronavirus patients is requiring more nurses and other staff than typical hospital patients, according to local hospitals and doctors.
“As this surge of very ill patients continues, it is no surprise that nursing resources are stretched,” St. Joseph Hospital officials said in a statement Wednesday to Voice of OC.
“For the safety of our caregivers and patients, we deliberately keep our Covid units and our general patient units quite separate. While this is our preferred option for care, it requires more resources—in many ways we are operating two separate hospitals,” they added.
“This increase of Covid patients will continue to strain nursing resources as long as the surge lasts. We strongly encourage the community follow recommended safety protocols including wearing face masks, physical distancing, frequent hand-washing and avoiding group gatherings.
Local hospital officials say the flexibility on nursing ratios has helped amid the local surge in patients.
“Now that we’ve seen our local surge, we’re grateful that [nursing ratio] flexibility does exist,” said Dr. Charles Bailey, medical director for infection prevention for St. Joseph Hospital in Orange and Mission Hospital in Mission Viejo.
“We may not have needed to use that earlier, but now that we are seeing that surge locally, we’re grateful that we can still accommodate those patients.”
“Orange County [hospitalizations for coronavirus] did ramp up fairly sharply about a month or so ago. It has plateaued. It’s still at a high rate…but I think we’re encouraged by the fact it isn’t going higher,” Bailey added.
“We have enough beds, we have enough ICU beds, we have enough staff – although they are stretched, and certainly working as hard as they can. But we’ve been able to provide care to all the patients that have required hospitalization.”
Dr. Jason Cord, president of the Orange County Medical Association, said it’s encouraging that daily hospital patient counts are not climbing, “but it certainly doesn’t mean we’re beating it right now.”
“The way to beat this is for everybody to wear a mask…and socially distance,” Cord said.
“We should recognize that it’s a very fragile position. And simple moves could destroy that” and cause hospitalizations to shift up again, he said.
“As communities are seeing larger gatherings, paired with the relaxation of safety guidelines, we understand that there is a need to underscore the continuance of necessary precautions and to emphasize the fact that the pandemic is not over,” said Adam Blackstone, a spokesman for the Hospital Association of Southern California, told Voice of OC on Wednesday.
“It’s always positive to see fewer hospitalizations; however, our hospital executives know that it doesn’t mean that it’s a time to let our collective guard down,” he added.
“With COVID-19 cases increasing, communities should not begin adopting an attitude of complacency. We understand that there is an urge to go back to pre-pandemic mode and fatigue has set in for many; however, we strongly encourage people” to continue wearing face coverings, practicing physical distancing, frequently washing hands, and avoiding gathering with people outside of one’s household.
The rate of people testing positive in Orange County is more than double where it was in early Jun, even as more tests are performed, which public health experts say is a sign of increased spread of the virus.
Many of the more recent infections have been among younger adults who are at lower risk of being hospitalized, though doctors emphasize the importance of preventing the spread from young people to older adults who are more at risk.
“Young people can spread the disease to others. So that’s what we worry about,” said Khan.
Local hospitals are also reporting an uptick in younger patients, including children.
“We are seeing younger patients..and we are seeing children,” said Newton, the Kaiser medical director. Children handle coronavirus better than elderly people, but can get sick with Multisystem Inflammatory Syndrome, he added. Children also “can infect their parents or their grandparents, which is a problem.”
As OC hospitals face higher volumes of coronavirus patients, they’ve moved to implement early stages of surge plans, including converting normal hospital beds and rooms into intensive care rooms.
“As COVID-19 hospitalizations increase, hospitals have proactively prepared to adequately provide care to both COVID-19 and non-COVID-19 patients by activating surge plans which may include modifying units, such as converting beds and rooms to ICUs and identifying additional settings of care,” Blackstone, the hospital association spokesman.
Supply problems at hospitals have mainly been with gowns and N95 masks, Health Care Agency officials said in response to questions from Voice of OC.
To help preserve protective equipment and supplies, some hospitals in Orange County have put a hold on non-emergency surgeries.
“As hospitals experience fluctuations in hospitalizations and make efforts to preserve PPE and supplies, some hospitals, at their discretion, have temporarily paused nonemergent surgeries and procedures such as knee replacements and cataract surgery,” Blackstone added.
“However, this is not a permanent solution for any hospital as data points to a growing concern of a secondary health crisis as the result of delaying care. It’s important to note that the majority of Orange County hospitals have not canceled services and procedures and continue to stand ready to care for all patients with health concerns.”
Khan said the toll on hospital workers has been especially difficult without the typical outlets to let loose like travel or socializing in person.
“I think it’s difficult because most of us now are going on five months without vacations, essentially always being on, and seeing patients die – and in many cases young patients who were previously very healthy, die very quickly, particularly from complications like blood clots,” Khan said.
“So I think that it’s tough. Many of us are used to working with sick patients, many of whom die in ICUs. But I think the length of this pandemic, and not having normal outlets to socialize or go on vacation or travel or participate in normal hobbies, that’s been difficult.”
Nick Gerda covers county government for Voice of OC. You can contact him at ngerda@voiceofoc.org.