Bay Area hospitalizations on the rise: ‘The surge plan is simmering’

Bay Area hospitalizations related to COVID-19 have spiked over the past two weeks, driven by a variety of factors, including a major outbreak at San Quentin State Prison and an uptick in summer social gatherings.

Those heightened numbers concern state and local health officials who keep a close eye on hospitalization rates as they decide whether counties should continue down the path of economic and social reopening or pull back. As the Bay Area moved into the July Fourth weekend, Gov. Gavin Newsom decided to slow things down in 19 California counties, including Contra Costa, Santa Clara and Solano, citing the growing burden on hospitals as a major concern.

“We’re not out of this pandemic. We’re still in the first wave, and we have a lot of work to do to mitigate the spread to make sure our hospital system is ready to receive people outside of an emergency or COVID-19-related cause and to make sure our ICUs are free from COVID-19,” Newsom said at a news conference Thursday.

Bay Area hospitals report rising COVID-19 hospitalizations, with a current total of 430 people hospitalized in six counties on Tuesday. The region hit its peak on April 7, when 471 people were hospitalized. That number fell to as low as 22, on June 1.

San Quentin’s outbreak is a big part of the recent rise, with 59 inmates transferred to local hospitals as of Thursday afternoon, California Department of Corrections and Rehabilitation spokeswoman Dana Simas said.

Across California, coronavirus patients in hospitals increased by 56%, and those in intensive care units jumped 49% over the past two weeks, Newsom said. On Thursday, 5,355 patients were hospitalized with COVID-19.

To put that in perspective, however, those patients filled just 7% of the state’s hospital beds. In the Bay Area, where shelter-in-place orders bought time for hospitals to prepare without being overwhelmed, hospitalizations are not yet straining capacity. Coronavirus patients are filling just a fraction of most counties’ hospitals, and medical facilities say they’re poised to utilize hundreds more beds if need be.

“The surge plan is simmering on the back burner. There’s always concern,” said Janet McInnes, chief nursing executive and administrative officer at Alameda Health System. “It’s on everyone’s mind all the time.”

Influx of prisoners

The increasingly grim situation at state prisons could play a significant role in hospital planning.

At San Quentin, more than 1,000 people — a third of all inmates — tested positive and two people died on Death Row. (One victim tested positive for COVID-19; the second is still under investigation.) The outbreak is filling more hospital beds across the Bay Area, where sick inmates are being transferred to community health facilities.

In San Francisco, hospitalized coronavirus patients spiked 61% over the past week, according to the Department of Public Health. That number can be misleading, as 12 of those patients came from San Quentin, adding to the total of 72 hospitalizations in the city. That also included four patients from Imperial County and one from Fresno County transferred to San Francisco.

At Alameda Health System’s hospitals, located in Alameda, San Leandro and Oakland, relatively stable numbers of COVID-19 patients ticked up when the hospital received seven patients from San Quentin, two of whom are in intensive care. The health system had an existing contract with the state to treat inmates. The system was treating 21 confirmed COVID-19 patients Wednesday.

Caring for sick inmates at hospitals involves a layer of security logistics. Patients transferred from a prison come with two to four guards, including one who stays in the hospital room at all times. The hospital provides these guards with personal protective equipment and training in how to use it. San Leandro Hospital was set to receive a few more inmate patients Wednesday, with room for only eight, McInnes said.

Mawata Kamara, a nurse in the emergency room at San Leandro Hospital, said the second floor is now filled with guards for San Quentin patients.

“A person is a prisoner, but still my patient,” she said. “I have to treat all my patients the same way.”

The prison outbreak isn’t the only driver of hospitalizations and pressure on hospital capacity. COVID-19 numbers started to steadily climb in the Bay Area about two weeks ago, with more patients in general care than intensive care. Hospitals also reported an increase in regular patient traffic, as people suffer routine injuries and also began returning to address non-emergency procedures and treatment.

Farmworker outbreak

In Solano County, which reopened its economy faster than its Bay Area counterparts, hospitalizations have quadrupled — from 10 to 41 — since June 17. A large outbreak among farmworkers in Sonoma and Napa counties who live in Solano County led to more patients, but hasn’t stressed facilities, the public health department said. Currently 68% of ICU beds in the county are filled with both COVID and non-COVID patients.

At NorthBay Medical Center in Fairfield, COVID-19 patient numbers have tripled since the end of May, where they have hovered around 15, said Steve Huddleston, vice president of public affairs.

“We’re very concerned about the trend line in the community,” Huddleston said. “The capacity is there for more cases and a moderate increase, but at some point we’ve got to see that curve flatten or we’ll likely be in for some capacity issues in the long run.”

Kaiser Permanente Vacaville Medical Center now has 10 positive patients, more than ever before, said nurse Becky Cherry-May. She’s worried about the availability and quality of personal protective equipment. Nurses reuse N95 masks, intended for one-time use but now commonly reused during the pandemic, to preserve supplies.

“I’m very concerned. We’re going into a very bad place,” she said. “We’re just starting our surge.”

A Kaiser Permanente spokesman said the hospital system was prepared to double its capacity and had access to enough hospital beds, ventilators and other equipment to meet the current and projected need in Solano County and statewide.

In San Francisco, coronavirus hospitalizations more than doubled in the past two weeks, to 72 on Wednesday. Around 70% of hospital beds were full — mostly with non-COVID patients. At UCSF, which had 22 COVID-19 patients Wednesday, the intensive care unit at the Parnassus campus was already 82% full with mostly non-COVID patients. At the Mount Zion campus’ respiratory isolation intensive care unit, six out of the seven beds were filled with COVID-19 patients.

Here’s where capacity stands in other Bay Area counties:

• In Marin County, where San Quentin is located, 7% of hospital beds are filled with COVID-19 patients.

• In Sonoma County, 3% of hospital beds are filled by COVID-19 patients.

• In Contra Costa County, COVID-19 patients fill around 2% of beds.

• In San Mateo County, which doesn’t report figures the same way, 20% of ICU beds are filled with COVID-19 patients.

• In Santa Clara County, COVID-19 patients fill 3% of hospital beds.

• Alameda County has the highest hospitalization numbers in the Bay Area, with 116 patients at local facilities. Half of hospital beds and fewer than half of ICU beds were occupied Wednesday. People with COVID-19 made up only 5% of those patients. Fewer were in the ICU than earlier in the pandemic.

Dr. Kathleen Clanon, medical director for Alameda County’s Health Care Services Agency, said the county is ready to surge if hospital capacity maxes out.

“When it gets very dangerous, like in some other counties, is when the hospital system gets overwhelmed with ICU patients,” she said.

Tiffany Talerico, a nurse at Santa Clara Valley Medical Center and member of the Registered Nurses’ Professional Association, watched numbers of COVID-19 patients on her floor increase from five to nine by the end of her shift on Sunday. She said she is less anxious now than she was at the start of the pandemic, when her hospital was in a hot spot.

“We have the resources and staffing to back it up right now. It may not always be the case as things pick up, but we have those things that are good to support us,” she said.

Breana Lastiri, a nurse at St. Rose Hospital in Hayward, feels safer than earlier in the pandemic, but is still worried.

“It’s pretty nerve-racking,” she said. “I just hope that we’re prepared.”