Surging virus exposes California’s weak spot: A lack of hospital beds and staff

For all its size and economic might, California has long had few hospital beds relative to its population, a shortfall that state officials now say may prove catastrophic.

California is experiencing its largest surge in coronavirus cases with an average of nearly 15,000 new cases a day, an increase of 50% from the previous record over the summer.

So even though the state has some of the country’s most restrictive measures to prevent the spread of the virus, an influx of people with severe cases of COVID-19 may force overwhelmed hospitals to turn patients away by Christmas, Gov Gavin Newsom warned this week.

A dearth of hospital beds has been a worldwide problem throughout the pandemic, but California, with a population of 40 million, has a particularly acute shortage. The wealthiest state in the wealthiest country has 1.8 hospital beds per 1,000 people, a level that exceeds only two states, Washington and Oregon, according to 2018 data compiled by the Kaiser Family Foundation. California has one-third the number of beds per capita as Poland.

Many hospitals in California have maintained lower numbers of beds in part to limit the length of patient stays and reduce costs. But that approach is now being tested.

In addition to beds, a shortage of nursing staff will make handling the surge of virus cases “extraordinarily difficult for us in California,” said Carmela Coyle, head of the California Hospital Association, which represents 400 hospitals across the state.

“This pandemic is a story of shortage, whether it is shortages of personal protective equipment, shortages of testing supplies, shortages of the trained staff needed to deal with these patients,” Coyle said. “It’s what has made this pandemic unique and different from other disasters.”

Also unlike other catastrophes, California will not be able to rely on other states for assistance. Mutual aid has been a cornerstone in its planning for disasters, requesting, for example, thousands of firefighters from neighbouring states to help in dousing the mega-fires of recent years.

But with so many parts of the country struggling with the coronavirus at the same time, there are few travelling nurses available or nearby hospital beds to spare.

“You have to think of this as a natural disaster, like an earthquake — there’s a lot of need for hospitalization,” said Dr George Rutherford, a professor of epidemiology at the University of California, San Francisco. “But the difference here is that it’s happening across the country. We can’t send people to Reno, Phoenix or Tucson. We’re stuck.”

The state government says it has 11 surge facilities, or alternative setups, including mothballed medical buildings and at least one sports arena, ready if hospitals become overloaded.

Beyond California, hospitals have been scrambling in recent weeks to handle a new rush of patients, particularly in parts of the Sun Belt and New England that had largely avoided coronavirus spikes in the spring and summer. The country is likely to hit a record 100,000 hospitalisations this week.

As hospitals exceed or get close to exceeding their capacity for coronavirus patients, state and local officials have been opening hospitals in parking lots or unoccupied buildings.

In Rhode Island, where infections have rapidly increased in recent weeks, a field hospital opened on Monday in the state’s second-largest city, Cranston. At a cost of $8 million, a former call centre for Citizens Bank was converted into a 335-bed field hospital. In New Mexico, a vacant medical centre in Albuquerque was being used for recovering coronavirus patients. “We are seeing the worst rates that we’ve seen since the pandemic hit,” Mayor Tim Keller said in a recent interview.

Nancy Foster, the American Hospital Association’s vice president for quality and patient safety policy, said hospital systems that are busy during the pandemic have not yet fully examined how they could have been better prepared. But she said the lack of hospital beds in many states reflected pre-COVID times.

“In an era when you’re focused on reducing the cost of health care, having excess capacity — that you’re heating and lighting and cleaning and all of that stuff — is just antithetical to your efforts to be as lean as possible, to be as cost-efficient as possible,” Foster said. “So we’re going to have some critical thinking around what’s that right balance between keeping costs low and being prepared in case a disaster happens.”

The number of hospital beds in California has declined over time partly because of a trend toward more outpatient care, said Kristof Stremikis, an expert on the state’s hospital system at the California Health Care Foundation. But more acute than the shortage of beds, Stremikis says, are staffing shortages, especially in regions with high concentrations of Black, Latino and Native American patients.

“The system is blinking red when it comes to the workforce,” Stremikis said. “It’s nurses, doctors, allied health professionals — we don’t have enough of many different types of clinicians in California, and they’re not in the right places. It’s a huge issue.”

Newsom has said California would draw from a registry of retired or nonpracticing health care workers and deploy them to hospitals.

But Coyle, the head of the California Hospital Association, says she does not think volunteers can bridge the gap.

“We are down to a very, very small fraction who are willing to serve,” she said. “Those volunteers were not trained at a level to be as helpful in a hospital setting.”

At the county level, health officers are counting down the days until their hospitals are full. On Sunday, California became the first state to record more than 100,000 cases in a week, according to a New York Times database. The state government estimates that about 12% of cases end up in a hospital.

Dr Sara Cody, the chief health officer for Santa Clara County, which includes a large slice of Silicon Valley, projects that hospitals in the county will reach capacity by mid-December.

“This is the most difficult phase of the pandemic so far,” Cody said. “Everyone is tired.”

She is expecting a spike in cases from Thanksgiving gatherings, which could accelerate the timeline, she said.

Few states have been as aggressive in combating the pandemic as California, which now has a stockpile of a half-billion face masks. Los Angeles last week announced a ban on gatherings with other households. In Santa Clara County, hotels are now only reserved for essential travel and a ban on contact sports is forcing the San Francisco 49ers to play home games in Arizona.

“We have done everything that we can do as local leaders and health officials,” said Cody, who led the effort in March to put in place the country’s first shelter-in-place order. “We have worked as hard as we can work. We have tried everything that we know how to do. But without bold action at the state or federal level we are not going to be able to slow this down. We are not an island.”

Across California a weary populace wondered about the effectiveness of the state’s measures.

In Los Angeles, local officials were under fire after hundreds of tests scheduled for Tuesday at Union Station were cancelled because of a film shoot, a remake of the 1990s romantic comedy “She’s All That.” People who had scheduled tests were informed of the cancellation on Monday afternoon, and it was not until after midnight that Mayor Eric Garcetti announced the tests were back on.

The filming was still taking place Tuesday morning as Wendy Ambriz swabbed her mouth at the station’s testing kiosk.

Ambriz did not think the county’s restriction of outdoor dining, which went into effect last week, was necessary, noting that kitchen staffs are fastidious about cleanliness. But she did not blame government officials for the coronavirus spiralling out of control in Southern California.

“People don’t really follow directions,” she said.

That assessment appears to hold true for some of the state’s officials.

Sheila Kuehl, who sits on the county board of supervisors, was spotted at an Italian restaurant in Santa Monica hours after publicly calling outdoor dining “a most dangerous situation” and voting to ban it. In a statement on Monday, Kuehl’s office noted that the ban had not yet gone into effect when the dinner occurred. Her meal recalled another moment of apparent hypocrisy, a meal attended by Newsom and a gaggle of lobbyists at the luxurious French Laundry restaurant in Napa Valley just as the governor was advising residents to avoid meeting with large groups.

Outside the Broad Street Oyster Company in Malibu last week, picnic tables were cordoned off and the restaurant was not seating customers. But that did not stop people from eating there — they just ducked under the tape.

c.2020 The New York Times Company