Contra Costa County, California – In a year defined by the pandemic, Christmas Day arrives as a significant milestone. As December draws to a close, Bay Area hospitals are near-capacity. Another holiday surge like the one after Thanksgiving and things could get much worse.
“Staffing in general has always been a very complex issue to address in hospitals, ’cause you’re dealing with a moving target,” explained UCSF nurse Sarah Egan.
The Bay Area’s ICU capacity dipped below 10 percent on Thursday. The effort to manage patients, beds and staffing is only getting more complicated.
“There are people in the ICUs who are scheduled to be in the ICUs after major surgery, for instance,” said UCSF epidemiologist George Rutherford. “And they try to move them out at a certain point in time so there’s an ebb and flow through ICUs.”
Those numbers always bounce around a little bit on their own. For example the holidays usually drive an increase in emergency room visits. The ever evolving coronavirus trends just get layered on top of all that.
“What do you want to see is the kind of overall trend and follow that,” Rutherford says. “You can always stop doing elective cases, which they haven’t asked yet.”
That is a change from back in the spring when hospitals did cancel elective surgeries and many outpatient procedures. This time, they’re trying to keep all of those services going.
“That means that you need nurses and other personnel to staff the operating rooms, the surgical street,” says UCSF health policy professor of Janet Coffman. “You may need more nurses on your general medical floors, and so that limits the number of nurses who are available to work in the ICU or the ED with Covid patients.”
The decision has frustrated nurses, now in increasingly short supply.
“Hospitals aren’t taking that step anymore,” Egan says. “They are continuing to do unnecessary procedures, bringing in more and more patients on top of the super sick Covid patients who come in.”
So the capacity issue isn’t going away, it’s still going in the wrong direction. Thus the dire warnings on holiday gatherings and travel.
“We cannot afford that,” Santa Clara County Health Officer Dr. Sara Cody said Wednesday. “We cannot afford another surge on a surge.”
The Bay Area escaping its current stay-at-home order depends on ICU numbers improving by January 7th, about two weeks from today. Two weeks from today is also about the time case numbers will tell us whether or not Christmas is going to drive another spike in cases.