Are Monterey Bay Area Hospitals Prepared for a Surge? Medical community gets ready for the worst

Emergency tents at Community Hospital of the Monterey Peninsula | Provided photo

PUBLIC HEALTH |

By Charlotte West

As the number of COVID-19 cases soars to 30,000 in the United States and more than 1,600 in California as of Sunday afternoon, hospitals in Monterey and Santa Cruz counties are preparing for what experts refer to as a “surge” of patients seeking treatment.

Hospitals in the region are taking increasingly more aggressive measures to protect patients. On Sunday, for instance, Community Hospital of the Monterey Peninsula adopted a no-visitors policy.

Medical and public health professionals say that Monterey Bay area hospitals have been preparing for an expected surge, but national health officials are warning that no region in the United States is fully prepared for the worst case scenario. Current measures include launching virtual medical services to discourage people from coming to hospitals and cancelling elective surgeries.

Public health officials in neighboring Santa Clara county, the hardest hit in the state with 263 confirmed cases and eight deaths, have already expressed a concern about a shortage of critical care beds for patients and protective medical equipment for hospital staff.

In a letter to President Trump on Thursday requesting the deployment of a hospital ship to California, Governor Gavin Newsom predicted last week that 56 percent of Californians could contract the coronavirus over the next eight weeks, although that doesn’t take into account the impact of current mitigation measures.

There were 15 confirmed cases in Santa Cruz County as of the health department’s latest report on Friday, while Monterey County reported a total of 14 on Monday, including a death on Saturday. Residents of both counties, along with the rest of the state, have been ordered to “shelter in place” until further notice, leaving home only for essential goods and services.

The number of cases is likely higher than those confirmed because hospitals have stringent requirements for who can be tested. When asked about the availability of testing during a press briefing on Friday, Allen Radner, chief medical office and infectious disease specialist at Salinas Valley Memorial Hospital, said, “I wish I knew. I’d be sleeping a lot better at night if I did.”

He said he is concerned about two things. The first is supplies. “We’re okay for the time being, but if this goes on for several months …” The second is whether the county can get rapid testing available soon. Once they do, he believes it will alleviate a lot of community concerns.

There are two major hospitals in Santa Cruz County and four in Monterey County. “The entire public health response is designed to lower the impact on hospitals, so that it doesn’t overwhelm the medical care system and deny care to people who really do need it,” Jason Hoppin, Santa Cruz County communications manager, told Voices. “That is what they mean when you hear the phrase ‘flattening the curve’. If the number of cases spike, you can’t get people into the hospital. It’s already kind of occurring with the testing. The testing demands are overwhelming, the capacity is extremely limited.”

In Santa Cruz County, the two major hospitals “have been prepared for surge for many weeks now,” Hoppin said. Hospitals are also taking measures to separate patients who might have been exposed from hospital staff and patients there for other reasons.

“I think they’re experiencing an extremely high volume of patients, and they have plans in place to kind of meet people at the curb,” he added.

According to a spokesperson for Dominican Hospital, they “have the supplies and equipment needed to effectively manage the care of any suspected or confirmed COVID-19 patients and…are continuously assessing the volume of supplies at our hospital.”

Dan Brothman, chairman of the board at Watsonville Community Hospital, told Voices that they are in possession of surge supplies for Santa Cruz County. “We have a large capacity of protective gear, including masks, the suits, everything,” he told Voices. “We feel that we’re in pretty good shape. But who knows what may happen. The volume might continue to grow at a reasonable rate or we could have a huge surge. But we practice for surges all the time. We’ve set up our surge tent [which serves as a staging ground for screening]. We don’t need it yet, but it’s set up and ready to go if we do.”

Monica Sciuto, assistant director of communication and marketing at Community Hospital of the Monterey Peninsula in Monterey, said they have been conducting practice drills and have prepared for weeks to handle any positive cases. The hospital recently set up an emergency incident command system.

“We have set up a medical tent near our Emergency Department to assess patients with flu or COVID-19-like illness separately from our general patient population. This is a proactive measure that all four hospitals in the county have taken to minimize exposure. Should someone test positive, we are prepared with isolation rooms, have a supply plan, and have implemented strict policies and procedures to keep our staff, patients, and community safe,” she added.

According to director of public relations Karina Rusk, Salinas Valley Memorial Healthcare System in Salinas has been in communication with vendors and other sources in case the hospital needs additional equipment and supplies.

“We have several systems in place to manage an influx of people with symptoms consistent with COVID-19. We also have the benefit of watching what has unfolded in other countries and other states,” Rusk wrote in an email. “Monterey County has had more lead time than most and has used that time efficiently and effectively to prepare for the weeks and months ahead.”

Recent analysis by USA Today showed that California might need eight times as many hospital beds than currently exist, and that assumes all are available. California would need 20 times as many open beds than are currently available when taking into account beds that are already occupied.

In Santa Cruz, Dominican is licensed for 222 inpatient beds. According to Brothman, Watsonville is licensed for 106 beds. with an average of 50 to 60 patients on a regular basis. “We could, on a surge basis, scale up pretty significantly from that,” he said.

In Monterey, Community Hospital has 240 beds. Mee Memorial has 94 beds, while Natividad Medical Center has 172 and Salinas Valley has 263.

Nationally, public health experts have noted that hospital intensive care units will be ill-equipped to handle a surge due to a shortage of ventilators, which help the most seriously ill patients breathe. Santa Cruz county currently has 31 ventilators between Dominican and Watsonville, Hoppin said

According to Monterey County public information officer Karen Smith, hospitals do not share total numbers of ventilators, only the number available.  “For example yesterday, one report was there are 12 ventilators available in total at all of the hospitals,” Smith wrote in an email. “We do have some portable ventilators from the state cache, however they need to have preventative maintenance before they can be used. That process is ongoing.”

Hoppin noted that there is a strong system of mutual aid within the medical system so counties are able to tap resources from others that might have them.

Rusk called the collaboration between hospitals and the Monterey County Health Department “unprecedented  in terms of strategy and coordination of policy and procedures.”

“We have been working together since early January and our weekly meeting schedule has become daily meetings,” she said.

“We have been holding weekly calls with the other hospitals in the county to talk about available resources and ways we can assist each other to meet demand. If there are resource needs we can’t meet through our regular channels, we work with the county and the state,” Brenda Moore, assistant director of community and marketing at Community Hospital, wrote in an email.

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Voices of Monterey Bay is a nonprofit online news source serving California's Central Coast.