The COVID tunnel: We need to push through

The numbers grow scarier each day.

Over the past week, California has topped more than 20,000 new cases of COVID-19 in a single day, with more than 8,000 people hospitalized due to the virus. Those volumes dwarf any seen in the past year, and the impact of get-togethers during Thanksgiving are not yet being felt, nor is the projected effect of the December and New Year’s holidays.

If this sounds grim, it’s because it is. This is the reality of our current situation, as California’s hospitals brace for unprecedented numbers of patients in the coming weeks.

Our health care workforce is stretched to the absolute limit. Fatigue, family needs, illness, and retirements are taking their toll.

This week, a full 75% and more of the state’s ICU hospital beds are filled, and if the numbers continue to climb at their current pace, the remaining ICU beds will quickly become occupied as well.

For California’s more than 400 hospitals, this is a daunting scenario, but one we have a better chance to meet if we address some key issues together.

First, our state’s health care workforce is exhausted and depleted, having battled through nearly a year of the virus’s unrelenting spread. At every hospital in the state, the concern about capacity is not about the number of beds, mattresses, and pillows, but rather the availability of nurses, doctors, respiratory therapists, and others to care for the people in those beds.

Our health care workforce is stretched to the absolute limit. Fatigue, family needs, illness, and retirements are taking their toll.

Of greater concern, the reserve group of travel and registry nurses typically used to bridge nurse shortage gaps are now serving in the Midwest and mountain states — places that surged before California — meaning reinforcements are scarce as well.

Because COVID-19 is a pandemic — it’s everywhere — we need to rethink how we help areas that are overwhelmed with illness.

We cannot train new nurses fast enough or find those we need today. That means we need to thoughtfully flex state rules, allowing those specially trained nurses who are available during this pandemic to care for one or two more patients each in order to ensure all Californians get the care they need.

Second, testing capacity, including laboratory supplies like reagents used to analyze test results, is strained. As testing is recommended for more people, like weekly “surveillance” testing for hospital workers recently recommended by the California Department of Public Health, we run the risk that supplies will run dry as we test people with no symptoms, leaving insufficient tests for people who have COVID-19 symptoms at exactly the time we are seeing a surge in those cases.

For the time being, we should prioritize testing for those showing symptoms of COVID-19, those who have come into contact with someone who has COVID-19, and those who ask to be tested.

Third, because COVID-19 is a pandemic — it’s everywhere — we need to rethink how we help areas that are overwhelmed with illness.

Typically, we transfer patients from overcrowded hospitals to other hospitals nearby. That solution does not work when every area is at risk for COVID surges and in need of hospitals, doctors, and nurses to care for many more patients. We need to bring state resources and help to local areas most stressed, ensure timely care for all, and avoid transferring patients far from home and family for care.

Whatever this virus may have delivered in the past, it is likely to pack an even stronger punch now.

We should continue to rely on counties to take the lead in moving patients first to other hospitals within the county and then to other contiguous counties if necessary.

Finally, personal protective equipment continues to be in limited supply. The availability of high-grade masks, gowns, gloves, and other gear fluctuates frequently as COVID-19 surges throughout the country and the world. While stockpiles have been partially replenished, any major outbreak means burning through astronomical rates of this life-saving equipment every hour of every day. That’s not sustainable for any extended period.

We need the federal government to do more to create the equipment that is needed worldwide and the state to share the contents of, and distribution plan for, its own stockpile of lifesaving equipment.

This has been a grueling year for every Californian, but our health care workers need more from all of us. With vaccine approvals in sight, there may be a light at the end of the tunnel, but we must get through the next few months. That will take cooperation, sacrifice, and a real understanding that whatever this virus may have delivered in the past, it is likely to pack an even stronger punch now.

We will only survive if all of us stand together — government, to “clear the decks” for health care providers; health care partners, to be supportive of flexibility as they are supported in their vital work; and all of us, who have an imperative duty to do our part by wearing a mask and staying home this holiday season.

We implore every Californian to do just a bit more, for just a bit longer, to help health care workers and their families stay safe.
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Editor’s Note: Carmela Coyle is the president and CEO of the California Hospital Association, which represents more than 400 hospitals and health systems.