SACRAMENTO, California (AP) – California Governor Gavin Newsom’s administration and the state hospital association are at odds over how best to create space for critically ill coronavirus patients in overburdened medical facilities that may soon be overburdened by expected increase in new cases of vacation dates.
A sudden increase after Halloween and Thanksgiving Day has produced a record hospitalization and now the most seriously ill patients are dying in unprecedented numbers. California health officials reported Thursday 583 new deaths and a two-day record total of 1,042.
The state deployed 88 refrigerated trailers, up from 60 a few weeks ago, for use as makeshift morgues, mainly in southern California.
Hospitalizations are approaching 22,000 and state models project the number to reach 30,000 on February 1. Many hospitals in Los Angeles and other hard-hit areas are struggling to stay updated and alerted that they may need to ration care as intensive care beds are shrinking.
Earlier this week, state health officials caught hospitals off guard and confused them with new orders, limiting non-essential surgeries and requiring hospitals with little ICU space to accept patients from those who ran out, an order that may require transfer. of patients for hundreds of kilometers.
The California Hospital Association said the orders did not go far enough to resolve a crisis that “cannot be overstated.” She wants changes, including reducing the paperwork she says is consuming hours a day from nurses who would otherwise be treating patients.
Carmela Coyle, the association’s president and chief executive, said the group is negotiating with state officials, but is not acting fast enough.
“We really need to act quickly to coordinate and see if we can remove the burden on the health care delivery system – focus on nothing but saving lives in the coming weeks,” she said.
State epidemiologist Dr. Erica Pan responded on Thursday that the government is “committed to continuing to coordinate and form partnerships with hospitals and local leaders.” She said state officials “are grateful for any suggestions from those who are on the ground fighting this pandemic every day.”
In the meantime, seeking to keep people closer to home, the Newsom administration issued a more strident travel statement, which says out-of-state residents are “strongly discouraged” from entering California and that Californians should avoid non-essential travel by more than 120 miles (193 kilometers) from home.
The state advisory in November encouraged people to stay at home or in their region without giving a specific number of miles. He described the quarantine guidelines for out-of-state travelers, but did not explicitly discourage travel.
Dr. Rajiv Bhatia, an associate professor of medicine at Stanford University and a former director of the San Francisco Department of Public Health, questioned the effectiveness of a distance requirement, noting that it will be difficult to apply and people can disconnect from another piece of state guidance. He said California, in general, did not provide adequate data to back up restrictions.
“They just don’t want to give anyone the opportunity to interact,” he said.
People traveling more than 120 miles are more likely to access commercial services such as hotels, said a California Department of Public Health spokesman, noting that the distance was designed to be fair for rural and urban residents.
Coyle said the orders affecting hospitals issued on Tuesday did not provide the help that hospitals desperately need.
Most hospitals affected by the order of non-essential surgeries have already canceled the type of procedure barred by the state, such as non-urgent spine or carpal tunnel surgery, she said. It applies only to hospitals in 14 of 58 counties, all in Southern California and in the San Joaquin Valley agricultural area, two regions that have the greatest shortage of ICU beds.
Coyle said it is also unclear how often the transfer order will be used. While it may mean sending patients hundreds of miles to northern California by ambulance, life-saving helicopters or other aircraft, it is more likely to facilitate transfers between nearby counties, she said.
During a previous outbreak, patients in Imperial County along the border with Mexico were sent to hospitals as far as the San Francisco Bay area. But the current outbreak is so widespread that only 11 mostly rural counties north of Sacramento and San Francisco are above the state’s limit of having at least 15% of the capacity for coronavirus patients in ICU beds. Those below that level are under stricter restrictions for companies.
UC Davis Health, which has the largest trauma center in the Sacramento area, said it has not received any transfer requests. A spokesman there and the Sutter Health system referred questions to the hospital association, while Kaiser Permanente did not immediately comment.
“If we can get patients in the right environment to start with, it will minimize the need to transfer patients after the fact, and this is frankly better for patient care,” said Coyle.
This means that California must start coordinating patient care at the state level, where authorities can get an overview of the best equipped hospitals at any time, instead of allowing local dispatchers to follow the usual practice of sending ambulances to the nearest facilities, she said.
“Yes, transferring patients is important, but we have a number of big issues that need to be addressed,” she said. This includes temporarily suspending regulations that she says can trap nurses in paperwork for hours and make it difficult to use a team approach to provide intensive care when hospitals do not have enough trained nurses in intensive care.
California Nurses Association director of government relations, Stephanie Roberson, said the nursing staff is a cost-cutting measure that would undermine patient care after hospitals have not adequately prepared for the increase.
“It is a slap in the face for safe patient care to really call graphics and documentation ‘bureaucracy’,” she said.
Pan said the state’s measures “will save lives” as officials seek to secure staff and resources for hospitals.
State health officials have not answered questions about how they expect health orders to be enforced or how many patients or hospitals may be affected.
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Associated Press writer Kathleen Ronayne in Sacramento, John Antczak and Christopher Weber in Los Angeles and Janie Har in San Francisco contributed to this story.