For weeks, intensive care nurse Suzie Minnich worked at the forefront of the Bay Area’s latest wave of COVID-19 at the heart of the region’s crisis: Santa Clara County.
A staggering 154 people a day were admitted to ICUs in Santa Clara County on average in January, and Minnich, the managing nurse for two ICUs at the Santa Clara Valley Medical Center in San Jose, said dealing with the flood of patients “is like work on quicksand. “
“I make a bed and two patients are already waiting for it,” she said.
The number of people in the county’s ICUs is almost seven times higher than in October before the holidays, and hospital officials estimate that at least half of these patients have COVID-19.
The flood of people in need of intensive care is prompting administrators to bring doctors from outside the ICU to help.
“Normally, we wouldn’t even think about doing that because these doctors are not well trained to care for this type of patient,” said Dr. Cliff Wang, head of the Department of Medicine at Santa Clara Valley Medical Center. But these are extraordinary times, he said, and these doctors can take on tasks that release ICU doctors, such as calling family members about a patient’s condition.
Santa Clara County hospitals are by far the hardest hit in the bay area, with 37% more new patients arriving at their ICU beds daily than in the second most saturated county, Alameda, which is serving an average of 113 new patients of ICU per day this month, from 19 per day in October.
Although Santa Clara County is struggling with the most new ICU patients each day – it is the largest county in the bay area, with 2 million residents – all counties in the region have had a tremendous jump since before the holidays, with increases that are nine, 10 and even 17 times more in some counties.
The growing numbers suggest that many people have simply ignored the public health experts who begged them to stay home while on vacation, if not to avoid illness, then to keep ICU beds available for emergencies, from car accidents to heart attacks.
Not everyone heard.
“During Christmas it was the worst nursing week I have had in 10 years,” said John Pasha, a coronary ICU nurse who works the night shift at Bom Samaritano Hospital in San Jose. A decade ago, Pasha traveled to Haiti to help after a 7.0 magnitude earthquake destroyed much of the country.
In a way, he said, this increase is even worse than that.
“I’ve never seen anyone have a respiratory arrest faster than someone with COVID-19,” said Pasha. “This person was saying that he was having trouble breathing. I looked away and turned around, and the person was dead.
“This is COVID,” he said. “This is what is scary.”
The intensive care units, with their specially trained doctors and nurses, accept only the most sick. All ICU patients have their own room. Each person is surrounded by life-saving machines, sometimes up to 15 IV pumps. Wires connect the patient to a monitor that beeps and emits a steady stream of vital data about oxygen levels, heart rate, breathing rates and body temperature. And now, as families are prevented from visiting patients, the mix of equipment includes tablets in stands so that these visits can take place virtually.
Under California law, each ICU patient can share a nurse with just one other patient. But because of the sudden increase and the objection of nurses who consider this unsafe, state officials now allow hospitals to request an exemption from these fees. Despite the limits, a patient’s cramped ICU room is often a crowded place, as nurses and technicians collaborate to turn the patient around safely, sometimes twice a day, or when a team of doctors and other specialists surround a patient , fighting for that person’s life.
Minnich said that at least half of the ICU patients at Santa Clara Valley Medical Center have COVID, many of them in their 40s and 50s – a younger group than she saw last spring.
Pasha, Minnich and Wang described their colleagues in the ICU as being incredibly tired.
“People are exhausted. Exhausted. Everyone is running on the reservation, ”said Wang. “The additional shifts mean you are not at home regularly – and you don’t sleep as well because you know you can be called up at any time.”
The difference from the usual experience of canine tiredness in the ICU is that “now there are so many patients that you really don’t have time to recover,” he said.
The other day, Minnich was walking down the hall and saw a nurse standing by the IV pump outside his patient’s room, looking somewhere, with hunched shoulders.
“He looked exhausted,” said Minnich. “I said, ‘Are you okay? You need help?’ He said, ‘No, I’m fine.’ I said, ‘You want this to end, don’t you?’ He said yes! ‘”
Five ICU beds have been added to the 40 that Minnich usually oversees, she said, and there is no guarantee that the unit will not be expanded again. She manages about 140 nurses.
Across the city, in Good Samaritan, Pasha works 12-hour shifts “with no meal breaks,” he said. “We cannot leave our patients because we have no people to replace us. There is no break nurse. We usually have a quick response nurse who can come if the patient is getting worse. We don’t have that anymore. There are no extra hands. “
Patients can stay in the ICU for weeks, sometimes more than a month, said Minnich, long enough for doctors and nurses to know and care about them.
“Think about it,” she said. “You are with someone every day for two to six weeks. You are taking care of them. This is someone who has a life. They have people who care about them and love them. They have hobbies. They had a life before they came to the ICU and are now very sick.
“People hear about numbers. But they are not numbers. They are people. The losses were many. And those who survive, many will face disabilities for the rest of their lives. It won’t end for them. “
More information
Santa Clara County hospitals are by far the hardest hit in the bay area, but all counties are experiencing huge spikes in ICU admissions. The figures below compare the daily average of ICU admissions in October and January.
Santa Clara County: Oct.: 24. Jan: 154, almost seven times as much.
Alameda County: Oct.: January 19th: 113, six times higher.
Contra Costa County: Oct.: 7. Jan.: 66, 10 times bigger.
Napa County: Oct.: 1. January: 17, 17 times more.
Solano County: Oct.: January 4th: 38, nine times more.
Marin County: Oct.: 1. January: 7, seven times more.
San Francisco County: Oct.: January 10th: 57, six times more.
San Mateo County: Oct.: January 6th: 41, six times more.
Sonoma County: Oct.: January 6: 19, three times higher.
Source: Chronic analysis of hospitalization data in California
Dr. Ahmed Kamal, director of health care preparation for COVID-19 in Santa Clara County, warned this week that relief from the post-holiday increase is not yet in sight, despite the arrival of vaccines.
“As terrible as it is, things can get worse,” he said, adding that the county “has not been in a situation where two people are short of breath and only one gets a fan.
“But we could get there.”
Nanette Asimov is a writer for the San Francisco Chronicle. Email: [email protected] Twitter: @NanetteAsimov