Only time will tell if the aggressive steps taken by Contra Costa health officials to order residents to shelter in place will limit the influx of patients to area hospitals.
As treatment of existing COVID-19 patients continues, area hospitals have been preparing for the surge that the models project will arrive by mid to late April.
For the moment, major health providers report being ready.
Contra Costa Regional Medical Center’s preparations include expanding operational capacity, accumulating the necessary protective equipment and ventilators, and getting personnel ready to go into areas where they have not normally been working so everyone will understand their responsibilities. In addition, staff is arranging for alternative care of patients in other locations.
“I want to believe that (the low number of cases) is the result of the precautions, but there is no scientific proof to show that is the cause,” said Dr. Samir Shah, chief medical officer.
Tents in parking lot
The most noticeable change is the erection of tents in the parking lots along Alhambra Avenue in front of the Martinez facility. The triage tent next to the emergency department is for screening patients entering the emergency department. Patients with COVID symptoms are medically screened, evaluated and tested in the tents, and then either discharged or admitted to the hospital. There are also some clinic tents where patients with fever or cough are evaluated and tested.
A similar sight may occur at John Muir’s main hospital or at its four remaining urgent care facilities in the county, including Walnut Creek, in preparation for the influx.
Shah said the staff, facilities and supplies are up to date. “We are happy to have the extra time,” said Shah. “All of these things in combination have been beneficial to our staff and patients, and they have prepared us well for the potential surge of patients to come.”
Postponing elective procedures
John Muir spokesman Ben Drew noted that staff levels and supplies generally are enough for now, though he acknowledged they are running low on face shields.
“The response from the community has helped to supplement what we get normally get from our suppliers,” Drew said, citing masks that the public has graciously donated.
Preparations for the impending surge have also taken the form of suspending elective surgeries as occurred at the county hospital, and the change has had a two-fold benefit. This allowed the main hospital to create 36 critical care beds that otherwise would have been used for post-op recovery, and surgical personnel have been freed up to be crossed trained for other areas.
Boosting staff levels
In addition, non-clinical staff, such as those in administration, are being readied to serve in roles such as running lab results from one place to another or answering calls.
“We can put them in roles that help the overall response,” Drew said.
Along with bringing in additional staff from facilities where there isn’t the need, John Muir is continuing to hire at this time to ensure that personnel get the proper breaks and rest.
And, they are moving existing patients to new quarters within the hospital.
“It is like moving pulse puzzle pieces around in the building to open other areas to accommodate the potential surge,” Drew said.
Using technology for family interactions
Other precautions taken at the county hospital include limiting hospital access of non-patients to minimize exposure to staff and patients. In its place is the greater use of technology and virtual platforms like telephones and tablets to supplement the direct contact with family and clergies for such things as the administration of sacraments like Last Rites.
Drew said John Muir also is trying to maximize the use of technology as a result of new access restrictions.
“We encourage FaceTime visits and using technology to the extent we can keep patients staying connected to their families and loved during this time,” he said.
Exceptions to access restrictions at John Muir include pediatrics, labor, delivery and post-partum as well as patients who have a language barrier or are end-of-life.
Anyone who enters John Muir Hospital or its urgent care facilities is required to wear a mask. A commercially produced mask will be provided upon entering.
Changes in place at Kaiser
Kaiser Permanente, too, has been crafting a comprehensive plan to ensures its staff and facilities are ready to safely care for the potential influx of patients, which has included increasing capacity and assessing non-traditional spaces to provide the necessary care. Donations from the community have aided in the effort.
“We are prudently managing our resources and aggressively pursuing additional supplies to ensure this equipment is available for our health care workforce for the duration of this pandemic,” said Kaiser spokesman Jonathan Bair.
Ramping up testing
At this point, Shah reported one confirmed positive case among hospital staff, and that individual is now self-quarantining at home. John Muir has also tested some personnel where symptoms were suspected, but none have come back positive.
As of April 2, the county had conducted 1,147 tests – with 40 coming back positive. While the turnaround time for tests conducted by the county is 24 hours, for commercial labs, it takes about five days – down from 10 days.
As more testing data about the community comes in, Shah believes officials will have a better idea if the early action of the county made a difference in mitigating the extent of the expected surge.
“I want to believe that is has given us the time,” he said.