As COVID-19 Cases Soar, Health Leaders Warn Of Dwindling Care—Even Before Getting To The Hospital

Dec 9, 2020

As COVID-19 caseloads climb throughout the state and country, many counties in our region, including Tulare and Fresno, are now reporting record-high numbers of patients with COVID-19 in area hospitals.

On Tuesday, for instance, Kaweah Delta Healthcare District in Visalia was caring for a record high 104 patients with COVID-19, 12 of whom were on ventilators in the intensive care unit. The hospital was reporting only 17 free beds—5 percent of its capacity—anywhere in its facility. “The hospital is incredibly full,” said CEO Gary Herbst during a media call on Tuesday.

Like many other hospitals, Kaweah Delta has also broken a record for the number of staff unable to work. On Monday, 146 hospital employees had tested positive for the virus, and another 50 were under quarantine due to a close exposure.

Though that’s the single highest total so far, Herbst warned the number could balloon even further. “Just yesterday by noon…already 150 of our employees had called our employee health department asking to be tested,” he said, “because they were either exhibiting symptoms or they were concerned about being exposed to somebody who’s positive.”

Unlike during the previous surge earlier this summer, when Kaweah Delta was among a handful of local hospitals to receive a team of military providers to assist with COVID-19 patients, the hospital now has to compete for staff with regions across the country all grappling with a crippling surge at the same time. As a result, said Herbst, hospital administrators are now asking retired providers to come back to the bedside. Nurses are taking on larger patients loads, and they’re being offered more shifts for overtime pay.

Over the weekend, Herbst said the hospital also requested 30 workers from a temporary state workforce known as the California Health Corps. He expressed doubt that any relief would come from the program, however, following a Sacramento Bee investigation that revealed the state program had enrolled only a fraction of the workers it had originally promised. “We certainly haven’t heard back relative to that request, so we’re kind of pulling out all the stops ourselves,” he said.

Other area hospitals are also reporting staggering numbers of employees temporarily out of commission while more and more patients need care. On Wednesday, Saint Agnes Medical Center in Fresno reported 109 employees had tested positive for the virus with another eight in quarantine, while Community Medical Centers cumulatively reported 355 employees in self-isolation, including 184 who had tested positive.

On paper, the single hospital in neighboring Mariposa County appears to be faring much better. Of John C. Fremont Healthcare District’s 18 beds, only five are full, and of those patients only one has a confirmed case of COVID-19.

However, the rural hospital doesn’t have an intensive care unit, which means patients in need of life support or ventilation have to be transferred to hospitals in Fresno or Modesto. On Wednesday, ICUs in those counties were 96 percent full.

Mariposa County Health Officer Dr. Eric Sergienko said the struggle to find ICU space is affecting his hospital’s emergency room. “We’re having patients hang out longer in our emergency department,” Sergienko said. “Or, if we find an accepting hospital, the ambulance gets there and they’re hanging out longer waiting to transfer that patient from the paramedics in the ambulance to the nurse in the emergency department.”

As more patients need transfers out of county, Sergienko worries paramedics may be in short supply. For instance, imagine you’re in a bad car accident in Mariposa County and the ambulance that would normally respond is transporting a patient to Fresno. “The firefighters who are the first responders are doing the best they can to keep you alive, but…the techniques that a paramedic could bring to the call are an additional 20 minutes away,” he said. “So even there, in the prehospital setting, you’ll see increased mortality.”

Sergienko argues stay-at-home orders may be important not just for reducing infections, but for reducing competition for scarce resources like ambulances.