Local hospitals have begun to strengthen their response by enforcing social isolation, establishing triage processes and trying to anticipate potential surges in patients, as confirmed cases of the coronavirus increase in Santa Barbara County.
At Cottage Health facilities in Goleta, Santa Barbara and the Santa Ynez Valley, facilities have prohibited outside visitors except in very specific cases, and asked medical staff not involved in direct patient care to stay home and telecommute if possible.
Remaining staff and nurses are being used in the areas of most need, and helping to screen visitors for symptoms at the entrances to hospital facilities.
As of Wednesday, nonessential surgical procedures are being delayed for the next two weeks. Scheduled surgeries that meet certain critical need criteria will continue.
In preparation for greater influxes of severely ill patients, triage centers are also being set up in tents outside of emergency areas in the hospital.
Cottage Health is handling updates and changing guidelines through a command center staffed with a cross-disciplinary response team. According to spokeswoman Maria Zate, hospital emergency departments have been experiencing an increase in calls regarding conavirus testing.
"Our emergency departments are prepared to provide care for patients with severe respiratory symptoms. Currently our hospitals are not able to offer COVID-19 testing for the general public presenting with low risk and with mild or no symptoms," Zate said.
Hospitals throughout the county are also following instructions from the Santa Barbara County Public Health Department regarding testing for patients through a three-tier system, as well as reporting cases.
The first tier, and first priority for testing, includes high-risk individuals including the elderly, those being kept in negative pressure rooms at hospitals due to severe respiratory illness, and members of the health-care workforce, including nurses, doctors and first responders.
The second tier includes those who are severely ill but do not fit into any first-tier qualifications. The third tier, and last priority for testing, includes those who have mild symptoms and can recover by staying at home.
Healthcare staff are instructed to submit tests for healthcare workers and other tier 1 patients to public health laboratories, where there is limited capacity but a turnaround of results within 1-2 days. Approval from the county public health officer is required for these tests.
Alternatively, tests for those who qualify as tier 2 or 3 patients and meet a certain criteria are sent to commercial laboratories such as Quest Diagnostics and LabCorp. The turnaround time for commercial labs is 4-6 days; these tests do not require heath officer approval.
All suspect cases must be reported to the California Public Health Department. In the case of commercial labs where health officer approval is not needed, suspect cases must be reported prior to receiving results.
The county public health department has also released a triage testing tool for healthcare workers outlining the qualifying criteria and symptoms.
After other illnesses have been ruled out through testing, patients qualify if they have a fever, cough and shortness of breath. Testing candidacy is further determined with other factors such as travel history, exposure to confirmed cases, underlying conditions and age.
Beyond adding triage services for additional acute care patients, medical staff are are also having to consider their capacity for acute care patients as far as beds, by freeing up as much space as possible.
As cases have increased, patient levels have remained fairly standard and some acute care beds have remained open at hospitals such as Marian Regional Medical Center in Santa Maria and Lompoc Valley Medical Center.
At a Friday press conference, county public health officials added that none of the nine confirmed cases in the county have resulted in hospitalization so far.
However, further spread due to lack of social distancing has remained a concern for public health officials. County Public Health Officer Dr. Henning Ansorg said Friday evening that if the virus is allowed to spread freely, 80% of the public would be affected within two months, which would cripple the local hospital system.
"We now have widespread community transimission. We can no longer hope that Santa Barbara will be spared from this virus," Ansorg said.
Research by the Harvard Global Health Institute into the projected demand for hospital beds as the virus spreads estimates that in a best case scenario, at least 20% of the population in most regions will be infected over the next 12 months, with "moderate" scenarios projecting infection rates around 40%.
In the moderate scenario, 20% of those infected are expected to need hospitalization, and 5% of those infected are expected to require acute care, according to a ProPublica story about the research.
Marian president Sue Andersen responded to this statistic at the Santa Maria City Council meeting Tuesday in regards to the city of Santa Maria population, where 8,000 infected people would theoretically require hospitalization over the next 12 months in a moderate scenario.
"Twenty percent of those that get infected could require hospitalization. It just depends on how many get infected. A lot of the people don’t require ICU care, a lot of them can go into isolation rooms," she said.
She added that social distancing greatly helps to spread out the cases, and that at this point thousands of beds for coronavirus patients are not likely to be required all at once.
As they wait to see how case numbers change, Andersen said hospital staff "hope and pray that [they] have enough rooms and enough beds."
Between the main county hospitals, there are 822 acute care and intensive care beds and 11 additional approved beds.
Marian has the largest bed capacity in North County, with 197 beds and an additional 11-bed unit that has been approved to be installed at the prior hospital location on Church Street in Santa Maria.
Lompoc Valley Medical Center has a total of 54 intensive and acute care beds.
Cottage Health offers 519 acute care beds at Santa Barbara Cottage Hospital and 52 at Goleta Valley Cottage Hospital.
Dignity Health Central Coast Chief Medical Officer Scott Robertson said at the Tuesday city council meeting that even if only 20% of the population contracted the virus at once, it would still be a severe blow for local hospitals.
Again, however, these cases are less likely to erupt all at once with social distancing to flatten the curve, he said.
"If we needed three, four thousand hospital beds all at once, that would be a severe crisis that no hospital on the Central Coast would be able to meet," he said.
Laura Place covers city government for the Santa Maria Times.
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