What ICU capacity tells us about COVID-19

We can’t say we weren’t warned. As Thanksgiving approached, health care providers, elected officials and public health experts cautioned Americans against traveling or gathering with friends and family members to avoid a surge in COVID-19 cases, hospitalizations and deaths.

Unfortunately, many did not heed their advice. In a pre-Thanksgiving poll, 2 out of 5 survey participants reported they planned to attend a gathering with more than 10 people or with people from outside their own household. One-third said they would not ask guests to wear face masks. And according to the federal Transportation Security Administration (TSA), more than 1 million people traveled by air in the days surrounding the holiday.

The result: a surge in the number of people infected with the novel coronavirus that causes COVID-19, and nearly every hospital across the country experiencing shortages of beds in critical care units, along with a lack of clinicians able to provide treatment. What’s more, California isn’t looking so golden after all, as it leads the country in setting records for new cases, with more than 50,000 confirmed COVID-19 infections reported per day, and even greater numbers forecast in the near future.

“Since the Thanksgiving holiday, we’ve seen a consistent increase in hospitalization due to COVID-19,” says Danisha Jenkins, director of critical care at Sharp Chula Vista Medical Center. ”Nevertheless, our nurses, staff and physicians care deeply about our community and do strive to take the best care of our patients through any challenge.”

Capacity is not only affected by the number of beds in a hospital
According to Jenkins, space is not always the only issue when it comes to a hospital’s ability to treat more patients. While there may be rooms available for more patients in other units, the rooms may not have the appropriate equipment to treat critically ill patients or may not be negative pressure rooms, which ensure infectious germs don’t spread to nearby areas. Additionally, there might not be enough appropriately trained providers, such as ICU nurses and respiratory therapists, to safely care for a greater number of patients.

“The safety of our patients and staff is our top priority,” Jenkins says. “We separate COVID from non-COVID units to limit exposure and conserve personal protective equipment. Patients requiring ICU care require special technology, monitoring, nurses and physicians. And while there has been a significant increase in patients, there has not necessarily been a surge of health care workers.”

Unprecedented number of cases leads to unprecedented measures
So, what happens when a hospital reaches capacity and no longer has the ability to care for more patients?

Some hospitals in areas of the country where COVID-19 cases are causing ICUs to reach capacity are delaying nonemergency surgeries and procedures, while others are setting up temporary field hospitals in parking lots, sports arenas or fairgrounds. Hospital systems, primarily in the Midwest, are also preparing to begin the rationing of care, which means hospitals will determine which patients are treated based upon a patient’s age, condition and the likelihood they will survive.

As the Southern California region watches the number of available ICU beds dip below 1%, the California Hospital Association offered suggestions to manage the surge. According to the organization, hospitals should first try to convert non-ICU rooms to accommodate COVID-19 patients; move patients who may no longer require ICU care to nonhospital settings; or transfer patients to another hospital.

In San Diego, the percentage of patients being treated for COVID-19 has exceeded the percentage of patients with other conditions in local ICUs for the first time since the pandemic began. In response, area hospitals are working together to ensure that everyone receives the care they need, whether it’s for COVID-19, a car accident or any number of reasons someone might need critical care.

If an ambulance arrives at the Sharp Chula Vista emergency department and an ICU bed isn’t available, Jenkins reports they will work diligently to provide lifesaving treatment, stabilize the patient’s condition and place the patient in the safest environment available. “This may mean that the patient might have to be transported to another hospital, or spend a longer period of time in the emergency department,” she says.

The toll it’s taking
However, health care providers are beginning to show signs of fatigue as they witness people willfully ignoring stay-at-home orders, and COVID-19 cases surge to unprecedented levels. And their greatest shared concern is that this trend will continue throughout the holiday season.

According to San Diego County officials, it has become clear that the general public’s actions directly impact case numbers, hospitalizations, ICU capacity and the number of deaths we might see in the coming weeks. As such, experts are renewing their call for everyone to do their part to reduce their chance of contracting COVID-19 and spreading it to others.

“Safe, high-quality care is always the top priority of our staff and physicians, but they have grown weary and tired,” Jenkins says. “In order to break this pattern with the upcoming holidays, we need everyone’s cooperation in following the county’s guidelines of masking, social distancing and staying away from gatherings outside of your household.”

Get COVID-19 information and access to resources from Sharp HealthCare.