Are Fresno hospitals ready for ‘secondary surge’ of COVID-19? Doctors have concerns
Two of Fresno’s largest hospitals are bracing for what they believe could be a substantial increase in COVID-19 admissions as the number of positive tests in the surrounding county continues to rise.
Chief medical officers from Community Regional Medical Center in downtown Fresno and Saint Agnes Medical Center in northeast Fresno said their facilities are already being “challenged” by a growing number of patients over the past couple of weeks and are making plans to deal with even more as the coronavirus pandemic continues unabated.
For weeks, the volume of COVID-19 patients being treated across Community’s facilities, including Clovis Community Medical Center and the Fresno Heart & Surgical Hospital, was around 30 to 35 patients, said Dr. Jeffrey Thomas. “Over the last couple of weeks, we went to 40, 50, sustained 60,” Thomas told reporters Thursday in a media briefing by the Fresno County Department of Public Health. “I would not be surprised if by Monday we’re well over 100.” He added that the three facilities had a total of 93 COVID-19 patients as of Thursday morning.
Over the same period, Thomas added, the number of patients whose illnesses were serious enough to require treatment in intensive-care units has more than doubled, from 10 to 15 a few weeks ago to 30 now.
ICU volumes have also doubled at Saint Agnes Medical Center, said Dr. W. Eugene Egerton. First one, and then both, of the dedicated respiratory care units set up especially for COVID-19 patients are “pretty full right now.”
The doctors’ remarks echo a concern expressed by Dr. Rais Vohra, Fresno County’s interim medical officer, over the growing rate of confirmed infections being revealed by increased testing for the virus across the county. Vohra said last week that hospitals throughout the county – not just Community and Saint Agnes – were reporting that they are at or near capacity. That includes the wide range of illnesses and maladies for which people are treated in normal times as well as the extra demands being created by the coronavirus pandemic.
Prepared for surge
Thomas and Egerton said their hospitals began developing plans early on to handle an increase in COVID-19 patients. “We prepared for a surge that … never quite manifested,” Thomas said. “We were waiting and waiting and anticipating … and it seemed like it passed us over.”
But, he added, “in the last 10 to 14 days it certainly hit us right between the eyeballs and we’re dealing with that.”
At Saint Agnes, the initial pandemic planning included setting up a dedicated respiratory unit to isolate COVID-19 patients, including medical-surgical and intensive-care capacity, Egerton said. “We have, since the secondary surge, opened up an additional designated respiratory unit and we are looking strategically within our hospital for other areas should we need to expand further.”
To keep from overwhelming the hospital and emergency staff at Saint Agnes, Egerton said a separate screening facility has been set up in a tent outside the emergency department. The hospital also created a fever and respiratory infection clinic at one of its northwest Fresno clinic sites “to direct patients who are highly suspicious for COVID-19 infection for evaluation and screening.”
“We expected this secondary surge once we started reopening” businesses in the community, “and the epidemiology suggested that would be the case,” Egerton added. “I think now it’s a delicate balance between how you do things to address normal operations and still manage the needs around safety and efficacy of care for those patients who require it for being infected with COVID-19.”
Balancing everyday needs
That balance between caring for everyday medical needs requiring hospitalization and the sometimes-extreme needs of coronavirus patients – whose stays in intensive-care units can two to three weeks or longer, Egerton and Thomas said – is a considerable challenge.
“We’re a very busy acute-care hospital with a lot of sick patients who don’t have COVID,” Thomas said. “We’re pretty challenged to be pretty much at capacity any day of the week with cases that come for trauma or other things. Those are all ICU patients that we have to accommodate.”
“Any space in the hospital could be an ICU bed if you want it to be,” he added. He noted the alternative-care site, or “field hospital,” that remains in a standby mode at the Fresno Convention Center to handle overflow patients from area hospitals if necessary to make room for more COVID-19 patients.
“Cots are cots, but until you have people and equipment to take care of the patients in those cots, it’s useless space,” Thomas said.
