Hospital ICU capacity has Fresno County officials expecting stay-at-home orders
The number of patients being treated in Fresno County hospitals for confirmed cases of coronavirus disease continued to climb this week, with 340 patients Thursday setting a new high-water mark for hospitalizations in the county since the COVID-19 pandemic reached the region in early March.
Of those hospitalized, 66 were sick enough to land in intensive-care units, just a few beds shy of peak ICU demand on several days in July and August.
“We are at a critical capacity level with ICU beds,” Dan Lynch, Fresno County’s emergency medical services administrator, told The Bee in an interview this week. “I’m very concerned about the ICU capacity in Fresno County because essentially the ICUs may be full, and what that means is that can back people up into the emergency departments.”
The county’s larger hospitals, including Community Regional Medical Center, Saint Agnes Medical Center and Clovis Community Medical Center, have the ability to make those kinds of adjustments, “but that limits the emergency room capacity,” Lynch said.
The concerns over ICU capacity took on new prominence this week as the potential trigger for a new regional stay-at-home order issued by California Gov. Gavin Newsom and the state Department of Public Health.
Under the order, five individual healthcare-delivery regions of the state will be evaluated based on the overall percentage of intensive-care unit beds that remain open for patient care. If a region’s collective available capacity falls to 15% or lower, businesses in counties within that region would have 24 hours to come into compliance with the more stringent measures intended to contain the spread of COVID-19.
Fresno County is one of 12 counties in the San Joaquin Valley region, along with Calaveras, Kern, Kings, Madera, Mariposa, Merced, San Benito, San Joaquin, Stanislaus, Tulare and Tuolumne counties. The Valley region had a collective ICU capacity available of 19.7% as of Thursday, the state Department of Health Services reported.
“Right now, we’re still above the 15% threshold,” said Dr. Rais Vohra, interim health officer for the Fresno County Department of Public Health, in a Friday videoconference with reporters. “If we as a county were being held to that 15% threshold, then we would already activate our shelter-in-place plan here in Fresno County.”
“However, they’re doing it by region, and as a region, we have 18% to 19% ICU bed availability,” Vohra added. “That’s why we’re not activating that shelter-in-place just yet.”
But given the overall trend of rising cases and increased demand for hospital and ICU beds across the broader region, the order could take effect almost any day now. “The way things are going, I won’t be surprised if it’s in the next couple of days,” Vohra said. “We’re bracing ourselves. We may get the announcement as early as tomorrow (Saturday).”
What’s the difference?
For the past several weeks, Fresno County and other neighboring Valley counties have resided in purple Tier 1 of the state’s color-coded Blueprint for a Safer Economy, with different tiers representing varying levels of risk for transmitting the virus in the community. Tier 1 is the most restrictive level limiting the extent to which businesses in a county can emerge from lockdown measures put into place earlier this year to contain viral spread.
In Tier 1, restaurants have been limited to outdoor-only dining as well as take-out or delivery orders; retailers and shopping malls have been able to open indoors at up to 25% capacity, and grocery stores at 50% capacity. Other services, such as barber shops, hair salons and personal services including massage, waxing, tattoo and piercing shops, have also been able to operate indoors.
If – or when – ICU capacity drops to 15% or below, even more stringent measures would take effect for a period of at least three weeks, including the closure of what the state has deemed “non-essential” businesses – including some of those that have been able to operate under the purple tier.
Barber shops, hair salons and other personal-care services would have to close. Restaurants could no longer provide outdoor dining, limited instead to only take-out or delivery. Retailers would face an additional 5% reduction in indoor capacity, down to 20%. Also included in the program is a restriction on all non-essential travel statewide.
Schools that have already reopened under county and state waivers by the time a stay-at-home order takes effect would be able to stay open.
The complete list of sectors that must close once the regional order takes effect – if they are not already closed under the blueprint tiers – includes: indoor and outdoor playgrounds, indoor recreational facilities, hair salons and barbershops, personal care services, museums; zoos and aquariums; movie theaters; wineries, bars, breweries and distilleries; family entertainment centers; cardrooms and satellite wagering; live audience sports; and amusement parks.
Vohra and public health director David Pomaville said the county’s strategy will be to rely on businesses and individuals to voluntarily comply with the orders when they come into effect.
“We are going to educate the business community about what the expectations are,” Pomaville said Friday. “Where we have entities that are not complying and we have significant public health concerns, then we will ratchet up enforcement.”
“We know we are heading into an area where it will be very difficult for businesses that have indoor operations to stay open,” Pomaville added. “We want to do everything we can to help.”
Pomaville said he is hopeful that additional state and federal assistance, similar to the federal Paycheck Protection Program of forgivable loans from the U.S. Small Business Administration earlier this year, will soon materialize to help small businesses and their employees stay afloat.
How critical is the situation?
Lynch said Fresno County hospitals and their intensive-care units are being pushed to their limits by an increase in patients – not only people needing to be treated for the coronavirus, but for all the other types of things that require hospitalizations, including surgeries, heart attacks, strokes, trauma and other illnesses.
As of Thursday, the number of patients in Freson County hospitals with confirmed cases of COVID-19 was higher than at any previous point in the coronavirus pandemic to date. In ICUs within the county, only 11 beds were available for new seriously ill patients.
Unlike a previous spike in cases and hospitalizations this summer, however, Lynch said there are fewer medical staffing resources available to deal with the influx of patients. In the summer, the Department of Defense deployed several medical teams to hospitals in Fresno, Madera and Tulare counties to help with the surge of patients in intensive-care units.
Now, not only are cases of coronavirus rising in the general population, more health care workers are having to quarantine because they either have contracted the virus or been exposed through close contact with infected people, Lynch said.
“Hospitals don’t have as much surge capacity right now because staffing is so limited,” he said. Fresno County and neighboring counties have requested additional help from the state, but almost every part of the state is also dealing with increased numbers of patients, so only a few more medical staff have been sent to assist locally.
“We’re pretty much on our own,” Lynch said.
The county’s ambulance system, which provide emergency transport for patients to hospitals, is also under strain from the pandemic, as crew members also confronting quarantines because of infection or exposure to the virus.
Lynch said the availability of ambulance crews, as well as longer times needed for hospital emergency departments to triage patients and screen them for the virus, is creating longer delays for for ambulances – sometimes as much as two to three hours – to return into service after they take a patient to a hospital
“COVID-19,” Vohra said, “is having ripple effects on every type of medical care.”
