Harvard: Coronavirus Patients Will Push San Diego Hospitals Beyond Their Capacity
Friday, March 20, 2020
Credit: Anne Wernikoff for CalMatters
An analysis of hospital bed data by Harvard researchers and journalists shows that even under what they consider the best case scenario, San Diego County hospitals will be filled beyond capacity in the coming months with an influx of patients needing treatment for COVID-19.
The models from the Harvard Global Health Institute, which are based on 2018 data, show that hospitals will be over capacity if 20% of the county’s population — between 60,000 and 70,000 people — is infected over the next 18 months. That is the best case scenario.
The worst case scenario has 60 percent of the population — over 1.8 million people — infected in a shorter time frame of 6 months. If this scenario plays out there will likely be five times as many patients as available beds, according to the analysis.
The data comes from the American Hospital Association and the American Hospital Directory and was analyzed by the Harvard institute and the nonprofit journalism organization ProPublica.
As of 2018, San Diego had 6,180 total hospital beds. Of those, about 68% were occupied at any given time. That leaves 1,950 beds, including 800 intensive care unit beds, available for new patients.
There have been a few additional hospitals built since 2018, so capacity has increased some but not dramatically, said Dr. Christopher Longhurst, associate chief medical officer at UC San Diego Health. He said local hospitals who are normally competitors are working together to make sure there is enough bed space as possible.
While San Diego has a relatively young population—just 13% of the 3.9 million residents are over the age of 65—new data from the Centers for Disease Control suggests that large numbers of younger people are also requiring hospitalization due to COVID-19.
The San Diego region is in worse shape than Los Angeles, Orange County and Riverside. In each of those regions, hospitals would be able to meet demand in the best case scenario. Under the worst case scenario, hospitals in those regions would have about four times as many patients as available beds.
Local hospital systems are already taking steps to meet the increased need. They include postponing all elective surgeries and non-essential surgeries and speeding up discharges.
At UC San Diego Health, there are currently 808 beds and 110 ICU beds available, according to hospital officials.
"We are reducing elective procedures, looking at contingency planning, how to expand our critical care beyond ICU beds, and looking at housing options on campus now that the students have moved out," said Dr. Longhurst.
He said UC San Diego Health is also boosting virtual visits to keep patients at home if possible. As of Thursday, 30% of the hospital’s visits were virtual, he said.
If more staff are needed, "we can extend physicians by bringing in internists who normally work in a different specialty," Longhurst said. "We'll also work to decrease exposure, by grouping patients who test COVID-positive together."
Kaiser Permanente San Diego is licensed for 621 beds between its Zion Medical Center and San Diego Medical Center and can access 100 patient beds at Palomar Health, according to spokeswoman Jennifer Dailard. She said their bed occupancy rate is always changing, but they have begun efforts to increase the number of available beds.
Scripps Health has 1,235 available hospital beds but is only staffed to care for 904 beds. As of right now, 700 of those beds are occupied, according to spokeswoman Janice Collins. The system has 169 ICU beds, 70 of which are occupied.
Scripps has already "cancelled a very large number of elective surgeries," Collins said. "The next step will be to transfer out or discharge any patient who could be discharged early or to a lower level of care or home health."
When beds are filled, Scripps Health will look for other open beds outside the region. Another possibility is what hospitals call surge tents. Scripps has eight tents which can each house 10 cots in close quarters, but only six with social distancing.
"But the surge tents would be used as a last resort," Collins said. "Staffing could also be an issue. If our doctors, nurses and support staff become ill, then even if we have a bed open, we might not have staff to care for patients."
If that happens, Scripps Health would try to bring in outside staff and then would ask government health agencies for support, including disaster medical assistance teams and medical reserve corps.
"But some licensure and credentialing issues would have to be addressed for these teams to work in the hospitals," Collins said.
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