San Diego-based hospital system Scripps Health is preparing for coronavirus cases in the city to "spike" in what CEO Chris Van Gorder describes as a "slow-moving tsunami" — even as it is already running out of surgical masks and doctors prepare to convert anesthesia machines into ventilators in a pinch.
"We know it's coming," he continued. "We can actually see it. We've got the early stages of it already coming ashore. You can see that with the positive patients we have in our hospital. But we don't know how big that tsunami is actually going to be."
Scripps Health operates five hospitals with 1,453 beds, 28 outpatient centers and treats roughly 600,000 patients each year. As of Monday, it had processed 4,822 coronavirus tests, identifying 217 COVID-19 patients, Van Gorder said. They had just nine coronavirus patients in the intensive care unit and five of them were using ventilators as of last week, he said.
San Diego is lucky. San Francisco Bay-area officials issued a stringent shelter-in-place order for roughly 7 million residents in Northern California on March 16, helping to slow the outbreak there. California Gov. Gavin Newsom expanded the order across the state three days later — when California had around 800 cases and New York had more than 4,100 cases — requiring all nonessential workers to stay at home except to obtain food, health care or go to the bank. It appears to have worked, giving hospitals some much needed time to prepare for an onslaught of cases and drawing praise Tuesday from President Donald Trump's coronavirus task force.
California currently has the third-highest number of COVID-19 cases in the country at 9,399, behind New Jersey at 22,255 and New York at 83,948, according to data compiled by Johns Hopkins University.
Newsom and other governors are trying to flatten or "bend the curve" — meaning the curve of a line graph that shows when cases will peak — using partial lockdowns and social distancing measures to keep cases from surging all at once. The worry is that it will stretch a hospital's capacity to treat patients, a dire scenario that's already starting to play out in New York City where 1,374 people have already died. The city currently has 20,000 hospital beds but is projected to need roughly 60,000 by the end of April when the outbreak is projected to peak.
Newsom said there are 416 hospitals in California with 78,000 fully staffed beds, and the state can add an additional 10,000 if needed.
"If we change our behaviors, that inventory will come down, if we meet this moment, we can truly bend the curve," he said.
Scripps Health has 1,453 beds in California and says it is working to expand its capacity even more. In addition to the nine COVID-19 patients in the ICU, five patients were in the medical-surgical unit, Van Gorder said. It had a total of 34 people under investigation as of last week, with six of those on ventilators.
Van Gorder, watching the outbreak rapidly expand in New York over the past month, said the health system has been preparing to get hit for quite a while. He said the staff has a "sufficient" number of N95 masks, which filter out about 95% of all liquid or airborne particles. "But once we get into our heavy time, we anticipate our supply could go very, very quickly," he said.
"We're continually working with our physician operating executives and doctors across the system and our staff to use them appropriately," he said. "Nobody is at risk. They all have sufficient supplies and protection to be able to take care of themselves. But we're also asking to be wise about the use because obviously there are communities like New York and others that are really suffering from that now."
Surgical and procedural masks are already in "very short supply," and "occasionally" staff is running out of those, he said. Hand sanitizer, bleach wipes, sandy wipes, and masks with eye shields are completely out of stock, he said.
"Face shields, full and three-quarter [length], are out of stock, but we're ordering more. And isolation gowns are in stock. We have about one- to three-days supply depending upon how much we use," he said, adding that staff is now directly sourcing some of its supplies from China.
Scripps has about 131 ventilators, he said, but hospital staff members are strategizing what other machines they could use as ventilators they predict will be "a real issue" for them.
"We have about 100 anesthesia machines and those machines can be used to be converted as a [ventilator]," he said. "And then BIPAP machines. They are not as good as ventilators but they could be used in a pinch."
Staff is also preparing for its hospitals to overflow. While Scripps has opened capacity, the staff has also discussed converting ambulatory surgery centers into so-called "mini hospitals." Dorms at the University of California San Diego, which has shifted all courses online, could be used to hold some patients, Van Gorder said.
"From the preparation standpoint, we've done a lot of things," said Dr. Ghazala Sharieff, chief medical officer at Scripps. But numbers on patients and supplies are "going to change as we get the surge."
A sort of silver-lining to come out of the outbreak was the health system making a successful transition to virtual care, Van Gorder said. As the entire state is under lockdown, patients are staying away and Scripps' doctors are now holding roughly 500 virtual care visits per day, he said. Before the COVID-19 outbreak, they had zero, he said.
"The doctors are really liking this right now because they are not putting themselves at risk during the appointment and neither are the patients," he said. "And they are finding it to be very, very efficient."
"Clearly people with a true emergency are trying to stay away," he said, adding they saw something similar during the 2008 financial crash.
Despite preparation, there is still a lot of anxiety among doctors and other health-care workers, Van Gorder and Sharieff said. The health system recently held a call with more than 300 doctors to address any concerns they had about the outbreak. Every Sunday, counterparts across the system and country also getting together to strategize as a community.
"For the ER doctors, we almost want it to hit because that's what we do best right. We jump into action," she said. "So, this is sort of a painful wait to get into these activities, which is likely to come shortly."