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Sutter Davis Hospital. Caleb Hampton/Enterprise photo

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Yolo County health care providers prepare for surge

As the number of COVID-19 cases in the United States continues to climb, hospitals and clinics have begun to see an influx of patients in severe respiratory distress. Intensive care units in New York and New Orleans nearly overnight, with cities for life-saving medical equipment.

As of last week, Yolo County had one coronavirus patient on a ventilator. On Sunday, the county . Eight other cases have been confirmed in the county, though limitations on testing mean the virus is almost certainly more widespread than the official count.

365体育投注California Governor Gavin Newsom 56 percent of Californians, about 22 million people, could be infected over the next two months.

Since January, local teams of physicians have been preparing for an unprecedented surge of patients. They have established testing and screening protocols, shifted non-urgent visits to telehealth appointments, postponed elective surgeries, reassigned medical personnel, relocated services, set up dedicated spaces to care for coronavirus patients and made contingency plans for worst-case scenarios.

365体育投注Physician leaders from the four health systems in the Sacramento area, Dignity Health, Kaiser Permanente, Sutter Health, and UC Davis Health, formed an advisory group to coordinate preparations and work with state government officials. “We are really working together on this, sharing information and collaborating,” said Dr. Richard Carvolth, Dignity Health’s Chief Physician Executive for the greater Sacramento region.

Freeing up space and reducing exposure risks

Last week, Dignity Health rolled out a telehealth screening system so that patients can be assessed in their homes and avoid potential disease exposure. Clinicians on the phone triage team help patients determine whether their illness is best managed at home or if they need a higher level of care.

Local health systems have also transitioned almost all non-urgent visits to telehealth appointments and postponed most elective surgeries. In addition to reducing exposure risks, these measures reserve space and clinician availability for patients with COVID-19. “We are trying to free up and create as much capacity as we can,” Carvolth said.

365体育投注To further reduce risks, Dignity Health and Sutter Davis have set up outdoor tents to screen patients who have symptoms consistent with COVID-19. “The tent is a place to screen respiratory illnesses in individuals away from the general population,” a Sutter Davis spokesperson said.

Dr. Ashley Sens, Chief Medical Officer for Dignity Health’s Woodland Clinic Medical Group. Courtesy photo

Relocating services 

Health systems are also relocating services to accommodate the routine health care needs of their patients while minimizing potential exposure to coronavirus. Dignity Health has designated certain buildings to serve patients with noninfectious medical needs.

“Our goal is to keep acutely ill patients out of the main Woodland Clinic building across from the hospital as well as out of the Davis building,” said Dr. Ashley Sens, Chief Medical Officer for Dignity Health’s Woodland Clinic Medical Group. “We want to keep those buildings available for elderly frail patients and patients with chronic illnesses that need ongoing management.”

As of Monday, Dignity Health triage teams will direct patients who may have coronavirus, as well as others in need of acute care, to the newly named Ambulatory Acute Care Center, formerly called East Woodland Clinic. Family medicine and pediatrics, which until Monday were at the East Woodland site, have been relocated to the main Woodland clinic and the Davis clinic.

365体育投注At the Ambulatory Acute Care Center, potential coronavirus patients may be evaluated in an outdoor screening area or in their cars to reduce exposure risks to health care workers and other patients. If symptoms are severe, the treatment team will either provide in-person care on site or transfer the patient to the Emergency Department at Woodland Memorial Hospital.

The East Woodland Urgent Care site will continue to serve patients with medical needs unrelated to coronavirus, but its hours are reduced (now open from noon to 8pm) and patients are asked to schedule appointments ahead of time to avoid sitting in the waiting room.

Dignity Health is also creating a dedicated COVID-19 ward at Woodland Memorial Hospital. “We feel the hospital and the clinic are very prepared for the surge that’s coming,” Sens said. “I want to reassure our community that we’ve got your back.”

Treatment protocol

While there is no definitive treatment for COVID-19, a team of doctors at Dignity Health in Woodland have developed treatment protocols for coronavirus patients. “We are actively looking at the latest recommendations,” said Sens.

Woodland Memorial Hospital. Courtesy photo

Protecting health care workers

365体育投注Health systems across the country have sounded alarms over , which physicians need to keep patients alive, and of personal protective equipment (PPE), which are needed to protect health care workers from infection.

“Right now, the hospital has a good supply of PPE but we are concerned — as is every other hospital in the country — about running through the supplies we have and not being able to replenish them. Running out of PPE is one of the biggest concerns for everyone,” Sens said.

On Monday, the state’s health care workers are expected to need 200 million sets of PPE to treat COVID-19 patients over the next three months.

365体育投注Several governors have urged the Trump administration to use the , usually reserved for wartime, to order companies to mass-produce key medical supplies. Thus far, President Trump has resisted using the act after the heads of large corporations .

Last week, U.S. health care workers to use scarves or bandanas if face masks run out, conceding that the garments’ “capability to protect health care providers is unknown.”

365体育投注On Monday, Newsom said California will and accept donated ventilators and PPE from the heads of Silicon Valley companies Tesla, Facebook and Apple.

365体育投注If protective masks, gowns, gloves or face shields run out, frontline health care workers are more likely to become patients themselves and to infect family members and others.

365体育投注In Wuhan, the was more than three times that of the general population. Roughly 1,300 medical staff in the city were infected and had to be replaced by nurses and physicians from other parts of China.

365体育投注Physicians in Yolo County said it could be difficult or impossible to replace local health care workers who fall sick. “If we lose a seasoned ER physician or an ICU nurse, they’re irreplaceable at this point,” one physician said.

Dignity Health is making contingency plans for the possibility that a substantial percentage of medical staff become ill. “We are working to identify physicians who work in the clinic who have critical care skills and would be able to work in the hospital if needed,” Sens said.

The local health systems are prepared to work together if a certain hospital becomes overwhelmed. “Any capacity concerns at the hospital would involve a coordinated effort with our local public health and with other nearby hospitals,” said Dignity Health regional communications manager Yessenia Anderson. “We have created collaborative networks with public health and CDC and other health systems in our community to ensure the patients who need care can get to a facility with capacity.”

Ventilators and intensive care units 

365体育投注California is roughly 50,000 hospital beds short of the amount that the expected surge in coronavirus patients may require, . Using outbuildings and tents, hospitals can reportedly stretch their capacity by about 30,000 beds. To further increase capacity, Newsom has mentioned the possibility of to serve as medical wards.

In New York, thirteen percent of people who tested positive have been hospitalized, with a quarter of those hospitalized requiring intensive care.

365体育投注According to hospital cost reports , there are 14 ICU beds in Yolo County and another 396 in Sacramento County. However, representatives of local health systems said the actual ICU capacity is greater than the reported figures.

365体育投注Anticipating a surge of patients who will require intensive care, Dignity Health is prepared to convert other hospital spaces into ICUs. Operating rooms and post-anesthesia recovery rooms can be used for intensive care, as can outpatient surgery centers that have suites equipped with ventilators. “We are looking at all of these things that we can bring to bear,” Carvolth said.

Healthcare providers and government officials are aiming to “flatten the curve” on the infection rate. Courtesy graphic

Testing remains limited

365体育投注 and across the country have reported being denied tests even when their physicians have requested them. According to local health care providers, it is unlikely testing will significantly expand before next week, though greater capacity is anticipated in April.

365体育投注For the past two weeks, local clinics contracting through commercial labs have tested some patients who met criteria outlined by the CDC. That criteria limits testing to people with a compromised immune system, older adults, patients sick enough to be hospitalized and health care workers with symptoms.

365体育投注“Broad scale testing is not available,” the California Department of Public Health said Friday in a .

Dignity Health has been testing a few patients per day at its East Woodland clinic. The tests are by appointment only and patients remain in their cars as health care workers collect swabs. “We have staffing capacity to test 20 people per hour, but we don’t have the tests,” said Sens. “They are in very short supply.”

365体育投注Despite , labs and clinics still lack essential testing supplies. Two weeks ago, that many of the test kits California received lacked the reagents required for them to work. Now, health systems are they need to collect samples, according to Carvolth and Newsom.

Even when testing supplies are available, turnaround times are slow. Most of the local clinics contract lab work through Quest Diagnostics, which in some cases has taken more than a week to return results, according to CommuniCare CEO Melissa Marshall and other local physicians.

365体育投注The UC Davis Medical Center has that delivers faster results, but the tests are not yet widely available. UC Davis began testing about 20 people per day last week, with plans to eventually increase capacity to 1,000 tests per day.

Stay at home

With local testing data too limited to be useful, physicians and public health officials are based on outbreaks in other places to predict when a major surge could arrive in the region. “It’s hard to know what the volume of the surge is going to be or the timing of it,” Carvolth said.

365体育投注The limited capacity to test also has urgent implications for social behavior. Studies suggest some of the largest coronavirus outbreaks by people who were asymptomatic and did not know they were infected. “Assume you are potentially contagious and act accordingly,” .

365体育投注California, Yolo County and the City of Davis have all issued “shelter-in-place” orders to limit social contact in order to slow the spread of the virus. “These measures are in place for a reason — to keep our hospitals from being completely overrun and to keep our health care workers healthy,” a local physician said. “Help keep us healthy so we can do our job keeping you healthy.”

— Reach Caleb Hampton at [email protected] Follow him on Twitter at @calebmhampton. We’ve put all COVID-19 news stories and local columns outside our paywall, to make sure all the information on local coronavirus response gets disseminated as widely as possible. To subscribe to The Enterprise and support local journalism, click here.

*To donate PPE items that are new and in their original packaging to Sutter Davis Hospital, visit Sutter Health’s or call 1-844-987-6099 for additional information.

*To donate PPE items that are new and in their original packaging to Dignity Health, email [email protected].

365体育投注*To donate PPE items that are new and in their original packaging to the UC Davis Medical Center, visit at .

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