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Saturday, Jan 28, 2023
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Surge and Routine

At the entrance to Adventist Health Glendale stand two military-looking tents where medical personnel test people for the coronavirus before deciding whether to send them home or admit them to the hospital. The tent is the first clue that these are not normal times at Valley-area hospitals, as public awareness has focused on the virus outbreak. In fact, hospitals in the Valley have seen a surge of COVID patients, but at a manageable volume, health care leaders said. Gov. Gavin Newsom required state hospitals, via a directive through the California Hospital Association, to increase capacity for patients by 45 percent, which executives said has helped with the influx. “Because we have a surge plan, we didn’t get close to our limit, but we did certainly have to take care of patients in alternative sites within the hospital to make sure we can provide excellent care,” said Dr. Bernard Klein, chief executive of Providence Holy Cross Hospital in Mission Hills and chair of the Hospital Association of Southern California. Holy Cross is No. 2 on the Business Journal’s list of Hospitals ranked by number of beds. “We all have developed that plan in case, God forbid, it gets really bad – like New York bad,” added Klein. The number of active coronavirus cases is back down in the 40s for Holy Cross, Klein said, but cases peaked at more than 60 on April 18 and 19. “Now, we’ve kind of settled into the 40s and we seem to be maintaining that number,” he added. Gustavo Valdespino, chief executive of Valley Presbyterian Hospital in Van Nuys, said the standalone hospital has seen more than 90 cases total, and is also in the 40s as of May 4. Valley Presbyterian is No. 9 in the Business Journal’s list of Hospitals by beds. Other hospitals interviewed declined to list case numbers, deferring to the Los Angeles County’s case numbers updated daily. Jennifer Swenson and Alice Issai, chief executives at Adventist Health Simi Valley and Glendale, respectively, said they operate on a “flex” basis, meaning non-COVID operations could get restricted if there is a surge of positive cases, or expand if the number of cases decreases. Adventist Simi Valley is No. 20 on the Business Journal’s list of Hospitals ranked by number of beds; Adventist Glendale ranks No. 4. Right now, Simi and Glendale are seeing a steady trickle of new cases, easily handled, and will slowly resume essential surgeries again if COVID cases remain at the same pace. Klein and Valdespino mentioned the same plan to expand available surgical procedures based on COVID cases. Surge plans To deal with the influx of COVID cases, hospitals have been screening potential patients before they can even step in the door, Klein said, with many setting up tents outside the emergency department and screening people outside, unless they’re exhibiting severe symptoms and need to be taken to the intensive care unit right away. “As more has been learned about this virus, our policies and practices have evolved,” added Dr. Nancy Gin, regional medical director of quality and clinical analysis for Kaiser Permanente Southern California, in an email to the Business Journal. Kaiser locations in the Valley ranked Nos. 21 and 22 on the Business Journal’s list of Hospitals by beds. “Since February, our national and Southern California command centers have overseen every aspect of coordinated response to COVID-19, from delivery of masks and gowns, to placement of ventilators, to opening extra space in our medical centers as needed for high number of members who need round-the-clock inpatient care.” Outdoor screening processes are part of surge plans local hospitals have in place to control capacity and infection rates within the facility, which take into account personal protective equipment, beds and allocating certain sections of a hospital for COVID patients. “We’re trying to understand who has COVID, who doesn’t, and physically separate them,” said Klein. “The next challenge was, as we got busier and busier — your surge plan. Where do you go when your ICU is full? Where do you go when your telemetry unit is full? And then making sure you have adequate personnel to treat the patient.” When the ICU at Holy Cross was full after a surge of patients several weeks ago, medical staff was ready with converted ICU space in what is normally the hospital’s surgery recovery room. Swenson told the Business Journal her facility has a trailer outside that helps with the triage process of separating patients, and doubled capacity in intensive care units. The Simi Valley team also created negative pressure rooms for infectious patients, Swenson said. Such rooms have air filtration systems that only pull air in, not out, creating a vacuum of sorts so that an airborne contagion cannot escape; air pressure in the room is lower than surrounding rooms. “We created those spaces too within other areas of the hospital, but right now we were able to contain it to one area,” said Swenson. “We have a 60-minute turnaround for those patients to be tested to see if they’re COVID or not COVID, which is huge.” Communication with competitors During the pandemic, hospitals have deepened or implemented communication networks between health care systems and standalone clinics that would normally be in competition with each other. “Gus Valdespino at Valley Presbyterian, he and I trade emails all the time,” said Klein. “We share, and also with Henry Mayo I’ve been sharing, and they’ve shared with me. This isn’t about competing; this is about taking care of our communities and our caregivers and our physicians.” “We’ve probably been talking between two to three times per week about working together on policies,” added Valdespino. “As a freestanding facility, I have reached out to many of my colleagues to just see where they’re going and work lockstep with them.” Open communication is key, Klein said, at a time when experts don’t know enough about the virus and directions from the Centers for Disease Control and Prevention and World Health Organization change constantly. “There’s a lot of rumor and false information, and there’s a lot of anxiety around it because we don’t totally understand how it’s transmitted,” added Klein. “I round every day at the hospital and a lot of my time is just trying to educate and reassure our incredible staff and doctors.” Dual roles Issai said going forward hospitals will have to marry normal operations with continuing separation measures for COVID patients. “You’re operating in two worlds,” said Issai. “We have to make sure this process of managing this infection keeps going, and it’s tight, while bringing our normal business back. Our service lines and our stroke program, all those interventional cardiology programs, orthopedic programs, making sure that’s vibrant and going on and people are getting the appropriate level of care that they deserve.” For most hospitals, that means widening the scope of surgeries and other operations allowed amid COVID-19 and assuring people that it’s safe to come to the hospital if needed during the ongoing pandemic. “What we’re seeing is, patients are delaying care. We just heard some really heartbreaking stories today from one of our ER docs, so we’re really trying to get the message out: It’s safe to come to a hospital,” said Klein. “When an ER doc, in an ER like this that is this busy, goes ‘I’ve never seen that before,’… it’s never good.” When is the end? Every medical professional interviewed by the Business Journal said that there really is no end to the pandemic. Rather, normal health care before the pandemic will fuse with mask-wearing, hand sanitizing and social distancing that is the “normal” we find ourselves in now. That is, until we gain herd immunity – or 83 to 94 percent of the population is immune, according to Lexico.com – or until a reliable vaccine is available. The Food and Drug Administration granted Gilead Science Inc.’s remdesivir for emergency use in COVID-19 patients, but full data on safety and efficacy has not been collected yet. The drug is reportedly priced at $4,460 per course of treatment. “The vast majority of the population is not immune to COVID,” said Klein. “We also don’t know, if you’ve had it, is that sustained immunity or does that change every year. Until we have widespread testing and we have a vaccine, and/or the vast majority of Americans come down with COVID, we’re going to have to continue social distancing, masks and PPE.” “The regular flu will come in at the same time, and it’s going to be very challenging to separate the two,” added Issai, referring to an expected resurgence later this year. “It’s something we’re already starting to plan, especially making sure we have all the supplies and PPE to manage the fall and winter.” Only 5 percent of the United States has gotten COVID, Klein added, and that number may be closer to 10 percent with those that are asymptomatic. “With some of these cities and states relaxing the social distancing now, are we going to see a surge sooner? Time will tell,” he said. “My guess is we will because we know it’s out there, we know it’s contagious and we know the safest thing to do is social distance.”

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