Editor’s note: Dr. William Miller, chief of staff at the Adventist Health Mendocino Coast Hospital, is writing weekly reports concerning the COVID-19 situation on the Mendocino Coast. We are pleased to be running his health column, with details on the medical fight against the pandemic. The views shared in this weekly column are those of the author, Dr. William Miller, and do not necessarily represent those of The Mendocino Voice or of Adventist Health.
Last week, I intended to address the topic of breakthrough cases. However, last week was also a week in which I was taking care of patients in the hospital and because of increasing cases throughout the county I ended up not being able to find the time to write my weekly column for which I apologize. This week, I want to give you an update on the local surge in cases and will dedicate next week to talking about breakthrough. In the meantime, The Wall Street Journal reported a headline today that I think sums the situation up very accurately and succinctly, “As Delta Surges, COVID-19 Breakthrough Cases Remain Uncommon.”
The past week has seen greater numbers of new cases in Mendocino County than during any part of the pandemic thus far. On August 13th, there were 150 new cases on that one day alone. This is a huge increase as the current running weekly average has been 40 per day. The highest number of cases previously was 74 on November 12th during the start of the winter surge.
If even 10% of those people end up requiring hospitalization, it will put a significant strain on our three hospitals over the next few weeks. The hospitalization rate with Delta may be closer to 20%. As of this writing, we have a total of 32 patients in our three hospitals with COVID. That comprises about 1/3 of all hospitalized patients. Compare that to the average number of hospitalized COVID cases the previous week which was 19. Nearly all these patients were unvaccinated.
Being that all three hospitals in the county are part of the Adventist Health (AH) system, we can freely share resources including some technical and leadership personnel, beds, ventilators, personal protective equipment (PPE) and medications. We have activated our Incident Command structure to coordinate all efforts so that resources can be directed where needed most. We are also able to tap into resources from the rest of the AH system.
To help meet the expected increased demand for hospital beds, we are postponing all but the most essential of elective in-patient surgeries. We have obtained five more ventilators from the AH system pool to be shared as needed between the three hospitals. We have enough PPE. The mainstay of treatment remains Decadron and Remdesivir, both of which we sufficient stocks of. Testing supplies remains adequate as well.
The biggest challenge is staffing. However, despite a rumor going around, at no time have we been understaffed at any of the three hospitals, meaning, we always remained within the regulated staffing ratios. However, at the Coast in particular, we have had to cap admissions at times to stay within those ratios. Our surge plan calls for reassigning staff within the hospital as needed to help ensure that we can care for patients as the surge continues. Most hospitals in Northern California are experiencing similar challenges making it less likely that we will be able to transfer patients out of the county.
There is a worsening national shortage of almost all types of hospital staff, especially nurses and respiratory therapists. Some parts of the country are paying very high premiums to get the nurses they need and this is starting to create competition between hospitals and hospital systems who need to get sufficient staff to care for these rising numbers of patients.
Both AH Ukiah Valley and AH Howard Memorial are near capacity, each with a small number of patients waiting in the ER to get admitted. AH Mendocino Coast has capacity and has been able to accept patients from our two sister hospitals to reduce the burden and ensure high quality care for all patients in our county. This is an important example of sharing resources. Our ambulance service has brought extra resources into play to help facilitate movement of such patients. This is being done in such a way as to ensure that we continue to have the same availability of ambulance services to respond to 911 calls on the Coast as always.
Our surge plan, which consolidates resources across the three hospitals includes bringing online almost 50 more beds in the county if needed. This will include opening up units at Ukiah and the Coast that are currently closed, such as the L&D unit on the Coast. We are continuing to monitor this unfolding situation and responding accordingly.
You can access previous Miller Reports by visiting www.WMillerMD.com.
The views shared in this weekly column are those of the author, Dr. William Miller, and do not necessarily represent those of the publisher or of Adventist Health.