Surge: Some ambulances forced to wait hours as Bay Area ICU availability plunges

California, Bay Area hospitals strain amid crush of ICU patients

San Francisco Chronicle, By Jill Tucker, January 2, 2021
A COVID-19 patient who has had a stroke is prepared to be flown from one hospital to another on Dec. 22. Hospitals across California are straining to keep up with the surge.
A COVID-19 patient who has had a stroke is prepared to be flown from one hospital to another on Dec. 22. Hospitals across California are straining to keep up with the surge. Photo: Francine Orr / Los Angeles Times

The Bay Area’s intensive care unit availability dipped to 5.1% — its lowest figure yet — on the second day of the new year, even as the state braces for a further surge from Christmas and New Year’s celebrations.

The situation has gotten so difficult in Santa Clara County that some ambulances are sitting outside emergency rooms for up to seven hours waiting for a bed to open up for the patients they are carrying, county health officials said.

The delays — which mean the waiting ambulances cannot respond to other calls — have caused the San Jose Fire Department to transport people to emergency rooms at least a half-dozen times in the past week, the county officials said.

It’s a problem that’s already well known to the hard-hit Los Angeles area, where ambulances have waited for up to eight hours outside a hospital before patients could be moved inside, according to the Associated Press. In some cases, doctors started treating cases inside the vehicles.

Across the state, the outlook remained bleak, with a record 4,531 coronavirus patients in California intensive care units on Friday and the number of cases continuing to rise. The state recorded 53,341 new coronavirus cases on Friday, the second highest single-day figure, and another 386 deaths.

Available intensive care unit capacity in the Greater Sacramento region dropped sharply on Saturday, from 11.5% on Friday to 6.9%. The region, which includes the California side of Lake Tahoe, remains under a stay-home order, as do the Bay Area, the San Joaquin Valley and Southern California. The latter two regions are drawing heavily on hospital surge capacity, since their regular ICUs have zero availability.

Experts fear it’s unlikely to get better anytime soon, because it’s still too early for hospitals to see the effects from a Christmas surge.

“Admission to the ICU is often 10 to 12 days after exposure,” said Dr. Robert Siegel, a Stanford virologist. “The number of deaths may continue to increase for another week or more.”

Siegel also expects spikes from Christmas gatherings “will merge with, and contribute to surges” from New Year’s gatherings.

The ambulance wait times in Santa Clara County could be an alarming sign of things to come. The county saw a record number of COVID-19 deaths Friday — 38.

Santa Clara County Supervisor Joe Simitian, who co-chairs the Health and Hospital Committee at the Board of Supervisors, said wait times for ambulances are not uncommon during busy times of the week or during holidays. But they typically last no more than an hour — not seven.

“Whatever the period of time is, it’s always a concern because by definition you have folks you want to have admitted as soon as possible, and you want to have an ambulance crew on the road as quickly as possible,” Simitian said.

The combination of New Year’s Eve and COVID may have added stress on the county’s emergency system, he said.

“When you put together New Year’s Eve compounded by the COVID crisis, there are going to be some outliers that are troubling,” he said. “My understanding is they were relatively few in number — but obviously that’s cold comfort if you’re the one waiting for an ambulance.”

James Williams, the Santa Clara County counsel, said the county’s hospital system has been “teetering on the edge,” since a post-Thanksgiving surge in virus hospitalizations. He fears that another, similar surge, would greatly exacerbate what is already a problem with wait times at hospitals.

“If we have another surge now, anything like what we had after Thanksgiving — it’s going to cause collapse,” Williams said. Unlike March, the county cannot just make room by transporting patients to other facilities in California or another state. Santa Clara County has contingency plans for how to provide “some level of support” to those who may need it during a potential surge. But, Williams warned, those contingency plans would not be “providing everyone with the level of medical care that we take for granted in the United States.”

The virus continued its indiscriminate path through the population, infecting the young, old, famous and infamous. Talk show host Larry King, 87, was hospitalized with the virus, according to reports Saturday, while Dawn Wells, who played Mary Ann on “Gilligan’s Island,” died Wednesday. And at least one person was hospitalized after a New York Republican club’s Christmas party featuring an unmasked conga line.

Between pandemic fatigue and the holidays, the current surge will probably continue well into January, with hospitals, funeral homes and nursing homes continuing to see the fallout. State prisons also continued to see a surge, with 6,510 reported cases in the last two weeks — a sizable portion of the 40,985 incarcerated people who have had COVID-19 at some point.

Across Southern California, where the virus has hit the hardest, mortuaries have had to turn away families due to lack of space for all the bodies — and with funeral homes filling up, there’s a backup of bodies at hospitals, Los Angeles County Director of Health and Human Services Dr. Christina Ghaly told the Associated Press. The county medical examiner is looking for alternatives to store the bodies, she said.

Although thousands of California front-line workers have received vaccines, there is no impact yet on case counts. But the idea of a vaccine may be having something of behavioral impact, for good or for bad, according to Stanford’s Siegel.

“Some people have increased their precautions with the realization that it would be tragic to be infected when their turn to be vaccinated may be just around the corner,” he said. “Other people have increased their risk behavior knowing they will soon be protected or knowing that other people around them are vaccinated.”

Chronicle staff writer Michael Williams contributed to this report.  Jill Tucker is a San Francisco Chronicle staff writer.