COVID-19's Impact On Riverside County Hospitals, Staffers

RIVERSIDE COUNTY, CA — The record-breaking rise in COVID-19 hospitalizations continued Wednesday in Riverside County, and medical teams are bracing for challenges ahead.

The addition of 28 patients since Tuesday brought the number of COVID-19 hospitalizations countywide to 628, up from 600 the previous day, according to the Riverside University Health System. That number includes 126 patients being treated in intensive care units — one less than Tuesday.

It was the fourth coronavirus hospitalization record set this week. On Sunday, health officials reported 573 total hospitalizations in county hospitals, RUHS spokesman Jose Arballo said. Prior to this week, the previous record high of 550 hospitalizations was set in July.

The total number of infections recorded countywide since the public health documentation period began in early March is 85,896, compared to 84,824 on Tuesday. The number of deaths stemming from complications related to COVID-19 stands at 1,444.

Hospital Staffing, Beds

Rising infection rates raise concerns about hospital bed capacity and staffing, but several Riverside County officials say facilities are logistically set up for this second wave.

"The difference this time around is we are more prepared and ready to handle the surge," Riverside University Health System-Medical Center CEO Jennifer Cruikshank told City News Service on Wednesday. “But as more people come in and more people become positive, it’s more difficult for our health care team to manage, and it stretches our staff.

“The sheer volume of patients is much higher than what we saw in the summer because our winter census tends to be higher," she said.

“We have exceeded our normal census for this time of year, and this past week we have had a record volume of patients,” Cruikshank continued. “We have also had to begin cancelling non-urgent surgeries to ensure adequate bed space.”

RUHS is the largest treatment facility in western Riverside County. According to Cruikshank, there are still patient beds available. The usual capacity is 439.

Cruikshank said there is a reliable stock of personal protective equipment available, and “patient flow processes” are better than four months ago, but there are ongoing concerns about the potential for staff becoming infected or having to drop shifts to "care for ill family members."

"RUHS, just like many hospitals across the county, does not have as many staff as we had in the summer surge because today, we are competing with hospitals nationally for those same resources that were not in such high demand across the country during the summer surge," the CEO told City News Service.

“The concern is around staff availability to manage this newer and likely larger surge of patients,” Cruikshank said.

A factor that may come into play for local hospitals is a directive issued Nov. 25 by the California Department of Public Health that requires all general acute-care hospitals in the state to begin COVID-19 weekly testing of all health care workers beginning Dec. 14. The testing could potentially lead to the discovery of asymptomatic health-care workers who will be required to take time off.

Burnout among health-care professionals has also been documented around the state.

Dr. Anil Perumbeti, medical director for the intensive care unit at Eisenhower Health in Rancho Mirage, told the Los Angeles Times that staff has taken pride in caring for patients during the pandemic, but there is a cost.

“There’s definitely [been] two-week periods of time where nobody makes it out of the COVID ICU, no one gets better enough to be transferred out, there are multiple deaths, there are no success stories, no one gets better,” he said. “I don’t think there’s any amount of experience that makes that OK or makes you feel like you did the best you could.”

While RUHS contends with COVID-19 deaths, staff is also contending with patients coming in for other health-care issues who are unknowingly infected with the virus, which adds another layer of complexity.

There is an "increase in the amount of asymptomatic patients" — people coming to the hospital and manifesting no outward signs of COVID-19, but coming up positive during screenings, Cruikshank said.

"Currently we are working on staffing to accommodate the increase in cases, along with bed allocation and conversion to place those patients," the CEO said, adding that "several patient care units are COVID-only."

She said there remains sufficient space for treatment of non-COVID patients.

The triaging process that was refined during the summer remains in place, according to Cruikshank.

On the upside, protocols have been amplified "to reduce hospitalized length of stay," moving people out of patient beds and back home to recover, according to Cruikshank.

"Our entire team has and continues to work tirelessly to ensure we can support the volume of patients coming to us to receive care while we keep our teams safe," Cruikshank said.

In July, Gov. Gavin Newsom announced the California Health Corps, which called on health-care providers, behavioral health professionals, and health care administrators to sign up to relieve pressure on the hospital system by providing care for non-COVID-19 cases.

On Monday, he renewed the call, asking recently retired health-care professionals, or those who may have let their licenses lapse, to consider signing up to help.

In a pre-Thanksgiving briefing last week, RUHS Dr. Geoffrey Leung said hospitals throughout the region were "starting to feel the strain" but stand prepared for an influx of patients.

"I think this (surge) will be a little different," Leung said, referring to the amount of preparation that occurred over the summer to ensure facilities have the resources on hand to address greater patient counts.

That sentiment has been echoed by county Emergency Management Department Director Bruce Barton, who recently assured the Board of Supervisors that facilities have access to sufficient personal protective equipment and have made arrangements for excess capacity if and when it's required.

Leung said residents who have any type of critical medical need should not delay care, because facilities are following protocols to separate the contagious from the non-contagious.

The overall licensed hospital bed capacity in Riverside County is 3,560 with 385 licensed ICU beds, according to the county's "Readiness and Reopening Framework" document. According to the document, the county can potentially add an additional 2,464 beds and an additional 716 ICU beds.

—City News Service, Patch Editor Toni McAllister