California hospitals facing dire staff shortages

California health officials say if the current surge of COVID-19 cases in the state continues, staffing shortages at already strained hospitals will erode the state's overall healthcare system.

"You can certainly stretch many rubber bands pretty far, as we are stretching many of our hospitals pretty far, but we know that that stretch has a limit before it breaks," said California State Health and Human Services Secretary Dr Mark Ghaly during an update Tuesday.

"We certainly know that Southern California hospitals are in crisis, and some have begun to implement parts of crisis care," he added.

As coronavirus cases rose through the holiday season and into the new year across the US, staffing has become a primary concern in hospitals.

As of Dec 28, there were 1,132 hospitals across the country experiencing a critical staff shortage, and 1,334 said they anticipated such shortages within a week, according to data from the US Department of Health and Human Services.

The situation is especially dire in California, the nation's most populous state and now the national epicenter for the coronavirus, where the overflow of patients has strained resources and taxed staff.

Among all states, California has the highest percentage of shortages, with 163 facilities dealing with critical staff shortages and 176 facilities anticipating shortages in the next seven days.

Dr Brad Spellberg, chief medical officer at Los Angeles County+ USC Medical Center, said in an email that the hospital has redeployed staff who care for patients outside the intensive care unit (ICU) to increase staffing in the ICU and the intermediate level of care areas.

"That means we are not doing elective surgeries or procedures, like colonoscopies. It also means fewer visits to outpatient doctors," he added.

The 600-bed public hospital located on Los Angeles' Eastside is one of the area's largest hospitals. It has been inundated with patients since the start of the pandemic, because many people who live near the hospital work in essential industries and the low-income, predominantly Latino community it serves has been hit hard.

Spellberg said the hospital has hired "as many temporary workers as we can", but the staff "are still stretched thin, particularly in the ICU.

"One cannot just create more ICU nurses and doctors. They are highly and specially trained. The state has sent some staff to help as well. If there is another surge of COVID pos-December holidays, it will not be enough," he warned, adding that the ICUs have "zero capacity".

Huntington Hospital's President/CEO Dr Lori Morgan called staffing the biggest challenge faced by the hospital in a briefing to Pasadena City Council members on Dec 14.

"The percentage of staff who are getting COVID in the community is only slightly lower than the community percentage that are getting it," she said.

Morgan said the hospital has a 30-bed ICU capacity but could "flex up" to 80 to 86 beds at maximum if it could employ additional pulmonologists and nursing staff. But given the current staffing constraints, it's going to be very difficult to meet that capacity, she said.

"To get to our 'stretch capacity', we have to go beyond state-mandated nurse staffing ratios. The physicians staffing ratios aren't state-mandated, but we have to ask people to take care of more patients than we would under normal conditions," she said.

Morgan also told city officials that the facility has experienced a "tsunami of COVID-19 patients" and that the number of hospitalized patients jumped five times during a three-week period.

"If you drive by the hospital, we are adding tents outside of our E.R. for additional holding and triage space for our emergency room, which has been extremely busy with long wait times to be seen, as well as holding patients while we try to prepare beds for them upstairs," she said.

A spokeswoman for the nonprofit hospital said that it is "assessing its ICU and overall capacity to provide care when it's needed most".

"The reality is this: Staffing and resources are becoming increasingly pressured — and could soon become scarce — should we continue to see an increasing influx of COVID-19 hospitalizations," Dorey Huston, senior manager of public relations and media, wrote in an email.

As of Friday, California recorded 2,292,568 confirmed cases and 25,971 deaths. The ICU capacity in the Southern California region remains at zero.

California on Thursday deployed 1,280 medical personnel to healthcare facilities around the state as part of an effort to relieve the stress on the system.

The Golden State also has sought federal help, including 200 Defense Department medical workers. The state is hiring traveling nurses from staffing companies, in addition to looking to other countries to fulfill staffing shortages.

A search on the San Diego-based AYA Healthcare, a provider of traveling nurses, returned more than 12,000 job postings in all 50 states on Friday. There were more than 1,000 requests from California, and many of the openings were for registered nurses in the ICUs.

Los Angeles County Public Health Director Barbara Ferrer told the Los Angeles Times: "Our hospitals continue to be overwhelmed. As more and more people are rushed to hospitals, the tragic fact is that hundreds more people will die every week from COVID-19. These trends, unfortunately, will continue into January."