Stanislaus County turns to help, moves COVID-19 patients to downtown Modesto facility
Local leaders are looking for positive signs that the surge in coronavirus cases has flattened out. But Stanislaus County hospitals are still contending with a relentless outbreak, even after a special unit was created to take some of the patients.
In an update Tuesday, county public health said 185 people stricken by COVID-19 disease were in local hospitals, a number that remained above the 200-mark in eight of the past 14 days. Intensive care units held 64 critically ill COVID patients and only six adult ICU beds were available in the county.
The county’s online dashboard does not count the 30 or so patients in a special COVID unit at Central Valley Specialty Hospital, the former Modesto City Hospital on 17th Street. The special unit was created a month ago and is caring for COVID patients transferred from regular hospitals.
Stanislaus County’s daily count of positive cases has jumped around from a two-day total of 697 on Friday and Saturday to 127 new cases Monday, 77 on Tuesday and 190 cases Wednesday. The county has recorded 85 of a total 212 deaths in the past two weeks.
In June, local hospitals began seeing an increase in COVID patients and the number needing hospitalization and critical care, and the surge intensified in July when the county recorded more than 6,000 new infections among residents.
“I can say the general pace of hospitalization has stayed consistent over the past several weeks,” said Gino Patrizio, chief executive officer of Memorial Medical Center, in response to questions from The Bee.
In the past few weeks, fewer than half of the patients admitted to Memorial have COVID-19, but about half the patients needing critical care are those with a COVID-19 diagnosis, Patrizio said.
Doctors and nurses covered in protective gear take care of large numbers of very sick patients, who may have extremely high temperatures and unusual chest X-rays showing severe lung inflammation. According to county public health, about 15 percent of hospitalized COVID patients in Stanislaus County have died this year.
The coronavirus mortality rate in hospitals was 26 percent in May and was 17 percent in July. The county’s coronavirus death toll has included adults ranging in age from 29 to 97.
Central Valley converts floor for COVID patients
To relieve pressure on the regular hospitals, Central Valley Specialty Hospital converted one floor for COVID-19 patients, starting with 20 beds a month ago and expanding to 36 beds, the hospital’s chief executive said.
Richard Murdock, assistant director of the county office of emergency services, said recently the Central Valley unit has served to decompress the hard-hit hospitals like Memorial and Doctors Medical Center.
“If Central Valley didn’t have hospital bed space we would be much tighter,” said Dr. Mark Fahlen, a medical staff leader at Doctors.
The Florida Avenue medical center, with 398 licensed acute care beds, has been running at 85 percent capacity; about 18 percent of patients at Doctors are suffering from COVID-19.
Soni Sidhu, chief executive officer and nursing director for Central Valley, said the separate COVID unit has its own entrance and exit because of the contagious nature of the COVID illness.
With the expansion, Central Valley began running out of ventilators and made a request for help to the county emergency operations center. The facility was provided with seven ventilators and has requested more.
The COVID patients were transferred from local hospitals to Central Valley and the majority are on ventilators, Sidhu said. Some of the patients were transitioned out of ICUs but still need clinical support.
“They may need a lot of clinical support with medications and IV fluid,” Sidhu said. “Or it may be patients in the transitional stage who are ready to be weaned off” breathing assistance.
Patients who are no longer dependent on breathing devices may be moved to the next level of care, whether it’s a rehab hospital, home or lower level care at a nursing home.
The patients are a mixture of seniors and younger adults with underlying health conditions. Central Valley is not a nursing home but a long-term acute care facility, which usually provides treatment or rehab for patients with complicated medical needs stemming from an injury or surgery.
Sidhu said the state and county approved the special unit. Central Valley is involved with county planning for managing the coronavirus patient surge.
Before the unit was opened, Central Valley had robust staff training in infection control, personal protective equipment and care for COVID-19 patients, the CEO said.
In March 2019, the state ordered the 100-bed center to improve its infection control practices. The owner brought in outside infection control experts to guide improvements. The facility says it’s an industry leader in the care of patients on ventilators.
Stanislaus County has far more coronavirus patients in its hospitals than larger counties in the Bay Area. Santa Clara County, for example, had 172 hospitalized Tuesday and about 100 were in San Francisco hospitals. Stanislaus has the same number of hospitalized COVID patients as Alameda County, which has 1.67 million residents.
The local hospitals and their staffs have been embroiled in the COVID-19 fight as the virus spread through lower-income neighborhoods, the ranks of farmworkers and other essential workers, and residents and employees in congregate care facilities.
Numbers no longer spiking at DMC
Cheryl Harless, chief nursing officer at Doctors Medical Center, said Tuesday the COVID patient numbers are plateauing and no longer spiking. The hospital still has an adequate supply of ventilators, she said.
Doctors is able to provide a higher level of care for difficult cases and has continually searched for effective treatments since the new infectious disease surfaced here in March, Harless said.
The hospital uses the antiviral drug remdesivir, along with steroids to reduce inflammation caused by the infection, antibody therapy and oxygen support.
Patients with severely infected lungs may be a candidate for an ECMO procedure at Doctors (standing for Extra Corporeal Membrane Oxygenation), which is more often a treatment for severe pneumonia or heart attack victims. The ECMO system takes de-oxygenated blood from the patient’s body and runs it through the machine to refresh the blood with oxygen before returning it to the patient’s bloodstream.
The critically ill patient gets oxygen without using the person’s fluid-filled lungs.
“It’s a treatment that’s been found to be helpful for some (COVID) patients,” said Harless, adding the results have been fair at Doctors. “We have seen it work very well on some patients.”
Nurses at local hospitals have watched many COVID patients not respond to treatment and die after remaining in ICUs for weeks, while cut off to family visits.
COVID-19 patients have extremely high fevers
A Modesto nurse said she has seen fevers of coronavirus patients spike to 107 degrees. Some of their chest X-rays look like spider webs obscuring the view of lung tissue.
She said nurses need a respite, or break, after working for months with COVID patients in ICUs, while risking infection and taking the virus home to family members.
A state emergency program has provided some staffing support to Memorial and Doctors medical centers and Oak Valley Hospital in Oakdale.
Harless said the National Guard recently sent six military medics to support Doctors. They have spent six days working at the hospital and helped with tasks in taking care of patients but don’t provide direct nursing care.
In response to a question about stressed-out nurses, Kaiser Permanente said it has pools of temporary nurses and on-call staff and can leverage its integrated system to provide staffing support across Northern California.
The Oakland-based health system encouraged staff to use paid time off and said nurses can take advantage of extended paid leave, as well as wellness programs to help with social needs.
Fahlen of Doctors said the hospital staff has come together during the crisis, with critical care doctors and nurse practitioners spending long hours on COVID floors and veteran nurses guiding those with limited experience.
“The medical staff and nursing staff are performing valiantly considering the challenges,” Fahlen said.
This story was originally published August 20, 2020 at 4:00 AM.
