When their emergency departments get really busy, hospitals often go on diversion, a term that means they are significantly reducing their ambulance traffic to buy a little time to handle a crush of patients already sitting in their waiting rooms.
But, as the number of patients arriving for care continued to increase Monday, the situation reached a point where almost all emergency rooms were on diversion, a rare situation where sending ambulances elsewhere no longer made sense. Nobody had any extra capacity.
The dire situation was made clear in a memo obtained by The San Diego Union-Tribune and sent by the county emergency services office to all hospitals at 2:45 p.m. The memo indicated that “San Diego County (Emergency Department) capacity is exhausted” with “more than 80 percent” of all civilian hospitals in the region already reducing their ambulance loads due to extremely high numbers of patients.
The bulletin warned that emergency services personnel should expect “very long” waits to offload patients.
It was really no surprise, as Monday brought the region’s highest single-day new-case total, with the number of positive test results reported to the county health department Sunday hitting 8,313. Earlier in the day, county public health officials said the region’s total number of hospitalized COVID-19 patients had reached 600, far fewer than the 1,800 seen during the same time last year when there was no vaccine available to take the edge off.
Dr. Eric McDonald, the county’s chief medical officer, said that local hospitals are prepared to handle the coming surge, though staffing was a concern.
“It appears now that our staff, our supplies and our structure at our health care systems will be able to handle that stress, but there is always some uncertainty,” McDonald said, speaking outside a county testing center in City Heights.
That’s not to say, however, that the increase in patients, especially those flooding emergency rooms, is going to go away quickly.
“At the present time, I think that things will worsen before they improve,” McDonald said, adding that those with mild symptoms, or no symptoms at all, should not go directly to hospital emergency rooms for care.
But many are.
Dr. Ghazala Sharieff, chief medical officer at Scripps Health, said the health system’s emergency rooms were so impacted mid-afternoon that many patients, most without COVID-19, were waiting for beds to open up so they could be admitted.
“We have 82 patients holding across our emergency departments for a bed, and 16 of those are COVID positive,” Sharieff said.
A big part of the problem, Scripps officials said, is a large number of skilled staff calling in sick after testing positive for coronavirus infection. Scripps Mercy in Hillcrest, for example, had to cancel several surgeries Monday and planned to delay at least seven more Tuesday due to COVID-related absences among those who work in its operating rooms.
While the total numbers of patients being admitted to hospital beds with COVID-19 is three times lower than it was last year, the sheer number of infections is clogging things up even though doctors say they’re detecting less severe illness — generally characterized by breathing problems — than was the case previously.
Things were tight enough at Rady Children’s Hospital that the San Diego medical center put out an urgent plea to the public to avoid its emergency department and urgent care centers if children only needed testing or mild symptoms.
Dr. Scott Herskovitz, director of emergency medical services at Rady, said parents should reach out to their pediatricians, or use their health provider’s 24/7 nursing line, before getting in the car and arriving at the ER. The crush of parents filling waiting rooms with relatively minor cases that may or may not be cronavirus are making it difficult to spot those who have truly dangerous conditions, Herskovitz said.
“Whether it’s people who are seeking testing after an exposure or whether it’s a new case with mild-to-moderate symptoms, those things inundate the emergency department and make it difficult for us to get to identifying some of those higher-acuity patients,” Herskovitz said.
While he said that no parent should feel the least bit of hesitancy at bringing their child in if they truly feel concern that they are very sick and likely to need immediate attention, symptoms like mild cough, congestion, runny nose and fever can be handled outside an urgent setting.
“If your concern is keeping you up at night, and you’re not able to talk to your pediatrician, then, if it’s that much of a worry, the emergency department is always there for you,” Herskovitz said.
But simply identifying whether mild symptoms are being caused by coronavirus or one of the other viruses going around this winter, that’s different.
“If it’s a cough, but they’re not having trouble breathing, if there’s congestion but they’re not having trouble breathing, if there is some runny nose but they’re not having trouble breathing, if they’re drinking and able to stay hydrated, those are things that, even in the face of a fever, can be managed without coming into the emergency department,” Herskovitz said.
Some might wonder why hospitals aren’t just sending those who arrive at ERs with mild symptoms home? Federal law, Herskovitz said, requires all who enter to be given a medical screening examination to determine if an emergency condition exists. A large number of such screenings, even if they’re for relatively minor symptoms, can swamp available resources.
As it comes time for kids to return to school and daycare and for adults to work, the demand for testing continues to increase.
The demand was so strong in La Mesa that the local police department warned the public to avoid a section of the city due to traffic congestion caused by demand for coronavirus testing.
Around 2 p.m. Monday, vehicles lined both directions of Parkway Drive approaching the Kaiser office in La Mesa where tests were being conducted. The queue of vehicles west of the site was even snaking onto nearby Baltimore Drive and around the corner to Fletcher Parkway, where it was knotting traffic in a busy intersection near exit and entrance ramps to Interstate 8.
Nathan Fletcher, chair of the San Diego County Board of Supervisors, said during Monday’s news conference that he believes that the county and private organizations such as drug stores are doing everything they can to offer as much testing as possible. The situation harkens back to the very beginning of the pandemic when testing was very new and in very short supply. As was the case then, leaders are reminding folks to do what’s important even if they don’t have definite confirmation of infection.
“If you can’t get in quickly, and you have symptoms, assume you have it and act accordingly,” Fletcher said.
He added that many of the lines at county testing facilities are made longer by those who return day after day.
“We are trying to encourage people not to come every single day to get tested,” Fletcher said.