California learns onerous pandemic lesson on hospitals

California learns onerous pandemic lesson on hospitals

In the early weeks of the pandemic, Democratic Gov. Gavin Newsom ordered alternate care sites be set up in a former professional basketball arena, two state centers that usually treat people with developmental and intellectual disabilities, and other facilities. It was part of an early plan to add an extra 66,000 hospital beds as California prepared for a projected crushing load of COVID-19 patients, one of many steps taken by the governor as he imposed the nation’s first statewide lockdown.

It was a costly way to learn California’s hospital system is far more elastic than was thought at the start of the pandemic. Through desperation and innovation, the system was able to expand enough to accommodate patients even during the dire surge that saw hospitalizations top 20,000 and nearly 700 people die weekly. “Definitely some hospitals, particularly in the Los Angeles area, were at the breaking point, but we did not see that much use of the alternate care sites relative to what was contemplated,” said Janet Coffman, a health policy professor at University of California, San Francisco. “As dire as the situation was in the winter, it could have been even worse.” Ultimately, the state spent $43 million to set up eight sites, $48 million to hire contract employees and $96 million to operate them under a scaled-back plan, according to tallies that The Associated Press requested from the departments of Finance and General Services and the Health and Human Services Agency.

The sites treated a combined 3,582 patients, records show, but half were during the first three months of the pandemic when the number of infections was still low and, as it turned out, the traditional hospital system could have handled them on its own. The sites reopened in early December, treating fewer patients during the next three months even though many hospitals were overflowing. The traditional hospital system squeaked through the worst of the pandemic with little overflow into the alternate care sites because the state temporarily eased nurse-to-patient staffing ratios — designed to protect the sick and their caretakers — and because of a scramble to bring in temporary outside workers, said Stephanie Roberson, government relations director of the California Nurses Association.

Brian Ferguson, a spokesman for the state Office of Emergency Services, said officials learned that it is better to align the state’s efforts with existing health care facilities than to set up makeshift, standalone hospitals. For instance, two vacant hospitals reopened during a surge last summer, one each in Northern and Southern California, as the most populous state overtook New York for the most cases in the nation. But it didn’t use them again during the winter surge, choosing instead to work more closely with existing hospitals. Similarly, Newsom in early April 2020 announced Sleep Train Arena, the former home of the NBA’s Sacramento Kings, would be turned into a 400-bed hospital. It wound up treating just nine patients over 10 weeks because existing hospitals in the region handled other cases.

The state never reopened that main arena when the virus surged again around Thanksgiving but instead treated 232 patients in the much smaller adjacent practice facility. “If you look in hindsight, you could say, ‘Well, we could have used the money that we spent to rent Sleep Train and we could have put it back into the hospital system or we could have put it into procuring PPE (personal protective equipment) or any number of things,’” Roberson said. “But these are lessons learned.” She added: “As we move forward, we have to take a look at all of these missteps and do better.”

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