Canceling or postponing non-urgent appointments, seeing patients through remote tools like telehealth and, in some cases, locking up face masks so they don't go missing: These are just some of the ways that local hospitals are preparing for an influx of coronavirus cases in the Bay Area.
This comes as the Centers for Disease Control and Prevention (CDC) announced that more cases of COVID-19 are likely to be identified and that widespread transmission could occur, which "would translate into large numbers of people needing medical care at the same time."
"I think what’s a little tricky now is it’s just not at all clear whether it’s going to be medium bad or quite terrible," said Dr. Robert Wachter, chair of the UCSF Department of Medicine. "We don’t want to panic anyone and we don’t want to overreact, but we feel that under-reacting could be the greater sin."
On Wednesday, the World Health Organization (WHO) said that the COVID-19 viral disease is now officially considered a pandemic.
Zuckerberg San Francisco General Hospital
At Zuckerberg San Francisco General Hospital (SFGH), officials said they're working to ensure that patients are routed to the right part of the hospital.
"It's critically important that people aren't in the emergency department unless they absolutely need to be there," said SFGH CEO Susan Ehrlich. "We have other resources for them on campus, including an urgent care clinic and a number of different primary care clinics and specialty clinics."
They're also canceling non-urgent medical appointments and conducting many appointments and evaluations over the phone.
Additionally, because California has declared a state of emergency over the coronavirus outbreak, Ehrlich said that the state Department of Public Health is now allowing the hospital more discretion over how the building can be used to better meet patient needs.
"Each space in the hospital is licensed for a very particular use — for example, labor and delivery, medical surgical floors or critical care floors," Ehrlich explained. "We have to use those spaces in those ways unless we have this special dispensation from the state to use them in different ways."
Stanford Health Care
At Stanford Health Care systems, which are located in Santa Clara County — where most of the Bay Area's confirmed cases of COVID-19 have been located — staff have confined those patients to particular sections at each hospital.
Dr. Yvonne Maldonado, a professor of pediatrics and an infectious disease epidemiologist at Stanford University School of Medicine, said that selecting one particular location in each hospital for these patients has logistical advantages.
"You can have one team that's going to clean those areas. One team is going to take care of those patients," she said.
Stanford hospitals' staff is currently conducting daily morning meetings, virtually or in-person, and having subcommittee meetings throughout the day to ensure that all their facilities are adequately staffed and have enough equipment.
Maldonado said they've also taken to locking away some of their protective gear, including N95 face masks, after some started going missing.
Maldonado said that people did not initially understand that N95 masks are not required for every patient, but only for a specific set of patients.
"We're doing a lot of training about what kinds of isolation equipment should be used for what kinds of patients and restricting the use to just those patients," Maldonado said.
As for seeing patients through remote video connections or over the phone, Maldonado said Stanford had already been using some telemedicine before the outbreak and are working on building out those systems.
"Obviously, you need to make sure that the facilities are sufficient on both ends," said Maldonado, referring as well to the ability of providers to work remotely. "Some people may not need to come in, and can see patients from off-site as well. But, again, that all needs to be set up so it's compliant with all of our hospital and regulatory requirements."
While there haven't been as many confirmed cases of COVID-19 in San Francisco County as in places like Santa Clara County, officials at UCSF are also working on getting ready for the potential influx.
"We have a hotline that patients are calling in on and we are trying to get the patients in who need to get in, but also giving information, advice to those who don't," said UCSF's Dr. Wachter. "We're also markedly ramping up our telemedicine capabilities."
UCSF has set up a tent outside one of their main hospitals to triage patients with respiratory illness. Wachter said that under a worst-case scenario, they could limit staff vacation time and delay elective surgeries.