'This Is Chaos': Hospitalizations Surge Amid Mounting Winter 'Tripledemic'

A “tripledemic” is straining hospitals across the region, from San Francisco to Santa Cruz and Sacramento, with some at — or well above — capacity. Influenza is spreading (PDF), case rates for RSV are still high, and COVID is on the rise, with wastewater data showing a surge as high as last winter’s omicron spike. There's also a shortage of fever-reducing medicine for kids, and doctors and nurses are frantically trying to keep up with crushing patient loads.

“We had 100 patients on the board yesterday in a space designed for 29 people,” said Dr. Guy Shochat, who works in the ER unit at UCSF’s Parnassus campus in San Francisco. “There are no downs (in patient numbers) anymore. At three in the morning the patients still keep coming. At three in the morning the waits are still six hours.”

Shochat said patients line the hallways and fill the pharmacy area and any other available space.

“We didn't expect a year with COVID, adult RSV and influenza, all early,” Shochat said. “There are over 30 patients admitted for boarding, with many of them sitting over 24 hours in a hallway, admitted and waiting to go upstairs. It's so hard to smile and be present for your patients, being exhausted before you start, just staring at this and knowing that tomorrow is going to be the same.”

The situation has been compounded by an adult RSV strain that has surged early this year, accounting for 4.7% of respiratory illnesses in the state by the end of September, a level usually not seen until November, according to the California Department of Public Health.

“Every five or six years we have what’s happened this year, where the RSV affects adults, too,” explained Shochat. “We knew there would be a COVID surge in winter, but it hit sooner than expected … So we now have an early severe influenza year and a very early RSV year and a system that was already beyond breaking — it’s just cracked entirely.”

It’s a similar situation in other hospitals, too.

Dr. Carolyn Robin Lanam, Emergency Department medical director at Mercy San Juan Medical Center in Carmichael, near Sacramento, said their hospital is at capacity and that they’re looking into opening up new overflow areas.

“I've seen wait times up to six hours … Influenza A, influenza B, RSV, COVID, that's driving a lot of this,” Lanam said. “We've seen a lot of positive patients for all of those viruses in the past few weeks.”

Tammy Green, manager of emergency services at Dominican Hospital in Santa Cruz, said the ER is overflowing with people coughing, with every inch of floor space being used to accommodate sick people.

“The first thing that’s going to come to mind is, ‘Oh my God. This is chaos,’” Green said. “The hospital is completely full. I mean, every room, every space. We saw almost 200 patients on Thanksgiving Day, and that just blew me away. I thought, ‘Oh my goodness, what is happening?’ And then it just continued like that. We have upwards of 18 patients here in our emergency department waiting for rooms for upwards of 24 hours or more. I am getting nervous leading up to Christmas and New Year's.”

But another factor is at play besides the so-called "tripledemic," and that is the nursing shortage. According to a 2021 UCSF report, the percentage of registered nurses age 55–64 planning to retire by 2023 more than doubled from 11.4% in 2018 to 25.2% in 2020 (PDF). And that was before COVID. The forecast for 2022 remained bleak, with an August 2022 UCSF report (PDF) stressing the “need to rapidly develop and implement strategies to mitigate the potential harm of shortages.”

“The nurses all quit,” said Shochat of UCSF. “We lost 20 nurses in the first year and a half of the pandemic. And they were senior nurses, so this was well over 200 years of institutional memory just disappearing. And it's hurt us … Everyone’s just well and truly burnt out. Hospitals spent so much money paying travel nurses and building out new areas to treat COVID patients that they’re running way over budget. And patient care suffers when staff are overwhelmed.”

Shochat warns the situation could get a lot worse if — or when — the doctors start quitting.

“Doctors are going to quit. They're planning to quit,” he said. “They're just doing it more slowly, working with their financial advisers to figure out whether they’re retiring or if they're going to [shift jobs]. People are sad and frustrated. It was bad enough three months ago … but how do we handle an influx of 40% over our expected patient load? And we're short-staffed. Why would I stay? Why would I not just cash in my retirement account?”

As the tripledemic and staffing shortages strain hospitals, medical professionals urge people to take responsibility for staying safe by masking, getting their vaccine boosters and not going to the ER unless they have to.

Mercy San Juan’s Lanam says that when it comes to respiratory illnesses, “the treatment is the same for everyone. You should take Tylenol and Motrin and stay well-hydrated. Get a humidifier if it helps for your cough. Drink a lot of tea with honey. There are certain populations at higher risk which would benefit from treatments for flu and COVID, like Tamiflu and Paxlovid. But for the large majority of people, if you're otherwise healthy, the side effects from the medications aren't worth it. Your body's going to recover on its own. If it's a really young baby or you're older or you have multiple comorbidities, then definitely see your doctor. Try to see your primary care [physician] as much as possible.”

“I desperately want society to understand what's going on,” said UCSF's Shochat. “They need to really think twice about casually coming to the ER for a prescription refill. But also, I don't want them to stay away when they have abdominal pain and have their appendix rupture at home.”

Shochat also wants to shed light on another factor that has taken perhaps an even greater toll on medical professionals than any other, one that's more nuanced than surges and shortages — one he describes as the “breaking of a social contract” between doctors and the public since the beginning of the COVID pandemic.

“In the beginning, they called us heroes and they told us to hold the line until the vaccine came out, and we did it,” he said. “We held the line. And then what happened? The vaccine came out and people didn’t bother to get them. And I'm not even talking about the anti-vax folks. Literally, there was a free vaccine on every corner, they went unused. And that broke us. That was wave one of us all giving up. Wave two was we curled ourselves into balls, cried a little bit, and we came back to work and just soldiered along, and now there’s this realization this isn't going away. It's just getting worse.”