'Overflowing With Patients': Why the Head of California's Hospital Association Thinks It's a Bad Time to End the State of Emergency

California is formally ending its COVID-19 state of emergency Tuesday after almost three years since the pandemic began.

This emergency declaration gave Gov. Gavin Newsom the power to suspend or change laws in California to combat COVID. These legal powers allowed Newsom to issue almost 600 pandemic-related health orders — the majority of which have now been lifted.

On May 11, the White House will lift its own federal states of emergency for COVID, which will have much bigger ramifications for funding around pandemic measures like vaccines, testing and treatments compared to California's earlier move. Californians will be protected, at least initially, from changes around health insurance brought on by the federal emergencies ending — thanks to laws that have been passed within the state in the last few years that force insurers to keep covering certain COVID costs.

The Newsom administration is framing the Feb. 28 date for lifting the California state of emergency as a logical step that was coming at the right time, while acknowledging the crucial role played by these emergency powers in fighting the pandemic. But not everyone agrees it’s the right time to end these emergency powers in the state.

One of those people is Carmela Coyle, head of the California Hospital Association, who told The New York Times earlier this month that February was "a terrible time to end the public health emergency," because of ongoing strain on California’s hospitals.

Coyle spoke to KQED's Natalia Navarro about the end of the state's emergency declaration and warned of the impacts she foresees on California's hospitals.

This interview has been edited for length and clarity.

Natalia Navarro: Do you still feel that Feb. 28 is a bad time to end the official emergency declaration in California? 

Carmela Coyle: While the state's COVID public health emergency is formally concluding, the real problem is that the state of the health care system remains in a very emergent state. And so while it's no longer COVID that's driving a real challenge to the health care system, the system remains challenged nevertheless.

The good news is that we gained quite a bit of experience and key learnings out of the pandemic. But it's not a matter of if — it's a matter of when the next challenge arises, whether that's an infectious disease or something else. We are now going to be facing that on top of a system that is very, very troubled.

The emergency declaration has allowed California hospital facilities to temporarily expand treatment spaces to deal with larger numbers of patients, and also to hire out-of-state workers to combat staffing shortages. What now?

In the state of California, most of those policies are being moved to a hospital-specific request process. So while previously things like the ability to use space in new and different ways — to create negative-pressure rooms, to treat patients with infectious diseases — was done more broadly, we will have the ability to apply to the state on a hospital-by-hospital basis. And that's a good thing because some of those spaces are still needed.

I think what perhaps is being missed is that the emergency that's affecting the health care system today, in hospitals in particular, is not driven by COVID. It is driven by all of the care that people did not seek while the COVID pandemic was underway. Today, California's hospitals are overflowing with patients, and that leaves us in a very challenging circumstance to be able to deal with the next emergency.

Newsom's administration has said it intends to ask lawmakers' approval to preserve some more of these emergency provisions — specifically those that allow different health care workers to perform certain COVID-related functions, like giving COVID medications or doing on-site tests. What kind of difference do you think this would make?

I think the challenge right now is that those flexibilities, which were extremely important, I don't mean to suggest anything else, but those flexibilities that were provided during the pandemic, many of them were very COVID-specific, pandemic-specific.

What we're now dealing with is a system that is breaking apart at the seams. We don't have enough health care workers to meet all of the health care needs of the people in the state of California. We have hospitals in the state that have declared bankruptcy, others that have closed. And this buildup of pressure started with the pandemic, but now it's well beyond the pandemic. That leaves our California health care delivery system at a very challenged moment so that even those flexibilities that the state provided during the pandemic are not going to be enough.

We need to shore up California's health care system. And that's not just hospitals. We need to shore up public health. We need to shore up primary care physicians, behavioral health, hospitals, nursing homes. But right now, if we were to experience any other kind of an emergency or a pandemic, I think our system would not be well prepared.

So what does need to be done, to lessen that pressure and shore up the health care system?

Fundamentally, the pandemic created a huge economic shock for health care providers, and hospitals in particular. I've described it as a flood. And while the COVID floodwaters have receded, all of the damage is still there. We have a long way to go to repair that damage, and that will require significant additional funding putting into the health care system, not just for public health, but in particular right now for hospitals to keep their doors open, to keep them from closing.

We need more investment in regrowing our health care workforce. That will take time. But if we don't start now, we will not have the number of caregivers needed to meet the demand for health care services. And we need the state's help in keeping inflationary costs down — pharmaceutical prices, and other kinds of prices also affecting our ability to provide health care now on a day-to-day basis.

What powers do hospitals and health care providers have on their own? Can they continue to require everyone to wear masks or require vaccination, for example?

It really varies, the degree to which hospitals can make individual decisions versus those that are regulated by the state.

I think what we have all come to understand is the importance of the basics — and the basics include vaccination. The basics include mask wearing, when called for, and all of the other kinds of processes and procedures we put in place that really help the state of California keep the pandemic as much in check as possible, given we are a state of 40 million people.

But I think the flexibilities that were granted during that pandemic, that playbook needs to stay right on the front corner of the table. They will be needed again.

We have got to make certain that in times of emergency or disaster, that we have the flexibility needed to meet Californians' needs.