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A View From The Front Lines Of California’s COVID-19 Battle

Yves here. It’s important to document the strain COVID-19 is placing on doctors and nurses. A lot of the resistance to the aggressive efforts to contain the virus comes from the “I’m not going to die of it, so why should I care” perspective. But it’s not just the generally devalued elderly who are prime targets. It’s also medical professionals. In Italy, virtually all doctors in hospitals, no matter what their specialty, have been tasked to treating coronavirus cases. Being exposed to a lot of sick people, and then being under stress and not getting enough sleep is a prescription for getting a serious case. Remember that the famous Chinese COVID-19 whistleblower, Dr. Li Wenliang, died at the age of 34.

. Kaiser Health News Senior Correspondents JoNel Aleccia and Jenny Gold contributed to this report. Published by California Healthline, a service of the California Health Care Foundation

On Tuesday, Dr. Jeanne Noble devoted time between patient visits to hanging clear 2-gallon plastic bags at each of her colleagues’ workstations. Noble is a professor of emergency medicine and director of the UC-San Francisco medical center response to the novel coronavirus that has permeated California and reached into every U.S. state.

The bags were there to hold personal protective equipment — the masks, face shields, gowns and other items that health care providers rely on every day to protect themselves from the viruses shed by patients, largely through coughs and sneezes. In normal times, safety protocols would require these items be disposed of after one use. But just weeks into the COVID-19 pandemic, supplies of protective gear at UCSF are already so low that doctors and nurses are wiping down and reusing almost everything except gloves.

“It is not a foolproof strategy at all; we all realize the risk we are taking,” Noble said. But as supplies dwindle, she increasingly finds herself asking the folks in charge of infection control at the hospital if they can make changes to protocols. “As days go by, one regulation after the other goes out,” she said.

Noble is among the Bay Area physicians applauding the decision this week by seven Bay Area counties and multiple others across California to order residents to shelter in placefor the foreseeable future, directives that are upending life for millions of people and shuttering schools and businesses across the state. Without swift and dramatic changes to curb transmission of the virus, hospital officials say, it is just a matter of time before their health systems are overwhelmed.

Interviews with California physicians on the front lines of COVID-19 offer a sobering portrait of a health care system preparing for the worst of a pandemic that could be months from peaking. In the Bay Area, the battle is being waged hospital by hospital, with wide variations in resources.

The tent where Noble tended to patients this week was set up to deal with a recent rise in people showing up with respiratory illness. Even without the coronavirus threat, UCSF’s emergency room is a busy one, and doctors frequently see patients in hallways and other spaces. But the current outbreak makes that close contact unsafe. So instead, everyone who comes to the hospital is being triaged. Most people with fever, cough or shortness of breath are diverted to the tent, which is heated and has negative air pressure to prevent the spread of infection. For now, the pace is manageable, but Noble fears what’s ahead.

Farther south, in Palo Alto, Stanford Medical Center was testing patients with respiratory problems in its parking garage. The private university hospital has more protective gear than the public one in San Francisco; a global scavenger hunt several weeks ago bolstered supplies, though Stanford, too, has adapted protocols to be more sparing with some items.

“We don’t have an unlimited supply,” said Dr. Andra Blomkalns, professor and chair of the Stanford School of Medicine’s Department of Emergency Medicine. “But at least we’re not looking at our last box.”

The entire country is short on protective gear, a result of both the surging demand for such equipment as the virus spreads and the implosion of supply chains from China, where much of the equipment is manufactured.

Noble believes some equipment will need to be made locally. “If the [federal] government doesn’t step in and force manufacturing of these products here now, we are going to run out,” she said.

Empty supply closets affect everyone who needs care, including heart attack victims and people in need of emergency surgery, said Dr. Vivian Reyes, president of the California chapter of the American College of Emergency Physicians and a practicing emergency physician in the Bay Area.

“I know it’s really hard for us Americans because we’re never told no,” she said of the shortfall of supplies. “But we’re not in normal times right now.”

And protective equipment isn’t the only thing in short supply.

Until a few days ago, UCSF had to rely on the San Francisco Department of Public Health for coronavirus testing, and a shortage of test kits meant clinicians could test only the most critically ill. The situation improved March 9, when the university started running tests created in its own lab. First, there were 40 tests a day. By Tuesday, there were 60 to 80. But a new shortage looms: The hospital has just 500 testing swabsleft.

Stanford pathologist Benjamin Pinsky built an in-house test that has been approved for use by the federal Food and Drug Administration. Since March 3, Stanford has used it to test more than 500 patients, 12% of whom had tested positive as of Tuesday. The university has been running tests for other hospitals as well, including UCSF. It’s a dramatic improvement from a few weeks ago, when Stanford relied on its county lab.

Blomkalns saw a sick patient in mid-February, before the hospital had its own test kits, who had symptoms of COVID-19 but didn’t qualify for testing under the narrow federal guidelines in place at the time. He went home, only to return to the hospital after his condition deteriorated. This time, he was tested and it came back positive.

In Santa Clara County, home to Stanford, 175 people have tested positive for COVID-19 and six have died. Late last week, the medical center’s emergency department saw the highest number of patients in one day in its history. Blomkalns doubts it’s because there are more cases in her area. “If you don’t test, you don’t have any cases,” she said.

Blomkalns worries about staffing shortages as health care workers are inevitably exposed to the virus. As of Tuesday, one doctor in the Stanford ER had tested positive. At UCSF, six health care providers had.

Not all Bay Area hospitals are seeing a flood of patients. In fact, some have fewer patients than usual, as they have canceled elective surgeries in anticipation of a COVID-19 surge.

The doctors treating COVID-19 patients say nearly all who test positive have a cough. They complain of fatigue, body aches, headaches, runny noses and sore throats. While most people are well enough to recover at home, those who get critically ill tend to do so in their second week of symptoms, and can deteriorate very quickly, several doctors noted. “We are recommending that patients get intubated a little earlier than they might otherwise,” said Reyes.

In general, officials are asking people who have mild cases of COVID-19 to treat their symptoms at home, as they would a cold or flu, and refrain from seeking care at hospitals. People experiencing shortness of breath, however, should definitely go to the emergency room, said Blomkalns.

For children, the criteria may be a bit different. Shortness of breath should trigger a visit, as should altered mental state, excessive irritability, or an inability to eat or drink, said Dr. Nicolaus Glomb, a pediatric emergency care physician at UCSF Benioff Children’s Hospital.

Gov. Gavin Newsom said Tuesday that rough projections suggest the state could need anywhere from 4,000 to 20,000 additional beds to treat patients with serious cases of COVID-19.

The testing problems worry Noble, as do the equipment shortages, but not nearly as much as the potential for a lot of sick people. “I’m mostly worried about a tsunami of very ill patients that we’re not equipped to take care of,” said Noble.

Blomkalns isn’t sure whether or when Stanford might exceed capacity, saying the caseload trajectory may hinge on how aggressively state and national authorities move to cut off routes of community transmission. “It all depends on what happens in the coming weeks and days,” she said. “We know what we need to do, and we’re doing the job.”

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72 comments

  1. Ignacio

    Same movie everywhere. Indeed HC personnel is at high risk and hospitals are hot contagion spots and that is why hospitals should be avoided except if one feels short of breath. They are not going to help you while you only manifest cough symptoms no matter how nasty they are. They can help when you need assistance for breathing. As for today March 19th the number of reported cumulative Covid 19 casualties in California is 16. In Italy a similar number of casualties was reported on Feb 27th (17) and in Spain in March 8th (17). In Italy it took 11 days more to declare emergency and quarantine everybody (March, 9th, 463 casualties) while in Spain it took 6 days (March, 14th, 193 casualties). Large urban areas like the Bay Area, LA and San Diego as well as counties that have shown epidemic spread should start general quarantines the sooner the better (NOW) as well as the rest of the state if HC overwhelming is to ve avoided. Washington is yet in a more advanced state of epidemic developments and NY is more or less there.

    I don’t look at confirmed cases. It is useless IMO.

    Reply
      1. Ignacio

        It is true that they are more resistant to quarantine but at the end they do it if forced. This is our experience here in Madrid. But, what about the homeless?

        Reply
        1. Wukchumni

          While not claiming to be an expert on homeless living, it seems to me to be rare to see 1 tent by itself, as there’s strength in numbers, somebody to watch over your worldly possessions while you’re out scrounging or begging for alms.

          That means most all of the homeless will be testing positive (not exactly, nobody will know they’ve contracted it) and seeing as they are the only ones really mobile in this siege situation, they’ll be just another one of the superpreaders.

          I’ve seen homeless camps where the denizens have a net worth income of $8 within a few hundred feet of $800k homes in SoCal, and everybody is breathing and exhaling the same air.

          Reply
        2. Beyond the rubicoN

          Here in SF CA, the homeless are the only people out really. The streets are pretty quiet. Everyone at my company who can work from home has been ordered to do so. I’m new, so I have to report in everyday. But don’t worry I have an entire 25,000 square ft floor all to myself.

          Reply
        3. BobW

          When I was homeless a few years ago, we stood in closely packed lines of about 100 people at churches that provided meals, rode crowded buses using monthly passes given out by the homeless day center, and routinely congregated with each other.

          Reply
      2. skk

        But unlike LA county they haven’t published counts in each city. Its not as if they are unaware of this request by residents – that twitter feed you linked to has a few replies asking for this. If not city, I’ll take the net lower level of granularity of data collection, if its lower than a city, I’ll do the aggregation by city.

        Reply
        1. JBird4049

          Many governments do not want to have an accurate count of the homeless for the same reason President Trump did not want sick Americans to be allowed back on land. The more sick, or homeless, the worse you look or at least are more vulnerable politically. That people are suffering doesn’t count.

          Reply
    1. Winston Smith

      “I don’t look at confirmed cases. It is useless IMO.”
      Absolutely. That has been one the big problems with reporting on COVID-19, this continuous stream of news of “number of cases” by the media rather than “reported/confirmed cases” has been misleading.

      Reply
  2. Tom Stone

    Well, that’s the end of my Chemo.
    Due to my sensitivity to Rituximab it has to be done in a hospital setting with full telemetry and all elective procedures have been canceled at the facility where I have been being treated.
    It’s the right decision and on the plus side I’ll be eating green salads months earlier than expected.

    Reply
    1. ChiGal in Carolina

      chemo is elective? who would get it by choice rather than medical advice? very sorry to hear it, Tom

      Reply
        1. Tom Stone

          Chemo is elective because I am not in any immediate threat of dying.
          The other consideration is that I have a seriously compromised immune system and spending 32 hours in a Hospital ( It’s a continous 24 hour infusion) is risky to say the least.
          I do have plenty of gloves (600 pair) and a dozen N100 mass I picked up last year due to the continuing threat of wildfires so I’m in good shape there.

          Reply
  3. ALM

    California political leadership is weak. Governor Newsom has failed to exert any actual authority over the Department of Motor Vehicles which is humming along with its notoriously long lines enabling the infection of God only knows how many Californians (because we also don’t have nearly enough tests to verify contagion).

    This is a major concern for me because I am 65 years old, a resident of the Bay Area subject to a shelter-in- place order, and required to make an in-person office visit to the DMV to renew my driver’s license before it expires next month. Because local Bay Area DMV offices are not accepting appointments for at least 3 months, to renew my driver’s license I must stand in the DMV’s notoriously long lines and risk contagion in a documented coronavirus hot zone.

    The Governor, the Senate, and the Assembly have completely failed to act to temporarily extend license renewal dates during this emergency or to waive in-person visits and allow license renewals by mail. Instead, the DMV has published a stupid statement requesting, not commanding, local traffic cops over whom they have no legal authority to go easy on drivers with expired licenses/registrations. This is not leadership. It’s a disgrace. And it also enters the criminally absurd. DMV leadership appears to have no understanding of contagious diseases because the Department has actually posted assurances that it’s taking extra care to clean the premises as if those of us standing in line infecting each other intend to lick their countertops and doorknobs if we live long enough to get near one.

    Reply
    1. doug

      I would take my chances with expired licence. Odds may be better. Good luck to you.

      We have first case in our county, and it is an OBGYN.
      That will ripple through a few more medical folks I imagine.

      Reply
      1. NotTimothyGeithner

        The rot of neoliberalism is on full display. These people have little knowledge of how things work. They know a few lines at the end of a budget and can propose cutting, but this is about it.

        Our technocratic geniuses are worred an undeserving person could get $250 ignoring states and localities are about to go belly up. The rampant stupidity and greed is so staggering, and they aren’t ready to even make credible suggestions.

        Reply
    2. Wyoming

      The basic penalty for driving on an expired license in CA is a maximum fine of $250. Considering the circumstances I would just blow it off for now.

      If you cause a wreck or get caught driving under the influence then it is going to be a much bigger deal. Drive safe. And if you get stopped just tell the officer you felt it was too dangerous to go to the DMV.

      Reply
      1. Ian Ollmann

        Hopefully the ID is not required for critical services. You will need a new one to get on a plane, but I’m sure that is low on your list of things to do.

        Reply
    3. John Wright

      I would let the license expire.

      The odds of getting caught with an expired license are small.

      Just make sure your insurance is in effect.

      And the criminal justice system is moving slowly anyway, as here is a notice about court closure from my local area, Sonoma County (north of San Francisco)

      from http://sonoma.courts.ca.gov/info/jury-service

      “Due to the Court Closure, Jury service has been deferred for all potential jurors who have been summoned to appear for jury service effective March 16, 2020 until further notice.”

      Reply
    4. Cas

      You can avoid DMV. I’m an SF resident, 65 years old, whose driver’s license expires in June. I was able to renew in by mail (also online was an option). Later I’ll need to go in person to get the new identity card, but that isn’t necessary until I want to travel out of state. My renewed license has already arrived.

      Reply
      1. ALM

        California drivers’ licenses cannot be renewed by mail/online in perpetuity. I have exhausted my easy renewals and must appear in-person for vision testing.

        Reply
    5. Synoia

      ALM, the way to avoid the line is to prepare by making an appointment. In and out in less then 10 minutes.

      I’ve done this for years, as I don’t like wasting my time standing in DMV lines.

      Reply
    6. Joe T

      I had a similar problem. I’m required at age 70 to take a written test and eye test. I needed to do it this month. I called and the DMV said: “Don’t go in”! Authorities are aware of the problem.
      Stay home and save a life!

      Reply
  4. Ignim Brites

    The only rationale for the shutdown of the country / economy is that the health care system must be protected from being overwhelmed. This means primarily that there is an adequate supply of PPE and that frontline personnel can get adequate rest. Secondarily there needs to be adequate supply of the materials to provide treatment. The rates of rates of infection are important only insofar as it affects the first two considerations. The only metrics that matter are those that shed light on the first two considerations. We cannot continue to proceed under the current regime of a vague commitment to flattening the curve. To do so poses an existential threat to the nation and the civilization.

    Reply
    1. Rex

      That’s sure is an awful lot of frictionless, spherical cow simplification of parameters for an existential threat.

      Reply
  5. Larry Y

    I’m hearing firsthand reports about my friend, who’s a critical care pulmonologist in Westchester county, NY. He’s too busy to talk about it, but his family does. His social media, which includes many other doctors, is a heartbreaking read.

    They were unprepared in terms of process, procedure and equipment. Had to use personal networks to get stuff done, including shipments of PPE from overseas.

    So yeah, it’s gotten personal.

    Reply
  6. Carolinian

    From this link

    https://medium.com/@ra.hobday/coronavirus-and-the-sun-a-lesson-from-the-1918-influenza-pandemic-509151dc8065

    In 1918, anyone at the emergency hospital in Boston who had contact with patients had to wear an improvised face mask. This comprised five layers of gauze fitted to a wire frame which covered the nose and mouth. The frame was shaped to fit the face of the wearer and prevent the gauze filter touching the mouth and nostrils. The masks were replaced every two hours; properly sterilized and with fresh gauze put on. They were a forerunner of the N95 respirators in use in hospitals today to protect medical staff against airborne infection.

    Time to start improvising?

    Reply
    1. marku52

      Kevin Drum, of all people, has a useful blog about various materials for do it your self masks. Turns out vacuum bag paper material is almost as good as a surgical mask.

      Maybe I ought to go buy some……

      Reply
      1. Carla

        Story of my life. Several years ago, I found some vacuum bags from a long-gone vacuum cleaner and threw them out, of course. WHO KNEW?

        Reply
    2. Else

      Yesterday in Boston, the president of MGH asked for anyone with a 3d printer to help them make masks. History repeats itself, I suppose.

      Reply
  7. Steve

    It is very likely the Coronavirus will run its course no matter what we do. The flattening of the curve basically helps by lessening the peak strain on the healthcare systems but the the projected infection rates are still around 60% of the population. The quarantines are helping but have no chance of working for more than a very short run. People at some point will just say “I don’t care, I’m not staying in”. The recent interviews and articles by Michael Osterholm and John Barry showcase some things that are widely accepted: We are in this for the long term (at least 18 months), and suppression will have to occur more than once. These periods of shut-in suppression will devastate people who live on the financial margins along with a tragic amount of small businesses. FEMA’s numbers show disasters of this scale usually result in 40% of businesses going under, and then a significant number failing afterwards. Suppression attempts also will not work due to group refusal at some point and overall cost. They also will not work because of the elephant in the room, “there isn’t a vaccine”. If there was suppression until the necessary percentage of people could be vaccinated that would be effective, but Osterholm and Barry have both said that a vaccine is a long way off, and it may not be effective enough once we have it. There are also the enormous logistics of producing enough vaccine and getting it to enough people. It may be better to do everything we can to protect healthcare workers and ramp up a system where people can get oxygen in their homes if necessary. I can’t see any other way than herd immunity being what finally slows down Coronavirus, no matter what efforts are made. We just do not have the capacity at this point to stop it, and now is the crucial moment, not 3 months from now.

    Reply
    1. NotTimothyGeithner

      Can you imagine people looking at their 401ks as piggy banks now?

      People trying to get jobs?

      Gig workers?

      But don’t worry Schumer is proposing low interest loans to small businesses! And Pelosi has a secret plan to make Trump pass tolerable ideas and win in November. Biden is sitting in the corner staring at nothing. At some point, he will bring his years of experience and sexual harass someone or use a decades old slur! We are in good hands.

      Reply
    2. furies

      Maybe I’m misremembering, but is there any *proof* resistance is formed after having the Covid infection? I’ve read one can get it again…

      Reply
      1. Adam1

        If covid-19 is anything like the 4 other common strains of coronavirus then immunity will last 6-9 months for an individual. That’s why people typically get head/respiratory colds every year or so, they get a coronoavirus and their immune system has forgotten how to attack it. It’s kind of like needing a tetanus shot every 10 years to keep reminding the immune system this is how to fight tetanus except it needs a reminder every 6-9 months.

        Reply
        1. BlakeFelix

          A potentially lethal reminder… Although hopefully the mortality will be lower for infections after the first…

          Reply
      2. LAS

        Actually as I understand it, flu viruses modify genetically rather quickly. That is why there are annual flu shots. So this virus may also genetically modify quickly and make a person susceptible again the next year.

        Reply
    3. MLTPB

      Taiwan and China – we can look and see what can be done, and what the future will look like.

      By the way, our federal government worked out a deal with Taipei to receive from them 100,000 medical face asks a week, when production stabilizes there.

      A bit of good news. Still have a lot to do.

      Reply
  8. NotTimothyGeithner

    If the federal government doesn’t force manufacturers to manufacture…free trade for the win. The US doesn’t have the capacity to simply ramp up manufacturing. 3d printed items might have a space. I am worried about how many of our technocratic elite simply have no understanding ramping up production isn’t something that simply happens.

    Reply
    1. Cat Burglar

      Equipment for breathing assistance would seem to be the most pressing need in the short- and medium-term.

      I wonder how the massive cost of shutting down the economy compares with the cost of a crash program of breathing aid equipment? We are flattening the curve because of the scarcity of the necessary equipment. We could shorten the length of the economic crisis and give better care.

      Perhaps.

      Reply
      1. NotTimothyGeithner

        Yeah, but factories are going to make this equipment. Ones supplying foreign countries located in foreign countries?

        Where are the machines coming from? APPLE wanted to build something in the U.S., but they could locate manufacturers for the screws they needed. Do they even exist? What about workforce? Where are they coming from? How long does it take to train?

        An industrial expert said he could probably gather every tool maker in the U.S. into a small room. There are consequences to the hallowing out of America and simply wishing for something doesn’t mean it will happen.

        Car companies are looking into it. Yes, they could turn factory lines for cars into tanks over the course of a couple of years (the SSA was signed in 1940. We weren’t completely unaware of hostility when we ramped up production).

        In case its not clear, I don’t have the machines or capability to produce the machines to make the breathing equipment in the short or medium term. All those people who have learned to code in the last twenty years are a ready work force, even if the machines existed.

        Reply
      2. CuriosityConcern

        It’s medical personnel and medical facility capacity as well as masks. That I feel comfortable stating confidently.
        Speculation: viral load. What if the disease is worse the more you are exposed to it?

        Reply
        1. Carla

          “What if the disease is worse the more you are exposed to it?”

          Isn’t that what we’re seeing with Italian doctors and nurses?

          Reply
          1. drumlin woodchuckles

            Could enough unbroken no-rest overwork fatigue the body enough to weaken the immune system enough to allow Coronavirus an easier path to infection?

            Reply
      3. LAS

        We also need trained respiratory therapists to manage the ventilator treatments. It is time-consuming and a cost to train up the people.

        Retired people are volunteering to help and young docs coming out of medical school early. But they’er all vulnerable.

        This really is a horrible situation.

        Reply
  9. curlydan

    I’ve been at home since Friday evening much of that time with a brutally runny nose. It’s interesting above that they say symptoms include “fatigue, body aches, headaches, runny noses and sore throats” although most other sources have said something more like “Upper respiratory symptoms, like runny nose and sinus congestion, are very uncommon in COVID-19” (https://intermountainhealthcare.org/blogs/topics/live-well/2020/03/whats-the-difference-between-a-cold-the-flu-and-coronavirus/).

    I’m assuming I have a cold, allergy, or sinus infection–hard to tell which for me. But my family is keeping a very low profile until I figure out what I (and my older son) have.

    Reply
    1. Winston Smith

      This is part of the problem…there does not seem to be an approved and reliable source of information that people can follow with some confidence given the cacophony from some elected officials, including the president (backed by FXXKS news) contradicting the advice of public health experts of all stripes.

      Reply
      1. JBird4049

        Isn’t one of the problems is that it is not like measles, smallpox, whooping cough or bubonic plague with their distinctive symptoms?

        From what I understand, the cold, flu, and COVID-19 have can all some of the same symptoms? A fever is a bog standard response to an infection. I can get a stuffy nose from allergies. Mix in the different strains of each and the different responses of individuals all one can say before test is that someone probably has or does not have x. That’s not good enough.

        Reply
  10. Susan the other

    If “they” have simulated and modeled a pandemic those tools should already have considered setting up service-supplies along the lines of a fire station – a building stocked with enough protective gear and basic medical supplies to handle the community for at least a month. Just-in-time purchasing and other absurdities have made that a non-starter. In fact the US Gov. has and is completely remiss to this day for not stocking needed essential drugs and ventilators. Didn’t any of them think there might be a world-wide run on these items? So why hasn’t anyone in congress proposed just this? And along with stockpiling supplies we should have a nationalized (not private) factory manufacturing all these necessities – more or less on call in an emergency. We have the dumbest and most irresponsible politicians in the history of mankind. Not to put too fine a point on it.

    Reply
    1. Winston Smith

      I know for a fact that large health care providers such as Kaiser Permanente employ AI professionals. Part of their job is to model different situations, you can be sure that they have already done that work with COVID-19 a while ago…probably early feb if not earlier

      Reply
    2. LAS

      There are ample predictive models. We don’t need more people modeling.

      What the issue actually is lack of infrastructure investment. For the past 40-50 years, government administrations have been looking to disinvest in population. That’s it.

      Reply
  11. antidlc

    There is a modelling tool written by Harvard Global Health Institute. It is at the NY Times website and
    here:

    https://projects.propublica.org/graphics/covid-hospitals

    It models whether there are enough hospital beds in your region (given certain assumptions)

    Take a look. I don’t think there will be enough beds in most areas.

    The model looks at different percentages of the number of people infected who will need to be hospitalized and looks at how many hospital beds will be needed if infections are spread out over 6 months, 12 months, 18 months.

    For my region, the only way we come close to enough beds is if the infections are spread over 18 months (flattening the curve) and only 20% who are infected get hospitalized. And even then we will not have enough. We will be close, but not enough. That’s the way I see it for my region. I looked at other regions as well.

    My apologies if this has been posted.

    Reply
  12. smoker

    Not mentioned in the piece, the sorry state of many California Nursing Home/Skilled Rehab Facilities, most especially For Profit Facilities, where there have now been at least two California coronavirus infection instances – in Sacramento, and now in Burlingame.

    031420 For-profit ownership and private-equity backing of nursing homes, academic studies show, may weaken facilities’ staffing levels and compliance with federal standards (do read the whole piece if you have the time).

    It’s a Thursday morning in San Francisco, the day after the World Health Organization declared the coronavirus a pandemic, and Ronald Silva hasn’t slept for days, “if not a week,” he says.

    Silva is the president and CEO of private-equity firm Fillmore Capital Partners and chairman of the board of the nursing-home chain Golden Living Centers. He’s been up early calling his managers and nurses, he says, “cheering them on.” His facilities still don’t have COVID-19 testing kits, he says, but they have been screening vendors and staff for signs of infection. And the company is trying to boost nurses’ morale during the outbreak, he says, by having T-shirts made for them, emblazoned with the slogan “The Bitches Ride at Dawn.”

    His nursing staff came up with the slogan, he says. “It might offend a couple people, but so what?”

    About 70% of U.S. nursing homes are run for profit, and private-equity activity in the industry has jumped in recent years.

    The fact that private-equity executives like Silva can play a pivotal role in nursing homes’ preparedness to fight the coronavirus-borne disease doesn’t sit well with some researchers and patient advocates. Many nursing homes are understaffed and ill-prepared to confront the pandemic because their owners have prioritized profits over patient care, patient advocates say. In particular, private-equity ownership of nursing homes across the U.S. has coincided with cost cutting, declining quality of care and increasing violations discovered in government inspections.

    I’ve dealt with four of them up front and personal on behalf of loved ones in Skilled Nursing Facilities for supposed to be temporary stays. All horrified me, despite some good people working at some of them. One, the once Nationwide and Infamous Beverly Care (at an outside of California facility where the loved one’s parent criminally died), which was finally liquidated, but no doubt remorphed into another beast[s] by legally rearranging the deck chairs and titles. The Board of Directors included some very well known Powers that Be.

    Another, in California, my parent was in and we had to rescue them from it in order for them not to end up in the Permanent ward. The Federal Government (but not the California Attorney General, despite a prior California Attorney General having sued Beverly Care) finally sued them for elder abuse. Most recently, also in California another loved one has ended up in two of them (no thanks to the horrid Hospital that discharged them there and the utterly broken California Regulatory Systems and Safety Nets for the vulnerable).

    My numerous calls to California Reps regarding both loved ones’ treatment were utterly ignored.

    What many don’t realize is that after an injury, or mental health issue, any age beyond a baby can end up discharged to a Skilled Nursing Facility – which are connected to the Nursing Homes – for Physical Therapy, Speech Therapy, ‘Occupational’ Therapy, or a combination of the three. Also, some of the Nursing Facility employees may work for more than one employer; e.g. obscenely underpaid and overworked Certified Nursing Assistants [CNA] might also work at a hospital or as in home support for someone. CNAs should be at the frontlines of those provided testing

    I pray that an upside of this bleak virus is forcing all US Nursing Facilities into publically owned facilities, and that Capitalism finally dies the death it’s long deserved.

    Reply
  13. Oregoncharles

    ” In normal times, safety protocols would require these items be disposed of after one use.”

    Caveat: this is actually off-topic, but could lead to a silver lining once things shake out: “in normal times,” medicine, and especially hospitals, are a major source of waste, much of it plastic, and frequently also of air pollution, because the stuff is incinerated (you don’t want a hospital room on the side toward the incinerator). That may be the safest approach, as well as the one requiring the least human care; but it exacts a considerable price, one of the “bads” that get counted in the GDP. Air pollution is a serious cause of vulnerability to coronavirus.

    If the pandemic can be made to lead to better sterilization and re-use protocols, out of necessity, that could turn out to be a good thing.

    Reply
  14. Tom Stone

    Gavin Newsome has been wholly owned by the Getty Family since before he was bon and as Mayor of San Francisco he was best known for snorting Cocaine off his ( Married) secretary Ruby’s ass.
    WASS.

    Reply
    1. smoker

      Indeed. Sounds like you have the same ‘fondness’ I do for Gavin Newsom. Were it not for his unlimited funding and support from horrid 1%ers, along with the Identitarian™ LGBT grandstanding – which other DemRats quickly incorporated, witnessing how stunningly successful it was in that so many Californians quickly forgot his multitude of self absorbed and self profiting shortcomings and disasters as Mayor – we might not be stuck with him. I imagine him seeing himself in the role of US President some time soon, at which point, I would hope to be dead.

      By the way, so very sorry about your putting off your elective treatment. I’ll be cancelling my upcoming cancer appointment, but perhaps unlike you, and despite still being under retirement age, I’m actually very ready to leave this horrid Capitalism poisoned life where I’ve been helplessly watching loved ones falling through crevices totally unnecessarily were this a decent State and Country. I’ve asked my oncologist (who despises hospital management, so that’s what we many times talk about for bleak humor) about California’s Right to Die qualifications and requirements if I get to that eligible point, and he basically implied it was loaded with a mind numbing tons of brutal paperwork, sigh.

      Reply
  15. smoker

    Question for Kaiser Health News, why don’t you have a phone number for those who either have limited to no affordable internet access: or for privacy reasons, are not willing to discuss their healthcare horrors in an email – none of which are private at the end of the day?

    Some of the most vulnerable have no internet access, yet are perfectly able to elucidate their nightmare Health Care Horrors over a telephone. You – along with a vast multitude of other Non Profit sites automatically presumed to be the peoples voice – are clearly missing a multitude of issues, increasingly experienced by millions, by not providing a phone number.

    Reply
  16. miguel99

    What about isolating the highest risk groups – over 60 years old, or younger with underlying conditions – and letting the rest of the population go on nearly as normal but with social distancing and testing/screening. Some of the high risk people could shelter in place at home. Others would need temporary accommodations: hotel rooms, apartments, prefab homes, etc. How long would it then take for the infection to spread through the rest of the population and the infectiousness subside? 2-3 months? If this could actually be done, would the number of cases requiring hospitalization – almost all from the under 60 and healthy group – still overwhelm the system?

    Reply
    1. Yves Smith Post author

      That has already been modeled. Impact too limited. I was seeing models like this on Twitter before, now confirmed by Imperial College of London study:

      The researchers then looked at the effect of different combinations of interventions — including home isolation of infected people, home quarantine for all household members of infected people, social distancing for all ages, and social distancing by those over the age of 70.

      One option they considered was a relatively modest restriction on social activity. It combined home isolation of cases, home quarantine for household members, and social distancing for only those over 70. This approach cut deaths in half and reduced peak health care demand by two-thirds, they found.

      However, it still resulted in many deaths and overwhelmed intensive care units. The simulation showed that the surge capacity of hospitals would be exceeded by at least eightfold. Even if all patients were treated, the U.S. would see more than 1 million deaths.

      In the model, keeping the numbers of deaths low and keeping health care systems functioning required social distancing for the entire population, over a long period of time.

      https://www.npr.org/sections/health-shots/2020/03/17/817214311/new-analysis-suggests-months-of-social-distancing-may-be-needed-to-stop-virus

      Reply
  17. SubjectivObject

    it’s triage
    priority one is to protect medical personnel at all costs
    if they cannot do their job with confident safety, then they don’t do it
    in principle and in this extreme context
    the rest of us do not get to rely on their concentrated selflessness to further our own life
    it’s finally luck of the draw here
    you get CV critical now, you can expect to die
    until such time as the rest of the support structure is adequately in place

    Reply

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