Differences in ICU bed numbers at heart of decision, concerns
A day after Gov. Gavin Newsom announced a new shutdown order — and a new series of regions and metrics for triggering it — five Bay Area counties and the city of Berkeley announced they would preemptively go into the stay-at-home order, even though the Bay Area region has not yet hit the metric triggering the governor’s order. On the same day, Sonoma County announced it would not be joining those other counties, and was in fact in conversation with the state as to a revamping of the county’s ICU bed availability numbers.
The governor’s order split the state into five regions, and introduced a metric that would trigger a stay at home order when ICU bed capacity in the region dropped below 15%. Sonoma County is part of the Bay Area region, which currently reports 25% ICU bed capacity. The Bay Area region is the only region not anticipated to be under lockdown orders within the next few days.
However, as cases surge statewide and locally, several counties (Marin, Contra Costa, Alameda, Santa Clara and San Francisco) felt their rapidly diminishing capacity indicated they should implement their own stay at home orders ahead of any mandatory orders from the governor. But, Sonoma County Health Officer Dr. Sundari Mase declined to join them.
“Sonoma County has decided not to join them,” she said in a briefing Friday afternoon. “We’re talking with our health care partners, and we will join those other counties if the need arises. But, we have concerns about the number the state’s using for ICU capacity, which shows us with less that 3% capacity. We do not believe they are reporting the true capacity.
“Just an hour ago we met with hospital administrators and found that out of 77 ICU beds, 40% are available right now. We are in conversation with CDPH and hope to have answers soon. We want to assure you that our hospital part can increase ICU capacity immediately if needed. We will track what other counties are doing, but we don’t believe current rates justify joining those counties,” she finished.
This issue with how ICU beds are counted is more complicated and confusing than one would expect, and it’s not clear how it’s going to be resolved. According to Mase and others on the call, including administrators of local hospitals, the issue relates to the difference between the number of licensed beds and the number of currently staffed licensed beds.
In a nutshell, there are 77 ICU beds in Sonoma County. However, for financial reasons, they are normally staffed at only a minimal level based on need. In other words, if there are three patients in the ICU, the hospital would normally have four beds staffed, to care for current patients and be able to take in an additional patient on an emergency basis. So, a hospital may have, for example 20 licensed ICU beds, that could be fully staffed within, say 48 hours, but that at a given moment in time may have only five staffed beds operating with only one available.
The states metric uses the rather ambiguous word “available” with no additional detailing of how that should be calculated.
However, that’s not the only challenge to getting an accurate count, as hospitals will also often have patients in ICU beds that could, theoretically, be moved to another department, such as acute care, if the ICU is already staffed. So, in case of a sudden need, those patients could be relocated to make space for patients who require ICU care.
However, this information doesn’t precisely make clear what numbers the state has been using, and why the county’s own dashboard also reflects apparently inaccurate numbers.
County health program manager Kate Pack says the county’s dashboard will be updated with more accurate figures, as well as some new capacity-related metrics soon.
Mase stated they had begun discussion with the state this morning when it realized that the state had rated Sonoma County’s availability around 3%, a number that she felt wasn’t correct based on her conversations with local hospitals.
“We’re getting on the same page and I believe this will be resolved shortly,” Mase said. “We’ve been discussing this all day, describing how our data is being looked at, and we are on our way to resolving things in our dashboard and the state’s dashboard.”
Mase wrapped up her briefing by saying that they planned to monitor numbers carefully and daily within the county, and would potentially have a discussion at Tuesday’s board of supervisor’s meeting if needed should trends indicate that the county should join the preemptive shutdown.
