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California May Need More Drastic Steps During COVID-19 Surge

NOEL KING, HOST:

California is in the middle of an overwhelming surge of coronavirus cases. Hospital ICUs are full. People are waiting longer to get care. And field hospitals are being erected. State health officials say they may need to take even more drastic steps, which health reporter Will Stone is here to explain. Good morning, Will.

WILL STONE, BYLINE: Good morning.

KING: How bad is the surge in California?

STONE: Well, at the moment, upwards of 19,000 COVID-19 patients are hospitalized in California. And that's just about where New York was during the height of its spring surge of cases. There's no real indication that California is at its peak yet. And the state had more than 300,000 new cases diagnosed in just the past seven days.

KING: And how are hospitals dealing?

STONE: They're doing all kinds of workarounds or adding more ICU beds, bringing in backup staff, delaying elective procedures. Dr. Nancy Gin at Kaiser Permanente says COVID patients currently take up about three-quarters of all their hospital beds in southern California.

NANCY GIN: In the worst case scenario, if we are really just at a point where the demand is so great in the hospital setting, we truly might not have enough people to ensure that the patient is receiving the care that we would normally want to provide.

STONE: And what's so concerning is that with hundreds of thousands of new cases in the state, that inevitably translates into many more hospitalizations. And the modeling shows that the number of people in California's hospitals could more than double over the next month.

KING: So hospitals are adding ICU beds. They're calling in backup nurses. There seems to be a fear, though, that this still might not be enough.

STONE: Yeah. Eventually, they may have to really cut back on care for some patients. California is not there yet. But hospital leaders are seriously discussing it and preparing for it. And the formal term here is crisis standards of care. Often, it's called rationing care. And it's based on a lengthy document that California, like many states, has developed. So if hospitals in a region have exhausted all the workarounds, there is an ethically sound process for deciding which patients to prioritize.

KING: Who makes those decisions and how?

STONE: It will depend on the hospital. But California's guidelines make it clear that these decisions can't be based on age, race, gender, disability and other factors. The goal is to avoid implicit bias. So there's a scoring system that looks at organ function and which patients are most likely to survive. And these are just wrenching decisions for doctors and nurses. I spoke to Dr. Alyssa Burgart at Stanford. She's a bioethicist and helped advise those who created California's crisis care guidelines.

ALYSSA BURGART: People who are put into this position of being triage officers want to do a good job. And they want to be able to get through this feeling that they made the best decision with a terrible hand. As a physician, I want all of my patients to do well.

STONE: And Burgart says a big shift from early in the pandemic is that, before, hospitals were really concerned about these black and white decisions over who gets a ventilator or a bed. But now the real limiting factor in California is trained staff. And not having enough nurses and doctors may be what ultimately pushes some hospitals to these decisions around rationing care.

KING: A sign of the times, I suppose. Health reporter Will Stone.

Thanks for this, Will.

STONE: Thank you. Transcript provided by NPR, Copyright NPR.