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  • Writer's pictureWilliam Miller, MD

COVID on the Coast: Update and Review

As we start into a new surge of cases in California fueled by the delta variant, it seems appropriate to briefly summarize the response taken here on the Coast since the pandemic began and bring us up to date on what the current situation looks like locally.

We started preparations for the pandemic in March of 2020 by developing an emergency response plan. This plan was revised in November and updated again this week to reflect considerations for the new delta variant. The plan details resources needed at various levels of a surge in cases and strategies for meeting those needs. It includes policies around isolation to protect other patients and staff from infection. This plan was reviewed by the state health department and I am proud to say that they used it as one of their model examples for other hospitals.

Our hospital has 25 beds of which four are ICU. Our surge plan increases the total number to 30 with 6 being ICU. Initial projections back at the start of 2020 were fairly dire. Fortunately, we never experienced anywhere near those predictions. This can be attributed to many factors, but probably the most important was the statewide shelter-in-place mandate at the start of the pandemic. A question often asked is, “How many ventilators do we have?” The answer is four with a backup supply from Adventist Health. Two of these were purchased for us by the Mendocino Coast Healthcare Foundation. However, the limitation of managing very sick patients on ventilators is not dependent upon the availability of ventilators as mush as on staff (ICU nurses and respiratory therapists) to care for such patients. Going into the pandemic there was already a national healthcare shortage and that has only worsened.

The first local case of COVID was identified in June, 2020. Shortly thereafter, there was an outbreak in Sherwood Oaks nursing home. During the outbreak, 24 of the 58 residents became infected along with 3 staff members. Eight residents died. Ending the outbreak involved a collaboration between our hospital, the nursing home, the county health department, and local city officials. The approach taken was to bring all new COVID cases from the nursing home to the hospital as a means of helping isolate them from other residents. The total number of residents brought over under this plan was 14, all of whom survived. It was considered a successful example of how the community worked together to meet the challenge, without which it is felt that more lives would have been lost.

In 2020, our ER treated a total of 38 COVID patients of which 15 were admitted to the hospital. Adding the 14 Sherwood Oaks patients, the total admitted here was 29 during 2020. Only two became seriously ill and required intubation and placement on a ventilator. Two patients were transferred to a higher level of care, with one of those patient’s unfortunately dying. To date, there have been no COVID related deaths in our hospital.

In 2021, we have admitted 18 COVID patients with 11 of those being in January through March, thus comprising the tail end of the winter cases. All of these have recovered and were discharged home. None required intubation or transfer to a higher level of care. Except for the nursing home outbreak when we reached 7, we have never had more than two COVID patients at any one time. The age range has been 27 to 99.

During the beginning of 2020, we experienced significant shortages in personal protective equipment (PPE). However, after our affiliation with Adventist Health (AH), we have had a good supply of PPE. Shortage of COVID testing supplies was a major challenge across the US. Initially, we had to rely on sending the swabs sent out. This continued to be a challenge until the Mendocino Coast Healthcare Foundation gave the hospital a $100,000 grant to purchase a new Cepheid machine so that tests are now run in-house with a turnaround of one hour.

Similarly, vaccinations were initially in short supply. Mendocino Coast Clinics (MCC), the county health department and AH collaborated on a mass vaccination effort. To date, MCC has given over 9,000 shots leading to 4,461 persons being fully vaccinated. AH has given over 6,000 shots on the coast leading to 3,145 fully vaccinated persons. MCC continues to provide drive through vaccination to the public without appointment every Thursday from 4-6 PM at 205 South Street in Ft. Bragg. The MCC FaceBook page also lists pop-up vaccination clinics in the area.

Responding to the challenges of COVID requires the community to work together. The community’s Foundation buying the Cepheid, the collaboration around containing the nursing home outbreak and the vaccination efforts of MCC and AH with the county are all examples of how this has worked well.

The new delta variant is now further challenging us as a community. Cases are rising here on the coast and disturbingly we are seeing some who are vaccinated becoming ill, although generally not seriously ill. As of this writing, we have one patient in our hospital with COVID. In the past 10 days, MCC, the ER and the AH clinic have run approximately 245 COVID tests with 39 being positive. Of those, 8 were fully vaccinated.

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