What North Bay hospitals have learned from the coronavirus pandemic

One year ago, while life slowed for many of us and we locked down, bought all the toilet paper and experimented with sourdough starters, an entirely different pace was being set by hospitals and health care workers.

Fueled by coffee and driven by a ticking clock, hospital IT departments embraced all-hours work to get caregivers comfortable with trading the walls of a clinic for the pixelated blue glow of a Zoom. Administrators scoured the depths of the Internet to secure sufficient masks and protective equipment. As neighbors laughed over “Tiger King,” doctors and nurses stood on street corners and besought their NextDoor friends to collect masks leftover from the wildfires.

The highways had tumbleweeds at rush hour, but certified nursing assistants, radiology techs, clinical laboratory scientists, environmental services, doctors, nurses and every other essential health care employee donned protective clothing, bloomed the lopsided-O bruise of an N-95 mask, and pushed through countless glove changes and cracked-hand sanitizing steps to continue showing up for their patients.

The debate that played out regularly on TV over whether COVID-19 was really as bad as all that, was bitter for our care providers, where front-line staff watched machines breathe for someone’s family member. The January surge led to a 447% increase in hospitalized COVID-19-confirmed patients in Sonoma County.

As we study the scars of a year under COVID-19, what have we learned?

We must invest in our public health infrastructure. Years of underfunding public health departments placed unprecedented strain on the health care system. Without significant financial investments and technology upgrades it threatens our readiness to handle the next disaster — whatever it may be. One such disaster, already on our doorstep, is the urgent need for more support for our community members living with opiate addiction and behavioral health needs.

The importance of addressing health equity. The pandemic — which has disproportionately impacted BIPOC — has laid bare the hurdles that remain to ensuring that all community members have access to equitable care. Hospitals, often among the largest employers in a community, are uniquely positioned to address inequities in both care delivery and employment opportunities.

There is tremendous value in health systems. The ability to collectively procure resources (think: masks, gloves, vaccines) has been an invaluable aid to system hospitals. This collegiality has likewise benefitted our system hospitals during wildfire season evacuations.

Drawing on the lessons of the pandemic, society needs to think differently about how we support these institutions that serve us all. Whatever the next disaster is, our hospitals will be there to care for their patients. The question stands: Is hardening against all disasters a realistic expectation? Current legislation mandates, for instance, that by 2030 all California hospitals must be fully operational after a major earthquake. The price tag associated with this legislation is about $100 billion. The “B” was not a typo. While Sonoma County hospitals have put in significant work for earthquake safety, retrofitting an entire facility could prove to be a price tag too steep for some, especially after the past year.

Over the last 365 days, hospitals’ commitments to their communities have never wavered. While there is an understandable desire to move on from COVID-19, we must acknowledge and incorporate the valuable lessons the past year has taught us. As more patients seek care outside the four walls of the hospital, this will necessitate a shift in how hospitals envision nearly every aspect of care delivery, from bricks-and-mortar departments such as the emergency room and urgent care, to reimbursement mechanisms, community engagement, and even office space for non-clinical staff.

Surge preparations, scarcity pricing for essentials such as travel staff to backfill those on leave, antibacterial room wipes and delayed care have devastated hospital finances, and the impacts will likely be felt for years to come. The financial challenges will only increase as Medi-Cal enrollment expands from an influx of patients impacted by the economic downturn. At the same time, hospitals have received scant few dollars in financial relief. That last point is important: Hospitals, the epicenter of care during this past year’s pandemic, have received minimal financial relief relative to what other industry sectors have received.

Looking forward, many of our caregivers are struggling under the heavy grief of a year of so much unfathomable loss. Seasoned professionals are pursuing early retirement, public health employees are opting for jobs that don’t incur constant critique and hostility, and forward-thinking epidemiologists are already wondering what the next pandemic will be. Further, after what has been a very dry winter, Sonoma County hospitals are preparing for another potentially punishing wildfire season.

Whether it be pandemic, financial struggles, wildfires, earthquake, power shutdown or any other challenge, one thing remains constant: hospitals’ doors remain open to care for all patients in all ways.