ICU patient and nurse
A nurse assists a coronavirus patient in an intensive care unit in Los Angeles. Image from LA County video

Riverside County’s hospitals are straining to meet demand amid the current coronavirus surge and other patient needs, with intensive care units at their limit and medical facilities’ morgues now beginning to run out of space, the director of the Emergency Management Department told the Board of Supervisors Tuesday.

“There are surge plans in place, so they can extend beyond surge capacity, and that’s what our hospitals are and have been doing,” EMD Director Bruce Barton said.

He told the board that, from a designation perspective, the county has essentially reached its maximum ICU bed capacity. However, medical facilities are working to set up additional critical care space wherever they can find it, and “a couple of hospitals have not hit 100% yet,” he said.

Last week, Riverside University Medical Center CEO Jennifer Cruikshank told the board that a storage room at the Moreno Valley hospital had been cleared and re-purposed for placing patients.

According to Barton, the county has been keeping up with demand for personal protective equipment, ventilators and other resource requests, but hospitals are experiencing staffing shortages, and “the well is dry.”

“We are assisting hospitals in any way we can,” he said. “But there’s not a very deep pool (of backup personnel).”

The California Department of Public Health has been alerted for supplemental health care workers, and 23 have recently been assigned to the county, he said.

According to Barton, although the coronavirus numbers are expanding rapidly, the patient load still does not reflect that a majority of those in need of hospital stays are infected. He said that 41% of general hospitalizations are currently attributable to COVID-19, while 36% of ICU occupancy is virus-related. The county has roughly 3,600 licensed beds.

The EMD director did not venture a guess on the mix of other patients and their diagnoses.

Barton said emergency room impacts are a mounting concern, reminiscent of the 2017-18 influenza season when some medical facilities had to resort to triaging patients outdoors.

“We are seeing significant increases in (911) call volume, and there are significant ambulance patient off-load delays in the system,” he told the board, noting that ambulances are having to idle for unspecified periods outside of facilities because there isn’t space inside to leave patients.

Another escalating area of concern is morgue space.

According to Barton, in the past week, “a couple of hospitals hit capacity,” unable to store decedents’ remains in on-site climate-controlled rooms.

“The county coroner is partnering with hospitals to restore morgue capacity,” he said.

The EMD chief pointed out that an upswing in body counts is not out of the ordinary for the early winter period.

“This time of year is generally the busiest for mortuaries,” he said. “It’s normal for them to be busy at this time. Now add the virus on top of that.”

Supervisor Karen Spiegel wondered whether the delays in moving remains out of hospitals to resting places might be connected to doctors having trouble confirming whether to code decedents as coronavirus victims, or wait for further analysis.

“If there are underlying issues, is it always going to be (recorded) as COVID over the underlying issues?” she asked. “What is the challenge?”

Barton replied that the “through-put process” was most likely hampering the movement of remains out of hospitals.

“Decisions have to be made (by families regarding a mortuary, a service and a burial site),” he said, adding that he could not comment on what factors go into making a final “determination of death.”

Supervisor Kevin Jeffries noted that during his years as a volunteer firefighter, the holidays were always the most demanding for paramedics.

“We always had the most CPR cases around Christmastime,” he said. “I don’t know if it was stress or what.”

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