California spent nearly $ 200 million building, operating and staffing alternative health centers that ended up helping little when the state’s worst coronavirus outbreak spiraled out of control last winter, forcing exhausted hospital workers to treat patients in tents and cafeterias.
It was a costly way to learn that California’s hospital system is far more flexible than was anticipated at the start of the pandemic. Through desperation and innovation, the system was able to expand enough to admit patients even during the horrific spike, when about 20,000 hospitalizations and about 700 people died each week.
“Certainly some hospitals, especially in the Los Angeles area, were at their limits, but we didn’t see as much use of alternative treatment points as envisioned,” said Janet Coffman, professor of health policy at the University of California. , San Francisco. “As dire as the situation in winter was, it could have been even worse.”
In the first weeks of the pandemic, Democratic Gov. Gavin Newsom ordered the establishment of alternative health care facilities in the former professional basketball arena, two government centers that routinely treat people with developmental and intellectual disabilities, and other facilities.
It was part of an early plan to add an additional 66,000 hospital beds as California braced itself for a projected crushing number of COVID-19 patients, one of many steps the governor took when he introduced the nation’s first isolation.
The state ultimately spent $ 43 million to build eight sites, $ 48 million to hire contract employees, and $ 96 million to operate them as part of a downsized plan, according to estimates the Associated Press requested from Treasury and General Services departments and the Agency. health and social services.
Records show that a total of 3,582 patients were treated at these centers, but half of them were during the first three months of the pandemic, when infections were still low and the traditional hospital system turned out to be able to cope with them on its own. The centers resumed operations in early December and treated fewer patients over the next three months, although many hospitals were overcrowded.
The traditional hospital system has seen its worst periods of the pandemic, with little overcrowding in alternative health facilities because the state has temporarily reduced the ratio of nurses to patients dedicated to protecting patients and their caregivers and due to the struggle to attract temporary staff. said Stephanie Roberson, director of government affairs for the California Nursing Association.
Brian Ferguson, a spokesman for the state’s Emergency Management Agency, said officials have learned it is better to align the state’s efforts with existing healthcare facilities than to create makeshift stand-alone hospitals.
For example, two empty hospitals reopened in a spike last summer, one each in Northern California and Southern California, as the most populous state overtook New York City for the most cases in the country. But they were no longer used during the winter surge, preferring closer collaboration with existing hospitals.
Likewise, Newsom announced in early April 2020 that the Sleep Train Arena, the former home of the Sacramento Kings NBA, would be converted into a 400-bed hospital. As a result, only nine patients were treated in 10 weeks, because the hospitals in the region dealt with other cases.
The state never reopened this main arena when the virus flared up again around Thanksgiving, and instead treated 232 patients in a much smaller adjoining health facility.
“If you look back in time, you could say, ‘Well, we could use the money we spent on the rent of the Sleep Train and we could return it to the hospital system, or we could invest it in purchasing PPE (funds personal protective equipment) or any number of items, ”said Roberson. “But these are lessons learned.”
She added: “As we move forward, we need to pay attention to all these mistakes and do better.”
According to Ferguson, officials have learned to be more flexible in opening and closing facilities and to “quickly flip the site for added value or purpose,” if patients didn’t need it.
For example, all emergency centers closed by March, when the worst wave of infection subsided. But two were transferred to other responsibilities related to the pandemic: one was used for testing for coronavirus and the other for treatment with antibody infusion.
Likewise, contracts with traveling healthcare professionals early in the pandemic required them to work in alternative healthcare settings, even if they weren’t often needed. But contracts during the winter spike were rewritten so that “when they are no longer needed, you can quickly move them to the hospital,” or to perform other duties such as administering vaccinations, Ferguson said.
State officials planned to rely more on the newly formed California Corps of Health Professionals, especially after 95,000 people initially responded to Newsom’s call for volunteers.
But only a small fraction actually qualified or signed up.
“When medical services fell short of expectations, travelers were the next best alternative,” said Coffman, who studies health workforce. “Yes, contracted travelers are expensive, but at least you are confident that this is someone we can count on to take good care of patients and have the necessary skills.”
California has spent $ 612 million on contract healthcare workers and $ 2.2 million on healthcare, most of which it hopes to reimburse through the federal government or the agencies where they worked.
The state has set aside $ 74.5 million for the fiscal year, which began this month, to cover late bills or if another spike occurs that requires the state to ramp up spending again.
“If things were to change for the worse – mostly delta… we still want to be able to move fast,” HD said. Palmer, spokesman for the California Department of Finance.