Board Report delivers HASC’s most up-to-date and comprehensive information briefing to the association’s Board of Directors.

Contact HASC President/CEO George W. Greene (below) with questions or comments.

Key HASC Activities and Advocacy

Los Angeles County Diagnostic Testing Public Health Officer Order 

As a result of our advocacy efforts with the county regarding the significant and unsustainable burden the original Public Health Order would place on hospitals, the Los Angeles County Department of Public Health has revised the order and removed acute care hospitals from their definition of “Health Facilities.” The revised order clarifies that acute, sub-acute and long-term health care facilities are expected to maintain their ability to test patients, as appropriate and in accordance with the Los Angeles County Department of Public Health testing guidelines.

Opposition to a Health Care Resolution Proposed by Riverside City Council

HASC authored a letter of opposition to a health care resolution proposed by the Riverside City Council, which would have negative consequences on limited resources that are critical in the fight to save lives during the COVID-19 pandemic. HASC also participated in meetings with the Greater Riverside Chambers of Commerce and city council members to express opposition to the resolution. The proposed resolution infringed on current federal, state and county policies and guidelines already in place to protect frontline health care professionals as well as the patients and families they serve. Among the onerous requests, the proposal would have placed the following requirements on hospitals in the city of Riverside:

• Provide employees with proper and adequate Personal Protective Equipment (PPE), which means including N95 masks, face shields, gloves, gowns, booties, hair coverings, if requested, and always for any employee coming in contact with a probable or confirmed COVID patient, or a hospital worker who has interacted with a hospital worker who has interacted with a COVID patient.
• Quarantined health care workers must test negative for COVID before they are required by hospital management to come back to work and must be given advance notice before they are required to do so.
• Ensure sufficient staffing at hospitals so COVID-19 patients and all patients receive quality care. Also ensure that due to furloughs, reduced hours, and staffing cuts, programs are funded so that workers can sign up for additional shifts to keep patients safe.

Exemption for Hospital Cafeterias (San Bernardino County)

Last week, San Bernardino County Environmental Health Services visited a couple of hospital facilities and communicated that they needed to close off their cafeteria seating areas to comply with the current health order prohibiting indoor restaurant seating. HASC engaged in and facilitated several discussions between County Public Health, CDPH, and CHA and it has been determined that hospitals are exempt from that order. According to California Retail Food Code Chapter 1, Section 113713, the responsibility and authority is left up to the local enforcement agency (San Bernardino County Public Health), and Dr. Erin Gustafson, acting health officer for San Bernardino County, confirmed in a memo that hospital cafeterias are exempt as long as physical distancing and infection control protocols are in place. Furthermore, CDPH is also aware and will reiterate this exemption with local district offices.

HASC-Led and Involved Activities

7/27 Bi-Weekly COVID-19 Riverside County Healthcare Coalition Call

On this bi-weekly call that includes hospital executives, EMS and public health, discussions occurred regarding the current state of COVID-19 cases and hospitalizations; surge planning and preparedness; testing, capacity and resources; Imperial County transfers; and public messaging.

Some highlights include:

• Riverside County EMS Agency (REMSA) is using CARES funding and assisting hospitals with DME specifically for surge, which is unique in this operational area.
• Imperial County transfers have tapered off and are not happening near the frequency that they were.
• There has been an overall reduction in 5150 transport volumes: 10-15% and as high as 17%.
• There are revised clearance protocols for health care workers returning to work. 
  • In acute care hospitals, infection preventionists can clear health care workers specific to their facilities rather than seeking approval letters from public health. Other major changes include: 
    • Removing the recommendation for a clear test back to return to work.
    • 72-hour timeframe for improved symptoms was reduced to 24 hours.
• HASC shared the development of messaging and communication efforts to encourage flu vaccinations. HASC is continuing to collaborate with counties and others.

7/30 Weekly Call with San Bernardino County Department of Public Health

On this weekly call that includes hospital executives, EMS and public health, discussions occurred regarding California surge plan guidance; testing updates; behavioral health; Ambulance Patient Offload Times (APOT), and an EMS update.

Some highlights include:

• Cases have increased by 25% since the previous week – 6,534 new cases.
• Serology testing is flat because the county ordered additional test kits, so data has been stagnant for a few weeks.
• Polymerase Chain Reaction (PCR) tests: 13.1% positivity rate.
• 27-28% of all hospitalizations are COVID-19.
• 50-60% of all ICU beds are COVID-19.
• The number of COVID-19 patients being held in EDs is about 50-55, which is a reflection of ICU utilization and inability to move patients internally.
• Overall hospitalizations have declined but ICUs showed more utilization over the previous week. Considering the new data metrics, we’re not certain if this is validated.
• July APOT data will be released soon and will likely show record numbers even higher than January 2020’s peak.
• Some pre-hospital policy changes and processes are currently being worked on such as “assess and refer” in the field of level 4 and 5 patients as well as a 911 nurse triage system.
• EMS/Paramedic Hospital Use Waiver: we’re awaiting approval from the state but likely to receive it soon. The waiver expands what paramedics can do at the hospitals for helping with APOT.

7/30 Weekly Call with Santa Barbara Department of Public Health and EMS

On this weekly call that includes hospital executives, EMS and public health, discussions occurred regarding COVID-19 cases, hospitalizations, testing and infection control updates.

Situational update as of 7/29 (data from prior day):

• A total of 91 COVID-19 cases and 32 deaths.
• Asymptomatic: 582, symptomatic: 3,458.
• Active cases in community: 349.
• Hospitalized COVID-19 patients: about 79.
• The positivity rate is just below 10.8%.
• Community-based testing sites remain at Santa Maria, Santa Barbara and Buellton. These test sites can test about 144 people a day utilizing Polymerase Chain Reaction (PCR) methods.

8/5 HASC Santa Barbara Area Meeting Call

On this call that includes Santa Barbara County hospital executives and HASC leadership, discussions occurred regarding current issues including what hospitals are experiencing regarding their responses to COVID-19.

8/6 Weekly Call with Santa Barbara Department of Public Health and EMS

On this weekly call that includes hospital executives, EMS and public health, discussions occurred regarding COVID-19 cases, hospitalizations, testing and infection control updates. 

• County Public Health is tracking COVID-19 outbreaks in 33 congregate living facilities.
• 30 medical reserve corps volunteers have been trained to assist congregate living facilities with swabbing, fit testing, and donning and doffing.
• The state has sent the county plenty of isolation gowns and they are ready to be distributed to hospitals. 
• Hospitals are still struggling to discharge patients into SNFs; many are not accepting patients due to COVID-positive staff or residents.

8/6 Weekly Call with San Bernardino County Department of Public Health, EMS and Hospitals

On this weekly call that includes hospital executives, EMS and public health, discussions occurred regarding surge; testing updates; county bed capacity and trends; APOT delays; and HASC updates.

Some highlights include:

• COVID-19 cases have increased 6% since prior week, with 1,900 new cases.
• 9-12% COVID-19 increase in pregnant mothers.
• Serology tests are showing a 0.95% positivity rate.
• Polymerase Chain Reaction (PCR) tests are showing a 13.2% positivity rate.
• 29-30% of all hospitalizations are COVID-19 (slight increase from last week).
• 50% of all ICU beds are COVID-19 (slight decrease from last week).
• COVID-19 patients are being held in EDs at a rate of about 50 patients.
• Pre-hospital transports are trending downward and stabilizing.
• APOT is trending downward.
• AMR is willing to support interfacility transfers with BLS units.

8/6 Bi-weekly Call with Los Angeles County Department of Public Health, EMS, DHS and HASC

On this bi-weekly call that includes hospital executives, EMS and public health, an overview was provided illustrating recent trends and developments within L.A. County.

Highlights include:

• The county is averaging 2,500-2,700 COVID-19 case counts a day.
• Inaccurate data is impacting the ability to conduct contact tracing.
• Outbreak investigations are open at over 900 institutional settings in the county.
• VA hospitals are accepting VA patients or patients with veteran status for transfers.
• The Fairview ACS in Orange County is still open with bed capacity for COVID-19 SNF patients.
• BYD N95 masks and gowns are being received and distributed to hospitals.
• The need for ventilators has decreased.
• Turnaround times for testing continues to be challenging.
• Antelope Valley Hospital and San Gabriel Valley Medical Center have had increased COVID-19 census and EMS is monitoring their level of COVID-19 burden.
• The Health Officer Order regarding diagnostic testing has been revised to exclude acute care hospitals.

8/6 Weekly Ventura County Health Care and EMS Partners Conference Call

On this weekly call that includes health care executives and EMS, discussions occurred updating participants on situational awareness, supplies and testing concerns and hospital updates.

Highlights include:

• Hospitals are to report information to Ventura County Public Health while CalREDIE is down.
• 37 congregate facilities are currently being monitored.
• EMS has excess testing bio-transport medium available to hospitals.

8/7 Monthly Call with Southern California Edison 

HASC remains in close contact with SCE as weather conditions present a risk for Public Safety Power Shutoffs (PSPS). PSPS events occur when power is temporarily shut off at a facility (or facilities) to reduce the risk of potential ignitions sparked by power lines. 

With Board Report questions or comments, contact HASC President/CEO George W. Greene.

Contact:
George W. Greene
(213) 538-0706
ggreene@hasc.org