By Mallory Moench
San Francisco Chronicle
SAN QUENTIN, Calif. — San Quentin State Prison’s coronavirus outbreak is straining hospitals in Marin County, which is already dealing with spiking community cases. But the state is making progress to provide more medical care on site, the county’s health officer said.
Hospitals in Marin shoulder the burden of caring for the sickest inmates, the county’s health officer, Dr. Matt Willis, said. Of 31 patients hospitalized for COVID-19 in the county Monday, 12 came from San Quentin. The majority were split evenly between Marin General Hospital and Kaiser Permanente San Rafael Medical Center, with one at Novato Community Hospital. At Marin General, half of the intensive care unit was filled with coronavirus patients from the prison, just 4 miles away.
“It is frankly a challenge to find beds for these individuals,” Willis said. “I think the hospitals recognize that everyone deserves the highest standard of care regardless of where they’re coming from. But we also have a limited number of beds and there are some unique challenges to inmate care specifically because they require corrections officers as well to be with them.”
The San Quentin outbreak, the largest in California’s prisons, is filling beds at hospitals in Marin County and around the Bay Area, colliding with spiking hospitalizations from the community. Although the influx puts a strain on resources, hospitals aren’t in danger of reaching capacity or triggering their surge plans, and the California Department of Corrections and Rehabilitation is isolating infected individuals and setting up beds to provide more medical care on site.
On Tuesday, 1,369 San Quentin inmates had tested positive, according to the department. Six have died of the disease. As of Monday, 62 had been transferred to local medical facilities.
The massive outbreak prompted the California Department of Corrections and Rehabilitation to set up an incident command center at the prison, where Willis spent the long weekend and said he saw signs of progress. On Monday, the department began moving infected inmates into tents to isolate them. That helps solve the problem of hundreds of inmates housed in open-air cells in the same room, contradicting best public health practices to separate sick and healthy individuals.
The department also is building an alternate care site with more than 100 beds it plans to start filling Wednesday, Willis said. That hopefully will reduce the number of transfers, up to 10 a day, to local hospitals. A majority of inmates infected with COVID-19 are asymptomatic or have mild symptoms that require only a nurse to monitor their oxygen, he added.
“The build-out of the alternative care site at San Quentin is really the most important solution to this problem to make sure inmates get the standard of care they deserve while protecting regional health care resources,” Willis said.
Marin’s hospital patients rose from a weekly average of six in late June to 25 this past week. It’s a relatively low number compared with other counties such as Alameda, with 146 patients this weekend, but Marin has a smaller population and fewer hospital beds. As of Monday, 11% of Marin’s hospital beds were filled with COVID-19 patients. By comparison, Alameda County’s ratio was half of that last week.
Willis said there is flexibility in that capacity — for example, hospitals could stop elective surgeries to free up beds. The county is not yet in danger of filling up or triggering surge plans, which include an alternate care site with up to 80 beds, he said. The site is currently empty and not staffed.
Gov. Gavin Newsom acknowledged the burden on Marin County spilling across the Bay Area in a news conference Monday.
“We’ve ... had a relationship with San Quentin and Marin General,” Newsom said. “It certainly put some strain on Marin General in particular, that’s why we’ve been working with St. Francis Hospital in San Francisco and Seton Medical Center in San Mateo County to absorb some of that responsibility.”
Neither hospital would disclose exactly how many inmates it was treating. San Mateo County Health Chief Louise Rogers told the county Board of Supervisors last week that 12 inmates had been transferred and the number could go as high as 50. In San Francisco, where St. Francis Hospital is located, patients transferred from San Quentin, Imperial County and Fresno County numbered 16 last weekend. Alameda Health System was treating 17 inmates Monday.
In Marin County, San Quentin transfers collide with cases rising in the community, especially among Latino essential workers and their families. The hospitalization rate is relatively low, but the high number of cases means that some do end up in the hospital, Willis said. After leaving San Quentin on Monday, he stopped at Latino community organization Canal Alliance in San Rafael to discuss how to partner more to contain the virus and support infected individuals.
Nurse Lynn Warner at Marin General Hospital said there’s enough space since the hospital outfitted every room with the capability to convert to the correct air flow to treat COVID-19 patients. What she’s concerned about is having enough personal protective equipment. She said the hospital asks nurses to reuse N95 masks, a policy change during the pandemic now ubiquitous across Bay Area medical facilities, but one she thinks doesn’t provide enough protection.
“I hope all their preparedness does allow for us to have enough staff ... and enough equipment available. That’s what’s most important in nurses’ minds, to safely care for the patient so she can go back safely to her family and community,” she said. “We are trying to provide best patient care to anyone who needs to be seen in the hospital during this unprecedented time.”
An added issue with inmate patients is protective equipment for guards. A California Department of Corrections and Rehabilitation spokeswoman said the state provides staff members with N95s when they are assigned to medical transportation and guarding. Hospitals provide any other personal protective equipment for guards inside COVID-19 patients’ rooms. Willis said he was “confident” the prison system would replenish that supply.
Marin General Hospital did not respond to a request for comment about its capacity. Kaiser Permanente and Sutter Health said they’re ready for the surge.
“Our Kaiser Permanente facilities, physicians and staff continue to be prepared and equipped to care for patients suspected or confirmed to have COVID-19 with safety and compassion, including any patients referred to us from San Quentin,” said a joint statement from Tarek Salaway, senior vice president and area manager for Kaiser Permanente Marin-Sonoma, and Dr. Naveen Kumar, physician in chief at Kaiser Permanente San Rafael Medical Center.
Sutter spokeswoman Ashley Boarman said the system’s hospitals, including Novato Community Hospital, were prepared to double or triple capacity.
“We are using the strength of our network to provide safe care for these prisoners with the same compassion we would any other patient,” Boarman said.
———
©2020 the San Francisco Chronicle