ICU capacity explained: What you should know amid COVID-19

Nurses watch as a respiratory therapist cares for an intubated COVID-19 patient in Chula Vista in April.

Dec. 11, 2020 Updated 12:53 PM PT

Coronavirus cases are surging, hospitalizations are rising and public health officials are increasingly watching an important metric: intensive care unit capacity.

The new stay-at-home order that hit 36 million Californians recently was triggered when several regions’ ICU availability slipped under 15%.

Public health officials fear that as the surge continues, hospitals could be overwhelmed — including the most vulnerable patients in the hospitals’ highest level care units. Staying home and preventing coronavirus infections will help hospitals manage the influx of patients. As officials wait and hope for the stay-at-home order to tame the surge, they are anxiously tracking ICU capacity.

Here’s what you need to know about ICU capacity and why it’s important at this stage of the pandemic.

Five things you need to know about COVID-19

UPDATED Oct. 2, 2020 | 5:15 PM

What are the symptoms of COVID-19?

A lot of them are the same as symptoms of a cold or the flu: cough, sore throat, congestion or a runny nose, fatigue, muscle or body aches, fever or chills, and shortness of breath. A person with COVID-19 may also experience diarrhea, nausea or vomiting, or a new loss of taste or smell. In cases of serious illness, it can take time for symptoms to worsen.

How long does it take for symptoms to appear after a person is exposed to the coronavirus?

The first symptoms can appear in as few as two days, but it can also take as long as two weeks, according to the CDC. An incubation period of four or five days is more typical. However, a significant proportion of people who are infected — perhaps as much as 45% — never develop any symptoms, researchers say.

What should I do if I think I'm infected?

If you have symptoms of COVID-19 or you’ve been in close contact with someone who has it, the CDC recommends that you get a coronavirus test. Until you get your test results, you should assume you are infected. That means staying at home as much as possible so that you don’t risk infecting others. Of course, if you’re having a medical emergency, don’t be afraid to call 911.

Some diagnostic tests look for genetic evidence of the virus in a sample of saliva or a specimen collected from the nose or throat. Others can detect specific coronavirus molecules that prompt the immune system to produce infection-fighting antibodies.

How can I reduce my risk of infection?

Limit contact with people outside of your household. When you do go out, wear a mask that covers your nose and mouth and stay at least six feet away from others whenever possible. Clean your hands frequently by using soap and water for 20 seconds or a sanitizer that contains at least 60% alcohol. Avoid touching your eyes, nose or mouth if your hands are dirty. At home, clean and disinfect tables, doorknobs, faucets and other frequently touched surfaces once a day.

How did the pandemic start?

Scientists think it began with a close relative of the novel coronavirus that has been circulating in bats and other animals for so long that it no longer makes them sick. That virus must have gained a key mutation that allowed it to infect humans. Health officials in China reported the first cases of the respiratory illness that came to be known as COVID-19 in December 2019. The first known case in Los Angeles was in January. California has had more than 800,000 confirmed cases since.

What is an ICU?

An ICU, or intensive care unit, is a specialized hospital department that cares for people in the most critical health situations, such as those with life-threatening injuries or severe illnesses. ICUs are equipped with specialized equipment, such as ventilators.

Most important, ICUs are staffed with highly trained nurses and physicians who provide round-the-clock care to their patients — checking their breathing, blood pressure, fluids and other vital signs. Dr. Shruti Gohil, an infectious disease specialist at UCI Health, said there is a 1-to-1 ratio of nurses to patients in ICUs.

“That kind of minute-to-minute, hour-to-hour care requires a level of training on the nurses to ... recognize problems quickly and address them quickly and then know what needs to be done while waiting,” Gohil said.

A COVID-19 patient with severe difficulty breathing may require ventilator support in an ICU.

“We are responding at the moment to a tsunami of COVID-19 patients in the hospital,” said Carmela Coyle, president and chief executive of the California Hospital Assn. “But that does not stop the heart attacks, the strokes, the cancer patients with serious, immediate needs.”

What is ICU capacity?

Capacity is the number of staffed beds available at a point in time.

Determining whether capacity has been reached is more nebulous.

The state determines a region’s ICU capacity with a weighted formula to ensure that some ICU beds remain open for non-COVID patients. When the state says a region has reached 0%, it may actually still have some beds available. Individual counties, such as Fresno, have reported having no open ICU beds.

Capacity also fluctuates as patients exit the ICU and others enter.

“There’s always sort of this movement that’s not always quite captured by the snapshots that we get,” said Dr. Rais Vohra, interim health officer for Fresno County. “Overall, the capacity is severely impacted.”

What happens when an ICU reaches 0% capacity?

Hospitals will likely place patients in open beds elsewhere in the hospital, such as emergency department rooms.

Having open beds in other parts of the hospital does not mean a hospital is equipped to handle more intensive care patients. Dr. Bill Stringer, chief pulmonologist at Harbor-UCLA Medical Center in Torrance, said the “limiting step is not going to be space or equipment. It’s going to be staff.”

Because of their specialized training in high-intensity situations, ICU medical professionals are scarce resources.

“The problem is, we’ve got a nationwide shortage of critical care nurses,” Coyle said. “It is not the case where you can pull any nurse into the ICU to provide that level of care.”

And when ICUs are stretched beyond capacity, the quality of care can decline and mortality rates can rise.

As ICU capacity shrinks, a hospital is likely to scale back elective procedures, freeing up staff. Some healthcare workers — such as those who work in trauma, surgery and anesthesia — are already trained for high-stress scenarios, so they would be “natural pivots” to the ICU, Gohil said. A critical care professional would supervise.

“In a poor, catastrophic state, it would be an all-hands-on-deck approach,” Gohil said.

If a hospital’s beds fill, some patients may be transferred to neighboring hospitals. But moving ICU patients is risky, Stringer said.

“Just imagine somebody who is just completely inert, that is sedated, that is being supported at least with a ventilator,” Stringer said. “It’s the most fragile and vulnerable patient being transferred. That’s a very difficult decision.”

How do I find out the ICU capacity where I live?

The state keeps an updated list of ICU bed availability by county.

Hospitals report their capacities daily, and the state tallies them.

Here are the regional numbers as of Thursday afternoon:

Southern California: 7.7%, down from 9% Wednesday
San Joaquin Valley: 1.9%, down from 4.2%
Greater Sacramento: 13.3%, down from 14.3%
Bay Area: 17.8%, down from 20.9%
Northern California: 30.3%, an improvement from 27.1%

I live in a region where ICU space is at capacity, but I have a medical emergency. What do I do?

You should still seek help. If you’re in a serious emergency, call 911.

Otherwise, Stringer said, call the hospital emergency departments near you to check their capacity. Then wear a mask and go.

“The hospital, even though we have plenty of COVID patients, is still a safe place to get care,” Stringer said. “It’s probably not as safe as being on a backpacking trip in the Rockies. But if you’ve got an emergency, you need to call.”