Overflowing intensive care units and spiraling case rates make this wave of the COVID-19 pandemic the deadliest yet for the Bay Area. But at Daly City’s Seton Medical Center, an entire 14-bed ICU unit sits empty.

The problem, public health officials and health care leaders say, is staffing.

“Surge capacity is a function both of the beds and the staff to support them,” said Preston Merchant, San Mateo County public information officer.

Last week, California’s intensive-care-unit capacity bottomed out, with overflowing hospitals in Southern California sinking the statewide average to 0 percent ICU availability. In San Mateo County, the numbers are less daunting, but with a post-holiday surge and a more transmissible variant of the virus possibly on its way, health care leaders are becoming increasingly worried.

In San Mateo County, just one staffed ICU bed was left unoccupied as of Tuesday. And while 88 surge beds remain available, they’re only useful if there are people available to staff them.

Calculating ICU capacity, as a measure of both the disease’s spread in the county and local reopening possibilities under state rules, is not simple.

Seton Medical Center CEO Anthony Armada explained that the hospital schedules staffing every 12 hours based on the volume of the emergency room and conversations with physicians, and the county’s data dashboard says hospital numbers “may vary greatly day to day as discharges, transfers, and deaths of patients occur throughout the day.”

Plus, Merchant said, the county’s dashboard doesn’t reflect Seton’s and other local health care providers’ ability to “tap into” the additional beds as they are brought online incrementally as needed and as staff is made available.

By contrast, the state’s dashboard, which showed 4 ICU beds available in the county on Monday, likely paints an inaccurate picture because it relies on averages and percentages, according to Merchant.

Staffing problems also quashed plans for a local surge care site run by the county. In April of last year, the county set up a 250-bed field hospital at the San Mateo Events Center in the event that hospitals would overflow with COVID-19 patients. But the health department soon pivoted to instead providing resources to help local hospitals scale up, County Health Deputy Chief Srija Srinivasan said last month. The county-run San Mateo Medical Center now has a surge tent in its parking lot for patients with influenza-like illness so they can be treated without overburdening the emergency department, Merchant wrote.

“Surge encompasses not just ICU beds and specialized staff but other means of ‘decompressing’ hospitals — taking some of the pressures off emergency departments to allow them to focus only on the most acute cases,” Merchant wrote.

Armada said Seton Medical Center continues to work with the state and private agencies to get more staff and physicians, but progress has been slow. Since mid-December, the hospital’s staff has increased only marginally.

There is some good news: Merchant reported Monday that enough staff for three additional ICU beds were added at Sequoia Hospital in Redwood City last week, and staff for seven more are expected this week.

At Kaiser Permanente of Northern California, Senior Vice President of Health Plan and Hospital Operations Michelle Gaskill-Hames wrote in a statement that the hospital network can still increase its capacity by 70 percent. The health care system is relying on its regional network of hospitals, including in Redwood City and South San Francisco, to help expand capacity and disperse this surge. Gaskill-Hames said Kaiser is also planning to increase staff by 10 to 20 percent above the normal winter season and to secure additional travel nurses for ICU and other needs.

“Because Kaiser Permanente is a fully integrated health care system, we can more readily accommodate patients, if needed, from one Kaiser Permanente medical center that is heavily impacted to other Kaiser Permanente sites that are less so,” Gaskill-Hames wrote. “We have the capabilities at all of our medical centers to quickly increase treatment space by converting existing space and adding equipment.”

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