Marin County hospitals and skilled nursing facilities received the first of the county’s allocation of 1,950 doses of the Pfizer COVID-19 vaccine December 16. This came on the same day Gov. Gavin Newsom followed through on a Dec. 3 warning and issued a more restrictive Stay-Home Order for 11 Bay Area counties, including Marin, based on limited intensive care unit capacity as cases surge across the region.
“This couldn’t come soon enough,” said Dr. Matt Willis, Marin County Public Health Officer. “Vaccinating our front-line health care workers will protect them as they manage surges in cases.”
The vaccine doses are the first of weekly deliveries. The first doses will be divided among three local hospitals and 13 skilled nursing facilities. It will take several months to implement widespread vaccinations in the community. Willis estimated the general population in Marin County might have to wait until March before they receive the vaccine.
“It’s quite exciting,” said Dr. Andrew Osugi, Chief Medical Officer at Sutter’s Novato Community Hospital. “We’re all really tired and this vaccine gives us some hope. There’s been a COVID surge since Thanksgiving. The staff has been busy, but now we’re all excited.”
Osugi was among the first people to receive the vaccine in Marin County. Osugi and others around the county reported the primary side effect was soreness around the injection site the following day, much like with a tetanus vaccine. Some reportedly felt tired or suffered mild nausea after receiving the COVID-19 vaccine.
“I wasn’t sure what the response would be to the idea of the vaccine, but it’s been good. People seem to want it and that’s encouraging,” Osugi said.
First responders and front-line workers, including health care staff are among the first to receive the vaccine. Novato Community Hospital vaccinated nearly 100 staff members the first day, last Thursday, and had hoped to have some 400 workers vaccinated by the end of the weekend.
Roughly 110 staff at The Tamalpais senior residential facility in San Anselmo received vaccinations last Thursday, while another group of staffers were scheduled to be vaccinated Sunday. The hope is that residents at The Tamalpais will begin receiving vaccinations as early as next week, according to Executive Director Wesley Bard.
“This is the best holiday present we could have possibly wished for,” Bard said.
Since the pandemic started in California in March, The Tamalpais has reported two COVID-19 cases among residents and 23 among staff. Bard said five members are currently isolating, but cautioned that does not necessarily mean they are suffering from COVID-19.
“Most of our staff has done an amazing job following the rules,” Bard said. “Many of our nurses don’t visit with their family or anybody. They sacrifice for the good of the residents.”
The Tamalpais established lockdown protocols in March, according to Bard, with fever monitoring, electrostatic foggers to clean high-contact areas, and other measures. Residents in both independent living and care facility programs can face-time with friends and relatives through Zoom, while visitors to the facility must pass health screening.
“Our clients are safer here than living out on their own,” Bard said. “We can buy stuff for them, we can drive to the pharmacies that don’t deliver to get their medicine. There is no better place to shelter in place than this.”
Bard warns that the COVID-19 vaccine does not provide 100 percent immunity and that immunity does not really take effect until two weeks after the second of the two shots. He also warns that people should continue to wear face masks and safe distancing among other practices.
The encouraging news about the vaccine’s arrival was tempered by Saturday’s news that Marin County’s number of available ICU facilities dipped to 12.2 percent. Combined, Marin’s three hospitals — MarinHealth, Kaiser in San Rafael, and Novato Community Hospital — have nearly 39 ICU beds total. There are a reported eight ICU patients with COVID-19, with 31 COVZID patients total in hospitals. Other ICU patients are suffering with cardiac or other severe conditions or injuries.
During an online town hall meeting on Friday, MarinHealth’s Chief Medical Officer Karin Shavelson reported the new Oak Pavilion facility has 17 patients in ICU, four of whom have been diagnosed with COVID-19. The hospital is licensed for 19 ICU beds.
There is growing concern about the lack of available facilities and staff, combined with worries that the COVID pandemic could be compounded by a flu epidemic.
“That’s why we’re appealing to the public to stay home, to not get COVID, not get in a car crash, and to be really safe right now,” Shavelson said. One of the main limiting factors for increasing ICU beds is hospital staff. Intensive care patients require more attention than others in a hospital, and there must be enough nurses available to care for them.
“In the past, we’ve been able to bring in extra nurses during the winter,” Shavelson said. “But there is not extra help right now. Everybody is over capacity.”
Shavelson reported Hayward Hospital has offered to take on some of Marin’s ICU patients.
At the same time, Southern California facilities are trying to find facilities in other areas, including Marin, to care for a growing number of patients. Shavelson said, however, that MarinHealth is unable to accept ICU patients from outside the Marin County area, with the exception of patients who live in neighboring counties but regularly commute to Marin and usually receive medical care in Marin County.
The California Department of Public Health implemented its Regional Stay-Home Order for 11 counties in the Bay Area after the region’s collective ICU capacity dipped below the 15 percent threshold, reaching 12.9 percent. The order went into effect at 11:59 p.m. Thursday, Dec. 17, and will remain in place for a minimum of three weeks, contingent on CDPH projections of whether the region’s ICU capacity will return to and stay above the 15 percent threshold.
In Marin, hospitals are switching from normal to surge plan operations because of increased COVID-19 cases and stretched staffing in ICU units. ICU units in Marin hospitals reached full, pre-surge capacity on December 15. ICU capacity, as reported, reflects the normally staffed and immediately available beds.
“There is still room for people needing critical care, but this is the start of true hospital surge for Marin,” Willis said. “It’s critical that we see the link between our everyday behavior and our health care system — the transmission happening in the community is driving hospitalizations. With this surge, the state is moving toward even tighter restrictions for community and businesses to follow to help stabilize the curve.”
Marin has 29 ICU beds that can be staffed under normal operations, according to Marin County Public Health. The next step is considered surge operations, at which hospitals implement or consider:
• physicians assessing all ICU patients to determine whether/when it is appropriate and safe to promote patients out of the ICU;
• nursing staffs being asked on a voluntary basis to work extra shifts beyond their usual assignments; and
• additional nurses being pulled in from rapid response teams and break/relief nurse lists.
The Stay-Home Order replaces Marin’s voluntary adoption of the order, extending beyond the original Jan. 4 end date. In addition, some industries will be held to tighter standards under the state’s interpretation of the order. Businesses and residents are encouraged to review the state’s Regional Stay-Home Order webpage for clarification on which activities are permitted under the order.
The U.S. Centers for Disease Control’s key steps to fight the pandemic includes protection of high-risk groups and health care workers, identifying and isolating cases, and tracing and quarantining people who have been in contact with confirmed COVID-19 patients. Everyone should be wearing face coverings, avoiding gatherings, postponing travel, and staying home whenever possible.
“We’re so close to beating this and we’re getting there,” Osugi said. “We will overcome together.”
More information about COVID-19 testing in Marin can be found at Coronavirus.MarinHHS.org/Testing.
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