Local hospital administrators are much better prepared than they were during the summer's COVID-19 surge, but it's a bittersweet feeling that Kern County is here again after beginning to flatten the curve.

"I’m sad that we’re going through the beginnings of another surge," said Chief Nursing Officer Terri Church at Bakersfield Memorial Hospital.

At its peak, Kern County had 321 patients with COVID-19 in its hospitals on Aug. 2. The state says there are now 182 patients in Kern hospitals. Experts say the influx of new cases from the Thanksgiving holiday have not yet shown up in hospitals — it typically takes two to three weeks for hospitals to be affected by such gatherings.

"Overall, we are definitely seeing an increase in the number of hospitalized patients that are admitted for COVID," said Kern Medical CEO Russell Judd. "That is a fact. That is what is happening."

There are some marked differences between the way hospitals are handling last summer's surge and the next rising tide of patients.

The simple fact of having practiced the surge plans that every hospital implements has made a difference. Church said the staff at Bakersfield Memorial Hospital knows what worked and what didn't, and it's ready to spring into action as cases rise.

Kern County Public Health Services Director Matt Constantine said every hospital in Kern County has the ability to increase its capacity by 40 percent. But because of their experiences, there are likely to be fewer tents expanding that capacity than there were in summer.

Memorial Hospital realized that a tent isn't the best option in Bakersfield, where it tends to be a little too hot or cold. The hospital will set up a temporary modular building that can be heated or air-conditioned. It will have bathrooms, plumbing and provide plenty of space and partitions for social distancing, Church said. Patients can receive respiratory treatments.

It will be a place to see patients with less serious symptoms for COVID and the flu, which is also expected to surge. This week, the hospital will receive a delivery of partitions so setup can begin soon.

Kern Valley Hospital is also nixing its tent surge plan. Tim McGlew, CEO of the Kern Valley Healthcare District, said the hospital is looking into acquiring a building down the street for more space. The hospital may also rely on the closed senior centers in the area, too.

The alternative center at the Kern County Fairgrounds remains ready to use for whatever hospitals believe will serve them best, Constantine said. Within 48 hours' notice, it can be up and running to help accommodate the surge of patients in hospitals — whether it is taking on less serious patients with COVID or other kinds of patients.

However, it is intensive care units, not hospital capacity, that is likely to be the most pressing issue as cases rise, hospital administrators say. Currently, Kern has 39 patients with COVID in ICU beds, according to state numbers. There are still 39 ICU beds available out of 228 beds currently. Kern hit its peak with 87 patients on Aug. 7. One problem is that those units need to be available for people with other serious and life-threatening conditions.

"Not only do hospitals have to remain available for possible COVID patients, but for accidents, falls and normal illness in Kern County," Constantine said.

This is especially worrisome for a trauma center like Kern Medical, according to Judd. He points out that people in ICU beds tend to stay in them longer than regular hospital beds: seven to 10 days compared to three to four days. And he says trauma cases have been rising.

One way that Kern County has become better prepared than the last time is through funding for the nurses that staff those ICU beds. In July, the Kern County Board of Supervisors reallocated $12 million in CARES Act funding that allowed hospitals to bring on 88 additional nurses through a contract with RightSourcing Inc. Some of those nurses are already working in hospitals.

David Bacci, regional vice president of the Hospital Council whose jurisdiction includes the southern Central Valley, said the county's "foresight" has given local hospitals an advantage. They're not having to compete for traveling nurses in the midst of a surge.

"They contracted with a firm themselves," Bacci said. "That’s been a very positive thing."

Bacci points out that across the board there is more knowledge about COVID-19 and tools to treat its patients. Many of the patients who would have been put on ventilators are receiving oxygen instead, he said. Or they're receiving treatments that help to keep them from getting to that point, such as remdesivir, which is now more widely available. Monoclonal antibodies, such as bamlanivimab and Regeneron, are not as widely available, but they have also proved to be useful in preventing vulnerable patients from requiring hospitalization, Bacci said.

WHAT THE FUTURE LOOKS LIKE

Projections are a tricky business, but the state lists several models at https://calcat.covid19.ca.gov/cacovidmodels that forecast a month out. An ensemble projection estimates COVID-19 hospitalizations in Kern County will rise from 179 to 541 within the month. A sobering ensemble projection estimates that the number of deaths will rise from 455 to 588, an increase of 133 deaths.

Local and national experts say hospitalizations are expected to go up in the immediate short term. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, warned of a "surge upon a surge" with the holiday season here. He means that cases that spread at Thanksgiving can turn into cases that spread at holiday seasonal gatherings in December.

"(Hospitals are) fully expecting this surge will continue and it will get worse before it will get better," said Bacci.

WHAT THE COMMUNITY CAN DO

Hospital administrators say that now isn't a time to be fatalistic and assume that the numbers will just automatically go up. 

"We have the ability to bend the curve and get back down," said Bacci. "There doesn’t have to be a Christmas curve coming."

Church knows that many in the community know the basics of bending the curve. They've learned to avoid big get-togethers that become superspreader events. But she says that many still want to hang out in small groups, and these "living room events" can spell trouble, too.

"You start out with good intentions, then you start to laugh," she said. "You get closer and closer and closer."

When a lot of people in the community who mean well are doing this, the virus can still spread rapidly. She knows it's hard, but she discourages people from holding these kinds of events with others from outside their household.

Now that coronavirus cases are starting to tick up in the hospital, Judd also encourages residents to rethink other behaviors that might land them in the hospital. Bending the virus curve is key, but so is driving safely. When ICU beds are low, that will impact both trauma victims and the most severely impacted COVID patients.

Tackling demand for hospital beds at the community level is key, but Bacci said that no matter what happens, local hospitals are doing their best to meet the demands in the community.

“There are thousands of people in Bakersfield and Kern County doing everything they can to make sure that we’re all able to go on,” Bacci said. “This is not the way any of them would choose for it to happen but they’re meeting the occasion.”