According to the National Institutes of Health, “A mass casualty incident (MCI) is defined as ‘an event that overwhelms the local healthcare system, where the number of casualties vastly exceeds the local resources and capabilities in a short period of time.’ Any MCI can rapidly exhaust available resources for not only the MCI but the normal day-to-day tasks of the hospital. Each hospital should institute a surge plan in preparation for anticipated, progressive, insidious ("notice" events), and sudden-onset ("no-notice" events) disasters occurring within the community.
First and foremost in responding to an MCI is identifying the type of MCI present. Categories include:
- Planned (sporting event)
- Conventional, which usually have some level of recurring frequency (transportation incidents, burn, and severe weather events)
- Chemical, biological, radiological
- Nuclear agents from an unintentional or accidental release or act of terrorism
- Catastrophic health events (nuclear detonation, major explosion, a major hurricane, pandemic influenza, or others).
Mendocino County CEO Carmel Angelo and Health Officer Dr. Andrew Coren both invoked the grim term “mass casualty” at last Tuesday’s Supervisors meeting in reference to the growing and accelerating covid cases, in anticipation of the accelerating spread of the disease mostly from urban areas to our south.
Mendo is preparing a “mass casualty plan” because of the rapid increase of cases in California to be ready for “the possible disaster that lies ahead.”
“I’m usually an optimistic guy,” said Dr. Coren, “but looking at where we are now, and where the counties to the south of us are, all of our efforts so far seem too little, too late.”
It will take months before the vaccines arrive in significant quantities and enough people get vaccinated to make a noticeable dent in the spread. No one knows the extent of mitigation the vaccines will provide, nor when cases will decline.
“We are looking into the availability of mortuary resources,” said Dr. Coren, “and also looking into the mass casualty plans, with an eye to possibly using the [Ukiah] fairgrounds or some other place with a medical tent to mitigate the possible disaster that lies ahead.”
Under normal circumstances, Mendo’s three Adventist-run hospitals have 16 ICU beds. According to Dr. Coren, “They can surge up to 45 ICU beds. But our concern is staffing, because these can’t just be real estate — you have to have the right number and trained people to staff those beds. So the plan may be good for 45 beds, but what can happen remains to be seen.”
Coren said that covid cases are expected to continue to rise over the next few months and if ICU beds get taken up by cases sent north from overwhelmed counties like Sonoma, “it will be worse than any of us have seen in our lives especially if you need the hospital for any [other] reason. There are not going to be the beds, there are not going to be the personnel to staff those beds.”
On Tuesday, Mendo had five of its 16 ICU beds remaining open.
“We did have a serious outbreak among the homeless at Building Bridges,” said Coren, “and that’s being mitigated by Redwood Community Services who’s putting all residents in hotels at this point so they can keep people separate while they clean their facility. Also, Round Valley is suffering a fairly large outbreak, and that’s being contained.”
Nevertheless, Dr. Coren attributed the local increase “not to outbreaks, but small gatherings, break rooms, eating and drinking together that leads to community spread. And people are not telling us where they actually caught it, so we may not have a lot of the specifics” about where or how a given case or outbreak began.
“Many people just don’t believe how terrible this is,” Dr. Coren added. “So the problem is minimal compliance. The more we say, the more people disbelieve. The more we order, the more people dig their heels in. This is not everybody, but it’s enough that our attempts at writing orders have been undermined.”
Instead of saying “if,” Dr. Coren laid out his own version of the domino theory:: “When the hospital system truly breaks down and when all three hospitals are having trouble managing the numbers of patients, the ICU, which requires the most people to attend to those very ill patients, will be overwhelmed, and so they’ll try and manage some of those patients [by moving them out of the ICU] and those [other] rooms will get flooded and there will be a decrease in the number of staff, and quality of patient care will also suffer as people are discharged perhaps earlier than they should be, perhaps people are turned away from the emergency room because there just isn’t enough care available, and people will be encouraged as much as they possibly can to care for themselves at home.”
In other words, a mass casualty comparable to an earthquake or terrorist attack, albeit in slow motion.
“People really need to become compulsive about masking, social distancing and stopping gatherings,” added Coren. “But we’re still going to have to deal with the rest of California.”
Dr. Coren did not speculate on what this dire situation will translate to in terms of reimposing lockdowns and curfews and business closures. But if he’s right about the growth of cases between now and whenver the vaccines kick in, such circumstances may force Mendo and the rest of the state to bring back the kinds of restrictions that were imposed last spring — and all the ripple effects that go with it.
Dr. Coren also mentioned Mendo’s growing but unquantified contingent of people who will be reluctant to take the covid vaccine, on top of the dangerously large, pre-existing free-floating antivaxxers. The greater the reluctance, the longer and larger the mass casualty event will last — along the collateral economic damage that comes with it.
• The State of California has activated its Mass Fatality program, to include Coroner’s Mutual Aid.
• An additional 5,000 body bags have been purchased by the State in response to the current surge.
• Sixty refrigerated storage units will be used throughout the state, including in the Bay Area, as overflow for coroners and morgues.
• Hospitals are not only running out of Intensive Care Unit (ICU) beds, they are running out of hospital beds, period.
This winter will likely prove to be the COVID-19 pandemic’s darkest hour. The nation and bay area region are currently experiencing the worst surge of COVID-19 cases and fatalities to date. Healthcare personnel are exhausted and bed capacity in hospitals has dropped at an alarming rate.