California hospital beds are filling up and doctors and nurses are just worn out

In November, a hospital worker takes a break in the Covid-19 unit at Providence Holy Cross Medical Center in Los Angeles.

(CNN)Earlier this year, medical facilities in California were tested by the emerging coronavirus pandemic -- but now things are different, a top hospital official told CNN on Monday.

Doctors and nurses back then were working on improving treatments and overcoming shortages of personal protective equipment (PPE).
Now the staff at hospitals are worn down. Finding fresh beds is one matter; having fresh staff is another.
"One of the most important things to remember is when we talk about ICU capacity, it's not just about beds and mattresses and pillows," said Carmela Coyle, president and CEO of the California Hospital Association.
    "The limiting factor, the most important factor in caring for people who have the Covid-19 disease are the nurses, the staff. That's what's short, and that's what's different this time around than it was during our summer surge."
    Covid-19 hospitalizations are up a daunting 72% and ICU admissions are up 69% over the past 14 days, Gov. Gavin Newsom announced Monday. He said officials have asked for 815 extra health care workers from staffing agencies, and other reinforcements have been requested from the federal government.
    Many of the temp agency health care workers will come on this week, and more than half of the total number will support state ICU teams, Newsom said.
    "Remember that those nurses and those doctors have been doing this for almost a year now," Coyle said. "They're exhausted. They need our support and help. The best thing we can do, keep the masks on, stay at home and stay safe."
    The tremendous upswell of patients has dropped available ICU capacity, prompting modified stay-at-home orders for Southern California and the San Joaquin Valley. Much of the Bay Area has preemptively enacted similar orders as well, though those communities do not fall under the state mandated order. The limited lockdowns end after three weeks -- if the numerical thresholds are met.
    Two vaccines that require two shots three to four weeks apart are being evaluated by the US Food and Drug Administration for emergency use authorization. That could come this week for the Pfizer vaccine and next week for Moderna's candidate.
    Among the first people in California to be vaccinated will be high-risk health care workers. California has more than 400 hospitals and 2.4 million health care workers. Officials expect to get 327,000 doses by next Tuesday, Newsom has said.
    The governor said Monday he anticipates a total of 2.16 million doses to arrive before the end of the year, with millions more expected in January and February. Those initial doses will be followed by the second doses needed for immunity within three weeks, Health Secretary Mark Ghaly explained.
    Coyle said Californians did a great job in the early days of the pandemic, when the state was the first to implement social measures to flatten the first curve. But as the months wore on, people got mentally worn out. And then came the holidays, during which most people typically went to parties and get-togethers.
    "We can track this surge literally to the Halloween weekend and people beginning to come together," she said. "It is fatigue. It is isolation fatigue."
    Coyle said 12% of people in California who get Covid-19 end up in a hospital.
    She asked people to wait a little while longer before relaxing.
      "I think the most important reminder is we can't drop our guard," the hospital association official said. "While we're tracking ICU beds and that's important, we want to maintain the capacity to treat not just Covid patients but heart attacks, and stroke patients, and cancer patients and more."
      Hospitals aim to treat everyone who seeks care, she said, but with cases rising so much "it is going to be tough and it is going to be tight."