A makeshift treatment tent, shown on March 7, was set up outside the University of California, San Francisco Medical Center to prepare for an influx of Covid-19 patients.
Photo: Noah Berger/UCSFSAN FRANCISCO—As the coronavirus pandemic swept from China into Europe last winter, the University of California, San Francisco Medical Center began preparing for the worst.
A triage tent was brought in. An entire floor was cleared for Covid-19 cases. A satellite campus was converted to take the overflow. Health screenings started for everyone from doctors to cafeteria workers.
But the onslaught that UCSF prepared for ended up arriving as a modest number of cases. The facility was one of dozens of health centers around the country that prepared for a surge in patients but have so far seen far fewer than expected.
The extensive preparation shows the lengths to which the nation’s hospital system went in hopes of avoiding the fate of facilities elsewhere around the world, as in Italy, where hospitals had to treat patients in hallways and limit those admitted to intensive-care units. It also underscores the unpredictable nature of the novel virus: Some areas, like New York City and Louisiana, became hot spots, while others have so far avoided a surge.
A coronavirus patient being treated in an isolation room at UCSF. The medical center laid the groundwork for its response in late January, hoping to avoid a crisis like those at facilities overseas.
Photo: SUSAN MERRELL/UCSFChristus St. Vincent Hospital in Santa Fe, N.M., cleared a critical-care unit and reassigned staff, and the Cleveland Clinic in Ohio converted part of a local medical-college campus into a 1,006-bed surge hospital for a rush of Covid-19 patients. But those facilities, and some field hospitals set up in places like New York and Philadelphia, were among the number that saw no more than a trickle of coronavirus patients.
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So far, hospital officials aren’t voicing regret for overpreparing.
“With viruses with which we have some experience…our expectations about the worst-case scenario can be better informed. But this pandemic is caused by a novel virus, which we had very little knowledge about earlier this year,” said Tom Nickels, executive vice president of the American Hospital Association. “Based on the world’s limited experience of the virus earlier this year, we anticipated what could have happened and prepared for it.”
All the preparation has come at a cost, including in lost business from canceled elective procedures and sick people afraid to come in. Hospitals now face sharp falls in revenue; the AHA puts losses expected at health-care facilities from those canceled surgeries, and the costs associated with Covid-19 treatment, at about $202.6 billion so far.
UCSF, which nearly tripled the number of beds for Covid-19 patients to 84 from 31, said it doesn’t regret the measures.
“We’re still not out of the woods,” said UCSF surgical nurse Maureen Dugan, referring to a potential second wave of infections that many epidemiologists say might yet come.
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In addition, other UCSF officials said the extensive preparation freed staff to help hard-hit facilities elsewhere in the country. After it became clear in early April that UCSF was unlikely to see a surge of coronavirus patients, it deployed teams of doctors and nurses to New York, the Navajo reservation in Arizona and New Mexico and other hot spots to help out.
San Francisco saw fewer cases than expected partly because of earlier lockdowns in the Bay Area, health-care workers and epidemiologists say. The city has reported just 2,131 cases so far and 36 confirmed deaths as of Monday. Of those, UCSF had treated 86 patients, including four who died.
That contrasts with the hot spots such as New York City, which has seen at least 190,408 cases and 15,888 deaths since March 1.
UCSF laid the groundwork for its response in late January, when the hospital activated its emergency-planning system—a protocol many medical institutions use in disasters—and after seeing what had occurred in China and Italy, said Adrienne Green, UCSF’s chief medical officer and leader of its Covid-19 response team. Her team brought in a triage tent outside UCSF’s main Parnassus Heights campus and designated all 31 rooms on the 15th floor to handle the initial influx.
Just days later, in early February, UCSF received its first two coronavirus patients: a couple from San Benito County, Calif., whose confirmed infections were among the first in the country.
“We were ready for them, and it gave us some practice,” Dr. Green said.
Medical professionals working in a triage tent at UCSF. Hospital officials said their preparations freed staff to help hard-hit facilities elsewhere in the country.
Photo: SUSAN MERRELL/UCSFIn the ensuing weeks, UCSF made more changes to deal with an expected surge. It opened 53 acute-care beds in the Mount Zion campus—a satellite hospital that operated mainly on an outpatient basis before the virus hit—to take an overflow of coronavirus cases and instituted new procedures such as requiring all employees to be screened at the front door for Covid-19 symptoms and potential exposures.
The hospital also required all staff to wear masks, although that rule didn’t go into effect until late March after UCSF was able to make sure there were enough supplies, said Dan Henroid, director of nutrition and food services for the hospital.
The food area swiftly took other steps such as eliminating the salad bar at the Moffitt Cafe in the Parnassus Heights campus. Hamburgers and other items are still made to order, although the gold pencils customers had used to write orders have been ditched indefinitely.
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“Anything self-service was eliminated, including soup,” Mr. Henroid said.
With bans on visitors buying food and on scheduled surgeries, UCSF officials expect a drop in revenue, though they say it is too soon to know by how much. UCSF’s total revenue last fiscal year was $4.37 billion.
The University of California has ruled out any layoffs of career employees related to Covid-19 for the rest of the fiscal year that ends in June. The hospital is trying to offset some losses through strategies such as selling employees harder-to-get items like bags of flour, milk and pasta sauces.
Meanwhile, UCSF has resumed some elective surgeries, and officials said they have time to hone safety protocols and stock up on necessary gear.
“We are not complacent,” Dr. Green said.
Write to Jim Carlton at jim.carlton@wsj.com
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