Petaluma Valley Hospital ER docs and nurses report high volume of respiratory patients

‘Have patience when you are a patient. It’s not a quick system any longer,’ says the head nurse at Petaluma Valley Hospital.|

A nationwide problem is hitting home for emergency room doctors and nurses at Petaluma Valley Hospital as the local ER is seeing a high volume of patients suffering from flu, COVID-19 and RSV.

Two top medical providers inside the ER say the soaring patient load has been difficult to quickly handle amid limited staffing.

The result has been fully occupied ER space, crowded waiting rooms, longer wait times, diversion of patients to other hospitals and an overall strained system, said the local hospital’s top ER doctor, Dr. Loren Fong, and head nurse, Wendi Thomas.

“Our emergency department visits are up 10% month over month. Our ER visits are also up 20% from a year ago,” Thomas said. “Unfortunately, we haven’t been able to increase our staffing by 20%. And that results in some longer wait times than we‘ve ever seen here.”

Lately, “A lot of people walk into the lobby and go, ‘Oh my goodness,’” she said.

The problem is twofold, Fong and Thomas said: too many patients, and not enough staff.

“There’s a national nursing shortage, this is not a secret,” Thomas said.

“Couple that with this flu season, COVID, RSV triple threat that is happening, and it’s tough,” she said. “The staff are tired.”

“The same thing is true for ER doctors,” Fong added.

When it comes to recruiting young medical professionals, both he and Thomas cited high housing costs as an obstacle in Sonoma County.

Both also cited the exodus of health care workers in recent years as medical providers came under unprecedented strain amid the COVID-19 pandemic. And while recruiting new staff remains a challenge, many current staff are nearing retirement age, they said.

“I’m the oldest ER doctor here in Sonoma County. I’ve been here for 26 years,” Fong said. For her part, Thomas has worked at Petaluma Valley Hospital for 24 years.

Managing ‘tridemic’

The good news is that the “tridemic” – the triple threat of RSV, COVID-19 and flu – is not quite as bad as it could be, because it’s not all happening at once.

A month ago, Thomas and Fong said, RSV – which stands for respiratory syncytial virus – was the biggest concern at Petaluma Valley Hospital. But now RSV is down, and influenza A is on the rise among both children and adults.

“Influenza Is definitely peaking,” said Fong. “In the last couple of weeks we’ve seen more and more people come in symptomatic.”

Symptoms for all three pathogens can include fever, chills, headache, nausea and vomiting.

“Your fever may spike up to 101, 102, maybe higher,” he said.

As for COVID-19, its numbers are “ticking just slightly up” in terms of hospitalizations, Fong said.

According to data from the Sonoma County Department of Health Services, hospitals countywide are seeing a dramatic surge in flu hospitalizations – 68 on Nov. 28 alone – while COVID-19 hospitalizations are less numerous – 49 on the same day – and relatively stable month to month.

By contrast, one year earlier on Nov. 28, 2021, there were 24 confirmed COVID-19 hospitalizations and no flu hospitalizations.

“Our emergency department is experiencing an increase in volume that has not been seen in over four years, up 15% from our historical volumes. Pediatric cases are up 25%,” said Christian Hill, communications manager for Providence, which owns and operates Petaluma Valley Hospital.

“Additionally, on Saturday the hospital had to divert patients to other local hospitals due to the influx of patients due to RSV and the flu.”

Treatment over diagnosis

Though patients often come to the ER seeking a diagnosis, Thomas and Fong said that from a practical standpoint, the symptoms are the same for all three viral infections, as are the treatments: fever management, hydration, isolation and rest.

Even if you don’t know precisely which virus is making you sick, “it’s OK,” Dr. Fong said. “We’re going to treat your symptoms just like anybody else.” He added that vaccinations have made COVID-19 much less dangerous now, and that home tests for the disease “are really very accurate.”

That’s one reason ER staffers are asking people not to come in unless they know they really need to. Patients with infectious diseases need private rooms, “and we don’t have a lot of private rooms,” Thomas said. As a result, she said, patients and their families are being “creative” in how they wait for treatment – such as waiting outside in their cars.

For those with serious illness, she said, “We might need to transfer you to a hospital that has a service that we don’t provide.” Pre-COVID, that wasn’t a problem, she said, but “Post-COVID that has become quite a tour,” resulting in some patients being sent to hospitals in San Francisco, Davis, Sacramento or farther.

To complicate things, Thomas said, some health care providers like Kaiser Permanente dictate where their members may be transferred. “So we wait for Kaiser to figure all that out, and sometimes it takes hours if not days.”

The ripple effects of overcrowded ERs can hurt those suffering from other maladies. For example, first responders such as Petaluma Fire Department personnel take injured people to hospitals, “and 80% of their transports come to Petaluma Valley,” Thomas said. However, “There’s not an open bed to be found in our ER, so they’re waiting longer. Then they (the first responders) wait with them, and can’t respond to 911 calls.”

Fong and Thomas stressed people in need of immediate medical care should come to the emergency room when called for – and Fong offered some practical advice on how to know when it’s time to come in (see fact box).

Even amid the current strain, emergency medical staff at the Petaluma hospital continue to deliver quality care, Fong added.

“In spite of those staffing difficulties that we’re experiencing, that everyone is experiencing, we still deliver five-star care here,” he said.

But Thomas had a word of advice for those who do visit: “Have patience when you are a patient. It’s not a quick system any longer.”

When to visit the emergency room

According to Dr. Loren Fong, people suffering from RSV, COVID-19 or influenza generally have similar symptoms – fever, chills, headache, body aches, and sometimes nausea and vomiting – which tend to be at their worst during the first few days of illness.

But as miserable as it feels, he said, “Unless you’re completely dehydrated and can’t keep anything down, you’re probably OK.”

Those visiting the hospital under normal conditions will get the same care that is available at home: take ibuprofen or acetaminophen with lots of clear liquids, get plenty of bed rest, and avoid exposing others to the disease.

People with an underlying condition, such as those who are immunocompromised, should not hesitate to check in to an ER.

For parents of small children who are infected, Dr. Fong said to watch to make sure their breathing isn’t too fast and labored, and that their lips and skin maintain a healthy pallor. Children who are properly hydrated should have “three to four wet diapers a day,” he said.

Watch their behavior too, he said.

“If they’re not acting normally, if they’re lethargic, and not engaging in their environment, that’s a concern,” Dr. Fong said. But “If your kid looks good, your kid looks good.”

Don Frances is editor of the Petaluma Argus-Courier. Reach him at

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