As local officials sound nightly warnings about hospitals’ capacity to care for COVID-19 patients, Bexar County’s emergency management personnel are stepping up efforts to prepare an 80-bed overflow hospital at Freeman Coliseum.

Though the bed capacity of Bexar County hospitals continues to dwindle, the area is not in need of using the overflow facility yet, Assistant City Manager Colleen Bridger said. Another option is the Texas Center for Infectious Disease (TCID), a 75-bed facility operated by the Texas Department of State Health Services.

“We’re not close,” Bridger said Tuesday. “Our first priority is to increase staffing in order to keep patients in the full service hospitals. If we get to the point where we build every possible bed by bringing in every possible nurse to do that, then our next step is to go to TCID. But right now, we are actively pursuing additional staff to be able to really maximize beds in our existing hospital systems.”

Overflow facilities, including TCID, would accept non-COVID patients, according to Woody Woodward, spokesman for the San Antonio Fire Department. The number of beds available at TCID is currently undetermined, he said.

Work setting up the overflow hospital at the Freeman Coliseum began in March, and during April and May when the area’s hospitalized patients stayed in the double digits, it seemed unlikely the facility would be needed. Now the Freeman Coliseum facility is in a “warm up” phase, meaning that if the overflow facility is needed, it will take less time to be activated, Woodward said.

With the facility largely prepared, it’s a matter of adding staff to take care of patients who end up occupying those beds, Mayor Ron Nirenberg said Friday.

“We actually have beds and we’re just waiting for staff so that we can increase capacity, but we don’t want capacity to [be] taken up every time it comes online with a new COVID-19 patient,” Nirenberg said during a media briefing Friday.

The overflow facility will be staffed by San Antonio-based nonprofit BCFS Health and Human Services’ Emergency Management Division, which has contracted with the state to provide emergency health and human services. BCFS System holds a controversial place in the nonprofit world as it has held contracts to run migrant children shelters, including the “tent city” in the West Texas town of Tornillo. BCFS Health and Human Services currently operates a Houston-area shelter for migrant children.

“If activated, the staffing levels will be determined by the state’s contractor, BCFS,” Woodward said in an email Wednesday. “It is not necessary to open Freeman just yet, as we are currently in a pre-surge plan, staffing additional beds in hospitals.”

But the calculus behind bed management at the Freeman Coliseum is not as simple as having a certain number of nurses per patient, said Eric Epley, executive director of the Southwest Texas Regional Advisory Council (STRAC). STRAC is a network of hospitals and first responders who maintain the regional trauma and emergency health care system for San Antonio and 22 surrounding counties. It is currently managing the area’s coronavirus response.

“It’s a complex process of making sure you’re matching the right nurses,” Epley said at a media briefing last week. “So a nurse is not a nurse is not a nurse, and it’s important for us to match the right critical care nurse, for instance, with an ICU bed and matching where we have new beds that are being basically created.”

As of Tuesday, about 240 nurses of the 250 total requested from state agencies had arrived in Bexar County, according to the mayor’s spokesman, Bruce Davidson. All those nurses will staff local hospitals.

Moving patients to the Freeman Coliseum is the last resort, Epley said.

“If you’ve looked at the State of Texas surge capacity plan for hospitals, moving to an alternate care site like the Freeman would be the fifth of five steps,” Epley said.

Before health officials make the decision to transfer non-coronavirus patients to an alternate care facility, they’d opt to add beds in non-traditional areas of hospitals first, he said.

“If you were in the cafeteria and a bed in the hospital, you still have radiology, you still have respiratory therapy, you still have imaging, lab capability – you have lots of things when you’re in the hospital that become much more difficult once you leave the property,” Epley said. “So that’s why it’s the fifth of those five levels of surge capacity planning.”

If needed, the Freeman Coliseum’s overflow facility can hold more than the 80 beds currently set up, Woodward said; BCFS has requested an additional 196 beds for the facility.

“There is [additional] space at Freeman if needed,” he said, “and we also have TCID, Texas Center for Infectious Disease to use as well.”

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Jackie Wang

Jackie Wang covered local government for the San Antonio Report.