Even in the age of coronavirus, life goes on — and so do sudden illnesses and injuries.

In response, the parking lots and garages of 15 Sutter Health facilities have been transformed into drive-through “urgent care” clinics, where patients with COVID-19-like symptoms can get help for coughs and fever but also other acute medical needs, such as stitches and abdominal pain.

All over the Bay Area, health care systems are taking steps to separate patients with respiratory symptoms from others, reducing the risk of spreading the virus.

But Sutter Health has gone one big step further, turning the parking areas of their facilities into outdoor clinics so they can deliver care to sick high-risk patients who are safely inside their cars. The experience is softened by sparks of creativity, such as friendly placards and smartphone-guided instructions.

This not only limits contact and potential exposure but provides comfort to those fearful of the newfound risks of waiting rooms inside medical facilities.

Initially, the intent of these Respiratory Care Clinics was to provide a safe place for COVID-19 testing.  But Sutter doctors quickly recognized that wasn’t enough. The “car clinic” is an in-person option for patients with serious respiratory symptoms who have already talked to a doctor by phone or video visit.

“It became very clear that we really needed to offer some additional services,” said Dr. Stephen Ryu, a Palo Alto Medical Foundation neurosurgeon who is co-directing the San Carlos Center’s clinic that has treated more than 2,500 patients since mid-March.

“It doesn’t make sense that just because you might have COVID, you have to go to the emergency room for a nosebleed,” he said. “It also doesn’t make sense that if you maybe sprained your ankle or you’ve got a fishbone stuck in your throat that you’d have to go to the emergency room because you happen to have a little bit of a cough or a fever.”

The new clinics also help patients who don’t have acute ailments or injuries, but suffer from chronic medical conditions like high blood pressure or asthma, with symptoms that may mimic those of COVID-19.

The pandemic has created a logistical challenge for doctors, whose patients need treatment, but don’t belong in an emergency room.

The clinic “fills that void (because) we can see people who are sicker than we’re comfortable with saying to stay at home … and to keep people out of the emergency rooms unless they absolutely have to go,” Ryu said.

On a few occasions, patients have needed more care than was available at the outdoor clinic, so they were directed to the emergency room or inside the medical center for additional testing, said Dr. Rajiv Bhatnagar, a dermatologist who is co-director of the San Carlos clinic.

Inside, waiting room seats have been taped off to ensure that patients sit at least six feet from each other.

Physicians say there is growing concern that patients — either with or without COVID-like symptoms — are deterred from seeking routine care either because they fear they’ll get infected with the new virus or that their doctors are overwhelmed. And when they do finally seek attention, it is often only after their symptoms have worsened.

“Health care workers are still here for you. We haven’t abandoned you. We will not abandon you,” Ryu said. “If you need to get taken care of, we will take care of you.”

Ben Drew, a spokesman for John Muir Health of Walnut Creek, said there have been instances of patients who should have seen a doctor much sooner than they did.

“We do not want patients to delay necessary care and come to us when a situation that could have been addressed earlier is now a much more complicated or debilitating injury or illness,” he said.

John Muir Health facilities now have separate areas in their buildings that segregate respiratory and non-respiratory patients who need “urgent care.” Signs and staff direct visitors to the correct destination.

At Natividad Medical Center in Salinas, suspected COVID-19 patients are screened by phone or video, then treated in negative pressure tents.  Kaiser Permanente’s medical centers also use “triage tents,” located at the entrances of emergency departments. Sutter Health’s San Francisco-based COVID-19 clinic is indoors, but segregated.

A visit to the doctor at a Sutter Health clinics starts in patients’ vehicles in the parking lot or garage.

There they are met by a health care professional holding signs reminiscent of the romantic scene in the holiday film “Love, Actually,” when actress Keira Knightley is wooed by a boombox and hand-written message cards.

The signs prompt patients to indicate — with a “thumbs up” or “thumbs down” — whether they’re there for the respiratory clinic, if they have been tested for COVID-19, possibly exposed or are experiencing any of the symptoms associated with the novel coronavirus or the flu.

Told not to open their car windows, patients are then shown a phone number to call. That essentially converts their cellphone into an old-fashioned walkie-talkie to communicate with the health care professionals in the garage or parking lot.

For many clinicians, the opportunity to lay eyes on a patient — even if through a car window — is a valuable one.

A protective mask may be hung on an IV pole to get it to the driver. Then the vehicle is escorted to a parking space that serves as a medical bay. The clinician’s name is written across his or her chest in a black Sharpie because the usual name tags are concealed by protective gear.

The San Carlos facility has a portable X-ray machine, designed for outside use, to help diagnose lung infections. Patients can get blood draws and even full examinations without ever entering the building.

Patients have responded positively to the setup, praising the “car side” manner of clinic staff and its much-needed sense of security, according to a Sutter Health spokesperson.

Open seven days a week, the clinic’s hours — 8 a.m. to 5 p.m. — are largely determined by daylight and temperature, closing it when it gets too dark or cold.

There were numerous logistical challenges to creating the San Carlos clinic, such as getting adequate phone lines installed in the garage and working out the best protocols, said doctors.

“The first week or so there was just a huge amount of work going into it and the constant anxiety that it could all fall apart in a variety of ways,” Bhatnagar said.

Now proud of the clinics’ role, “I tell everybody at our morning huddle — our employees and the amazing staff that show up every day — that we’re on the front lines. What you do matters,” Ryu said.

“This was kind of an experiment on how to deliver care,” he said. “It’s evolved a lot.”

Over time, the outdoor services will likely continue to expand and improve, according to Sutter Health. Comparing best practices and problem solving, the directors of the San Carlos facility routinely confer with leaders at other Respiratory Care Clinics in Palo Alto, Fremont, Santa Cruz, Lakeport and other communities. While each site is unique in its layout and services, “all try to take the best ideas from each other and share them and implement them,” Bhatnagar said.

“The biggest challenge to building a clinic like this is that it’s never been done before,” Ryu said. “There is no manual for how to do this.”

Seeking ‘car care’?

To be treated at a parking lot clinic, Sutter Health patients should have:

  • Respiratory symptoms attributable to possible COVID-19 infection and be very sick or in danger of becoming very sick.
  • Possible exposure to COVID-19 and be very sick or in danger of becoming very sick.

If you have respiratory symptoms but you aren’t showing signs of distress or at risk of deteriorating, you’ll be asked to stay home. If you think you’ve been exposed but have no symptoms or acute medical need, you’ll also be asked to stay home.