More than half of the 410 hospitals in California have at least one building that probably wouldn’t be able to operate after a major earthquake hit their region, and with many institutions claiming that they don’t have the money to meet a 2030 legal deadline for earthquake retrofits, the state is now granting relief to some while ramping up pressure on others to get the work done.

Gov. Gavin Newsom in September vetoed legislation championed by the California Hospital Assn. that would have allowed all hospitals to apply for an extension of the deadline for up to five years. Instead, the Democratic governor signed a more narrowly tailored bill that allows small, rural or “distressed” hospitals to get an extension of up to three years.

“It’s an expensive thing and a complicated thing for hospitals — independent hospitals in particular,” said Elizabeth Mahler, an associate chief medical officer for Alameda Health System, which serves Northern California’s East Bay and is undertaking a$25-million retrofit of its hospital in Alameda, on an island beside Oakland.

The debate over how seismically safe California hospitals should be dates to the 1971 Sylmar quake near Los Angeles, which prompted a law requiring new hospitals to be built to withstand an earthquake and continue operating. In 1994, after the magnitude 6.7 Northridge quake killed at least 57 people, lawmakers required existing facilities to be upgraded.

The two laws have left California hospitals with two sets of standards to meet. The first — which originally had a deadline of 2008 but was pushed to 2020 — required hospital buildings to stay standing after an earthquake. About 20 facilities have yet to meet that requirement for at least one of their buildings, although some have received extensions from the state.

Many more — 674 buildings, spread across 251 licensed hospitals — do not meet the second set of standards, which require hospital facilities to remain functional in the event of a major earthquake. That work is supposed to be done by 2030.

“The importance of it is hard to argue with,” said Jonathan Stewart, a professor at UCLA’s Samueli School of Engineering, citing a 2023 earthquake in Turkey that damaged or destroyed multiple hospitals. “There were a number of hospitals that were intact but not usable. That’s better than a collapsed structure. But still not what you need at a time of emergency like that.”

The influential hospital industry has unsuccessfully lobbied lawmakers for years to extend the 2030 deadline, though the state has granted various extensions to specific facilities. Newsom’s signature on one of the three bills addressing the issue this year represents a partial victory for the industry.

Hospital administrators have long complained about the steep cost of seismic retrofits.

“While hospitals are working to meet these requirements, many will simply not make the 2030 deadline and be forced by state law to close,” Carmela Coyle, president and chief executive of the California Hospital Assn., wrote in a letter to Newsom before he vetoed the CHA bill. A 2019 Rand Corp. study paid for by the CHA pinned the price of meeting the 2030 standards at $34 billion to $143 billion statewide.

Labor unions representing nurses and other medical workers, however, say that hospitals have had plenty of time to get their buildings into compliance, and that most have the money to do so.

“They’ve had 30 years to do this,” Cathy Kennedy, a nurse in Roseville and one of the presidents of the California Nurses Assn., said in an interview prior to the governor’s action. “We are kicking the can down the road year after year, and unfortunately, lives are going to be lost.”

In his veto message on the CHA bill, Newsom wrote that a blanket five-year extension wasn’t justified, and that any extension “should be limited in scope, granted only on a case-by-case basis to hospitals with demonstrated need and a clear path to compliance, and in combination with strong accountability and enforcement mechanisms.”

He also vetoed a bill directed specifically at helping several hospitals operated by Providence, a Catholic hospital chain.

But he signed a third bill, which allows small, rural and “critical access” hospitals, and some others, to apply for a three-year extension, and directs the Department of Health Care Access and Information to offer them “technical assistance” in meeting the deadline.

The state designates 37 hospitals as providing “critical access.” An additional 56 are considered “small,” meaning they have fewer than 50 beds, 59 are considered “rural,” and 32 are “district” hospitals, meaning they are funded by special government entities called “health care districts.” They can seek a three-year extension as long as they submit a seismic compliance plan and identify milestones for implementing it.

Debi Stebbins, executive director of the Alameda Health Care District, which owns the Alameda Hospital buildings, said small hospitals face a big challenge. Even though Alameda is close to San Francisco and Oakland, the tunnels, bridges, and ferries that connect it to the mainland could easily be shut in an emergency, making the island’s hospital a lifeline.

“It’s an unfunded mandate,” Stebbins said of the state’s 2030 deadline.

The Rand study estimated the average cost of a retrofit at more than $92 million per building, but the amount could vary greatly depending on whether it’s a building that houses hospital beds.

Small and rural hospitals can get some aid from the state through grants financed by the California Electronic Cigarette Excise Tax, but Andrew DiLuccia, spokesperson for the Department of Health Care Access and Information, said that would yield just $2 million to $3 million total annually. He added that the Small and Rural Hospital Relief Program also has received a one-time infusion of $50 million from a tax on health insurers to help with the seismic work.

Labor unions and critics of the extensions often point to the large profits that some hospitals reap: A California Health Care Foundation report published in August found that California’s hospitals made $3.2 billion in profit during the first quarter of 2024. The study notes that there “continues to be wide variation in financial performance among hospitals, with the bottom quartile showing a net income margin of -5%, compared to +13% for the top quartile.”

Stebbins has had to help her district figure out a plan.

After Newsom vetoed a bill in 2022 that would have granted an extension on the seismic retrofit deadline specifically for Alameda Hospital, the hospital system and its partner health care district used parcel tax money to help back a loan.

The cost to retrofit will be about $25 million, and the system is also investing millions more into other projects, such as a new skilled-nursing facility. The construction work is set to be completed in 2027.

“No one wants things crashing in an earthquake or anything else, but at the same time, it’s a burden,” Mahler of Alameda Health System said. “How do we make sure that they get what they need to stay open?”

This article was produced by KFF Health News, a national newsroom that produces in-depth journalism about health issues.

The National Oceanic and Atmospheric Administration has issued a severe geomagnetic storm watch that could disrupt communications, the power grid, navigation, radio and satellite operations but also generate a nighttime light show.

The category G4 watch from NOAA’s Space Weather Prediction Center — the second such alert issued this year — warns of the possibility of a solar flare for Thursday and Friday, with a resulting coronal mass ejection from the sun that could disturb Earth’s electromagnetic field.

A sunspot group erupted Tuesday night that gave signs of a strong release of solar material and embedded magnetic fields, also known as a coronal mass ejection, which causes geomagnetic storms when they are directed at Earth, according to the prediction center.

The storm’s impact is an estimation, as scientists don’t know for certain the effect of this geomagnetic storm until it arrives near two satellites that are 1 million miles from Earth, said Sean Dahl, service coordinator for the Space Weather Prediction Center.

The coronal mass ejection is predicted to reach the satellites Thursday morning, Eastern time. Experts could not offer an exact time. When that happens, the geomagnetic storm is expected to reach Earth 15 to 30 minutes later.

A severe geomagnetic storm includes the potential for an aurora borealis — also known as the northern lights — visible as far south as Alabama and Northern California.

At this time, scientists couldn’t point to specific times or exact locations where the aurora might be visible.

If you want to catch a glimpse of the aurora, experts recommend that you follow along with the Prediction Center’s aurora dashboard and the 30-minute forecast online for updates.

NOAA experts say the best time for greater aurora visibility is between 10 p.m. and 2 a.m. from a high vantage point with minimal light pollution.

Experts say this severe geomagnetic storm won’t surpass the storm that occurred in May when a storm was caused by a series of coronal mass ejections. This time around there is only one coronal mass ejection and experts believe the duration of the event will be much shorter.

People hospitalized for COVID-19 early in the pandemic suffered an increased risk of serious “cardiac events” such as heart attacks and strokes that was akin to people with a history of heart disease, a newly released study has found.

Researchers from USC, UCLA and the Cleveland Clinic analyzed more than 10,000 COVID cases tracked by the UK Biobank to examine how COVID affected the risk of heart attacks and other cardiac threats.

Their study, released Wednesday in the journal Arteriosclerosis, Thrombosis, and Vascular Biology, assessed outcomes for people sickened in the first year of the pandemic and followed for a period of nearly three years.

The findings underscore that among “people who don’t have any evidence of heart disease, having severe COVID put them at a significantly increased risk of heart attack, stroke and death,” said principal investigator Hooman Allayee, professor of population and public health sciences at USC’s Keck School of Medicine.

Among the most striking findings: Being hospitalized for COVID in 2020 amplified the risk of heart attacks and other cardiac events so much that it ended up being comparable to people who had a history of heart disease but who hadn’t gotten COVID, the study found.

Although the analysis showed that the added risk was especially stark among people with severe cases, researchers stressed it was still apparent for patients who had gotten any form of COVID.

Such risks were roughly twice as high in people who had gotten COVID at all levels of severity, and four times as high for hospitalized cases, compared with people who hadn’t gotten COVID, the study found.

The study indicates that the increased risk “shows no apparent signs of attenuation up to nearly three years after SARS-CoV-2 infection and suggest that COVID-19 continues to pose a significant public health burden with lingering adverse cardiovascular risk,” they wrote.

Scientists also found that the risk differed by blood type: Being hospitalized for COVID ramped up the risks among people with blood types A, B or AB more than it did among people with type O blood.

“Your genetics actually plays a role in this increased risk of developing future heart attacks and stroke,” said James Hilser, a Keck doctoral candidate in biochemistry and molecular medicine who helped write the paper.

Researchers said their findings could help shape how doctors try to head off such health problems in the future. Doctors routinely offer preventative treatment to patients with medical conditions such as cardiovascular disease or diabetes that put them at a higher risk of heart attack or stroke.

Allayee said that if someone walks into a doctor’s office and is newly diagnosed with diabetes, “it doesn’t matter what their cholesterol is … They get put on a lipid-lowering medication. They get put on a baby aspirin.”

But when physicians think about preventing heart attacks, “nobody is taking into consideration COVID — whether it’s severe or otherwise — in how to manage a patient,” Allayee said. In light of the findings, he said, “this is something that doctors should be discussing,” as should regulatory bodies for cardiac care.

The study, which was funded by the National Institutes of Health, had some limitations: It examined only COVID cases early in the pandemic before vaccines became available. (Another study published earlier this year, which also relied on the UK Biobank data, found that the incidence of heart attacks and strokes was generally lower after each dose of a COVID vaccine.)

Researchers also cautioned that some COVID patients may have had undiagnosed heart disease when they were hospitalized, which would not be evident in the UK Biobank data.